Citation Nr: 9805531 Decision Date: 02/25/98 Archive Date: 03/20/98 DOCKET NO. 96-22 025 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to an increased disability evaluation for hidradenitis suppurative, currently evaluated as 10 percent disabling. WITNESS AT HEARING ON APPEAL Appellant INTRODUCTION The appellant served on active duty from February 1968 to September 1969 and from March 1970 to December 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a decision dated in March 1996, by the Atlanta, Georgia, Department of Veterans Affairs (VA) Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that his service-connected skin disorder has increased in severity and warrants a higher disability evaluation. Specifically, he argues that he experiences constant exudation from his ears, buttocks and groin with itching which he believes warrants a 30 percent disability evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the appellant’s claim to an increased disability evaluation for hidradenitis suppurative. FINDING OF FACT The appellant’s hidradenitis suppurative is manifested by subjective complaints of recurring eruptions requiring drainage and medication and is productive of a state of mild activity with no current objective symptomatology. CONCLUSION OF LAW The criteria for a disability evaluation in excess of 10 percent for hidradenitis suppurative are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, Diagnostic Codes 7899-7806 (1997). REASONS AND BASES FOR FINDING AND CONCLUSION Background Review of the record reveals that in November 1985, the RO granted service connection for hidradenitis suppurative and assigned a 10 percent disability evaluation. The rating board noted that in October 1985, a VA physician, after physical examination and review of the appellant’s claims folder, concluded that the appellant had been misdiagnosed and that the correct skin diagnosis was hidradenitis suppurativa. The examiner further noted that the hidradenitis suppurative was manifested by nodules located below the left ear, left breast, right and left scrotum as well as on the left buttock. The 10 percent disability evaluation has been carried forward to the present appeal. In January 1996, a VA dermatological examination was conducted. The appellant reported that his skin disability primarily involved his back and groin but that in recent years he had changed his lifestyle which improved the condition. He further indicated that he experienced recurrent infections manifested by large bumps which open and drain. On physical examination, the sternal area of the chest revealed a macular, confluent, slightly desquamative dermatitis suggesting tinea versicolor. In the groin region there was a macular, hyperpigmented desquamative dermatitis typical of tinea cruris. There were no papules, pustules or cysts noted at those sites, but there were some cysts, comedones and papules on the back which were suggestive of acne vulgaris. On the axillae, there were also some regressing lesion manifested by some papules but no pustules. There was no cervical, axillary or inguinal adenopathy and there was one single papule on the scrotum suggestive of a sebaceous cyst. The examiner commented that the hidradenitis suppurative was in a state of mild activity, if at all. The diagnoses were hidradenitis suppurative, history of, presently mild, tinea cruris, localized confluent tinea versicolor on the sternal area of the chest and mild acne vulgaris on the back. In September 1997, a hearing was held before the undersigned Acting Member of the Board. The appellant testified that his skin disorder flared every 30 to 60 days and that he experienced constant exudation from his ears, buttocks, and groin. He stated that the flare-ups varied in severity which occasionally required treatment by drainage and packing. He further noted that he had received treatment for his skin disorder for many years and believed that he should be assigned a 30 percent disability evaluation for this condition. Analysis Initially, the Board notes that the appellant has presented a well-grounded claim for an increased disability evaluation for hidradenitis suppurative within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 C.F.R. Part 4 (1997). The average impairment is set forth in the VA's SCHEDULE FOR RATING DISABILITIES, codified in C.F.R. Part 4 (1997), which includes Diagnostic Codes which represent particular disabilities. The pertinent Diagnostic Codes and provisions will be discussed below as appropriate. 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 for the higher rating. 38 C.F.R. § 4.7 (1997). When a disability is encountered that is not listed in the rating schedule it is permissible to rate under a closely related disease or injury in which the functions affected, the anatomical location and the symptomatology are closely analogous to the condition actually suffered from. 38 C.F.R. § 4.20 (1997). Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. Peyton v. Derwinski, 1 Vet.App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet.App. 55, 58 (1994). The appellant’s hidradenitis suppurative is currently rated by analogy to eczema pursuant to Diagnostic Code 7806, which provides that a 10 percent disability evaluation is warranted for symptoms of exfoliation, exudation or itching, if involving an exposed surface or extensive area. A 30 percent disability evaluation is warranted for constant exudation or itching, extensive lesions, or marked disfigurement. After review of the evidence of record, the undersigned concludes that entitlement to an increased disability evaluation for hidradenitis suppurative is not warranted. While the appellant has testified that he suffered from recurring episodes of swelling and bumps which required drainage, and that he also had itching due to the skin disorder, the objective evidence of record does not reflect symptomatology of such severity as to warrant a 30 percent disability evaluation. In fact, on VA dermatological examination in January 1996, findings of tinea versicolor over the chest area, tinea cruris and acne vulgaris on the back were noted. However, these skin disorders are not service-connected and as such, their symptomatology may not be considered in evaluating the appellant’s claim. Although a single papule was found on the scrotum, the examiner indicated that it was suggestive of a sebaceous cyst and that hidradenitis suppurative is not a sebaceous condition but a condition of the sweat glands. Upon conclusion of the examination, the VA examiner stated that “the diagnosis of hidradenitis suppurative is in a state of mild activity, if at all.” He further indicated in his diagnosis that the hidradenitis was “presently mild.” The appellant’s contentions and testimony in support of his claim are found to be outweighed by the objective evidence of record. In reaching this conclusion, the Board places particular emphasis upon the findings reported on VA dermatological examination in January 1996. In the absence of additional evidence to establish the presence of symptomatology analogous to constant exudation or itching, extensive lesions, or marked disfigurement, entitlement to an increased disability evaluation for hidradenitis suppurative is not warranted. ORDER The appeal is denied. James W. Engle Acting Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), 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, 102 Stat. 4105, 4122 (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. - 2 -