Citation Nr: 0811455 Decision Date: 04/07/08 Archive Date: 04/23/08 DOCKET NO. 02-14 494 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Hartford, Connecticut THE ISSUES 1. Entitlement to an initial rating in excess of 10 percent from October 30, 2000 to May 9, 2007, and in excess of 30 percent beginning on May 10, 2007, for the service-connected pseudofolliculitis barbae. 2. Entitlement to an initial compensable evaluation from October 30, 2000 to August 26, 2007, and in excess of 10 percent from August 27, 2000, for the service-connected atopic dermatitis. 3. Entitlement to service connection for claimed hearing loss. REPRESENTATION Appellant represented by: Connecticut Department of Veterans Affairs ATTORNEY FOR THE BOARD K. Fitch, Counsel INTRODUCTION The veteran served on active duty from November 1972 to March 1982. This case initially came to the Board of Veterans' Appeals (Board) on appeal from a July 2001 RO decision that denied service connection for left ear hearing loss. In that decision, the RO granted service connection for a left knee disability and assigned a 10 percent evaluation, effective on April 28, 2000. Also, the RO granted service connection for pseudofolliculitis barbae and atopic dermatitis and assigned both conditions noncompensable evaluations, effective on November 3, 2000. The veteran immediately appealed the RO's July 2001 rating action. During the course of the appeal, the RO in the April 2003 rating action assigned an increased rating of 10 percent for service-connected pseudofolliculitis barbae. In that decision, the RO continued the 10 percent rating for service- connected left knee and the noncompensable rating for atopic dermatitis. In the October 2004 Supplemental Statement of the Case (SSOC), the RO continued the denial of the claim of service connection for hearing loss. The veteran offered testimony before the undersigned Veterans Law Judge at a videoconference hearing held in April 2005. A transcript of these proceedings has been associated with the veteran's claims file. In June 2005, the Board increased the evaluation of the service-connected left knee disability and remanded the claims for higher evaluations for the service-connected pseudofolliculitis barbae and atopic dermatitis and the claims of service connection for hearing loss and tinnitus. In a September 2007 rating decision, the RO increased the evaluation of the service-connected pseudofolliculitis barbae to 30 percent disabling effective on May 10, 2007, increased the evaluation of the service-connected atopic dermatitis to 10 percent disabling effective on August 27, 2007, and granted service connection and assigned an initial 10 percent rating for tinnitus. FINDINGS OF FACT 1. Prior to December 5, 2006, the service-connected pseudofolliculitis barbae is not shown to have been productive of exudation or itching constant, extensive lesions, or marked disfigurement; did not require systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long- wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy for a total duration of six weeks or more, but not constantly, during the past 12-month period; to have affected 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas or required systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past twelve-month period; to have been manifested by scarring that limited function or that was superficial, unstable, poorly nourished, had repeated ulceration or was tender and painful on objective demonstration; to have been productive of severe deformity of the head face, or neck or 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 had two or three characteristics of disfigurement. 2. Beginning on December 5, 2006, the service-connected pseudofolliculitis barbae is not shown to affect more than 40 percent of the entire body or more than 40 percent of exposed areas, to require constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during the past twelve-month period; to require constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long-wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy during the past 12-month period; to cause limitation of the affected part; or to be productive of visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or have four or five characteristics of disfigurement. 3. Prior to August 27, 2007, the service-connected atopic dermatitis was not shown to have been manifested by exfoliation, exudation or itching involving an exposed surface or extensive area; nor after August 2002, did the evidence show involvement of 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 or that intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, was required for a total duration of less than six weeks during the past twelve-month period. 4. Beginning on August 27, 2007, the service-connected atopic dermatitis is not shown to affect 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas or to require systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past twelve-month period. 5. The veteran currently is not shown to have a hearing loss disability in either ear for VA compensation purposes. CONCLUSIONS OF LAW 1. The criteria for the assignment of an initial evaluation in excess of 10 percent from October 30, 2000 through December 4, 2006 for the service-connected pseudofolliculitis barbae have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.118 including Diagnostic Codes 7800-7805, 7806, 7817 (2002) and (2007). 2. The criteria for the assignment of an evaluation of 30 percent beginning on December 5, 2006, for the service- connected pseudofolliculitis barbae, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.118 including Diagnostic Codes 7800-7805, 7806, 7817 (2007). 3. The criteria for the assignment of an initial compensable evaluation from October 30, 2000 through August 26, 2007, and an evaluation in excess of 10 percent beginning on August 27, 2007 for the service-connected atopic dermatitis, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.118 including Diagnostic Code 7806 (2002) and (2007). 5. The claim of service connection for a hearing loss must be denied by operation of law. 38 U.S.C.A. §§ 1110 (West 2002); 38 C.F.R. §§ 3.385 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VCAA The Veterans Claims Assistance Act of 2000 (VCAA), codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented at 38 C.F.R. § 3.159, amended VA's duties to notify and to assist a claimant in developing the information and evidence necessary to substantiate a claim. Under 38 U.S.C.A. § 5103, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate the claim, which information and evidence that VA will seek to provide and which information and evidence the claimant is expected to provide. Furthermore, in compliance with 38 C.F.R. § 3.159(b), the notification should include the request that the claimant provide any evidence in the claimant's possession that pertains to the claim. In letters dated in May 2001, October 2005, June 2006, April and May 2007, the RO provided the veteran with the required notice under 38 U.S.C.A. § 5103 and 38 C.F.R. § 3.159(b) with respect to his claims, including that a disability rating and an effective date for the award of benefits will be assigned if the claims are granted. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The veteran was also generally invited to send information or evidence to VA that may support his claims, was advised of the basic law and regulations governing his claims, the basis for the decisions regarding his claims, and the cumulative information and evidence previously provided to VA, or obtained by VA on the veteran's behalf. In this regard, the Board notes that, with respect to the veteran's increase rating claims, the Board observes that in Dingess v. Nicholson, the Court recently held that upon receipt of an application for service connection, VA is required to notify a claimant of what information and evidence will substantiate the elements of the claim for service connection, including that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Dingess v. Nicholson, 19 Vet. App. 473 (2006). In Dingess, however, the Court also declared, that "[i]n cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated-it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled." Id. at 491. As such, no further VCAA notice is required with respect to the veteran's claims for initial higher disability ratings; and under the circumstances, the Board finds no prejudice to the veteran in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384 (1993); see also Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). For these reasons, the Board finds that the RO substantially complied with the specific requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002) (identifying evidence to substantiate the claim and the relative duties of VA and the claimant to obtain evidence); Charles v. Principi, 16 Vet. App. 370 (2002) (identifying the document that satisfies the VCAA notice); and 38 C.F.R. § 3.159(b) (the content of the notice requirement, pertaining to the evidence in the claimant's possession or a similar request to that effect). In this context, it is well to observe that VCAA requires only that the duty to notify be satisfied, and that claimants 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). The Board also finds that VA has made reasonable efforts to assist the veteran in obtaining evidence necessary to substantiate his claims. 38 U.S.C.A. § 5103A (West 2002). In particular, the information and evidence associated with the claims file consists of the veteran's service records, post-service medical and treatment records, VA examinations, the veteran's testimony before the Board, and statements submitted by the veteran and his representative in support of the claims. Under the circumstances of this case, the Board finds that VA undertook reasonable development with respect to the veteran's claims and concludes that there is no identified evidence that has not been accounted for. Under the circumstances of this case, VA has satisfied its duty to assist the veteran in this case. Accordingly, further development and further expending of VA's resources is not warranted. See 38 U.S.C.A. § 5103A. II. Increased ratings. Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. See 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2006). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7 (2006). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. See 38 C.F.R. § 4.3 (2006). The veteran's entire history is reviewed when making disability evaluations. See 38 C.F.R. 4.1 (2006); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1995). However, where the question for consideration is the propriety of the initial evaluation assigned after the grant of service connection, evaluation of the medical evidence since the effective date of the grant of service connection and consideration of the appropriateness of "staged ratings" is required. See Fenderson v. Brown, 12 Vet. App. at 126. The Board also notes that the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as the veteran's relevant medical history, his current diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Here, the Board notes that, effective August 30, 2002, VA amended the rating schedule for evaluating skin disabilities. See 67 Fed. Reg. 49,596 (Jul. 31, 2002) (to be codified at 38 C.F.R. § 4.118). Where a law or regulation changes during the pendency of a claim, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C.A. § 5110(g) (West 2002) can be no earlier than the effective date of that change. The Board must apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. As such, VA must generally consider the claim pursuant to both versions during the course of an appeal. VAOPGCPREC 3- 2000, 65 Fed. Reg. 33422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). A. Medical evidence related to the veteran's skin disabilities. The medical evidence in this case, related to the veteran's service-connected pseudofolliculitis barbae and atopic dermatitis consists primarily of VA examinations dated in October and December 2000, March 2003, December 2006, and May and July 2007. The veteran's claims file also contains treatment records in connection with his skin disabilities, to include a treatment reported dated in August 2007. The October 2000 examiner indicated that the veteran had hyperpigmentation noted along the shaving line with small follicles consistent with pseudofolliculitis. There was no drainage or open ulcer. The veteran was diagnosed with pseudofolliculitis barbae and noted to currently use topical steroids with resolution of symptoms. The veteran was also afforded a VA examination for his skin in December 2000. The examiner indicated that the veteran's claims file had been reviewed in connection with the examination. The veteran was noted to have been treated for atopic eczema and pseudofolliculitis barbae in service. His pseudofolliculitis barbae and atopic dermatitis were both treated with topical steroids. At the time of the examination, the veteran was noted to not to be applying any topical lotions or steroids to the surface. Upon examination, the veteran was noted to have small hypopigmented lesions without ulcerations or exfoliations at the thigh and at the tibia anterior. There was evidence of dry scales at the anterior tibia bilaterally and posterior behind the knees. Small macular lesions in the right and left antecuboidal fossa and upper arms with some mild dry scales were noted. On the face, areas of hyperpigmentation at the shaving line and small follicles without eruptions or evidence of infections, and no erythema, were indicated. The veteran was diagnosed with pseudofolliculitis barbae, chronic, atopic dermatitis, and tinea. The veteran was again examined by VA in March 2003. The examiner indicated that pseudofolliculitis barbae and skin rashes have been a persistent problem for the veteran. The pseudofolliculitis barbae was noted to have caused mild hyperpigmentation to the face. The veteran also indicated that he has a erythematous rash involving his hands and the scrotum that typically appears in the summer months and lasts for two to three months. He was indicated to have been treated with creams and a topical steroid. Upon examination, the veteran was indicated to have hyperpigmentation in the face along the shaven areas. There were no active lesions. The examiner noted scattered erythematous lesions on the veteran's hands, and also on his scrotum. The veteran stated that the veteran suffers from pseudofolliculitis barbae and as likely as not has atopic dermatitis in the hands and scrotum. He was indicated to use intermittent steroid cream for this condition. A reported dated on December 5, 2006 of a VA examination is also of record. The veteran's medical history was briefly noted. The veteran was noted to continue to have pseudofolliculitis barbae. The veteran was noted to have used daily oral Doxycycline, and creams including Triluma 1-2 times per day and Azelex locally, in the past 12 months. The examiner also indicated that the veteran had been on Elidel and Hydrocortisone for an unquantified amount of time. The veteran complained of irritation , hyperpigmentation and itch in the affected area. Upon examination, the examiner noted that the area of involvement was the full beard area, which was estimated to be 2% exposed BSA, or 50% of the face, or 70% of the anterior neck. Scarring was noted, especially in the jaw line and under the mandible and neck. There were pustules especially in the anterior neck area. The skin in the affected area measured 15 cm by 11 cm on each side of the face. The veteran's rash was indicated to be hyperpigmented, with mild scarring, multiple pustular eruptions, pruritic, non- tender, non-adherent, stable, flat, superficial, with no significant edema or keloid formation, but with pustules, and with no induration. The examiner also stated that the rash did not cause significant limitation of neck movement and was moderately disfiguring because of location. An additional VA examination was afforded the veteran on May 10, 2007. The findings of this examination were essentially the same as the findings of the December 2006 examination. Another VA examination was performed in July 2007. The examiner indicated that the claims file had been reviewed in connection with the examination. Again, the findings were in-line with the December 2006 VA examination. Finally, a medical treatment note dated August 27, 2007 noted atopic dermatitis on the hands and groin. A few scattered papules on dorsum hands and upper thighs and scrotum were indicated. The veteran reported that this condition was usually worse in the spring and summer and has been intensely pruritic. The veteran indicated that he was symptom-free until two days earlier when he developed recurrence of the rash on dorsum wrists and forearms, bilaterally. The veteran also indicated similar rash in his groin. The veteran indicated that in the past he had noted vesticles, though these were not noted upon examination. The veteran reported having flares one or two times per year involving his forearms, tops of hands, thigh and groin area. The flare was reported to be intensely itchy and uncomfortable. During a flare, the veteran used Triluma. The physician indicated that no intensive light therapy, UVB, PUVA, or electron beam therapies were used. No side effects of treatment were indicated, and there were no local (skin) symptoms or systemic symptoms such as fever or weight loss. No current lesions were noted on examination, but the physician indicated that during a flare the area affected was 15% TBA. 1-2 small hyperpigmented macules on the left high c/w post inflammatory hyperpigmented changes were noted. The physician found no pain in the scarring, no adherence to underlying tissue, normal skin texture, and no elevation or depression of the scarring. The scarring was noted to be superficial, with no inflammation, edema, or keloid formation, with no area of induration or inflexibility, and no limitation of function related to the scarring. The veteran was diagnosed with atopic dermatitis. Exposed areas affected were indicated to be 2%; percent of the entire body affected was indicated to be 15%. B. Evaluation of pseudofolliculitis barbae. The veteran's pseudofolliculitis barbae is currently evaluated as 10 percent disabling from October 30, 2000 through May 9, 2007, and as 30 percent disabling beginning on May 10, 2007 under Diagnostic Code 7817. Diagnostic Code 7817, effective after August 2002, provides ratings for exfoliative dermatitis (erythroderma). Exfoliative dermatitis with any extent of involvement of the skin, and; no more than topical therapy is required during the past 12-month period, is rated noncompensably (0 percent) disabling. Exfoliative dermatitis with any extent of involvement of the skin, and; systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long- wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy required for a total duration of less than six weeks during the past 12-month period, is rated 10 percent disabling. Exfoliative dermatitis with any extent of involvement of the skin, and; systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long- wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy required for a total duration of six weeks or more, but not constantly, during the past 12-month period, is rated 30 percent disabling. Exfoliative dermatitis with generalized involvement of the skin without systemic manifestations, and; constant or near- constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long-wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy required during the past 12-month period, is rated 60 percent disabling. Exfoliative dermatitis with generalized involvement of the skin, plus systemic manifestations (such as fever, weight loss, and hypoproteinemia), and; constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long-wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy required during the past 12-month period, is rated 100 percent disabling. 38 C.F.R. § 4.118. Diagnostic Code 7817, in effect prior to August 2002, provided that dermatitis, exfoliative was to be rated as eczema under Diagnostic Code 7806, dependant upon location, extent, and repugnant or otherwise disabling character of manifestations. Diagnostic Code 7806 in effect prior to August 2002 provided that eczema, with slight, if any exfoliation, exudation or itching, if on a nonexposed surface or small area, warranted a noncompensable evaluation. A 10 percent rating was warranted where there was exfoliation, exudation or itching involving an exposed surface or extensive area. A 30 percent rating was warranted where there was exudation or itching constant, extensive lesions, or marked disfigurement. And a maximum 50 percent evaluation was warranted with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or where the condition was exceptionally repugnant. The veteran's pseudofolliculitis barbae could also be evaluated under Diagnostic Code 7806, effective after August 2002. Pursuant to the revised Diagnostic Code 7806, if the skin condition covers an area of less than 5 percent of the entire body or exposed areas affected, and no more than topical therapy is required during the past 12-month period, a noncompensable rating is warranted. If 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 if intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past twelve-month period, a 10 percent rating is warranted. A 30 percent rating requires 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or; that systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past twelve-month period. Finally, a rating of 60 percent under the revised criteria is warranted when the condition covers an area of more than 40 percent of the entire body or when more than 40 percent of exposed areas affected, or; when constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past twelve- month period. Finally, the veteran's pseudofolliculitis barbae could also be evaluated under Diagnostic Codes 7800 to 7805. In this regard, the Board notes that the Diagnostic Codes 7800 through 7805 did not change materially from the codes in place prior to August 2002. Diagnostic Code 7805 is identical to the revised code and applies to scarring that limits the function of the affected part. Diagnostic Codes 7801 and 7802, prior to August 2002, dealt only with scars from burns, and are therefore not applicable to the veteran's case. Diagnostic Codes 7801 and 7802 after August 2002 apply only to scars other than scars of the head, face, and neck, and are therefore also not applicable to the veteran's case. Diagnostic Codes 7800, 7803 and 7804 are applicable to scars that are disfiguring to the head, face, or neck; superficial, poorly nourished, with repeated ulceration; or scars that are superficial, and are tender and painful on objective demonstration. Here, the Board finds that an initial evaluation higher than 10 percent is not assignable from October 30, 2000 through December 4, 2006 in this case. In order to obtain a higher evaluation under Diagnostic Code 7817-7806 in effect prior to August 2002, the condition would have to have been productive of exudation or itching constant, extensive lesions, or marked disfigurement. The medical evidence for this period indicates that the veteran had hyperpigmentation noted along the shaving line with small follicles consistent with pseudofolliculitis. There was no drainage or open ulcer, and the condition was indicated to be without eruptions or evidence of infections, and with no erythema. There were no active lesions, and the hyperpigmentation was indicated by one examiner to be mild. This evidence does indicate exudation or itching constant, extensive lesions, or marked disfigurement, and therefore an evaluation higher than 10 percent under these criteria is not warranted. Diagnostic Code 7817, effective after August 2002, could provide an evaluation in excess of 10 percent, if the veteran's condition had any extent of involvement of the skin, and systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long- wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapies were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. While the veteran clearly had some involvement of the skin, the record indicates only that the veteran used topical steroids intermittently with resolution of symptoms. There is no evidence of systemic therapy being employed to treat the condition, including therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long- wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy was required for a total duration of six weeks or more, but not constantly, during the previous 12-month period. Diagnostic Code 7806, effective after August 2002, could also provide an evaluation in excess of 10 percent if at least 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or if systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the previous twelve-month period. As noted, there was no evidence of systemic therapy being employed to treat the condition. The veteran is reported to have used only topical steroids on an intermittent basis. And the area affected was indicated to be essentially mild hyperpigmentation along the shaving line. No percentage of total body or exposed area was indicated. Without more, an indication of hyperpigmentation along the shaving line is not sufficient for a higher evaluation. Finally, the Diagnostic Codes 7800 through 7805 could be used to evaluate the veteran's disability prior to December 5, 2006. As noted, Codes 7800 through 7805 did not change materially from the codes in place prior to August 2002. Diagnostic Code 7805 is identical to the revised code and applies to scarring that limits the function of the affected part. Diagnostic Codes 7801 and 7802, prior to August 2002, dealt only with scars from burns, and are therefore not applicable to the veteran's case. Diagnostic Codes 7801 and 7802, effective after August 2002, apply to scars other than scars of the head, face, or neck, and are therefore also not applicable to the veteran's case. Diagnostic Codes 7800, 7803 and 7804, before and after August 2002, are applicable to scars that are disfiguring to the head, face, or neck, are superficial, unstable, poorly nourished, with repeated ulceration, or are tender and/or painful on objective demonstration. In this case, an evaluation under Diagnostic Codes 7803 and 7804, before and after August 2002, will not yield a higher evaluation for the veteran, as these criteria provide for a 10 percent evaluation as the highest rating, and the veteran is already evaluated as 10 percent disabling for this period. And a higher evaluation is not warranted under either the former of current Diagnostic Code 7805 since there is no indication in the record that the veteran had scarring that limited his function in any way. In addition, under the prior Diagnostic Code 7800 disfiguring scars of the head, face or neck, warranted an evaluation in excess of 10 percent where the condition was indicated to be severe, especially if producing a marked and unsightly deformity of eyelids, lips, or auricles. The medical evidence in this case shows that the veteran had hyperpigmentation noted along the shaving line with small follicles consistent with pseudofolliculitis. There was no drainage or open ulcer, and the condition was indicated to be without eruptions, evidence of infections or erythema. There were no active lesions, and the veteran's condition was indicated by one examiner to be mild. This did not indicate severe deformity, according to any health care professional. Under Diagnostic Code 7800, effective after August 2002, an evaluation in excess of 10 percent is not warranted unless the disfigurement of the head, face or neck is productive of 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 has two or three characteristics of disfigurement. As noted, however, the evidence does not indicate a disfigurement that rises to the level required for a higher evaluation under these criteria. Next, the Board finds in this case that an evaluation of 30 percent beginning on December 5, 2006 is warranted. In order to warrant an evaluation in excess of 30 percent under the revised Diagnostic Code 7817, the veteran's condition must be productive of generalized involvement of the skin without systemic manifestations, and must have required constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long-wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy during the past 12-month period. The evidence in this regard consists of a VA examination performed on December 5, 2006. The examinations dated in May and July 2007 indicated essentially the same findings as were noted in the December 2006 examination. In this examination, the veteran was noted to have used daily oral Doxycycline, and creams including Triluma 1-2 times per day and Azelex locally, in the past 12 months. The examiner also indicated that the veteran had been on Elidel and Hydrocortisone for an amount of time. The veteran complained of irritation, hyperpigmentation and itch in the affected area. Upon examination, the examiner noted that the area of involvement was the full beard area, which was estimated to be 2% exposed BSA, or 50% of the face, or 70% of the anterior neck. Scarring was noted, especially in the jaw line and under the mandible and neck. There were pustules especially in the anterior neck area. The skin in the affected area measured 15 cm by 11 cm on each side of the face. The rash was indicated to be hyperpigmented, with mild scarring, multiple pustular eruptions, pruritic, non-tender, non-adherent, stable, flat, superficial, with no significant edema or keloid formation, but with pustules, and with no induration. The examiner also stated that the rash did not cause significant limitation of neck movement and was moderately disfiguring because of its location. While the December 2006 examination indicated involvement of the full beard area and treatment with oral and topical medical in the previous 12 months, the evidence did not indicate constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long-wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy during the past 12-month period. Thus, higher than 30 percent under Diagnostic Code 7817 is not warranted. Under Diagnostic Code 7806, effective in August 2002, the veteran's disability could receive an evaluation in excess of 30 percent if the condition affects an area of more than 40 percent of the entire body or more than 40 percent of exposed areas, or if constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past twelve-month period. However, the December 2006 examiner found that the area of involvement was the full beard area, which was estimated to be 2% exposed BSA, or 50% of the face, or 70% of the anterior neck. The examiner did not specifically indicate what percentage of the veteran's exposed areas this represented, noting only the percentage of the face affected. It is clear, however, that if the affected area is 50% of the face, that is would be less than 40 percent of the total exposed areas. And the beard area represented only 2 percent of the entire body. Finally, as noted, the medical evidence does not indicate constant or near-constant systemic therapy such as corticosteroids or other related immunosuppressive drugs were required during the previous twelve-month period. Finally, the revised Diagnostic Codes 7800 through 7805 could be used to evaluate the veteran's disability after December 5, 2006. As noted, Diagnostic Code 7805 applies to scarring that limits the function of the affected part. Diagnostic Codes 7801 and 7802 apply to scars, other than the head, face or neck, that are deep, that cause limitation of motion, or that are superficial and do not cause limitation of motion but generally affect significant areas of the skin. Diagnostic Codes 7800, 7803 and 7804 are applicable to scars that are disfiguring to the head, face, or neck; superficial and unstable, or that are superficial and painful upon examination. Diagnostic Codes 7801 and 7802 are not for application since these codes deal with scars other than the head, face or neck, and the veteran's pseudofolliculitis barbae affects his head, face, and neck. Diagnostic Codes 7803 and 7804 will not yield a higher evaluation, since each provides only a 10 percent evaluation. Diagnostic Code 7805 will also not provide a higher evaluation, since that code requires limitation of the affected part, and the December 2006 examiner specifically found that the veteran's condition did not cause significant limitation of neck movement. And a higher evaluation under Diagnostic Code 7800 will only provide a higher evaluation where the veteran's disability is productive of visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or has four or five characteristics of disfigurement. In this case, the December 2006 examiner indicated that the area of involvement was the full beard area and was noted to be hyperpigmented, with mild scarring and multiple pustular eruptions. The examiner stated that the rash was moderately disfiguring because of location. The evidence does not indicate a disfigurement that rises to the level required for a higher evaluation under these criteria. C. Evaluation of atopic dermatitis. In this case, the veteran's service-connected atopic dermatitis is evaluated as noncompensable from October 30, 2000 to August 26, 2007, and 10 percent disabling from August 27, 2007, under Diagnostic Code 7806. Pursuant to Diagnostic Code 7806, in effect after August 2002, if the skin condition covers an area of less than 5 percent of the entire body or exposed areas affected, and no more than topical therapy is required during the past 12- month period, a noncompensable rating is warranted. If 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 if intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past twelve-month period, a 10 percent rating is warranted. A 30 percent rating requires 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or; that systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past twelve-month period. Finally, a rating of 60 percent under the revised criteria is warranted when the condition covers an area of more than 40 percent of the entire body or when more than 40 percent of exposed areas affected, or; when constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past twelve- month period. Diagnostic Code 7806, in effect prior to August 2002, provided that eczema, with slight, if any exfoliation, exudation or itching, if on a nonexposed surface or small area, warranted a noncompensable evaluation. A 10 percent rating was warranted where there was exfoliation, exudation or itching involving an exposed surface or extensive area. A 30 percent rating was warranted where there was exudation or itching constant, extensive lesions, or marked disfigurement. And a maximum 50 percent evaluation was warranted with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or where the condition was exceptionally repugnant. Based on the evidence in the record, the Board finds that an initial compensable evaluation for the veteran's atopic dermatitis from October 30, 2000 through August 26, 2007 is not warranted. In order to warrant a higher evaluation under the former and current Diagnostic Code 7806, the service-connected atopic dermatitis must have been manifested by exfoliation, exudation or itching involving an exposed surface or extensive area and, after August 2002, manifested by disability affecting 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 if intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past twelve-month period. Here, the record shows that, from October 30, 2000 through August 26, 2007, the service-connected atopic dermatitis was productive of small hypopigmented lesions without ulcerations or exfoliations at the thigh and at the tibia anterior. There was evidence of dry scales at the anterior tibia, bilaterally, and posterior behind the knees. Small macular lesions in the right and left antecuboidal fossa and upper arms with some mild dry scales were noted. The veteran was also indicated to have an erythematous rash involving his hands and the scrotum that typically appeared in the summer months and lasted for two to three months. He had been treated with creams and a topical steroid. Scattered erythematous lesions on the veteran's hands and also on his scrotum were indicated. This evidence does not warrant a higher evaluation prior to August 27, 2007. The evidence, while noting small hypopigmented lesions and dry scales, does not indicate exfoliation, exudation or itching involving an exposed surface or extensive area. And there is no indication that the disability affected 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed area or required intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during any past twelve-month period. In addition, the Board finds that the evidence does not warrant the assignment of an evaluation for the service- connected atopic dermatitis in excess of 10 percent beginning on August 27, 2007 or thereafter. In order to warrant a higher evaluation after August 27, 2007, the veteran's atopic dermatitis must be manifested by disability that affects 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or requires systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past twelve-month period. The medical evidence from August 27, 2007 consists primarily of a medical treatment note dated August 27, 2007. This report indicated atopic dermatitis on the hands and groin. A few scattered papules on dorsum hands and upper thighs and scrotum were indicated. The veteran reported that this condition was usually worse in the spring and summer and had been intensely pruritic. The veteran was symptom-free until two days earlier when he developed recurrence of the rash on dorsum wrists and forearms, bilaterally. He had similar rash in his groin. The veteran indicated that, in the past, he had noted vesticles, though these were not noted upon examination. He reported flares one or two times per year involving his forearms, tops of hands, thigh and groin area. The flare was reported to be intensely itchy and uncomfortable. During a flare, the veteran was indicated to use Triluma. The physician indicated that no intensive light therapy, UVB, PUVA, or electron beam therapies were used. No side effects of treatment were indicated, and there were no local (skin) symptoms or systemic symptoms such as fever or weight loss. No current lesions were noted on examination, but the physician indicated that during a flare the area affected was 15% TBA. 1-2 small hyperpigmented macules on the left high c/w post inflammatory hyperpigmented changes were noted. The physician noted no pain in the scarring, no adherence to underlying tissue, normal skin texture, no instability, and no elevation or depression of the scarring. The scarring was noted to be superficial, with no inflammation, edema, or keloid formation, with no area of induration or inflexibility, and no limitation of function related to the scarring. The veteran was diagnosed with atopic dermatitis. Exposed areas affected were indicated to be 2%; percent of the entire body affected was indicated to be 15%. The medical evidence in this regard does not support a higher evaluation from August 27, 2007. The medical evidence does not show that the veteran's condition affects 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas, nor does it indicate that systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past twelve-month period. As such, a higher evaluation for atopic dermatitis from August 27, 2007 is not warranted. D. Extraschedular analysis. Finally, the record does not establish that the schedular criteria are inadequate to evaluate the service-connected disabilities so as to warrant assignment of a higher rating on an extraschedular basis. In this regard, the Board notes that there is no showing that any of the disabilities have resulted in marked interference with employment. In addition, there is no showing that the disabilities have necessitated frequent periods of hospitalization or have otherwise rendered impractical the application of the regular standards. In the absence of evidence of such factors, the Board finds that the criteria for submission for assignment of an extraschedular ratings pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). III. Service connection for hearing loss. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b). The regulations also provide that service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In this case, the veteran's claims file contains the results of several audiological examinations. The veteran's service entrance examination dated in October 1972 revealed pure tone threshold levels, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 25 10 25 LEFT 10 25 25 35 35 Upon service separation in October 1981, the pure tone threshold levels, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 15 20 15 LEFT 10 10 10 35 30 These results suggest that the veteran's hearing acuity actually improved slightly at certain frequencies on testing during service. After service, the veteran underwent several audiological examinations in connection with his claim. A private examination report dated in October 2000 indicated pure tone threshold levels, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 20 30 N/A 35 LEFT 30 25 30 N/A 40 Speech audiometry testing revealed speech recognition ability of 92% in the right ear and 96% in the left ear. A VA examination report dated in November 2000 certified pure tone threshold levels, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 20 35 25 LEFT 25 25 25 35 25 The authorized speech audiometry testing revealed speech recognition ability of 100% in the right ear and 96% in the left ear. Another private audiological examination report dated in October 2006 indicated pure tone threshold levels, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 35 35 45 LEFT 25 25 35 45 50 Speech audiometry testing revealed speech recognition ability of 92% in each ear. Finally, an authorized VA examination report dated in December 2006 certified pure tone threshold levels, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 25 30 25 LEFT 15 20 25 35 35 The authorized speech audiometry testing revealed speech recognition ability of 100 percent in each ear. As noted, in order for impaired hearing to be considered to be a disability, the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz must be 40 decibels or greater; or the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz must be 26 decibels or greater; or the speech recognition scores using the Maryland CNC Test must be less than 94 percent. 38 C.F.R. § 3.385. The veteran's claims file contains differing audiological results. Significantly, the initial VA examination results in October 2000 found no hearing loss disability as defined by regulation for VA compensation purposes. The most recent VA examination in December 2006 also showed no hearing loss disability for VA compensation purposes in either ear. In this case, the Board finds that the weight of the competent evidence currently is against a finding of hearing loss disability for VA compensation purposes. \ The results of the October 2006 private examination, while confirming the VA findings of some elevated puretone results and showing reduced discrimination abilities in each ear, are not authorized examinations for showing the current nature and severity of claimed hearing loss. Here, the Board must rely on the certified examination findings of the standardized VA audiometric testing. In this case, the Board finds that the weight of the competent evidence is against a showing that the veteran currently has hearing loss disability for VA compensation purposes. Without a current disability, a claim of service connection for any such condition cannot be sustained. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). While the veteran may feel that he has bilateral hearing loss that is related to his service, the Board notes that, as a lay person, the veteran is not competent to establish a medical diagnosis or show a medical etiology; such matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements or opinions); see also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). ORDER An initial rating for the service-connected pseudofolliculitis barbae in excess of 10 percent from October 30, 2000 through December 4, 2006 is denied. Subject to the regulations governing payment of VA monetary benefits, a 30 percent rating for the service-connected pseudofolliculitis barbae beginning on December 5, 2006, is granted. An initial compensable rating for the service-connected atopic dermatitis from October 30, 2000 through August 26, 2007, and in excess of 10 percent beginning on August 27, 2007, is denied. The claim of service connection for hearing loss is dismissed. ____________________________________________ STEPHEN L. WILKINS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs