Citation Nr: 1320202 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 10-10 462 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE Entitlement to an initial evaluation in excess of 10 percent for pityrosporum folliculitis. REPRESENTATION Appellant represented by: African American PTSD Association ATTORNEY FOR THE BOARD P. Olson, Counsel INTRODUCTION The Veteran had active military service from July 1998 to August 2002. This matter initially came before the Board of Veterans' Appeals (Board or BVA) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran seeks a higher disability evaluation for his service-connected pityrosporum folliculitis which has been evaluated as 10 percent disabling pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7899-7806. Under Diagnostic Code 7806 prior to October 2008, disorders of the skin are rated as follows: 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; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period will result in a 10 percent evaluation. 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period will result in a 30 percent evaluation. More than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period will result in a 60 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2007). The Veteran underwent VA examination in September 2008 at which time he complained of a rash on his back and arms which had become progressively worse. The Veteran described the rash as intermittent and extremely pruritic. Physical examination of the Veteran that he had diffuse follicular hyperpigmentation noted mostly on the upper back and some on the upper extremities covering at least 5 percent of the total body surface area and zero percent of the exposed body surface area. The examiner also noted a scar from biopsy site noted in the abdominal skin area. The impression was pityrosporum folliculitis covering at least 5 percent of the total body surface area and zero percent of the exposed body surface area. In October 2012, the Veteran underwent VA examination at which time he was diagnosed as having dermatitis or eczema and pityrosporum folliculitis. Physical examination demonstrated that the skin of the back and the backs of both arms showed numerous 1- to 2-millimeter hyperpigmented lesions (many more on his back than on backs of arms), which were not raised, non-tender, no erythema, no pustules. The examiner noted that it appeared chronic and inactive at that time. The Veteran underwent VA examination in February 2013 at which time he reported having itchy tiny sores (pimples/pustules) on arms, back, and chest. The Veteran stated that he had been having this rash with flare-ups once every two to three months, more frequently during hot weather. The Veteran reported that he starts breaking out into tiny itchy pimples which last for a week and resolve leaving hyperpigmented spots behind. The Veteran reported using over-the-counter Hydrocortisone cream for the rash on an as-needed basis and had never been on oral steroids of immunosuppressive medications. On physical examination there was no active rash or pustules; however, there were post-inflammatory hyperpigmented spots of about 1-2 millimeters on his back, on the posterior aspects of both arms, and a few on his chest. The examiner noted that the pityrosporum folliculitis when active affected "< 20-40% of total body surface area and 0% of exposed body area." The Board is uncertain whether the statement above, "< 20-40% of total body surface area" means more than 20 but up to 40 percent of total body area or more than 20 percent and more than 40 percent of total body area. As such, the Board must return the claims file to the VA examiner who conducted the February 2013 examination for clarification. Accordingly, the case is REMANDED for the following action: 1. The Veteran's claims file should be returned to the VA examiner who conducted the February 2013 VA examination for preparation of an addendum report which clarifies the amount of total body area affected by the Veteran's pityrosporum folliculitis. The examiner should clarify the extent of the pityrosporum folliculitis in terms of a percentage of the body affected and a percentage of exposed areas affected. Specifically, the examiner is asked to determine if the Veteran's pityrosporum folliculitis affects a total body area of less than 5 percent, 5 percent to less than 20 percent, 20 percent to 40 percent, or more than 40 percent. 2. If and only if the VA examiner who conducted the February 2013 VA examination is unavailable, the Veteran should be afforded an additional VA examination. Efforts should be made to schedule the Veteran for an examination during a time when his symptoms are at their most active stage. The claims file must be made available to and reviewed by the examiner in conjunction with the examination, and the examination report should reflect that such a review was made. The Veteran should be asked to describe the ebb and flow of the disorder, and times when it is most severe. All pertinent symptomatology and findings should be reported in detail. Any indicated diagnostic tests and studies should be accomplished. The examiner should provide a rationale for the opinion and reconcile it with all pertinent evidence of record. Specifically, the examiner should: * Identify all pathology related to the Veteran's pityrosporum folliculitis. * Specify the location and extent of the pityrosporum folliculitis in terms of a percentage of the body affected and a percentage of exposed areas affected, and state the frequency that systemic therapy, such as corticosteroids or immunosuppressive drugs, have been required during the past 12-month period. Specifically, the examiner is asked to determine if the Veteran's pityrosporum folliculitis affects a total body area of less than 5 percent, 5 percent to less than 20 percent, 20 percent to 40 percent, or more than 40 percent. * Indicate whether the Veteran has experienced any flare-ups of his pityrosporum folliculitis during the last year. * Note whether the Veteran's pityrosporum folliculitis is productive of scarring and specify the size of any scar, whether it causes limitation of motion, is unstable or superficial, and whether it limits function. If limitation of function is shown, state what motions or functions are limited and to what extent. Describe the current extent and severity of any scarring. * Discuss how the Veteran's pityrosporum folliculitis impacts his activities of daily living, including his ability to obtain and maintain employment. 3. The case should be reviewed on the basis of the additional evidence. If the benefit sought is not granted in full, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (2012).