Citation Nr: 18146021 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 17-50 615 DATE: October 30, 2018 ORDER Entitlement to service connection for migraine headaches is granted. Entitlement to a compensable disability rating for service-connected bilateral foot tinea pedis is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his migraine headaches are at least as likely as not related to in-service headaches. 2. At no point during the period on appeal did the Veteran’s service-connected fungal infection of the feet manifest at least 5 percent of the total body or the exposed area of the body, and the Veteran was not prescribed intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs. CONCLUSIONS OF LAW 1. The criteria for service connection for migraine headaches are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for a compensable evaluation for tinea pedis of both feet have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.7, 4.71a, 4.118, Diagnostic Code (DC) 7813. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1973 to July 1976 in the United States Army. 1. Entitlement to service connection for migraine headaches is granted. The Veteran contends that his current migraine headaches are etiologically related to his noted in-service headaches. The Board concludes that the Veteran has a current diagnosis of migraine headaches that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). December 2011 private treatment records show the Veteran has a current diagnosis of recurrent headaches, and the December 2016 VA examiner opined that the Veteran’s headaches, diagnosed as migraines, were less likely than not etiologically related to service. The rationale was that, despite acknowledging the Veteran’s in-service headaches and headaches noted at separation, the Veteran’s current headaches “cannot be determined/or sign and symptoms due to recent facial and head trauma that has also resulted in headaches…both are likely mut[u]ally aggravating and cannot be differentiated…[t]he recent CT exam demonstrated multiple facial fractures that can contribute to headache symptoms.” The Board finds that, affording the Veteran the benefit of the doubt that his current migraine headaches are etiologically related to those noted during service and at separation. The December 2016 VA examiner specifically acknowledged this in-service evidence and the opinion indicates that the examiner is unable to determine whether the current migraine headaches are related to service or a manifestation of the facial fractures. While the Board notes that the injury that caused the facial fractures is an intervening injury, the Veteran has competently reported experiencing his headaches ever since those documented in-service and the assault that caused the facial fracture only occurred in 2016. Additionally, the VA examiner’s opinion indicates that this incident was only “aggravating” and that such fractures “can contribute to headache symptoms.” Therefore, resolving reasonable doubt in the Veteran’s favor the Board finds that the evidence supports a finding that the Veteran’s current migraine headaches are etiologically related to those noted in-service and at separation. 2. Entitlement to a compensable disability rating for service-connected bilateral foot tinea pedis is denied. The Veteran contends that the tinea pedis on both of his feet is worse than initially rated. The Veteran’s tinea pedis is currently evaluated under the hyphenated DC 7813-7806. The rating criteria of DC 7813 take into consideration the conditions of dermatophytosis, specifically tinea pedis of the feet. This condition is to be rated as disfigurement of the head, face or neck (DC 7800), scars (DC’s 7801, 7802, 7803, 7804, or 7805), or dermatitis (DC 7806), depending on the predominant disability. See 38 C.F.R. § 4.118, DC 7813. The Veteran’s disability does not result in any disfigurement or scars. Therefore, the Board finds that the Veteran should be evaluated under DC 7806. Under DC 7806 the criteria for a 10 percent rating includes characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of the exposed areas affected; or intermittent systemic therapy, including but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than six weeks over the past 12-month period. In December 2016 the Veteran underwent a VA examination to assess the nature and extent of his service-connected bilateral foot tinea pedis. The Veteran indicated that his tinea pedis was active at the time of this examination. The Veteran’s treatment over the previous 12-month period was positive for topical treatment only with Lamisil for less than six weeks. The approximate total body area and the exposed area impacted by tinea pedis were both identified as less than five percent. The specific location was identified as the soles of the Veteran’s feet. The Veteran’s VA and private medical treatment records note the Veteran’s history of tinea pedis (athlete’s foot) but do not include any associated medications or treatments, topical, systemic, or otherwise. The Veteran, in his September 2017 VA Form 9, stated that he felt the examiner had misdiagnosed his bilateral foot tinea pedis because the condition spread to his hands “sometimes.” The Veteran further stated that he had to continuously treat his feet to prevent “severe blistering and pain.” The Board finds that the evidence of record does not support a compensable disability rating for service-connected tinea pedis. There is no medical evidence to indicate that the Veteran’s treatment for tinea pedis has been anything other than topical treatment. While the Veteran disputes the extent and frequency of the treatment he has not disputed the manner of treatment, topical application of Lamisil. Even accepting the Veteran’s statement that his treatment is “constant” there is no evidence that it has ever been anything other than topical in nature. The Board notes that the Veteran also disputes the diagnosis, but the Board finds that the Veteran is not competent as a lay person to diagnose his skin condition. Furthermore, the Veteran has stated the condition has manifested on his hands “sometimes.” While the Veteran is competent to state what he experiences, the Board finds that there is no corroborating evidence of record to document a skin condition manifesting on the Veteran’s hands. The Board is cognizant of the ruling in Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017) in which the Federal Circuit ruled that applications of topical corticosteroids may constitute systemic therapy under DC 7806. However, the topical treatment identified by the evidence of record, Lamisil, is not a corticosteroid. As there is no competent evidence of characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of the exposed areas affected; or intermittent systemic therapy, including but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than six weeks over the past 12-month period, a compensable disability rating for service-connected tinea pedis is denied. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. McLeod