Entitlement to service connection for hypertension is remanded.

Citation Nr: 26001408 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 08-04 247 DATE: January 30, 2026 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to an initial increased rating above 10 percent for tinea versicolor is remanded. Entitlement to an effective date earlier than September 27, 2011, for the grant of a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1978 to March 1993. The Board thanks the Veteran for her service to our country. This legacy appeal stems from September 2006 and July 2008 Rating Decisions. In April 2014, the Veteran testified at a Board hearing before a Veterans Law Judge other than the undersigned; a transcript of that hearing is associated with the claims file. In a December 2015 Decision, the Board remanded all claims herein. In a January 2020 Decision, the Board: denied an effective date prior to July 26, 2005, for tinea versicolor; and remanded entitlement to an initial compensable rating for tinea versicolor. In a September 2021 Decision, the Board granted an increased rating for tinea versicolor (from zero to 10 percent) prior to February 19, 2020. In August 2022, VA mailed the Veteran a letter informing her that the Veterans Law Judge who conducted the April 2014 Board hearing could no longer participate in the adjudication of the appeal and the Veteran could request a new Board hearing if she so desired; however, the Veteran never requested another Board hearing. Arneson v. Shinseki, 24 Vet. App. 379 (2011). In a December 2022 Decision, the Board remanded all claims herein except the tinea versicolor claim. In a June 2023 Memorandum Decision, the U.S. Court of Appeals for Veterans Claims (Court) vacated the September 2021 Board Decision. In July 2024, February 2025, and November 2025 Decisions, the Board remanded all claims herein. 1. Entitlement to service connection for hypertension 2. Entitlement to an initial increased rating above 10 percent for tinea versicolor 3. Entitlement to an effective date earlier than September 27, 2011, for the grant of a TDIU A remand by the Board confers the right to compliance with remand orders. Stegall v. West, 11 Vet. App. 268 (1998). The November 2025 Board Decision explained that remand was warranted because the AOJ failed to substantially comply with prior remand directives; unfortunately, due to the AOJ's continued failure to substantially comply with the Board's remand directives, remand is again warranted. Stegall, supra. Regarding the hypertension claim, the February 2025 Board Decision directed the AOJ to obtain a pertinent etiological opinion (as directed by the December 2022 Board Decision) without in-person examination; the AOJ was specifically directed to provide an opinion as to whether the Veteran's hypertension was at least as likely as not related to service, including from toxic exposure risk activity (TERA), with the examiner required to address potentially-favorable evidence (diastolic blood pressure readings over 90mm from May 1988 and February 1992; July 1992 Report of Medical History wherein the Veteran reported "high or low blood pressure;" and vasovagal syncope and sinus tachycardia in April 1990 and October 1992). The November 2025 Board Decision found that the AOJ did not substantially comply with the February 2025 Board directives because it did not obtain such an opinion through the Acceptable Clinical Evidence (ACE) process and that further remand was warranted because that opinion would have provided relevant and potentially-favorable information for the claim. Stegall, supra. Despite repeated directives in the November 2025 Board Decision for the AOJ to obtain an etiological opinion without in-person examination (through the ACE process) if the Veteran refuses, the AOJ again failed to substantially comply by failing to obtain an ACE opinion before recertifying the appeal to the Board. See December 2025 Exam Requests and Subsequent Development Letter (attempting to schedule an in-person examination, which the Veteran refused); see also December 2025 Supplemental Statement of the Case (SSOC) and January 2026 Docketing Letter (re-certifying the appeal to the Board without having obtained the ACE opinion). Stegall, supra. Regarding the tinea versicolor claim, the February 2025 Board Decision (along with the July 2024 Board Decision) directed the AOJ to clarify conflicting medical information about the nature and severity of this disability. The November 2025 Board Decision found that the AOJ did not substantially comply with the February 2025 Board directives because it did not obtain the requested clarification, which was still required because prior VA examinations did not provide all of the medical findings necessary to accurately rate this disability under the General Rating Formula For the Skin (specifically, evidence indicates that the Veteran uses topical therapy for this disability [see July 1997, September 2011, and February 2020 VA examinations; see also November 2017 private dermatology record] but the medical findings of record are ambiguous as to whether that therapy amounts to systemic therapy for VA purposes). 38 C.F.R. § 4.118, General Rating Formula For the Skin; Johnson v. Shulkin, 862 F.3d 1351 (2017) and Warren v. McDonald, 28 Vet. App. 194 (2016) (the Court held that: the use of a topical corticosteroid is not systemic therapy unless administered on a large enough scale such that it affects the body as a whole; and "systemic therapy" was not limited to corticosteroids or immunosuppressive drugs and that the Board must determine whether a given treatment is "like" a corticosteroid or other immunosuppressive drug in determining whether the treatment constituted a systemic therapy to warrant a higher rating); Burton v. Wilkie, 30 Vet. App. 286 (2018) (the Court further held that the Board must consider the following two questions, in any order, when determining whether topical treatment for a skin disorder constitutes "systemic therapy such as corticosteroids or other immunosuppressive drugs" under the pre-August 13, 2018, version of DC 7806: (a) whether the topical treatment operates by affecting the body as a whole in treating the Veteran's skin condition; and (b) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug). Despite repeated directives in the November 2025 Board Decision for the AOJ to obtain a clarifying opinion without in-person examination (through the ACE process) if the Veteran refuses, the AOJ again failed to substantially comply by failing to obtain an ACE opinion before recertifying the appeal to the Board. See December 2025 Exam Requests and Subsequent Development Letter (attempting to schedule an in-person examination, which the Veteran refused); see also December 2025 SSOC and January 2026 Docketing Letter (re-certifying the appeal to the Board without having obtained the ACE opinion). Stegall, supra. Regarding the TDIU claim, the November 2025 Board Decision explained that the TDIU claim was inextricably intertwined with the hypertension and skin claims because the outcomes of the hypertension and skin claims would likely alter the combined rating for compensation, affecting the adjudication of the TDIU claim. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Gurley v. Peake, 528 F.3d 1322 (Fed. Cir. 2008). The TDIU claim remains intertwined with the other remanded claims herein and must be remanded concurrently. The matters are REMANDED for the following action: 1. Obtain an ACE opinion as to whether the Veteran's hypertension was at least as likely as not related to service, including from TERA. The examiner must address the following, potentially-favorable evidence: diastolic blood pressure readings over 90mm from May 1988 and February 1992; July 1992 Report of Medical History wherein the Veteran reported "high or low blood pressure;" and vasovagal syncope and sinus tachycardia in April 1990 and October 1992. 2. Obtain an ACE opinion as to whether the Veteran's use of topical therapy for her skin disability (see July 1997, September 2011, and February 2020 VA examinations; see also November 2017 private dermatology record) amounts to systemic therapy for VA purposes. The examiner is reminded of the following Court holdings regarding "systemic therapy" for VA purposes: (a) Johnson (the use of a topical corticosteroid is not systemic therapy unless administered on a large enough scale such that it affects the body as a whole); (b) Warren ("systemic therapy" was not limited to corticosteroids or immunosuppressive drugs and the Board must determine whether a given treatment is "like" a corticosteroid or other immunosuppressive drug in determining whether the treatment constituted a systemic therapy); and (c) Burton (the Board must consider the following two questions, in any order, when determining whether topical treatment for a skin disorder constitutes "systemic therapy such as corticosteroids or other immunosuppressive drugs" under the pre-August 13, 2018, version of DC 7806: [a] whether the topical treatment operates by affecting the body as a whole in treating the Veteran's skin condition; and [b] whether the given treatment is "like" a corticosteroid or other immunosuppressive drug). (Continued on the next page) ? 3. After completing the above, readjudicate the TDIU claim. T. Raymond Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Daus, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.