Citation Nr: 0008587 Decision Date: 03/30/00 Archive Date: 04/04/00 DOCKET NO. 92-52 910 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to an evaluation in excess of 10 percent for tinea versicolor. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and W. M. ATTORNEY FOR THE BOARD T. S. Tierney, Counsel INTRODUCTION The veteran served on active duty from June 1967 to June 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 1989 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, which granted service connection for tinea versicolor and assigned a noncompensable rating from February 23, 1989. In rating decision of September 1996, the RO granted a 10 percent evaluation for tinea versicolor, effective from February 23, 1989. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the issue on appeal has been obtained. 2. The veteran has periodic episodes of tinea versicolor with itching; neither exudation, constant itching, extensive lesions, ulceration, disfigurement nor nervous manifestations of the tinea versicolor are not shown. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for tinea versicolor have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. §§ 4.7, 4.14, 4.118, Diagnostic Codes 7806, 7813 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). Further, the Board is satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the veteran's skin disability. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (1999). The Board attempts to determine the extent to which the veteran's disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1999). Additionally, the Board observes that in a claim involving disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. See Fenderson v. West, 12 Vet. App. 119 (1999). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 (1999). The RO rated the veteran's skin disability as dermatophytosis under Diagnostic Code 7813. Under that code, the skin disability is to be rated as scars, disfigurement, etc., on the extent of constitutional symptoms and physical impairment. A noncompensable rating is assigned for disfiguring scars of the head, face or neck, which are slight. A 10 percent rating is assigned for scars of the head, face or neck, which are moderately disfiguring. 38 C.F.R. § 4.118, Diagnostic Code 7800. Under Diagnostic Code 7806, which provides ratings for eczema, a 10 percent rating is warranted for exfoliation, exudation or itching, if involving an exposed surface or extensive area. A 30 percent rating is warranted for exudation or itching constant, extensive lesions, or marked disfigurement. A 50 percent rating is appropriate for ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptional repugnance. 38 C.F.R. § 4.118, Diagnostic Code 7806. Where there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). Service connection for tinea versicolor was granted in an August 1989 rating decision, evaluated as noncompensably disabling from February 23, 1989. The veteran appealed the evaluation. In October 1992 and in November 1995, the Board remanded the issue for further development. In a rating decision dated in September 1996, the veteran was granted a 10 percent evaluation also effective from February 23, 1989. In March 1997, the Board remanded the issue for further development and mistakenly noted that the tinea versicolor was still evaluated as noncompensable. In addition, the Supplemental Statement of the Case dated in December 1999 erroneously noted that the tinea versicolor was currently evaluated as noncompensably disabling. There is no indication in the evidence of record that the 10 percent evaluation for tinea versicolor was found to be in error or has since been reduced. The evidence contains VA and private treatment records which show that the veteran has had a periodic skin disorder on the chest, back, abdomen, upper arms, and neck. During a VA hospitalization in February 1989, examination of the skin revealed an extensive, chronic low grade fungus appearing dermatitis all over the veteran's chest, lower neck and in large areas of his back. No neurodermatitis was seen. The diagnosis was chronic low grade pruritic dermatitis of the trunk, etiology to be determined. A VA outpatient treatment record dated in May 1989 shows a history of scaly hyperpigmented macular rash on the upper arms, chest and upper body which was very itchy. The diagnosis was tinea versicolor and the veteran was prescribed medications. A VA examination in June 1989 showed that the veteran had some areas of the skin of the upper and mid-back plus the anterior chest that looked like tinea versicolor. The veteran reported that the skin rash over the anterior chest, back and abdomen, began in 1967 when he was in the service. He further reported that it would clear up temporarily and then come back. He stated that the rash itched and he was taking some medication for it. The diagnosis was tinea versicolor. A VA outpatient treatment record dated in September 1989 shows that the veteran had a rash on his stomach and chest. The diagnosis was tinea versicolor and he was prescribed a cream. Another record dated in January 1990 notes that the rash appeared to be healed and was quiescent at that time. A VA hospitalization record for the period from April 30 to May 7, 1990, shows that the veteran had minimal dermatitis on the trunk, which was probably a low grade fungal infection. The diagnosis was history of chronic low grade fungal infection of the skin of the trunk. A VA outpatient treatment record dated later in May 1990 shows that the veteran had more than a 20 year history of a rash on his shoulders. He reported that it itched. The examination showed hypopigmented, scaly macular rash on the upper back and shoulders. The diagnosis was tinea versicolor and he was prescribed medications. At a personal hearing before a hearing officer at the RO in September 1990, the veteran testified that he had a rash all over his body and that it itched all the time. He stated that everyday he found bumps on his skin and that heat made it worse. He testified that he had been given creams and pills for the rash. According to the veteran, his skin sometimes cleared up but he would still have the itching. A VA outpatient treatment record dated in February 1991 notes that the veteran had an itchy, hypopigmented, scaly, macular rash on the upper back and chest. The diagnosis was tinea versicolor and medications were prescribed. Another record dated in May 1992 shows that the veteran had hypo and hyperpigmented scaly macular rash on the upper back, chest and neck. The diagnosis was tinea versicolor and he was given medication. A VA dermatology examination in February 1993 showed that the veteran reported having more trouble with the rash in the summer than in the winter. The examination revealed that the veteran had mild tinea versicolor scattered over his back. The chest was clear. Nothing was seen on his upper arms. He also had some dry skin on the buttocks and thighs which was not tinea versicolor. At the VA dermatology examination in March 1996, the veteran reported an itchy rash involving the upper chest, neck and arms ever since going into the service in 1967. He had used creams on the skin without improvement and had received temporary relief from itching with Benadryl. He felt that the itching was much worse in hot or humid conditions. It was noted that the skin eruptions did not prevent the veteran from carrying on his day to day activities. The examination revealed somewhat hyperpigmented macules with scale on the anterior and lateral neck, as well as on the upper back and shoulders. KOH was positive for grape-like clusters of spores and glassy hyphae. The diagnosis was tinea versicolor. At another VA dermatology examination in September 1997, the veteran reported that since the onset of the skin eruptions in 1967, he had experienced recurrences which were exacerbated by and much worse in the summer. According to the veteran, the skin disorder improves in the winter months but never goes away completely. The veteran also reported that his physician had prescribed topical Nizoral shampoo in July 1997, and since that time he had experienced much improvement. However, he still related that he experienced short episodes of five to six minutes of itching for no reason. The veteran complained of itching, burning after bathing in hot water, itching and burning following sun exposure, "ashy" scaling, and aggravation of the condition in hot weather and with perspiring. On examination, there were mild residual, scattered, non-scaly slightly hyperpigmented patches involving the chest, neck, back, and shoulders. There was no exfoliation, no exudation, no desquamation and, at the time of the examination, the veteran denied itching. There was no evidence of any active dermatosis presumably because he had been using the topical Nizoral shampoo. The diagnoses were tinea versicolor and post-inflammatory hyperpigmentation. The examiner prescribed additional medication and gave him special soap and lotion. The private and VA records pertaining to treatment and examination of the veteran since 1989 show that he has been treated on a number of occasions for skin problems, variously diagnosed as chronic low grade pruritic dermatitis, dermatophytosis, and most often as tinea versicolor. No ulceration, exudation, or nervous manifestations of the skin disorder were noted in any of the medical records pertaining to the severity of the veteran's skin disability. Most recently, the VA examination in September 1997 revealed tinea versicolor on the chest, neck, back and shoulders. Again, no ulceration, exudation, or nervous manifestations of the tinea versicolor were noted. Moreover, the pertinent medical evidence does not show constant itching, extensive lesions associated with tinea versicolor, or that the skin disability is productive of disfigurement. Therefore, the Board must conclude that the skin disability more nearly approximates the criteria for the currently assigned 10 percent evaluation than those for a higher evaluation. ORDER A rating in excess of 10 percent for tinea versicolor is denied. SHANE A. DURKIN Member, Board of Veterans' Appeals - 2 - - 1 -