Citation Nr: 1320842 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 00-14 879 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia THE ISSUES 1. Whether new and material evidence to reopen a claim for service connection for arthritis of the cervical spine and right elbow has been received. 2. Whether new and material evidence to reopen a claim for service connection for arthritis of the shoulders has been received. 3. Entitlement to an increased (compensable) rating for left ear hearing loss, on an extra-schedular basis pursuant to 38 C.F.R. § 3.321. 4. Entitlement to a rating in excess of 30 percent for atopic dermatitis prior to August 30, 2002, to include on an extra-schedular basis pursuant to 38 C.F.R. § 3.321. 5. Entitlement to a rating in excess of 60 percent for atopic dermatitis from August 30, 2002, to include on an extra-schedular basis pursuant to 38 C.F.R. § 3.321. REPRESENTATION Appellant represented by: Virginia Girard-Brady, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD April Maddox, Counsel INTRODUCTION The Veteran served on active duty from January 1964 to January 1966. This appeal to the Board of Veterans' Appeals (Board) arose from an October 1999 rating decision in which the RO in Washington, DC, denied, inter alia, the Veteran's claims for increased ratings for left ear hearing loss and for dermatitis. The RO also declined to reopen the Veteran's claims for service connection for arthritis. In February 2000, the Veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in June 2000, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) later that month. Jurisdiction of the appeal was subsequently transferred to the RO in Roanoke, Virginia. In February 2004, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge in Washington, D.C. A transcript of that hearing is of record. In September 2004, the Board remanded the claims on appeal to the RO, via the Appeals Management Center (AMC) in Washington, DC, for further action, to include additional development of the evidence. After completing further action, the AMC continued to deny the claims (as reflected in two November 2006 supplemental SOCs (SSOCs)) and returned the matters on appeal to the Board for further appellate consideration. In May 2007, the Board denied the Veteran's claims (issues 1, 2, 4, and 5, as recharacterized on the title page). The Veteran appealed the May 2007 Board decision to the United States Court of Appeals for Veterans Claims (Court). In June 2009, the Court granted a joint motion for remand filed by representatives for both parties, vacating the Board's decision as to the issues noted above, and remanding these claims to the Board for further proceedings consistent with the joint motion. In March 2010, the Board remanded the matters on appeal to the RO, via the AMC, for further action, to include additional development of the evidence. After completing further action, the AMC continued to deny the claims (as reflected in an October 2010 SSOC) and returned the matters on appeal to the Board for further consideration. In February 2011, the Board again remanded the matters on appeal to the RO for further action, to include additional development of the evidence. After completing further action, the RO, in a March 2012 rating decision, granted a higher, 30 percent rating for the Veteran's service-connected atopic dermatitis, effective February 19, 2012. Additionally, in a March 2012 SSOC, the RO determined that new and material evidence had been received to reopen claims for service connection for arthritis of the cervical spine, right elbow, and shoulders, as well as service connection for allergic rhinitis, but denied these matters on the merits. It continued to deny the remaining claims on appeal, and returned these matters to the Board for further consideration. In characterizing the issues on appeal, the Board notes that, regardless of the RO's actions, the Board has a legal duty under 38 U.S.C.A. §§ 5108, 7104 (West 2002) to address the question of whether new and material evidence has been received to reopen a claim for service connection. That matter goes to the Board's jurisdiction to reach the underlying claim and adjudicate the claim on a de novo basis. See Barnett v. Brown, 83 F. 3d 1380, 1383 (Fed. Cir. 1996). As the Board must first decide whether new and material evidence to reopen the claim has been received, the Board has characterized these matters as set forth on the title page. Furthermore, the Board has also considered the decision of the United States Court of Appeals for the Federal Circuit (Federal Circuit) in Boggs v. Peake, 520 F. 3d 1330 (Fed. Cir. 2008). In that decision, the Federal Circuit held that a claim for one diagnosed disease or injury cannot be prejudiced by a prior claim for a different diagnosed disease or injury. Rather, the two claims must be considered independently. See Ephraim v. Brown, 82 F. 3d 399 (Fed. Cir. 1996). Here, the Veteran was previously denied service connection for arthritis. At the time of the prior denials, there were the same complaints made in connection with the current claims. As such, any diagnoses pertaining to the cervical spine, right elbow, and shoulders made since the prior denials do not constitute different disabilities. As such, new and material evidence is required to reopen these claims for service connection. In August 2012, the Board determined that the matter of a compensable rating for left ear hearing loss, on an extra-schedular basis pursuant to 38 C.F.R. § 3.321(b) had been raised by the record, and thus expanded the appeal, accordingly. The Board then took action that essentially bifurcated the expanded appeal, denying a compensable rating on a schedular basis and remanding the matter of a compensable rating on an extra-schedular basis, along with the other issues noted on the title page, to the RO, via the AMC, for additional development. The Board also found that no new and material evidence had been received to reopen the previously denied claim of entitlement to service connection for allergic rhinitis. After completing further action, the RO, in a March 2013 rating decision, granted a 30 percent rating for the Veteran's service-connected atopic dermatitis, effective July 10, 1999 and a 60 percent rating, effective August 30, 2002. With regard to the remaining claims on appeal, the AMC continued to deny the claims (as reflected in a March 2013 SSOC) and returned the matters on appeal to the Board for further consideration. With regard to the Veteran's claim for increased rating for atopic dermatitis, the Board observes that while an increased rating was granted during the appeal, this issue remains pending before the Board because higher ratings remain assignable for dermatitis both before and after both July 10, 1999 and August 30, 2002. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (holding that, on a claim for an original or increased rating, a veteran will generally be presumed to be seeking the maximum benefit allowed by law and regulation, and it follows that such a claim remains in controversy, even if partially granted, where less than the maximum benefit available is awarded). In addition to the paper claims file, there is a paperless, electronic (Virtual VA) file associated with the Veteran's claim. A review of the documents in such file reveals VA treatment records dated from August 2011 through January 2013 which were considered by the RO in the most recent March 2013 SSOC. The remainder of the records are either duplicative of the evidence in the paper claims file or are irrelevant to the issues on appeal. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate each matter herein decided have been accomplished. 2. In a July 1986 decision, the Board denied service connection for allergies; although notified of the denial, the Veteran did not initiate an appeal of the decision. 3. No new evidence associated with the claims file since the July 1986 Board decision, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection for allergic rhinitis, or raises a reasonable possibility of substantiating the claim. 4. In an April 1987 rating decision, the RO denied service connection for arthritis of both shoulders; although notified of the denial by letter dated in May 1987, the Veteran did not initiate an appeal of the decision. 5. No new evidence associated with the claims file since the RO's April 1987 denial, when considered by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for arthritis of the both shoulders. 6. The applicable schedular criteria are adequate to rate the Veteran's service-connected left ear hearing loss at all points pertinent to this appeal. 7. Prior to the August 30, 2002 change in the rating criteria for the disorders of the skin the Veteran's atopic dermatitis was manifested by dry skin; there was no evidence of ulceration, extensive exfoliation, or crusting with systemic or nervous manifestations, or an exceptionally repugnant condition 8. Since August 30, 2002, the Veteran's service-connected atopic dermatitis has been assigned a 60 percent rating, the maximum rating authorized under Diagnostic Code 7806; the disability has not otherwise manifested by visible or palpable tissue loss, or characteristics of disfigurement including the elevation or depression of lesions on palpation, adherence to underlying tissue, or missing underlying soft tissue. 9. The applicable schedular criteria are adequate to rate the Veteran's service-connected skin disability at all points pertinent to this appeal. CONCLUSIONS OF LAW 1. The July 1986 decision in which the Board denied service connection for arthritis of the cervical spine and right elbow is final. 38 U.S.C.A. § 7104(a) (West 2002); 38 C.F.R. § 20.1100 (2012). 2. As pertinent evidence received since the July 1986 denial is not new and material, the criteria for reopening the claim for service connection for arthritis of the cervical spine and right elbow are not met. 38 U.S.C.A. §§ 5108, 7105 (West 2002); 38 C.F.R. § 3.156 (as in effect prior to August 29, 2001). 3. The RO's April 1987 rating action denying service connection for arthritis of both shoulders is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 3.104, 20.302(a), 20.1103 (2012). 4. As pertinent evidence received the RO's April 1987 rating action is not new and material, the requirements for reopening the claim for service connection for arthritis of both shoulders are not met. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (as in effect prior to August 29, 2001). 5. The criteria for a compensable rating for left ear hearing loss on an extra-schedular basis pursuant to 38 C.F.R. § 3.321(b)(1) are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321 (2012). 6. The criteria for a rating in excess of 30 percent for atopic dermatitis, prior to August 30, 2002, are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.20, 4.27, 4.118, Diagnostic Codes 7800, 7806 (as in effect prior to August 30, 2002). 7. The criteria for a rating in excess of 60 percent for atopic dermatitis, from August 30, 2002, are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.20, 4.27, 4.118, Diagnostic Codes 7800, 7806 (as in effect prior to October 2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Due Process Considerations The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100 , 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim(s), as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim(s); (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim(s), in accordance with 38 C.F.R. § 3.159(b)(1). The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353-23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b)(1), which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. Specific to requests to reopen, the Veteran must be notified of both the reopening criteria and the criteria for establishing the underlying claim for benefits. See Kent v. Nicholson, 20 Vet. App. 1 (2006). In rating cases, a claimant must be provided with information pertaining to assignment of disability ratings (to include the rating criteria for all higher ratings for a disability), as well as information regarding the effective date that may be assigned. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include the AMC). Id.; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. As regards the requests to reopen the claims for service connection for arthritis of the cervical spine and right elbow, and of the shoulders, post-rating letters dated in January 2006, March 2006, May 2010, and August 2011 advised the Veteran that his claim had been previously denied because there was no evidence that the Veteran's claimed arthritis was incurred in or aggravated by military service. These letters specifically advised the Veteran that, in order to be considered material, the evidence must pertain to the reasons his claim was previously denied. They also informed him that, in order to be considered new and material, the evidence would have to raise a reasonable possibility of substantiating the claim, and could not simply be repetitive or cumulative of the evidence of record at the time of the previous denial. Finally, these letters provided the Veteran with information pertaining to the assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations, consistent with Dingess/Hartman. With respect to the increased rating claims for left ear hearing loss and atopic dermatitis, in the August 2011 letter, the RO provided notice to the Veteran explaining what information and evidence was needed to substantiate his claim for higher ratings, what information and evidence must be submitted by the appellant, and what information and evidence would be obtained by VA. This letter also provided the Veteran with general information pertaining to VA's assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations. After issuance of the above-described notices, the March 2013 SSOC reflects readjudication of the claims on appeal. Hence, the Veteran is not shown to be prejudiced by the timing of this VCAA notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in an SOC or SSOC, is sufficient to cure a timing defect). The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matters herein decided. Pertinent medical evidence associated with the claims file consists of service, VA and private treatment records (as requested by the Board in its prior remands). There are also the reports of multiple VA audiological and dermatological evaluations, including examinations which fulfill the Board's prior requests for additional medical evidence. Finally, also of record and considered in connection with the appeal are the various written statements provided by the Veteran, and by his representative, on his behalf, in addition to a transcript of oral testimony provided during the February 2004 Board hearing. The Board finds that no additional RO action on any of the claims herein decided, prior to appellate consideration, is required. As regards the Board hearing, is noted that, in Bryant v. Shinseki, 23 Vet. App. 488 , the United States Court of Appeals for Veterans Claims (Court) recently held that 38 C.F.R. § 3.103(c)(2) (2010) requires that the VLJ who chairs a hearing fulfill two duties to comply with the above regulation: (1) to fully explain the issues, and (2) to suggest the submission of evidence that may have been overlooked. Here, during the hearing, the VLJ noted the basis of the prior determination and noted the elements of the claims that were lacking to substantiate the claims for benefits. In addition, the VLJ sought to identify any pertinent evidence not currently associated with the claims file that might have been overlooked or was outstanding that might substantiate the claims. It is noteworthy that neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2) nor has identified any prejudice in the conduct of the VLJ hearing. Moreover, the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claims for benefits. As such, the Board finds that, consistent with Bryant, the undersigned complied with the duties set forth in 38 C.F.R. § 3.103(c)(2), and that hearing is thus legally sufficient. As regards compliance with prior Board remands, the Board notes that, since the May 2007 Board decision was vacated by the Court in June 2009, the Board has remanded this case on three occasions, March 2010, February 2011, and August 2012. The Court has held that a remand by the Board confers on a veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that, in the March 2010 remand, the Board instructed the RO that proper notice under Kent and Vazquez was to be given and the Veteran was to be afforded new VA examinations for his left ear hearing loss and atopic dermatitis. The RO attempted to provide proper Kent notice in May 2010 and the Veteran was afforded VA skin and audiological examinations in July 2010. In the February 2011 remand, the Board instructed the RO that the May 2010 letter was not Kent complaint, requested VA treatment records regarding the Veteran's skin disorder from 2007 to the present, and directed that an ear, nose and throat physician examine the Veteran regarding his left ear hearing loss claim. On remand, proper Kent notice was sent in August 2011 and VA treatment records dated from October 2006 to August 2011 were obtained; however, the Veteran was actually evaluated by an audiologist, in December 2011. In this case, however, the Board notes, that the audiologist conducted appropriate testing, as requested - the results of which provide the basis for evaluation of hearing loss under VA's rating schedule - as well as provided comments regarding the functional effects of the disability, a matter within the audiologist's area of expertise. In the August 2012 remand, the Board instructed the RO to consider the Veteran's claims for increased ratings on an extra-schedular basis pursuant to 38 C.F.R. § 3.321, provide the Veteran with a VA skin examination, and obtain VA treatment records dated since August 2011 regarding the Veteran's claimed arthritis. On remand, the Veteran was afforded a VA skin examination in February 2013, the RO obtained VA treatment records dated through January 2013 and uploaded these records into the Virtual VA file, and considered the Veteran's claims for increased ratings on an extra-schedular basis pursuant to 38 C.F.R. § 3.321 in the March 2013 SSOC. The Court has held that a remand by the Board confers on a veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Under these circumstances, the Board finds that there has been substantial compliance with the prior remands. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Hence, no further RO action in this regard is required. Finally, the Board acknowledges that the Veteran was not afforded a VA examination in connection with his claim to reopen a claim of service connection for arthritis of the cervical spine, right elbow, and bilateral shoulders. However, as will be discussed below, no such examination or medical opinion is required in this appeal as the Board finds that new and material evidence has not been associated with the file since the prior denial. See 38 C.F.R. § 3.159(c)(4)(iii) (2011). See also Woehlaert v. Nicholson, 21 Vet App 456 (2007). In summary, the duties imposed by the VCAA have been considered and satisfied. The Veteran has been notified and made aware of the evidence needed to substantiate the claims herein decided, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with any of these claims. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the Veteran or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matters herein decided, at this juncture. See Mayfield, 20 Vet. App. at 543. See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis A. Requests to Reopen Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Veteran's claim for service connection for arthritis of the cervical spine and the right elbow has been previously considered and denied. By decision of July 1986, the Board denied a claim for service connection for arthritis of the cervical spine and right elbow. The pertinent evidence then of record included the Veteran's service treatment records (which showed complaints of pulled muscles in the back and side, but no complaints regarding the cervical spine or right elbow, and normal separation examination findings), private treatment records showing complaints right elbow pain as early as September 1981, private treatment records showing spondylosis at C-5 with an impression of cervical spondylosis as early as September 1982, and a November 1983 VA examination diagnosing degenerative disc disease of the cervical spine and degenerative changes of the right elbow. The basis for the Board's determination was that the diagnosed cervical spine and right elbow arthritis were not shown in service, during the presumptive period, or for many years thereafter, and were not shown to be related to service. Also noted was the Board's belief that the back complaints in service were due to acute injuries not related to the subsequent arthritis. Although notified of the Board's July 1986 denial, the Veteran did not initiate an appeal. The Board's July 1986 denial of this claim is therefore final as to the evidence then of record, and is not subject to revision on the same factual basis. See 38 U.S.C.A. §§ 5108, 7103, 7104; 38 C.F.R. §§ 3.104, 20.302, 20.1100. The Veteran's claim for service connection for arthritis of the shoulders has also been previously considered and denied. By decision of April 1987, the RO denied a claim for service connection for arthritis of both shoulders. The pertinent evidence then of record included the Veteran's service medical records (which were negative for treatment of arthritis of the shoulders), a private treatment record showing complaints of right shoulder pain as early as September 1982, a private treatment record showing right rotator cuff tendonitis in March 1984, a VA treatment record dated in December 1999 showing a left shoulder injury with an impression of minor rotator cuff injury, and subsequent VA and private treatment records showing complaints regarding the shoulders and notations of "arthritis." The basis for the RO's determination was that there was no evidence of arthritis during service or the presumptive period. The RO's April 1987 decision is final as to the evidence then of record, and is not subject to revision on the same factual basis. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 3.104, 20.302(a), 20.1103 (2012). However, under pertinent legal authority, VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of the Veteran. 38 U.S.C.A. § 5108 ; 38 C.F.R. § 3.156(a); see also Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). In April 1998, the Veteran filed to reopen his previously denied claims for arthritis of the cervical spine, right elbow, and shoulders. Regarding petitions to reopen filed prior to August 29, 2001, 38 C.F.R. § 3.156(a) provides that "new and material evidence" is evidence not previously submitted which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. [Parenthetically, the Board notes the regulations implementing the VCAA include a revision of 38 C.F.R. § 3.156. However, that revision applies only to claims filed on and after August 29, 2001. Given the April 1998 date of the claim to reopen culminating in the instant appeal, the Board will apply the version of 38 C.F.R. § 3.156(a) in effect prior to August 29, 2001.] In determining whether new and material evidence has been received, VA must initially decide whether evidence received since the prior final denial is, in fact, new. As indicated by the regulation cited above, and by judicial case law, "new" evidence is that which was not of record at the time of the last final disallowance (on any basis) of the claim, and is not duplicative or "merely cumulative" of other evidence then of record. This analysis is undertaken by comparing the newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-83 (1996). Here, the last final denial of the cervical spine/right elbow claim is the July 1986 Board decision and the last final denial of the bilateral shoulder claim is the RO's April 1987 rating decision. Furthermore, for purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). Evidence added to the claims file since the July 1986 and April 1987 denials includes additional lay statements by the Veteran regarding ongoing treatment for the cervical spine, right elbow, and bilateral shoulders, as well as private and VA medical records showing treatment for the cervical spine, right elbow, and bilateral shoulders since 1981. Also of record are a number of VA examination reports; however, such reports do not contain findings pertinent to the Veteran's claimed arthritis. The Board finds that, while this evidence is "new," it is cumulative of evidence previously of record. In this regard, none of the evidence addresses whether there is a nexus between the Veteran's claimed arthritis of the cervical spine, right elbow, and bilateral shoulders and service; it also does not demonstrate a chronic joint disability or symptoms of a chronic joint disability during or shortly after service. Rather, the additional evidence merely confirms that the Veteran has the claimed disability, without any evidence or opinion that it had its onset in service or is in any way related to service. As such, the evidence is not "material" because none of it, by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. As for any statements by the Veteran (as well as those by his attorney, on his behalf) that his claimed arthritis is related to service, the Board points out that these assertions were before the RO at the time of the July 1986 and April 1987 decisions. Moreover, laypersons without appropriate medical training and expertise are not competent to render a probative (persuasive) opinion on a medical matter-to include the matter of a medical etiology of a back disability. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) (holding that a layman is generally not capable of opining on matters requiring medical knowledge). Therefore, where, as here, resolution of the appeal turns on a medical matter, unsupported lay statements, even if new, cannot serve as a predicate to reopen a previously disallowed claim. See Hickson v. West, 11 Vet. App. 374 (1998); Moray v. Brown, 5 Vet. App. 211, 214 (1993). Under these circumstances, the Board concludes that the criteria for reopening the claim for service connection for arthritis of the cervical spine, right elbow, and bilateral shoulders are not met, and that the July 1986 Board denial and April 1987 RO denial of these claims remain final. See 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156. As the Veteran has not fulfilled his threshold burden of submitting new and material evidence to reopen the finally disallowed claim, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). B. Increased Rating Claims Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is entitlement to a higher initial rating assigned following 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 rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson, 12 Vet. App. at 126. Additionally, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The following analyses are therefore undertaken with the consideration that different ratings may be warranted for different time periods. VA's Rating Schedule will apply unless there are exception or unusual factors, which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). Under those circumstances, where the schedular evaluations are found to be inadequate, a veteran may be awarded a rating higher than that encompassed by the schedular criteria. 38 C.F.R. § 3.321(b)(1). According to the regulation, an extra-schedular disability rating is warranted upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. Id. There is a three-step analysis for determining whether an extra-schedular rating is appropriate. Thun v. Peake, 22 Vet. App. 111, 115 (2008). The threshold factor for extra-schedular consideration is a finding on the part of the RO or the Board that the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability at issue are inadequate. See Fisher, 4 Vet. App. at 60. See also 38 C.F.R. § 3.321(b)(1); VA Adjudication Procedure Manual, Pt. III, Subpart iv, Ch. 6, Sec. B(5)(c). Therefore, initially, there must be a comparison between the level of severity and the symptomatology of the claimant's disability with the established criteria provided in the rating schedule for this disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the disability picture is contemplated by the rating schedule, the assigned rating is therefore adequate, and no referral for extra-schedular consideration is required. See VAOGCPREC 6-96 (Aug. 16, 1996). See also Thun, supra. If the rating schedule does not contemplate the claimant's level of disability and symtomatology, and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms" (including marked interference with employment and frequent periods of hospitalization). 38 C.F.R. § 3.321(b)(1). If so, then the case must be referred to the Under Secretary for Benefits or the Director of Compensation and Pension Service for completion of the third step: a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extra-schedular rating. Thun, supra. 1. Left ear hearing loss on an extra-schedular basis Under the applicable criteria, ratings for hearing loss are determined in accordance with the findings obtained on audiological evaluation. Ratings for hearing impairment range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per seconds. To evaluate the degree of disability from hearing impairment, the rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). As discussed in the introduction above, the Board has already adjudicated the matter of entitlement to a compensable rating for left ear hearing loss on a schedular basis, and determined that a compensable rating is not warranted. Thus the only matter remaining for consideration is whether a compensable for left ear hearing loss is warranted on an extra-schedular basis. Considering the pertinent evidence of record in light of the above, the Board finds that the criteria for assignment of a compensable rating for the Veteran's service-connected left ear hearing loss, on an extra-schedular basis pursuant to 38 C.F.R. § 3.321(b)(1), have not been met at any point since the effective date of the award of service connection for the disability. Historically, on May 1999 VA audiological evaluation, pure tone thresholds, in decibels, were as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Left Ear 45 75 75 85 70 Speech audiometry revealed speech recognition ability of 64 percent in the left ear. A diagnosis of left ear sensorineural hearing loss, mild to severe, was indicated. On February 2002 VA audiological evaluation, audiometric testing revealed pure tone thresholds, in decibels, as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Left Ear 50 70 80 85 71 Speech audiometry revealed speech recognition ability of 84 percent in the left ear. A diagnosis of left ear sensorineural hearing loss, mild to severe, was indicated. With respect to the disability's effect on the Veteran's daily life occupation, the Veteran reported he had difficulty hearing in noisy environments and that he required increased volume when watching television. During the February 2004 Board hearing, the Veteran testified that his left ear hearing loss had required amplification since 1983. As for the effect on his daily life, he indicated that his telephone and television volumes were turned up extremely loud. He also noted difficulty understanding conversations with background noise. Finally, the Veteran stated that he was unable to wear his hearing aid while at work, thereby making communication with others more difficult, because use of the hearing aid would amplify many unpleasant sounds associated with mechanical work. On October 2006 VA audiological evaluation, audiometric testing revealed pure tone thresholds, in decibels, as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Left Ear 30 35 55 75 49 Speech audiometry revealed speech recognition ability of 88 percent in the left ear. A diagnosis of left ear sensorineural hearing loss, mild to severe, was indicated. On July 2010 VA audiological evaluation, audiometric testing revealed pure tone thresholds, in decibels, as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Left Ear 70 80 85 90 81 Speech audiometry revealed speech recognition ability of 66 percent in the left ear. A diagnosis of left ear sensorineural hearing loss, mild to profound, was indicated. With respect to the disability's effect on the Veteran's occupation, the Veteran reported that he could not hear in his left ear and that he often had to read lips to understand people. The examiner assessed that the functional impact of the Veteran's left ear hearing loss on occupational activities would be significant. On December 2011 VA audiological evaluation, audiometric testing revealed pure tone thresholds, in decibels, as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Left Ear 75 80 85 95 84 Speech audiometry revealed speech recognition ability of 66 percent in the left ear. A diagnosis of left ear sensorineural hearing loss, mild to profound, was indicated. The examiner assessed that the functional impact of the Veteran's left ear hearing loss would be significant. Specifically, she noted that "[a]n asymmetrical hearing loss of this degree would cause difficulty localizing sounds . . . [and could] create potential hazards for driving and alerting to traffic hazards." His hearing loss would also cause significant difficulty understanding speech in noisy situations and use of the telephone would be nearly impossible in the left ear. In the August 2012 Board decision/remand, the Board noted that the RO had not considered 38 C.F.R. § 3.321 in the adjudication of the Veteran's claim for an increased rating for left ear hearing loss. Thus, to avoid any prejudice to the Veteran, the Board directed the RO to consider the matters of higher, extra-schedular ratings for left ear hearing loss in the first instance. In the March 2013 SSOC the RO considered 38 C.F.R. § 3.321 in the adjudication of the Veteran's claim for an increased rating for left ear hearing loss. Specifically, the RO considered the impairment specific to asymmetric hearing loss, specifically localization of sounds and inability to hear speech from the left ear. However, the RO noted that the scheduler rating criteria specifically provides for ratings based on all levels of hearing loss, including exceptional hearing patterns which are not demonstrated in this case, and as measured by both audiological testing and speech recognition testing. Speech recognition testing is a scheduler rating criterion that recognizes such an inability to understand certain words in conversation. The rating schedule address asymmetric hearing loss, as evidence by the use of speech recognition and audiological testing in both ears being used to assign a single evaluation. In addition, the rating schedule also recognizes situations where there is severe hearing loss in one ear that is service connected and the other ear is not, which is listed at 38 C.F.R. § 3.383 and does not apply in the Veteran's case. For these reasons, the RO found that the scheduler rating criteria in this case are adequate to rate the hearing loss in the Veteran's left ear. In the absence of evidence that the scheduler rating criteria are inadequate to rate the Veteran's disability, the RO found that referral for extra-schedular evaluation was inappropriate. The Board agrees. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular evaluation for the service connected left ear hearing loss is inadequate. The rating criteria reasonably describes the Veteran's disability level and symptomatology as due solely to one service connected ear. The rating criteria contemplate a level of impaired hearing as shown by objective testing, and the Veteran does not experience any symptomatology not contemplated by the rating schedule. Thus, the threshold requirement for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) is not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). For all the foregoing reasons, the Board finds that the claim for a compensable rating for left ear hearing loss, on an extra-schedular basis must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against this claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Atopic dermatitis Historically, in a November 1977 rating decision, the RO granted service connection and assigned an initial 10 percent rating for atopic dermatitis, pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7817-7806, effective July 19, 1977. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27, Diagnostic Code 7817 applies to exfoliative dermatitis (erythroderma) and Diagnostic Code 7806 applies to dermatitis or eczema. The Veteran did not file a specific claim for an increased rating for his skin disorder, however, he submitted private treatment records from Kaiser Permanente on July 10, 1999 in conjunction with a different claim. The reports from Kaiser Permanente were accepted as a claim for an increased rating for the Veteran's atopic dermatitis. By rating decision dated in October 1999, the RO continued the 10 percent rating, solely under Diagnostic Code 7817. The Veteran disagreed with this decision and perfected an appeal. In a March 2012 rating decision, the RO granted a higher, 30 percent rating for the Veteran's service-connected atopic dermatitis, effective February 19, 2012. Thereafter, in a March 2013 rating decision, the RO granted a 30 percent rating for the Veteran's service-connected atopic dermatitis, effective July 10, 1999 and a 60 percent rating, effective August 30, 2002 At the outset, the Board notes that the criteria for rating the skin have been revised twice during the pendency of this appeal, first effective August 30, 2002 and second effective October 23, 2008. The diagnostic code assigned to the Veteran's dermatitis in the October 1999 rating on appeal was 38 C.F.R. § 4.118, Diagnostic Code 7817 (prior to August 30, 2002), applicable to atopic dermatitis. Under the former criteria, the disabilities listed in Diagnostic Codes 7807 through 7819 are to be rated as for eczema. Under the criteria of former Diagnostic Code 7806 (as in effect prior to August 30, 2002), eczema with slight, if any, exfoliation, exudation, or itching, if on a non-exposed surface or small area, warrants a noncompensable rating. A 10 percent rating requires exfoliation, exudation, or itching involving an exposed surface or extensive area. A 30 percent rating requires constant exudation or itching, extensive lesions, or marked disfigurement. A 50 percent rating requires ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or the skin disorder must be exceptionally repugnant. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2002). Under the criteria of revised Diagnostic Code 7806 (effective on and after August 30, 2002 through October 23, 2008), dermatitis or eczema affecting less than 5 percent of the entire body or less than 5 percent of exposed areas, with no more than topical therapy required during the past 12-month period warrants a noncompensable rating. A 10 percent rating requires that 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 be affected, or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than 6 weeks during the past 12-month period. A 30 percent rating requires that 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of 6 weeks or more, but not constantly, during the past 12-month period. A 60 percent rating requires more than 40 percent of the entire body, or more than 40 percent of exposed areas be affected, or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during the past 12-month period. 38 C.F.R. 4.118, Diagnostic Code 7806 (from August 30, 2002 through October 23, 2008). As above, the criteria for rating scars were revised again in October 23, 2008. However, these newly revised criteria only apply to claims filed on or after October 23, 2008, and to those claims where a request for consideration of the new criteria has been received. See 73 Fed. Reg. 54708 (Sept. 23, 2008); see also 77 Fed. Reg. 2909 (Jan. 12, 2012) (correcting the applicability-date language for the revised rating criteria for scars). As the claim for an increased rating was filed prior to the effective date of the revised criteria, and the Veteran has not requested consideration of his claim under the revised criteria, those criteria are not for application. Thus, all diagnostic codes discussed herein are the versions in effect prior to October 23, 2008. As the RO also considered the former criteria, the Veteran is not prejudiced by the Board's application of the criteria in effect prior to October 23, 2008. In the May 2000 SOC, the RO listed Diagnostic Code 7813, applicable to dermatophytosis, as well as the note indicating that Diagnostic Codes 7807 through 7819 are to be rated as eczema. In analyzing the disability, the RO discussed the criteria applicable to eczema under former Diagnostic Code 7806. In the November 2006 SSOC, the AMC listed and considered the Veteran's dermatitis under the August 30, 2002 revised Diagnostic Code 7806, applicable to dermatitis or eczema. In the October 2010, March 2012, and March 2013 SSOCs the AMC listed the October 23, 2008 revised Diagnostic Codes, applicable to scars but did not consider the Veteran's dermatitis under these criteria as they were not pertinent to the dermatitis. The Board finds that the above documents reflect that the Veteran has been sufficiently apprised of the relevant criteria so that there is no due process bar to the Board considering the former and revised criteria. Evidence relevant to the level of severity of the Veteran's atopic dermatitis from one year prior to his claim in April 1998 to the present includes VA skin examination reports dated in February 2002, October 2006, July 2010, February 2012 and February 2013 as well as private and treatment records dated from February 1998 through January 2013. February 1998 Kaiser Permanente treatment notes reflect that the Veteran stated his dermatitis was much improved and that he no longer took antihistamines. On examination, there were only a few small patches with mild erythema of the upper and lower extremities, and the diagnosis was dermatitis, resolving. During the February 2002 VA skin examination the Veteran reported that he was working as an automobile mechanic. The Veteran reported that his skin was itching and "breaking out," especially affect the skin of his hands. The Veteran was under the care of a primary physician at the VA Medical Center. He was also being seen by dermatology service at VA since January 2002. At this examination he was reportedly diagnosed with dry skin and dermatitis papulosa nigra affecting the skin of the face. Treatment was provided by LacHydrin lotion. On physical examination, the Veteran's skin was dry in general, with the dryness more pronounced on the skin of the legs and hands. There were several fissures on the hands and several oval patches of eczematoid skin on the legs. There was also a 4 x 5 millimeter (mm) evenly pigmented macule on the sole of the right foot. The diagnosis was atopic dermatitis with minimal activity present on examination, severely dry skin, generalized, and junction nevus, right sole. After the effective date of the revised criteria, a March 2005 VA dermatology clinic outpatient treatment (VAOPT) note reflects that the Veteran was experiencing an exacerbation of his eczema, with hands hurting and some splitting, in addition to a rash on the feet. On examination, the skin was extremely dry from the neck down with few fissures on the fingertips, a few hyperpigmented macules on the top and side of the feet with extreme dryness. There were also hyperpigmented nails, and hyperpigmented plaque and papules around the eyes, cheeks, and in the left ear. The diagnoses were melasma, seborrheic keratosis, extreme xerosis, and eczema not under control. During the October 2006 VA skin examination, the Veteran reported that he was treatment by the VA dermatology service every 90 days for his skin. He was given a topical steroid ointment and found that it was helpful when he used it. There was a new immediate "skin" problem. The Veteran had a swollen tender area under the right axilla which had been going on for about three weeks. He also complained of a scar on the left shoulder where a growth was removed. He stated that he had an inguinal hernia scar from surgery. His skin gave him trouble and he had to use Lubriderm lotion on a very frequent basis. He also had difficulty with dryness of the feet and irritation. Physical examination revealed that there was an acute eczematous dermatitis covering a minimal area of the right side of the neck. The skin over the body was, in general, "simply dry." He also showed evidence of dryness of the skin over the trunk and extremities. The Veteran worked as an automobile mechanic and his hands were excessively dry. Examination of the right axilla showed a 3 cm slightly raised area which was acutely tender; nonfluctuant. There was a scar in the left inguinal area of 4 centimeters, well healed and nontender. Examination of the lower body showed dry skin with marked scaling over the plantar surface of the feet. There was thickening and dystrophy of the toenails. A scaly dermatitis extended a distance of 6 to 8 cm. around the ankles. The impression was of furuncle of the right axilla, eczematous dermatitis, exposed surface area 0 percent, body surface area 5 percent. Other skin disabilities diagnosed were right axilla acute furuncle, xerosis of the skin, exposed surface area 15 percent body surface area 60 percent, and tinea pedis and onychomycosis, exposed area 0 percent body surface area 6 percent. During the July 2010 VA skin examination, the Veteran reported ongoing problems with his skin for the last 40 plus years with dryness, itching, rashes, and hyperpigmentation. Over the years he had been treated primarily with topical emollients and topical steroids. There was one recent (2007) episode of short term oral steroid for a flare of dermatitis (Prednisone 60 milligrams (mg) for one week). No long term systemic medications or light treatments had ever been used to control the dermatitis. The medical records (CPRS) showed that the Veteran's last dermatology visit was in November 2008, at which time the Veteran's skin condition was being well managed with topical steroids and emollients. There were no dermatology notes/other dermatology visits after 2008. The Veteran stated that he "just refills the stuff they gave me," and had not had the need to see dermatology for some time. The Veteran denied any oral/injectable/systemic medical treatment for dermatitis in over a year. On physical examination of the skin the examiner noted dermatitis, eczema, leishmaniasis, lupus, dermatophytosis, bullous disorders, psoriasis, infections of the skin, cutaneous manifestations of collagen vascular diseases, and papulosquamous disorders. The percentage of exposed areas was less than 5 percent and the percentage of total body area affected was greater than 40 percent. The examiner noted that there was generalized xerosis of the skin with relative sparing of the face/neck (xerosis involved less than 5 percent of exposed areas, 60 percent of the total BSA (body surface area). The facial/neck skin showed hyperpigmentation only, without active dermatitis. Similarly, the dorsal hands showed xerosis and hyperpigmentation only without active dermatitis. There was a patch of hyperpigmentation with linear excoriation scars on the upper back. On the extensor right elbow and forearm, and the bilateral anterior and lateral thighs there was keratosis pilaris (exposed BSA 0 percent, total BSA less than 5 percent). There were thickened, dystrophic toenails (10/10), no dermatitis. There was no active eczematous dermatitis present on the trunk/extremities. The diagnosis was generalized xerosis, keratosis pilaris, eczematous dermatitis with residual hyperpigmentation with no active disease on daily topical treatments, and onychomycosis. During the February 2012 VA skin examination, the Veteran reported a chronic history of atopic dermatitis. Over the past three years the main areas of involvement had been the face, hands, upper extremity, as well as the dorsal aspects of the feet bilaterally. The examiner noted the use of systemic Prednisone in December 2007 in combination with Eucerin cream, hydrocortisone cream, and Clobetasol ointment. In November 2008 he was prescribed topical Desonide, topical Triamcinolone Acetonide, as well as topical Urea cream with continuing use of Eucerin lotion. At the time of the examination the veteran reported using basis soap daily along with Hydrophilic ointment as a moisturizer twice a day and intermittent oral Benadryl for itching. The examiner noted that the Veteran's skin conditions did not cause scarring or disfigurement of the head, face, or neck. There were no benign or malignant skin neoplasms and no systemic manifestations due to any skin diseases. With regard to oral or topical medications in the past 12 months, the Veteran reportedly used antihistamines for six weeks or more, but not constant. The Veteran also used Hydrophilic ointment as well as basis soap on a constant or near-constant basis. The Veteran denied any treatments or procedures other than systemic topical medications in the past 12 months for exfoliative dermatitis or papulosquamous disorders. The Veteran denied any debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. On physical examination of the skin, the Veteran reportedly had eczema at 5 to 20 percent total body area and 20 to 40 percent exposed area. The examiner noted that the Veteran had skin type VI. There was mild erythema and scaling of the left frontal hairline extending onto the temple. Examination of the hands revealed prominent hyperpigmented lichenified scaly plaques consistent with the diagnosis of chronic eczematous dermatitis. There were similar erythematous scaly plaques on the dorsal aspects of the feet bilaterally. There were also xerotic patches on the posterior aspect forearms bilaterally. Over, the skin disorders involved 25 percent of the exposed body surface and 15 percent of the total body surface area. It was indicated that the Veteran's skin disorder did not impact his ability to work. As above, the Board remanded this case in August 2012. The Board noted that it appeared that the February 2012 VA examiner considered the Veteran's areas of xerosis (i.e., dry skin) to be associated with his service-connected dermatitis. Conversely, the July 2010 VA examiner appeared to indicate that xerosis is a separate disability not associated with dermatitis. The Board indicated that there was no discussion as to whether areas of xerotic skin are to be considered when evaluating the percent of total body surface area or exposed body surface area affected by the Veteran's service-connected dermatitis. As such, the Board concluded that a medical opinion was necessary to resolve this issue. The Veteran was afforded a new examination, as requested by the Board, in February 2013. During the February 2013 VA skin examination the examiner noted that the Veteran had served in the military between 1964 and 1966. He was diagnosed with a skin rash of the hands specifically in service in 1964. A review of the claims file revealed a specific mention of a rash in December 1965, however, the specific details of the rash were not mentioned with regard to location. Within the claims file there were pictures dated in September 1977 which showed an eczematous rash involving the legs, axilla, and arms. There was documented treatment with Lidex .05% cream during an evaluation in September 1977. Additional therapy included topical urea cream and lac-hydrin lotion. Over the course of the past several years, he had intermittent continued breakouts on the back, arms, and legs. The examiner noted that the Veteran's skin conditions did not cause scarring or disfigurement of the head, face, or neck. There were no benign or malignant skin neoplasms and no systemic manifestations due to any skin diseases. With regard to oral or topical medications in the past 12 months, the Veteran reportedly used Urea 20 percent cream for six weeks or more, but not constant. The Veteran denied any treatments or procedures other than systemic topical medications in the past 12 months for exfoliative dermatitis or papulosquamous disorders. The Veteran denied any debilitating or non-debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. On physical examination of the skin the Veteran reportedly had eczema at 5 to 20 percent total body area and 5 to 20 percent exposed area. Physical examination revealed the presence of xerotic eczematous patches and plaques involving the mid superior chest, the bilateral palmar hands, as well as the bilateral anterior and posterior lower extremities extending from the knees to the feet. It was indicated that the Veteran's skin disorder did not impact his ability to work. The examiner reviewed the claims file and, again, noted the service treatment records showing a rash in December 1964 with no specific details of the rash with regard to location and post-service pictures dated in September 1977 showing eczematous rash involving the legs, axilla, and arms as well as intermittent continued breakouts on the back, arms, and legs over the years, the opined that the Veteran's current xerotic/eczematous skin noted on examination is consistent with the Veteran's current service-connected dermatitis. a. Prior to August 30, 2002 Considering the pertinent evidence cited above in light of the applicable rating criteria, the Board finds that a rating greater than 30 percent for the Veteran's atopic dermatitis is not warranted prior to August 30, 2002. As above, the rating criteria for the skin were revised August 30, 2002. Under the pre-August 30, 2002 rating criteria, a higher rating of 50 percent is not warranted unless evidence demonstrates ulceration, extensive exfoliation, or crusting with systemic or nervous manifestations, or an exceptionally repugnant condition. A review of the above evidence is negative for ulceration, exfoliation, crusting and/or systemic or nervous manifestations. The Veteran's condition cannot be considered to be exceptionally repugnant because the primary symptom is dry skin, his face is not involved, and there are no symptoms such as weeping, flaking, oozing, or crusting, nor were there raised or discolored lesions or other evidence of any disfigurement as a result of skin disease. b. Since August 30, 2002 Considering the pertinent evidence cited above in light of the applicable rating criteria, the Board finds that a rating greater than 60 percent for the Veteran's atopic dermatitis is not warranted at any point since August 30, 2002. The Board reiterates that the Veteran's current 60 percent rating is the maximum rating assignable under Diagnostic Code 7806. As such, the Board has considered the applicability of alternative diagnostic codes for evaluating the Veteran's service-connected skin disability. However, there is simply no medical evidence of disfigurement of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features, or; with six or more characteristics of disfigurement. As such, a rating in excess of 60 percent pursuant to Diagnostic Code 7800 is not warranted. Moreover, there is no medical evidence that the service-connected skin disability involves exfoliative dermatitis (erythroderma) with generalized involvement of the skin, plus 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. Rather, the Veteran reported that the treatment for his skin included cream and antibiotics. As such, a rating in excess of 60 percent pursuant to Diagnostic Code 7817 is not warranted. See 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7817. Under these circumstances, the Board finds that the record presents no basis for assignment of a higher schedular rating under the applicable rating criteria during the period in question. In assessing the severity of the disability under consideration, the Board has considered the Veteran's assertions regarding his symptoms, which he is certainly competent to provide. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of a rating in excess of 60 percent pursuant to any applicable criteria at any point pertinent to this appeal. Additionally, the Board finds that at no pertinent point has the disability under consideration been shown to be so exceptional or unusual as to warrant the assignment of any higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1) (cited in the March 2013 SSOC). In the August 2012 Board decision/remand, the Board noted that the RO had not considered 38 C.F.R. § 3.321 in the adjudication of the Veteran's claim for an increased rating for atopic dermatitis. Thus, to avoid any prejudice to the Veteran, the Board directed the RO to consider the matters of higher, extra-schedular ratings for atopic dermatitis in the first instance. In the March 2013 SSOC the RO considered 38 C.F.R. § 3.321 in the adjudication of the Veteran's claim for an increased rating for atopic dermatitis. Specifically, the RO found that the symptomatology and impairment caused by the Veteran's skin disease was specifically contemplated by the scheduler rating criteria. Significantly, the scheduler rating criteria both prior to and after the date in law change specifically provided for disability ratings based on the symptoms, treatment, and location and percentage of skin areas affected. In addition, there are several alternate criteria which can be used when considering impairment from disabilities of the skin, to include ratings based on disfigurement and scarring, none of which were shown to be applicable in the Veteran's claim. In short, all of the symptoms the Veteran experiences from his skin disease are explicitly listed in the scheduler rating criteria. No exceptional factors involving the Veteran's skin were noted. For these reasons, the RO found that the scheduler rating criteria in this case are adequate to rate the Veteran's atopic dermatitis. In the absence of evidence that the scheduler rating criteria are inadequate to rate the Veteran's disability, the RO found that referral for extra-schedular evaluation was inappropriate. The Board agrees. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular evaluation for the service connected atopic dermatitis is inadequate. The rating criteria reasonably describes the Veteran's disability level and symptomatology as due the symptoms, treatment, and location and percentage of skin areas affected. The rating criteria contemplate a level of symptomatology as shown by the examination reports, and the Veteran does not experience any symptomatology not contemplated by the rating schedule. Thus, the threshold requirement for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) is not met. See Bagwell, 9 Vet. App. at 338-9; Floyd, 9 Vet. App. at 96; Shipwash, 8 Vet. App. at 227. For all the foregoing reasons, the Board finds that, there is no basis for any further staged ratings for Veteran's service-connected skin disability, pursuant to Hart, and that a higher rating at each stage must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, as the preponderance of the evidence is against assignment of any higher rating at any pertinent point, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. TDIU consideration As a final point, the Board notes that, although a claim for a total disability rating based on individual unemployability (TDIU) may be raised in the record as a component of a claim for higher rating (see e.g., Rice v. Shinseki, 22 Vet. App. 447 (2009)), here, there is no indication that the Veteran is unemployed, nor is there evidence or argument that the Veteran's left ear hearing loss and/or atopic dermatitis renders him unemployable as he has reported working as an automobile mechanic throughout the course of the appeal. As such, a claim for a TDIU due to either of the service-connected disabilities under consideration has not reasonably been raised, and need not be addressed. ORDER As new and material evidence to reopen the claim for service connection for arthritis of the cervical spine and right elbow has not been received, the appeal is denied. As new and material evidence to reopen the claim for service connection for arthritis of the shoulders has not been received, the appeal is denied. A compensable rating for left ear hearing loss, on an extra-schedular basis pursuant to 38 C.F.R. § 3.321, is denied. A rating in excess of 30 percent for atopic dermatitis prior to August 30, 2002, to include on an extra-schedular basis pursuant to 38 C.F.R. § 3.321, is denied. A rating in excess of 60 percent for atopic dermatitis from August 30, 2002, to include on an extra-schedular basis pursuant to 38 C.F.R. § 3.321, is denied. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs