Citation Nr: 18148539 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 17-01 800 DATE: November 7, 2018 ORDER On and after September 15, 2016, a rating of 30 percent, but no higher, for service-connected seborrheic dermatitis is granted, subject to the laws and regulations governing the payment of monetary awards. REMANDED Entitlement to service connection for bilateral knee disorder, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for right ankle disorder, to include as secondary to service-connected disability, is remanded. FINDING OF FACT On and after September 15, 2016, the Veteran’s seborrheic dermatitis affected approximately 25 percent of the scalp and facial areas.   CONCLUSION OF LAW On and after September 15, 2016, the criteria for a rating of 30 percent for seborrheic dermatitis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code 7806 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1978 to January 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office. The Board notes the Agency of Original Jurisdiction (AOJ) certified the issue of entitlement to an increased rating for service-connected lateral collateral ligament sprain, left ankle (left ankle disability), to the Board. However, the Veteran’s VA Form 9 clearly reflects his intent to appeal only the issues addressed herein, and as such, the Board will not assume jurisdiction of the issue of an increased rating for left ankle disability. Entitlement to a compensable, initial rating for service-connected seborrheic dermatitis The Veteran asserts the severity of his seborrheic dermatitis warrants a compensable rating. To that end, disability ratings are determined by applying a schedule of ratings that are based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Prior to this decision, the Veteran’s service-connected seborrheic dermatitis was assigned a noncompensable rating under 38 C.F.R. § 4.118, Diagnostic Code 7806, which rates dermatitis and eczema. Under Diagnostic Code 7806, a noncompensable rating is warranted when less than five percent of the entire body or less than five percent of exposed areas are affected, and not more than topical therapy was required during the past 12-month period. A 10 percent rating is warranted with at least five percent, but less than 20 percent, of the entire body affected, or at least five 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. A 30 percent rating is warranted with 20 to 40 percent of the entire body affected, 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. Diagnostic Code 7806 also provides a 60 percent rating when more than 40 percent of the entire body or exposed areas are affected, or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118. In October 2015, a VA examiner found the Veteran’s total body area and approximate total exposed body areas both amounted to less than five percent. See VA Examination Report, October 2015. The examiner described the Veteran’s skin condition as “scalp with few scaly patches with erythematous base. Mild yellowish greasy scaling around nasolabial fold”. The Veteran had not been treated with oral or topical medications in the past 12 months. Based on this evidence, a compensable rating is not warranted. A September 15, 2016, private treatment record, however, shows a private physician examined the Veteran’s head, including the scalp and scalp hair, skin of the left and right eyelids, right and left external ears, left and right eyebrows, upper and lower lips, and his neck. The private physician diagnosed seborrheic dermatitis, unspecified, and reported that 25 percent of the scalp and facial areas was affected. Upon review, the Board finds a rating of 30 percent, but no higher, for seborrheic dermatitis is warranted on and after September 15, 2016, the date of the private treatment record reflecting the increase in the severity of the Veteran’s service-connected seborrheic dermatitis. Throughout the appeal period, the criteria for a rating of 60 percent are not met as the evidence does not reflect the Veteran’s seborrheic dermatitis affected more than 40 percent of the entire body or exposed areas, or the need for constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during the past 12-month period. In conclusion, the Board finds the criteria for a 30 percent rating, but no higher, are met as of September 15, 2016. See 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Entitlement to service connection for bilateral knee disorder and right ankle disorder, to include as secondary to service-connected disability The Veteran was not afforded a VA examination specifically for his claimed bilateral knee disorder or right ankle disorder. Generally, a VA medical examination is required for a service connection claim only when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in-service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Here, the medical evidence demonstrates reports of pain and diagnoses, to include osteoarthritis, for the claimed disorders during the pendency of the appeal. Additionally, the Veteran asserts such disorders are secondary to his service-connected left knee disability. In this respect, a private physician opined in a December 2016 letter that “it was at least as likely as not that Mr. [redacted] service-connected left ankle condition causes, contributes to, or aggravates his current right ankle and bilateral knee condition”. The private physician reported that one could not say exactly how long these conditions existed prior to the date of diagnosis or definitively state their causes. Upon review, the Board finds additional examination is necessary to properly determine entitlement to service connection for bilateral knee disorder and right ankle disorder. Here, the private physician did not provide any rationale for the positive opinion, nor does the record cite to or include treatment records supporting the conclusion. As such, remand for additional VA examination and medical opinion is warranted. Accordingly, this matter is REMANDED in part for the following action: 1. Schedule the Veteran for examination(s) by appropriate clinician(s) to determine the nature and etiology of any current knee disorder and right ankle disorder, even if such has resolved. The record must be made available to the clinician. The clinician is asked to report the following: (a.) Identify all current knee and right ankle disorders. In this respect, the clinician specifically should state whether the Veteran’s reports of knee pain and right ankle pain are attributable to known clinical diagnoses. Additionally, the examiner is directed to assume the Veteran has a current disability if there is functional impairment associated with any complaints of pain of the right knee, left knee, and/or right ankle. (b.) For each disorder, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is proximately due to and/or aggravated by a service-connected disability. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. (c.) If arthritis of any disorder is diagnosed, the examiner should offer an opinion as to whether it manifested within one year of the Veteran’s separation from service in January 1979, and, if so, describe the manifestations.   A rationale for all opinions offered should be provided. M. M. Celli Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jones, Associate Counsel