Citation Nr: 9831696 Decision Date: 10/26/98 Archive Date: 11/02/98 DOCKET NO. 96-22 372 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to an increased evaluation for a disorder of the sweat glands, hidradenitis suppurativa, evaluated at 30 percent. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Crawford, Associate Counsel INTRODUCTION The veteran had active service from October 1954 to May 1958 and from April 1974 to October 1976. This appeal arises from a rating decision in which the Department of Veterans Affairs (VA) Regional Office (RO) at Honolulu, Hawaii denied entitlement to an increased evaluation in excess of 10 percent for the veteran’s service- connected disorder. The veteran appealed. On appellate review in July 1997, the Board of Veterans’ Appeals (Board) remanded the case for additional development. It is noted that during the pendency of the appeal, the veteran’s claims folder was transferred from Honolulu, Hawaii to Lincoln, Nebraska. After completing the requested development, in February 1998, the RO increased the rating from 10 percent to 30 percent, effective from June 15, 1995. Since a rating in excess of 30 percent is possible for the foregoing disability and the veteran continues to express disagreement, the issue of entitlement to an increased rating remains on appeal and is before the Board in accordance with AB v. Brown, 6 Vet. App. 35 (1993). On the June 1998 VA Form 646, the veteran’s representative indicated that on substantive appeal in February 1996, the veteran indicated that he wanted to pursue a claim of entitlement to an earlier effective date for the assignment of an increased evaluation for this disability. Because no action has been taken in response to this assertion, the matter is referred to the RO for any development deemed appropriate. EF v. Derwinski, 1 Vet. App. 324, 326 (1991). CONTENTIONS OF APPELLANT ON APPEAL The veteran maintains that symptoms associated with the service-connected hidradenitis suppurative disability have increased in frequency and severity. He maintains that he has lesions not only over the scrotum area, but also over other parts of the body. The lesions are productive of discharge, swelling, redness, and pain. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), has reviewed and considered all of the evidence and material of record in the veteran's claims file. 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 veteran’s claim of entitlement to an increased evaluation in excess of 30 percent for residuals of hidradenitis suppurative. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran’s appeal has been obtained. 2. The veteran’s hidradenitis suppurativa is manifested by recurrent boils of the groin region of the thighs and scrotum area with odorous discharge, swelling, redness, and pain. Evidence of crusting and systemic or nervous manifestations is not present. CONCLUSION OF LAW The criteria for an increased rating in excess of 30 percent for hidradenitis suppurativa have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.118 Diagnostic Code 7806 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran’s claim is plausible and thus well grounded within the meaning of 38 U.S.C.A. § 5107(a). See Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The VA, therefore, has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a). The Board is satisfied that all relevant evidence has been obtained with respect to this claim and that all relevant facts have been developed. The Board concludes that, as required by the applicable statute, the duty to assist has been fulfilled. Id. In January 1977, entitlement to service connection for residuals of a perineal abscess, recurrent was granted and evaluated as noncompensably disabling, effective from November 1, 1976 and as 10 percent disabling, effective from July 5, 1977. In that determination, the RO considered the veteran’s service medical records and a July 1977 VA outpatient treatment report which shows a diagnosis of left perineal abscess. The record also contains a July 1977 VA hospital summary report which shows that the veteran was hospitalized for recurrent anorectal fistula with increasing pain, redness, and swelling of the left periscrotal area and that the discharge diagnoses included recurrent anorectal fistulae with cellulitis and involving the left portion of the scrotum. In November 1977, the disability was recharacterized as hidradenitis suppurativa and evaluated as zero percent disabling effective from November 1, 1976, as 100 percent disabling effective from July 4, 1977 (Paragraph 30), and as 10 percent disabling effective from September 1, 1977. On VA examination in July 1979, objective evaluation revealed several scars of the perianal regions with one draining area, in which a small amount of periform material could be expressed. The diagnosis was residuals of perineal abscess postoperative. In August 1979, the 10 percent evaluation was confirmed and continued. On VA examination in June 1995, the veteran complained of increased infection and recurrent abscesses. Examination revealed the presence of three sinus tracts. The largest measured 1 x 1-centimeters in diameter and the other two measured approximately .5-centimeters. Draining blood and moderate tenderness were also noted. The assessment was sinus tract infection – probable hidradenitis. VA outpatient treatment reports extending from June to October 1995 show that in June 1995, multiple perineal/scrotal tracts with scars and one tract exuding bloody drainage were noted. Evidence of tenderness, erythema, and abscesses was not shown. The impression was hidradenitis suppurative. A separate June 1995 clinical entry shows that the veteran experienced drainage in the right medial upper thigh area and that a fistula, without drainage, was present in the right groin area. On that report, the diagnosis was probable scrotal cellulitis; multiple cystic lesions probably infected. In addition, reports in September 1995 document complaints of pain of the right breast. On that entry, the assessment was right breast tenderness. Medical reports from Queens Hospital dated in May 1995 are also of record, but those reports show that the veteran received treatment for an unrelated disorder. After reviewing the foregoing evidence, in a December 1995 rating action, the 10 percent evaluation was confirmed and continued. At his personal hearing in March 1996, the veteran testified that symptoms associated with the service-connected disorder had increased in frequency and severity. He also stated that the disorder not only became manifest in the scrotum area, but also over other parts of the body. The veteran stated that the episodes lasted for about three weeks in a row, approximately every other month. The veteran also added that he had been on antibiotics for over a year. During the hearing, the veteran also stated that the disability should be characterized as hidradenitis suppurativa versus a recurrent perianal abscess. The veteran’s spouse also stated that the disorder interfered with the veteran’s walking and extra-curricular activities. In an October 1995 statement, R.W., M.D., stated that the veteran had a condition of the sweat glands which drained intermittently. The doctor also stated that it would be beneficial if the veteran could work in a cooler climate as compared to a tropical climate. VA outpatient and hospital reports extending from June 1992 to October 1997 show that the veteran continued to received treatment for symptoms associated with the hidradenitis suppurativa disability. The reports generally show that the veteran complained of pain, swelling, redness and draining and received treatment. However, a May 1996 report shows that the veteran denied experiencing the aforementioned symptoms, even though examination of the scrotum area revealed positive erythema with 3 x 4 centimeter areas of induration at the base of the scrotum and small open areas with draining brown fluid. Evidence of pus was not seen. The assessment was suppurative hidradenitis without abscess or pus. In addition, a September 1997 report shows that the veteran received treatment for recurrent exacerbation of the thigh and groin areas. It is noted that even though an October 1997 clinical report references an unrelated disability, it shows that the veteran walked two miles a day and worked as a telecommunications specialist. On VA examination in January 1998, the veteran gave a history of chronic, recurrent hidradenitis suppurativa. He stated that the episodes had worsened over the recent years and that he experienced more recurrent boils of the groin region of the thighs and the scrotum over the past few years. The veteran’s episodes consisted of the manifestation of three to four lesions with drainage each month. During this time, the veteran stated that he had to wear a protective garments to catch discharging pus and the lesions took several weeks to heal. The veteran also stated that he took antibiotics, presently Ciprofloxacin, to control eruptions and to shorten the healing course. He added that the medication did not prevent eruptions but kept them from becoming extensive and crippling, as the discharge created offensive odors. The examiner then stated that at that time, the veteran was in a semi-quiescent state, but he was starting a new series of lesions, and he could see a site developing in the groin area where an erythematous patch had developed. The examiner added that within the next week or two, the lesion would develop into a hard, erythematous nodule which would eventually discharge its sebaceous contents. The assessment was hidradenitis suppurativa, chronic and active. On the examination report, in relevant part, the examiner also stated that the eruptions were difficult, in the sense that, when they occurred each month, it was difficult for the veteran to sit or walk properly because of pain, swelling and discharge. Further, the areas had to be constantly maintained and cleaned to prevent soiling of the clothes and the presence of a foul smell from the discharge. The prognosis was very poor and it was noted that the disorder would probably continue for many years and eventually some of the areas with the development of chronic sinuses would require surgical correction or excision of the sinuses. After reviewing the foregoing evidence of record, in February 1998, the 10 percent evaluation was increased to 30 percent, effective from June 15, 1998. As previously indicated, the veteran contends that he is entitled to an increased evaluation. Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities, which is based on average impairment of earning capacity. Different diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Although the evaluation of a service-connected disability requires a review of the veteran’s medical history with regard to that disorder, the primary concern in a claim for an increased evaluation for a service-connected disability is the present level of disability. The United States Court of Veterans Appeals (Court) has held that, where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In this case although the Ratings Schedule does not provide a listing for rating hidradenitis suppurativa, it does provide that eczema with constant exudation or itching, extensive lesions, or marked disfigurement warrants a 30 percent evaluation and eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations or that is exceptionally repugnant warrants a 50 percent. 38 C.F.R. § 4.119, Diagnostic Code 7806. As such, in this case, rating by analogy to the aforementioned code is both possible and appropriate under 38 C.F.R. § 4.20 (1998). 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 this case, an increased evaluation in excess of 30 percent evaluation is not warranted. Although clinical findings show that the veteran experiences recurrent eruptions with offensive odorous exudation, pain, swelling, and redness, the clinical data does not show that the veteran’s disability picture more nearly approximates the criteria required for an increased rating. 38 C.F.R. § 4.7. The clinical data of record does not suggest that the veteran’s disability is productive of extensive exfoliation or crusting or productive of any systemic or nervous manifestations. In addition, although there is evidence of difficulty with odor and discharge, there is no evidence of record that suggests that the disability is exceptionally repugnant. On examination in January 1998, objective findings revealed that the veteran’s recurrent boils appeared in the groin region of the thighs and in the scrotum area. It is also noted that a VA outpatient treatment reports extending from June 1992 to October 1997 show that the veteran works as a telecommunications specialists and, at times, walked two miles a day. There is no evidence of record which demonstrates that the veteran’s disability interferes with his lifestyle or employment. Upon reviewing the applicable law and the veteran’s disability picture, because the clinical evidence of record does not show that the veteran’s hidradenitis suppurativa is productive of ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations or is exceptionally repugnant, an increased rating in excess of 30 percent is not warranted. 38 C.F.R. §§ 4.7, 4.119, Diagnostic Code 7806. The Board further notes that other pertinent provisions of 38 C.F.R. Parts 3 and 4, and 38 C.F.R. § 3.321(b)(1) (1998) have been considered. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The evidence of record does not show that the veteran’s hidradenitis suppurativa presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant the assignment of an evaluation pursuant to 38 C.F.R. § 3.321(b)(1). Evidence of an exceptional disability picture, such as that manifested by frequent hospitalization or marked interference with employment, is not demonstrated. The record shows that the veteran is employed as a telecommunications specialists and is devoid of any indications which would demonstrate that the veteran’s service-connected disability is productive of frequent hospitalization. Thus, an increased rating on an extraschedular basis is not warranted. In accordance with applicable schedular criteria, therefore, the Board concludes that an increased evaluation in this regard are not warranted. ORDER Entitlement to an increased rating in excess of 30 percent for hidradenitis suppurativa, is denied. V. L. Jordan Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), 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 -