Citation Nr: 9903584 Decision Date: 02/09/99 Archive Date: 02/17/99 DOCKET NO. 96-34 254 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York THE ISSUE Entitlement to an increased rating for cystic acne, with scars of the face and chest, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Schlosser, Associate Counsel INTRODUCTION The veteran had active military service from January 1990 to January 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 1996 rating action in which the RO continued a 10 percent rating for a skin disorder characterized as cystic acne, with scarring of the face and chest. The veteran appealed for a higher rating. He appeared before the undersigned member of the Board for a hearing at the RO in September 1998. In a February 1998 rating action, it appears that the RO found that new and material evidence had not been submitted to reopen a claim for service connection for a back disorder. The veteran was sent a letter by the RO to this effect. The letter is dated February 4, 1998. The first two pages of the three page rating action are not in the claims folder. Additionally, there is no record of the veteran having filed Notice of Disagreement (NOD) to the February 1998 rating action and that issue is not before the Board at this time for appellate consideration. REMAND Cystic acne is rated analogous to eczema. 38 C.F.R. § 4.118 (1998). When cystic acne involves an exposed surface or extensive area and is manifested by exfoliation, exudation or itching, a 10 percent rating is assigned. When cystic acne is productive of constant itching or exudation, extensive lesions, or marked disfigurement, a 30 percent rating is assigned. When cystic acne is exceptionally repugnant, or manifested by ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, a 50 percent disability rating is warranted. 38 C.F.R. § 4.118, Diagnostic Code 7806 (1998). Scarring to the head, face or neck which is moderate and disfiguring is rated 10 percent disabling. When scars to the head, face or neck are severe, especially if they are productive of marked and unsightly deformity of the eyelids, lips, or auricles, a 30 percent rating is warranted. Scarring which results in complete or exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement, is rated as 50 percent disabling. 38 C.F.R. § 4.118, Diagnostic Code 7800 (1998). On VA examination in March 1996, the veteran was noted to have hypertrophic scars of the chest and back due to acne. The veteran indicated that he had been treated for acne in service and prescribed Accutane. After his discharge from service, the veteran was given a second course of Accutane in 1995. At his Travel Board hearing in September 1998, the veteran testified that his acne has spread to other areas of his body, including his legs and thighs. He has scarring all over his chest, back and face. He described pain and itching because of his acne and the residual scarring. He is currently taking a third course of Accutane. He does not generally shave, because of the significant scarring on his face. He said that he has lost a lot of confidence in himself as a result of his acne. He is unable to take off his shirt due to embarrassment and does not have much of a social life. The veteran indicated that he had received treatment as recently as two weeks before the hearing; he is receiving treatment for his service connected cystic acne at the Fort Hamilton VA Medical Center (VAMC) in Brooklyn, New York. There are no post-service treatment records in the claims folder. No pictures have been associated with the claims folder. It is the opinion of the Board that unretouched color photographs of the veteran's current skin disorder should be obtained. The case is REMANDED to the RO for the following action: 1. The RO should contact the Ft. Hamilton VAMC in Brooklyn, New York and obtain a copy of all medical treatment records referable to the veteran's skin disorder since March 1996, the date of the VA examination. The records obtained should be associated with the claims folder. 2. Following receipt of the aforementioned evidence, the RO should schedule the veteran for a comprehensive VA examination with a dermatologist. The purpose of the examination is to ascertain the current severity of the veteran's cystic acne. The claims folder MUST be available for review and the examiner should indicate in his/her written report that a review of the claims folder was accomplished. All findings should be reported in detail. Following a complete examination of the veteran's skin, the examiner should (a) identify all anatomical areas in which the veteran has cystic acne; (b) indicate whether there is constant exudation or itching, extensive lesions or marked disfigurement in any area affected by acne or residual scarring; (b) indicate whether there is ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or whether the veteran's cystic acne with residual scarring produces exceptional repugnance. With respect to the residual scarring from the veteran's cystic acne, the examiner should indicate whether there is scarring of the head, face or neck and, if so, whether it is severe, especially if producing a marked and unsightly deformity of the eyelids, lips, or auricles, or whether such scarring is productive of exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement. It is requested that the examiner include several unretouched color photographs of the veteran's cystic acne to illustrate the current severity of his skin disorder. 3. Following completion of the foregoing, the RO must review the claims folder and ensure that all of the aforementioned development action has been conducted and completed in full. If any development is incomplete, appropriate corrective action is to be implemented. The RO should then review the record and the claim should be readjudicated. If the determination remains adverse to the veteran, both the appellant and his representative should be provided with a Supplemental Statement of the Case. The veteran and his representative should be given the opportunity to respond within the applicable time. Thereafter, the case should be returned to the Board, if in order. The appellant need take no action unless otherwise notified. The purpose of this remand is to procure clarifying data. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Veterans Appeals for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1998) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. BRUCE E. HYMAN Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1998). - 4 -