BVA9412308
DOCKET NO.  92-18 817     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Los Angeles,
California

THE ISSUE

Entitlement to an increased evaluation for skin disabilities,
currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Robert P. Regan, Counsel
INTRODUCTION

The appellant served on active duty from December 1955 to August
1967.

This matter came before the Board of Veterans' Appeals
(hereinafter Board) on appeal of a January 1991 rating
determination by the Department of Veterans Affairs (hereinafter
VA) Regional Office (hereinafter RO) located in Los Angeles,
California.  In the January 1991 rating determination, the RO
denied entitlement to an increased evaluation for fungus
infection involving the toenails and fingernails and seborrheic
dermatitis involving the lower sternum.

In response to a November 1993 request for information made by
the RO to the appellant regarding his claim for service
connection for residuals of exposure to radiation and toxic
chemicals, he submitted a statement in support of his claim which
was received by VA in December 1993.  At that time, the
appellant's case was pending before the Board on the current
issue.  Accordingly, this document is referred to the RO for
appropriate action regarding the appellant's claim of entitlement
to service connection for residuals of exposure to radiation and
toxic chemicals.

CONTENTIONS OF APPELLANT ON APPEAL

The appellant maintains that his skin problems are very
contagious and, if he is not careful, will quickly spread from
his feet to his groin area and hands.  He states that the
involved areas constantly itch and, if the areas on the palm of
his hands are not treated well, they will blister.  He also
experiences an infected area in the groin.  He states that the
involved area results in constant pain.  He reports that his
toenails will fall off and occasionally he will have swelling in
his feet.  He reports that the treatment he has received for his
fungal infection from private and VA doctors has been
unsuccessful.

DECISION OF THE BOARD

In accordance with the provisions of 38 U.S.C.A. § 7104 (West
1991), following review and consideration of all evidence and
material in the appellant's claims folder, and for the following
reasons and bases, it is the decision of the Board that the
weight of the evidence supports the appellant's claim for an
increased evaluation for skin disabilities.

FINDINGS OF FACT

1.  The skin disabilities currently involve the toenails, soles
of the feet, inguinal area bilaterally, right fourth fingernail,
and dorsum of the left hand and are manifested by recurrent
puritic vesicles and complaints of constant itching.

2.  The service-connected skin disorders do not result in
ulceration or extensive exfoliation or crusting, systemic or
nervous manifestations, or exceptionally repugnant disfigurement.

CONCLUSION OF LAW

The schedular criteria for a 30 percent evaluation for skin
disorders have been met.  38 U.S.C.A. §§ 1155, 5107 (West 1991);
38 C.F.R. §§ 3.321, 4.7, Part 4, Diagnostic Code 7806 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Initially, the Board has found that the appellant's claim is well
grounded in accordance with 38 U.S.C.A. § 5107 in that his claim
is plausible and capable of substantiation.  Murphy v. Derwinski,
1 Vet.App. 78 (1990).  This finding is based on the appellant's
assertion that his skin disorders have worsened, resulting i

involvement of his hands, feet, and groin with constant pain and
itching.  Proscelle v. Derwinski, 2 Vet.App. 629 (1992).  As
such, VA has a statutory duty to assist the appellant in the
development of evidence pertinent to his claim.  38 U.S.C.A.
§ 5107.  Accordingly, in April 1993, the Board remanded the case
to the RO for a VA dermatological examination.  That action has
been completed, and the Board is satisfied that the statutory
duty to assist the appellant in the development of evidence
pertinent to his claim has been met.

The RO has assigned a 10 percent evaluation for the appellant's
skin disabilities, in accordance with the criteria set forth in
the VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4,
Diagnostic Code 7806.  Diagnostic Code 7806 provides for the
evaluation of eczema.  When there is exfoliation, exudation or
itching, if involving an exposed surface or extensive area, a
rating of 10 percent is provided.  With exudation or itching
constant, extensive lesions, or marked disfigurement, a rating of
30 percent is provided.  With ulceration or extensive exfoliation
or crusting, and systemic or nervous manifestations, or
exceptionally repugnant, a rating of 50 percent is provided.

A review of the service medical records reflects that the
appellant was treated at the dispensary on several occasions for
skin problems, which were variously diagnosed, to include
allergic dermatitis, jock itch and dermatophytes, tinea pedis,
and tinea corporis.

A VA examination was performed in November 1972.  At that time,
the appellant indicated that he had received treatment for a
fungus infection regularly since 1957.  He stated that the fungus
in his nails and crotch improved but always recurred after
periods of remission.  He also reported recurrent patches on his
trunk.  The examination showed minimal dystrophic thickening of
the toenail edges, the right ring and middle fingers.  The left
ring fingernail showed mild dystrophic changes due to trauma as
the residual of a sustained burn.  Over the midsternal line and
above the umbilicus, there was a suggestion of seborrheic
dermatitis, but not of fungus, clinically.  Below the left crotch
folds, there were few erythematous isolated patches.  The
diagnoses were onychomycosis of the toenails, terminal edges,
minimal, and of three fingers; and seborrheic dermatitis, lower
sternum, left crural area and umbilical area.

In a December 1972 rating action, the RO granted entitlement to
service connection for a skin disorder and assigned a 10 percent
evaluation.  The 10 percent evaluation has been in effect since
that time.

In conjunction with the appellant's current claim, he submitted
private medical records showing treatment beginning in the early
1980's to 1991 primarily for orthopedic problems.  A VA
examination was performed in August 1991.  At that time, the
appellant reported that, due to his disabilities, he had been
unable to work for the prior 10 years.  He gave a history of
extensive orthopedic problems, including surgeries on his hip and
arms.  He further gave a history of exposure to radiation and
toxic substances during active duty.  He stated that his skin
condition developed in 1956 and had been chronic with multiple
exacerbations and remissions since that time.  The skin condition
was characterized by the appearance of small liquid-filled
papules in all areas of sweating, including the soles and top of
his feet, intercrural area, penis, scrotum, axilla, and belt
area.  These papules increased in density and itching and they
eventually broke, weeping a clear liquid which may have led to
bleeding.  He reported that he had been treated with anti-fungal
agents.

The evaluation showed that the appellant walked with a cane in
his right hand to support his left leg.  An examination of the
skin showed no evidence of excoriation or inflammation.  There
were few small papules on the lateral aspect of the feet,
bilaterally, and occasional small papules were seen in the
intercrural area and on the scrotum.  Examination included blood
studies.  The diagnoses included a skin condition characterized
by recurrent pruritic vesicles.  The appellant was referred to
the VA dermatology clinic.

The appellant was evaluated at the VA dermatology clinic in
September 1991 for numerous skin lesions involving the chest and
pubic area.  An evaluation showed folliculitis of the pubis,
mycosis involving the groin and feet, onychomycosis, an

angiomas involving the chest.  Skin tags were also noted.  It was
remarked that there was no dermatological explanation for the
appellant's complaint of pain in his feet.  Medication was
prescribed.

Received in 1992 were copies of medical text regarding toxic
fungal chemicals and information pertaining to the diagnosis of
treatment of fungal infections.

A VA dermatological evaluation was performed in May 1993.  At
that time, the appellant indicated that all medical problems he
was experiencing were being treated by a VA medical facility.  He
gave a history of chronic pruritic skin eruptions involving the
hands, feet and axillary area.  He reported yellowing and
thickening of both fingernails and toenails.

An examination showed that the appellant did not appear to have
any joint or extremity pain while standing or walking.  There
were a few skin tags between 1 and 3 millimeters in diameter
located at the axillary areas, bilaterally.  There was yellow
thickening of the distal right fourth fingernail.  There was
longitudinal grooving in the right fourth fingernail.  The
remainder of the nails in the right hand were normal.  No other
abnormality of the right hand was noted.  There was a mildly,
erythematous, papular eruption noted between the 1st and 2nd
fingers of the dorsum of the left hand.  The referenced site was
4 centimeters in diameter.  The nails in the left hand were
normal and the remainder of the left hand examination was normal.

The evaluation further showed the presence of an erythematous,
yellow macular eruption, 4 centimeters in diameter, in the left
medial inguinal area adjacent to the scrotum.  There was an
erythematous, macular eruption noted in the medial right inguinal
area adjacent to the scrotum.  The eruption site was
2 centimeters in diameter.  There was a mild, nonerythematous
scaly eruption noted throughout the sole of the left foot.  The
skin on the dorsum of the left foot was normal.  All toenails of
the left foot were yellowed and thickened.  There was mild
nonerythematous, scaly eruptions on the sole of the right foot.
The skin on the dorsum of the right foot was normal.  All
toenails of the right foot were yellow and thickened.

The examiner commented that the skin eruptions in the right and
left axillary areas by history were believed to represent fungus
infections.  There were no axillary eruptions at the time of the
examination.  The yellow, thickened, right fourth fingernail was
believed to represent onychomycosis.  The cause of the papular
eruption on the dorsum of the left hand was undetermined.  The
appellant had bilateral tinea crural and bilateral tinea pedis
with a scaly eruption on the soles of both feet with
onychomycosis involving all toenails.

The appellant was seen at a VA dermatology clinic in June 1993,
at which time the assessments were onychomycosis, tinea pedis and
some involvement of the groin.  It was remarked that the
appellant apparently had a reaction to the medication he was
utilizing and a different medication was prescribed.

To summarize, in order to be entitled to a 30 percent evaluation
for the appellant's skin condition, the evidence must reflect the
presence of exudation or constant itching, extensive lesions, or
marked disfigurement.

 The appellant, in his statements and in his testimony during his
hearing at the RO in August 1991, described his skin disorder as
being chronic and recurrent in nature.  He indicated that he will
develop blisters in the involved areas and that the blisters will
eventually break and weep, followed by healing in the involved
area.  Shortly thereafter, this process would begin all over
again.  He further reported constant itching of the involved
areas.  The statements and testimony of the appellant with regard
to his own direct observation of the symptoms of his skin
disorders are considered to be competent evidence.  Espiritu v.
Derwinski, 2 Vet.App. 492 (1992).  As such, this evidence must be
reviewed in conjunction with the objective medical evidence.  The
VA examiner, in August 1991, indicated that the skin disorders
were characterized by recurrent pruritic vesicles.  The May 1993
VA examination showed that his skin disabilities involved the
soles of his feet, toenails, the axillary areas, bilateral by
history, both sides of the groin area, right fourth fingernail,
and dorsum of the left hand.  Although the examination showed no
evidence of any exudation, this is not inconsistent with the
clinical history of skin disorders.  Again, as the appellant has
indicated, his skin disorders are cyclic in nature.  He has
further reported constant itching and on occasion involvement of
other areas of his body, to include this chest.

 It is the Board's judgment that the current medical evidence
when viewed in conjunction with the appellant's statements and
testimony, presents a disability picture which more nearly
approximates the criteria for the 30 percent evaluation under
Diagnostic Code 7806 in conjunction with 38 C.F.R. § 4.7.  The
veteran describes constant itching, and his statements are
consistent with the clinical findings.  There is some question as
to whether the manifestations of disability warrant a finding of
constant itching, as some of the descriptions indicate cyclical
rather than unrelenting periods of exacerbation.  However, the
descriptions also refer to repeated episodes, with little or no
periods of relief.  Therefore, the manifestations of the
disability approximate the 30 percent criteria more closely than
the 10 percent. criteria.  On the other hand, a rating higher
than 30 percent is not warranted; the evidence does not show that
the skin disabilities satisfy the criteria for the 50 percent
evaluation, which requires ulceration or extensive exfoliation or
crusting, and systemic nervous manifestations or an exceptionally
repugnant disfigurement.

In rendering this determination, the Board has considered all the
pertinent aspects of 38 C.F.R. Parts 3 and 4 as required by the
United States Court of Veterans Appeals in Schafrath v.
Derwinski, 1 Vet.App. 589 (1991).  In doing so, the Board has
predicated this grant on the application of 38 C.F.R. § 4.7.
However, the remaining sections do not provide a basis
demonstrating that a higher rating is warranted. The evidence
does not show the presence of such an unusual disability picture,
i.e., frequent periods of hospitalization or marked interference
with employment as to render impractical the application of the
regular schedular standards.  38 C.F.R. § 3.321(b)(1).  The
record reflects that the appellant has been unable to work
primarily due to orthopedic problems.

ORDER

Entitlement to an increased evaluation for skin disabilities is
granted, subject to the law and regulations governing the payment
of monetary benefits.

          G. H. SHUFELT

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals within
120 days from the date of mailing of notice of the decision,
provided that a Notice of Disagreement concerning an issue which
was before the Board was filed with the agency of original
jurisdiction on or after November 18, 1988.  Veterans' Judicial
Review Act, Pub. L. No. 100-687, § 402 (1988).  The date which
appears on the face of this decision constitutes the date of
mailing and the copy of this decision which you have received is
your notice of the action taken on your appeal by the Board of
Veterans' Appeals.