Citation Nr: 0717957 Decision Date: 06/14/07 Archive Date: 06/26/07 DOCKET NO. 03-08 490 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to an initial evaluation in excess of 10 percent for acne vulgaris prior to September 29, 2005. 2. Entitlement to an evaluation in excess of 30 percent for acne vulgaris from September 29, 2005. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD A. Shawkey, Counsel INTRODUCTION The veteran served on active duty from November 2, 1982, to November 23, 1982, and from July 1983 to April 1996. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. In that decision the RO granted service connection for acne vulgaris and assigned the veteran a 10 percent evaluation effective in January 2000. The veteran disagreed with the percentage assigned and filed a timely appeal. This matter was previously before the Board in December 2004 and February 2006 at which times the case was remanded for further development. In September 2006, the RO increased the veteran's evaluation for acne vulgaris to 30 percent with an effective date of September 29, 2005. FINDINGS OF FACT 1. Prior to September 29, 2005, the veteran's acne vulgaris did not cause exudation, or itching, extensive lesions or disfigurement; severely disfiguring scars of the head, face or neck; scars affecting 40 percent of more of the face; symptomatic scars or scars causing limitation of function. 2. From September 29, 2005, the veteran's acne vulgaris was not productive of ulceration, exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant; marked or repugnant bilateral disfigurement; tissue loss, gross distortion or asymmetry of features; nor was the acne shown to affect more than 40 percent of the veteran's entire body, 40 percent of the exposed areas affected, or systemic therapy during the past 12 month period; the scars are not symptomatic and do not cause functional loss. CONCLUSIONS OF LAW 1. The criteria for evaluation in excess of 10 percent for service-connected acne have not been met at any stage prior to September 29, 2005. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7803-7805 (2001, 2006), Diagnostic Code 7806 (2001), and Diagnostic Code 7828 (2006). 2. The criteria for evaluation in excess of 30 percent for service-connected acne have not been met from September 29, 2005. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7803-7805 (2001, 2006), Diagnostic Code 7806 (2001), and Diagnostic Code 7828 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 Initially, the Board notes that, in November 2000, the Veterans Claims Assistance Act of 2000 (VCAA) was signed into law. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, and 5107 (West 2002). To implement the provisions of the law, VA promulgated regulations codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2006). The VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify the claimant what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). The United States Court of Appeals for Veterans Claims' (Court's) decision in Pelegrini v. Principi, 18 Vet. App. 112 (2004) held, in part, that a VCAA notice, as required by 38 U.S.C. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. In this case, the RO furnished VCAA notice to the veteran regarding the issue on appeal in January 2005 which was after the January 2002 rating decision on appeal. Because the VCAA notice in this case was not provided to the appellant prior to the RO decision from which he appeals, it can be argued that the timing of the notice does not comply with the express requirements of the law as found by the Court in Pelegrini. While the Court did not address whether, and, if so, how, the Secretary can properly cure a defect in the timing of the notice, it did leave open the possibility that notice error of this kind may be non-prejudicial to a claimant. In this respect, all the VCAA requires is that the duty to notify is satisfied, and that appellants be given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996); see also 38 C.F.R. § 20.1102 (harmless error). VA has fulfilled its duty to notify the appellant in this case. In the January 2005 letter as well as a March 2006 letter, the RO informed the appellant of the applicable laws and regulations, including applicable provisions of the VCAA, the evidence needed to substantiate the claim, and which party was responsible for obtaining the evidence. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Also in these letters, VA informed the appellant that it would obtain the available records in the custody of federal departments and agencies and request medical records from identified private health care providers. VA further informed the veteran to send copies of any relevant evidence she had in her possession and that she could also get any relevant records herself and send them to VA. Thus, the Board finds that VA's duty to notify has been fulfilled and any defect in the timing of such notice constitutes harmless error. During the pendency of this appeal, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; (3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. The Court held that upon receipt of an application for a service- connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Dingess/Hartman, supra. All five elements were provided in the information noted above, with specific notice of elements four and five in a December 2006 letter from the RO. The Board also finds that all necessary assistance has been provided to the appellant. The RO has made reasonable and appropriate efforts to assist the appellant in obtaining the evidence necessary to substantiate her claim, including obtaining medical records identified by the appellant. In addition, the appellant was afforded VA examinations during the appeal period. She was also informed of a scheduled Board hearing in November 2003 at the RO, but failed to report to the hearing. The appellant has not indicated that any additional pertinent evidence exists, and there is no indication that any such evidence exists. Under these circumstances, the Board finds that VA has fulfilled its duty to notify and assist the appellant in the claim under consideration and that adjudication of the claim at this juncture, without directing or accomplishing any additional notification and/or development action, poses no risk of prejudice to the appellant. See, e.g., Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The appeal is now ready to be considered on the merits. II. Facts The veteran's service medical records show treatment for acne. In February 2000, the veteran had a follow up visit for acne at the VA dermatology clinic. She reported noticing a modest improvement with Retin A and described her acne as being relatively well controlled that day. Findings revealed 1-2 centimeter hyperpigmented papules at the edge of her mandible. She was prescribed Retin A, Cleocin T and doxycycline 100 mg. A March 2000 VA outpatient record from the dermatology clinic notes that the veteran was using doxy 100 mg po bid and Retin A and Cleocin with minimal improvement. Findings revealed multiple large pustules on the jaw line and one erythematous pustule on the check, with scattered hyperpigmentation. The veteran was assessed as having acne and was prescribed glycolic acid. The veteran reported during a March 2001 VA examination that she has had acne since 1985 or 1986. She said she was using an ointment intermittently for the past six months that worked well, except for peeling of the skin. She also said she used Clearasil solution, oral doxy 100 mg b.i.d. and Retin-A 0.5% cream. She denied having acne on her back or chest. On examination there was a 2.5 cm x 1.1 cm hyperpigmented plaque on the left forearm with terminal hair growth, noted to be present since birth. There were a few follicular papules and hyperpigmented macules on her back. On her face there were a few erythematous hyperpigmented papules and multiple ice-pick scars on the cheek. The hyperpigmented papules were on the cheek and chin. The veteran was diagnosed as having acne vulgaris and congenital nevus. In April 2001, the veteran returned to the VA outpatient clinic for a follow up visit. She reported improvement with her prescribed medications, but complained that her skin was dry and flaky. She also reported that she still experienced outbreaks that were worse around her menstrual cycle. Findings revealed few telangiectasias on the nose and sides of the nose. There were also multiple pitted scars on the bilateral cheeks and some hyperpigmented macules on the cheeks. In addition, there were few closed comedones on the cheeks. The veteran was advised to return to the clinic in two to three weeks. During an April 2001 VA general examination, the veteran was diagnosed as having acne rosacea that was well controlled. Her medications included topical Retin-A and MetroGel. In the substantive appeal dated in March 2003, the veteran reported that the severity of her acne had increased "tremendously" with "huge" lesions during breakouts which were filled with a white substance. She said the acne remains on her face for weeks and leaves scars. She reported spending thousands of dollars on medication for her skin problem. During a June 2005 VA dermatology examination, the veteran complained of "breakouts" and "eruption" on her face that had been ongoing off and on, but severely erupted one and a half years earlier. Findings revealed multiple hyperpigmented macules, papules, pustules ala nasi with telangiectasias. Onset and course was intermittent and non- worsening. There was no functional impairment, systemic symptoms, malignancy or neoplasm, urticaria, vasculitis, erythema multiforme, acne, alopecia, scarring or disfigurement. The percent of the entire body affected was less than 5%. The percent of exposed areas was less than 3%. The veteran was assessed as having acne, no comedones, superficial cysts, deep inflamed nodules or pus-filled cysts. There was no visible or palpable tissue loss or gross distortion or asymmetry of two features. The veteran was diagnosed as having acne vulgaris - moderate inflammatory and telangiectasias - nose. The veteran's prognosis was "good". The examiner noted that color photos were not ordered since there was no disfigurement. In September 2005, the veteran was again evaluated by VA for her acne vulgaris. She reported that she worked as a defense contractor which involved shipping and supplying. She also reported that the condition began during service in the 1980s. Her present treatment included Obaji system, Retin-A cream and topical erythromycin with no reported side effects or systemic side effects. On examination there were multiple hyperpigmented macules, papules, a few erythematous papules. Also noted were scattered comedones, depressed ice-pick scarring on bilateral cheeks and dyschromia. There was no facial asymmetry or significant loss of tissue. The veteran's chest and back had a few hyperpigmented macules. The onset and course of the condition were intermittent and non-worsening. The veteran was noted to not be using corticosteroid, immunosuppressive drugs, UVB, PUVA, or electron beam therapy. Also noted was no functional impairment, systemic symptoms, malignance or neoplasm, urticaria, vasculitis, erythema multiforme, alopecia, scarring or disfigurement. The percent of entire body affected was less than 5%, and less than 1% of exposed areas affected. The veteran was diagnosed as having acne vulgaris - moderate inflammatory and comedonal, and scarring and dyschromia secondary to acne. The veteran was given a fair prognosis with continued treatment necessary. Since there was no disfigurement, photographs were not taken. A VA progress note dated the same day states that scarring and cyschormia of the face and neck "involves apply 50%". In November 2005, the veteran was seen at a VA medical facility on an outpatient basis for treatment of her acne. She said she was using the Obagi system, but that she didn't think it was helping. She reported that she was also using tretinoin cream which she blended together. She said that laser treatments had helped, but she could no longer afford that treatment. She also said that peels and injections helped. Findings revealed a few erythematous papules and hyperpigmented macules mainly on her cheeks. Also noted were a few pitting scars on the cheeks. A VA outpatient record dated in December 2005 notes that the veteran had recently returned to VA for dermatology treatment and was not able to afford medications from an outside provider. In December 2005, the veteran presented to a VA outpatient dermatology clinic for her first beta-sal peel. Findings revealed a few erythematous papules, hyperpigmented macules mainly on her cheeks, and a few pitting scars on her cheeks. She was assessed as having acne that was mainly inflammatory and dyschromia. VA outpatient records show that the veteran reported to the dermatology clinic in February 2006 and March 2006 for beta lifts #1 and #2, respectively. The veteran relayed that the jessner peels worked well and she was happy with the process, but reported minor peeling. Findings revealed positive hyperpigmented macules mainly on the cheeks and a few pitting scars on the cheeks. The veteran was assessed as having acne, dyschromia and telangiectasias. The veteran underwent a VA dermatology examination in March 2006. The veteran reported getting peels over the past year as well as clindamycin solution and tretinoin .1% cream as well as doxycycline 100 mg. She denied any side effects from her medication and reported being happy with her regimen. She said it helps to keep it under control. Her chest and back were found to be clear. Also noted were some problems with shoulders, but with no treatment to this area. Examination of the veteran's face revealed mild dyschromia along the anterior hairline and mild erythema along the nasal folds. There were a few pitted scars on the veteran's cheeks and rolling scars on her chin. She was diagnosed as having acne vulgaris. III. Pertinent Criteria Disability evaluations are determined by the application of the Schedule For Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall 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. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as in the instant case, the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). While this appeal was pending, regulatory changes amended the VA Schedule for Rating Disabilities, 38 C.F.R. Part 4, including the rating criteria for evaluating skin disabilities. See 67 Fed. Reg. 49596 (July 31, 2002) [effective August 30, 2002]. The veteran was provided notice of these changes in the January 2003 statement of the case and the RO has evaluated the veteran's service-connected acne under both the old and new versions of the criteria. Cf. Bernard v. Brown, 4 Vet. App. 384 (1993). The Board will similarly apply both the old and new versions of the criteria to the veteran's claim. Former Criteria The former criteria did not have a specific Diagnostic Code that addressed acne. Diagnostic Code 7806, pertaining to eczema, provided for a 10 percent evaluation when the skin disorder involved an exposed surface or area and there was exfoliation, exudation, or itching. A 30 percent evaluation required exudation or itching constant, extensive lesions or marked disfigurement. A 50 percent evaluation required ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant. 38 C.F.R. § 4.118. Diagnostic Code 7800, pertaining to disfiguring scars of the head, face, or neck, provided a 10 percent evaluation for moderate disfiguring scars of the head, face, or neck. An evaluation of 30 percent required severe disfiguring scars of the head, face, or neck, especially if producing a marked and unsightly deformity of eyelids, lips, or auricles. An evaluation of 50 percent required complete or exceptionally repugnant deformity of one side of face or marked or repugnant bilateral disfigurement. 38 C.F.R. § 4.118. The Board notes that under Esteban v. Brown, 6 Vet. App. 259 (1994), a separate, additional rating may be assigned if the veteran's disability is manifested by a scar that is poorly nourished with repeated ulceration, a scar that is tender and painful on objective demonstration, or a scar that is otherwise causative of limitation of function on part affected. 38 C.F.R. § 4.118, Diagnostic Codes 7803, 7804, 7805 (2001); Esteban, supra. Revised Criteria The revised Diagnostic Code 7828 pertains specifically to acne and provides that deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck or deep acne other than on the face or neck warrants an evaluation of 10 percent. An evaluation of 30 percent requires deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck. Diagnostic Code 7828 also provides that acne may be rated as disfigurement of the head, face or neck or as scars, depending on the predominant disability. Id. Revised Diagnostic Code 7800, pertaining to disfigurement of the head, face, or neck, provides that an evaluation of 10 percent is warranted for disability of the skin of the head, face, or neck with one characteristic of disfigurement. An evaluation of 30 percent requires disability of the skin of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears, (auricles), cheeks, lips) or with two or three characteristics of disfigurement. A 50 percent evaluation requires visible and palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears, (auricles), cheeks, lips) or with four or five characteristics of disfigurement. Note (1) to Diagnostic Code 7800 provides that the 8 characteristics of disfigurement, for purposes of evaluation under § 4.118, are as follows: Scar 5 or more inches (13 or more cm.) in length. Scar at least one-quarter inch (0.6 cm.) wide at widest part. Surface contour of scar elevated or depressed on palpation. Scar adherent to underlying tissue. Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.). Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.). Underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.). Skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Under the current Diagnostic Code 7806, dermatitis or eczema covering at least 5 percent, but less than 20 percent of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than 6 weeks during the past 12-month period warrants a 10 percent disability rating. Dermatitis or eczema covering 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, during the past 12-month period warrants a 30 percent disability rating. Dermatitis or eczema covering more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12 month period warrants a 60 percent rating. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2006). A 10 percent evaluation is warranted for a scar which is superficial and unstable. 38 C.F.R. § 4.118, Diagnostic Code 7803 (2006). Under Diagnostic Code 7804, a scar which is manifested as superficial and painful on examination will be assigned a 10 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2006). Under Diagnostic Code 7805, other types of scars will be rated based on limitation of function of affected part. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2006). The old regulatory criteria must be applied prior to the effective date of the new criteria, which is August 30, 2002. See Green v. Brown, 10 Vet. App. 111, 116-19 (1997). The new rating criteria are not retroactive and can only be applied as of the effective date of the change. See VAOPGCPREC 3- 2000; 65 Fed. Reg. 33422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). IV. Discussion Evaluation in Excess of 10 Percent Prior to September 29, 2005 In September 2000, the veteran's 10 percent evaluation was increased to 30 percent effective September 29, 2005. The increase was pursuant to the revised Diagnostic Code 7828 for scars requiring deep acne (deep inflamed nodules and pus- filled cysts) affecting 40 percent or more of the face and neck. The 30 percent rating is based a VA progress note dated September 29, 2005, stating that the scarring on the veteran's face and neck "involved apply 50%". VA construed this as meaning scarring involving approximately 50 percent of the veteran's face and neck. Evidence of deep inflamed nodules and pus-filled cysts is replete in the medical records as far back as a March 2000 record noting findings of multiple large pustules on jaw line and an erythematous pustule on the check. Thus, the criteria for a 30 percent evaluation has been met as of the date of the September 29, 2005, VA progress note. The question thus becomes whether there is evidence to support the 30 percent evaluation prior to September 29, 2005. Unfortunately, there is no evidence prior to the September 29, 2005, VA progress note that indicates the percentage of the veteran's face and neck affected by acne scars. The medical records prior to September 29, 2005, such as VA records dated in March 2001 and April 2001, note only that the veteran had multiple pitted scars on her cheeks. Indeed, one basis of the Board's December 2004 and February 2006 remands was to obtain medical evidence to find out the percentage of her face and neck affected by acne scars. The veteran explained in March 2003 that her acne leaves scars. Thus, the more acne she gets the more scars she has. There is simply no way to determine whether her face and neck scars met the criteria for a 30 percent rating, i.e., affected 40% or more of her face and neck, prior to September 29, 2005. Diagnostic Code 7800 provides for a 30 percent rating for severe disfiguring scars of the head, face, or, neck, especially if producing a marked and unsightly deformity of eyelids, lips, or auricles (criteria prior to August 30, 2002), or, disfigurement of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features; with two or three characteristics of disfigurement (criteria effective August 30, 2002). The evidence does not satisfy these criteria prior to September 29, 2005. Rather, VA outpatient records merely described the veteran's facial scars as consisting of multiple pitted scars on her cheeks. Moreover, the June 2005 VA examiner explained that color photographs were not taken because there was no disfigurement. Accordingly, the criteria under the former or revised Code 7800 have not been met prior to September 29, 2005. Regarding a 30 percent evaluation under Diagnostic Code 7806 for symptoms analogous to dermatitis or eczema, the evidence does not show exudation or itching constant, extensive lesions or marked disfigurement (criteria prior to August 30, 2002), or, dermatitis or eczema covering 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, during the past 12- month period (criteria effective August 30, 2002). Instead, findings recorded on VA outpatient records from 2000 to 2005 primarily described the veteran's acne as a few erythematous papules, hyperpigmented macules mainly on the cheeks, and a few pitting scars on the cheeks. These findings simply do not meet the criteria for a 30 percent rating under the former or revised Diagnostic Code 7806 prior to September 29, 2005. Furthermore, absent findings of superficial, poorly nourished, unstable, tender, or painful scars, the assignment of separate, 10 ratings, under 38 C.F.R. § 4.118, Diagnostic Codes 7803 and 7804 (2001, 2006) is not warranted. See Esteban, supra. There is also no limitation of function from the acne scars reported or shown. Indeed, the June 2005 VA examiner specifically stated that there was no functional impairment. Therefore, an evaluation based on limitation of function of the part affected is not warranted. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2001, 2006). Based on the foregoing, the preponderance of the evidence weighs against the assignment of an initial rating in excess of 10 percent at any point prior to September 29, 2005, for the veteran's acne vulgaris. As such, "staged ratings" are not for application. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). As the preponderance of the evidence is against the claim, the benefit-of-the doctrine does not apply and the claim must be denied. 38 U.S.C.A. § 5107. Evaluation in Excess of 30 Percent From September 29, 2005 The pertinent evidence for the period from September 29, 2005, consists of the September 29, 2005, VA examination report as well as VA outpatient records dated in 2005 and 2006. Findings from this evidence do not warrant a higher than 30 percent rating under any potentially applicable criteria. To begin with, the veteran's present 30 percent evaluation is the maximum rating under revised Diagnostic Code 7828 for acne. A higher than 30 percent rating is also not warranted under revised Diagnostic Code 7800 for disfigurement of the head, face or neck. As noted above, the September 2005 VA examiner stated that there was no disfigurement, facial asymmetry or tissue loss. In addition, the findings as noted above do not satisfy the criteria for a higher, 60 percent, evaluation under the revised Code 7806 requiring symptoms analogous to dermatitis or eczema that covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12 month period. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2006). In this regard, while the veteran's acne scars were noted in September 2005 to cover more than 40 percent of her face and neck, her actual acne has not. For a higher than 30 percent rating under the former Diagnostic Codes 7800 or 7806, the evidence would have to show complete or exceptionally repugnant deformity of one side of face or marked or repugnant bilateral disfigurement (Code 7800), or, symptoms analogous to eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant (Code 7806). The evidence simply does not satisfy the criteria under either code. The September 2005 VA examiner stated that there was no deformity, facial asymmetry or significant loss of tissue on examination. He also noted there were no systemic symptoms. Moreover, there is no indication of these findings or of extensive exfoliation or crusting, nervous manifestations, or exceptionally repugnant, on the VA outpatient records in 2005 and 2006. Rather, findings from this evidence revealed multiple hyperpigmented macules mainly on the cheeks, papules, a few erythematous papules, scattered comedones and depressed ice-pick scarring on bilateral cheeks and dyschromia. The September 2005 VA examiner assessed the veteran's acne vulgaris as "moderate inflammatory and comodonal". In view of this evidence, the criteria under former Diagnostic Codes 7800 and 7806 for the period from September 29, 2005, are not met. Also, in light of the absence of findings of superficial, unstable or painful scars on examination, or of limitation of function, separate 10 percent ratings under Codes 7803, 7804 and 7805 are not warranted (2001, 2005). See Esteban, supra. For the foregoing reasons, the weight of the evidence is against a disability rating in excess of 30 percent at any point from September 29, 2005. As such, "staged ratings" are not for application. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board notes that when the preponderance of the evidence is against a claim, the doctrine of reasonable doubt is not for application. 38 U.S.C.A. § 5107. Lastly, there is no indication that the schedular criteria are inadequate to evaluate the veteran's acne. The veteran does not allege, and the evidence does not establish, that this disability causes marked interference with employment (i.e., beyond that contemplated in the assigned evaluation), or necessitates frequent periods of hospitalization. With respect to employment, the September 2005 VA examination report shows that the veteran worked as a defense contractor with duties involving shipping and supplying. There is no indication from this record or any other record that her acne has markedly interfered with her employment. Thus, the veteran's claim for higher evaluations for acne does not present such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. The Board is thus not required to remand this matter to the RO for the procedural actions outlined in 38 C.F.R. § 3.321(b)(1) (2002). See Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). (CONTINUED ON NEXT PAGE) ORDER Entitlement to an initial evaluation in excess of 10 percent for acne vulgaris prior to September 29, 2005, is denied. Entitlement to an evaluation in excess of 30 percent for acne vulgaris from September 29, 2005, is denied. ____________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs