Citation Nr: 18149479 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-32 898 DATE: November 9, 2018 REMANDED The issue of entitlement to an initial compensable rating for bilateral hand dermatitis is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2002 to February 2005; June 2005 to February 2006; February 2006 to August 2008; and from December 2008 to December 2010. This appeal comes before the Board of Veterans’ Appeals (Board) from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The Board notes that the Veteran submitted a form in May 2018 opting into VA’s new Rapid Appeals Modernization Program (RAMP). As this election was made after this appeal was activated for adjudication, it is not subject to the RAMP provisions. However, the RAMP provisions shall be applicable to all of the Veteran’s appeals that are activated after May 16, 2018.   Claim for an Initial Compensable Rating for Bilateral Hand Dermatitis The Veteran states that he should be assigned a 10 percent rating for his bilateral hand dermatitis because he had been required to take corticosteroids in the previous 12 months, for a duration of less than 6 weeks; and that his treatment records reflect that he took systematic steroids on multiple occasions. See October 2013 Notice of Disagreement; see also July 2016 VA Form 9. The Veteran underwent a VA examination for skin diseases in July 2013. The VA examination report reflects that the Veteran had not been treated with oral or topical medications in the prior 12 months for any skin condition. However, contrary to the VA examiner’s findings, the Veteran’s treatment records reflect that his bilateral hand dermatitis was managed by topical corticosteroids and other topical treatment. See e.g. April 2012 Dermatology Follow-Up Progress Note (reflecting that the Veteran was taking a topical corticosteroid drug, Triamcinolone; and that the side effects of topical steroids were discussed at his appointment); see also June 2013 Dermatology Follow-Up Progress Note (reflecting that the Veteran had been diagnosed with dermatitis for the five years preceding this treatment note, and that he had used many potent topical steroids). Thus, the Board cannot rely on the VA examination because the findings are inconsistent with the treatment records. Further, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has held that “use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case”. Johnson v. Shulkin, 862 F.3d 1351, 1356 (2017). The Federal Circuit explained that a topical treatment administered on a large enough scale to affect the body as a whole could constitute systemic therapy. Id. at 1355. In Warren v. McDonald, the United States Court of Appeals for Veterans Claims (CAVC) held that “systemic therapy”, for DC 7806 purposes, was not limited to corticosteroids or immunosuppressive drugs and that the Board must consider whether a given treatment is “like” a corticosteroid or other immunosuppressive drug to determine whether such treatment was a systemic therapy. 28 Vet. App. 194 (2016). In a very recent decision, CAVC clarified the holding in Johnson, supra, and held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole, without regard to whether the topical treatment was applied to where the condition was located or on some other part of the body, since the body, in its entirety, would be involved in the treatment; and (2) whether the given treatment is “like” a corticosteroid or other immunosuppressive drug.” Burton v. Wilkie, No. 16-2037 (September 28, 2018). Only the second question need be addressed if the treatment is clearly systemic. The Board notes that effective August 13, 2018, VA amended DC 7806, in part, to include a definition of “systematic therapy” as treatment administered through any route other than the skin. However, the former rating criteria, which did not define “systematic therapy,” shall be applicable to claims that were pending prior to the effective date of the new rule, when it is more favorable to a Veteran. Burton v. Wilkie, No. 16-2037 (September 28, 2018). In this regard, the Board notes that the Veteran’s claim was pending prior to August 13, 2018. Although the Veteran’s treatment records, as indicated above, reflect that the Veteran was using topical corticosteroid drug for his treatment, a remand is required for a new VA examination to determine whether the Veteran’s topical treatment with steroid and/or corticosteroid drugs, of record, affected his body as a whole; and/or whether the Veteran’s treatment is “like” a corticosteroid or immunosuppressive drug. The matter is REMANDED for the following action: 1. Schedule the Veteran for a new VA examination to assess the severity of his bilateral hand dermatitis. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. All necessary tests and studies should be accomplished and all clinical findings reported in detail. To the extent possible, the VA examiner should use the appropriate DBQ questionnaire. The VA examiner must address the following: a. Whether any topical treatment with steroid and/or corticosteroid creams and/or drugs, of record, affected the Veteran’s body as a whole. b. Whether any topical treatment of the Veteran’s bilateral hand dermatitis is “like” a corticosteroid or immunosuppressive drug. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V-N. Pratt, Associate Counsel