Citation Nr: 18151904 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-29 391 DATE: November 20, 2018 ORDER An initial evaluation in excess of 20 percent for degenerative joint disease (DJD) of the left shoulder with a labrum tear and cyst is denied. A 20 percent evaluation, but no higher, for DJD of the right shoulder with a SLAP tear and paralabrum cyst, beginning August 1, 2012, is granted. An initial 30 percent evaluation, but no higher, for dermatitis, beginning August 1, 2012, is granted. A 10 percent evaluation, but no higher, for gastroesophageal reflux disease (GERD) with hiatal hernia, beginning August 1, 2012, is granted. An effective date of August 1, 2012, but no earlier, for the award of service connection for esophageal stricture is granted. REMANDED Entitlement to an initial compensable evaluation for esophageal stricture prior to July 9, 2013, and in excess of 30 percent thereafter, is remanded. FINDINGS OF FACT 1. The Veteran’s left shoulder more closely approximates a limitation of motion to the shoulder level throughout the appeal period; he has not had any impairment of the clavicle, scapula, or humerus, and has not had ankylosis of the scapulohumeral articulation of his left shoulder. 2. The Veteran’s right shoulder more closely approximates a limitation of motion to shoulder level throughout the appeal period; he has not had ankylosis of the scapulohumeral articulation of the right shoulder, or impairment of the clavicle or scapula throughout the appeal period; any recurrent dislocation (subluxation) of his right scapulohumeral joint has resulted in no more than infrequent episodes and guarding at the shoulder level only. 3. Throughout the appeal period, the Veteran’s dermatitis affects 20 to 40 percent, but not greater than 40 percent, of his total body area affected; the Veteran has not had more than 40 percent of his total exposed areas affected in this case, nor has he required at least 6 weeks of systemic corticosteroid or immunosuppressive drug use or any more than intermittent immunosuppressive therapy throughout the appeal period. 4. Throughout the appeal period, the Veteran’s GERD with hiatal hernia has ot resulted in persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health; his symptoms more closely approximate to two or more symptoms of such criteria of less severity. 5. The Veteran initially filed his claim of service connection for an esophageal stricture on April 19, 2013—within one year of discharge from service—entitlement to service connection for esophageal stricture was no later than the day after he was separated from active service. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 20 percent for DJD of the left shoulder with a labrum tear and cyst are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5200-5203. 2. The criteria for a 20 percent evaluation, but no higher, for DJD of the right shoulder with a SLAP tear and paralabrum cyst, beginning August 1, 2012, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5200-5203. 3. The criteria for a 30 percent evaluation, but no higher, for dermatitis, beginning August 1, 2012, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, Diagnostic Codes 7806, 7827. 4. The criteria for a 10 percent evaluation, but no higher, for GERD with hiatal hernia, beginning August 1, 2012, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, Diagnostic Code 7346. 5. The criteria for an effective date of August 1, 2012, but no earlier, for the award of service connection for esophageal stricture are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 3.400(b)(2). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from July 1988 to July 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). During the pendency of the appeal, an October 2016 rating decision awarded a 20 percent evaluation for the Veteran’s left shoulder disability, effective July 9, 2013, which is the initial date of the award of service connection in this case. The Board has recharacterized that issue as above in order to comport with that award of benefits. Finally, the Board acknowledges that the Veteran has additionally filed separate appeals for the effective dates assigned for the awards of the 30 percent evaluation for his dermatitis, the 20 percent evaluation for his right shoulder disability, and the10 percent evaluation for his GERD. The Board reflects, however, that it has characterized the issues on appeal as appeals of the initial evaluation of those disabilities and has considered all of the evidence associated with regards to the Veteran’s disabilities relevant to the increased evaluation claims in this case since the date of service connection. Increased Rating Claims Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). Bilateral Shoulders In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. 38 C.F.R. § 4.69. In this case, the Veteran’s right upper extremity, including his right shoulder, has been found to be his major or dominant extremity for purposes of evaluation, as shown below by the evidence of record. Diagnostic Code 5200 provides that ankylosis of the scapulohumeral articulation (the scapula and humerus move as one piece) of the major upper extremity is rated 30 percent when it is favorable, with abduction to 60 degrees and able to reach mouth and head. A 40 percent is assigned with intermediate ankylosis (between favorable and unfavorable); and it is rated 50 percent when unfavorable, with abduction limited to 25 degrees from side. Minor arm evaluations for each of those criteria are 10 percent less than the major arm evaluations. See 38 C.F.R. § 4.71a, Diagnostic Code 5200 and Note. Under Diagnostic Code 5201, for limitation of motion of the arm, a 20 percent evaluation is warranted for limitation of motion of the major or minor arm at the shoulder if it is limited to shoulder level, or a minor arm with limitation of motion to midway between the side and shoulder level. A 30 percent evaluation is warranted for a major arm with limitation of motion to midway between the side and shoulder level, and for a minor arm with limitation of motion to 25 degrees from the side. Finally, a 40 percent evaluation is warranted for a major arm with limitation of motion to 25 degrees from the side. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. Diagnostic Code 5202 provides a 20 percent evaluation for malunion of the major humerus with a moderate deformity and, and a 30 percent evaluation with a marked deformity; malunion of the minor humerus with either a moderate or a marked deformity warrants 20 percent. A 20 percent evaluation is also warranted for recurrent dislocation of the major humerus at the scapulohumeral joint with infrequent episodes and guarding of movement only at the shoulder level, and a 30 percent rating is warranted for frequent episodes and guarding of all arm movements; a minor arm with either of those symptoms is evaluated as 20 percent disabling. Impairment of the major humerus is rated at 50 percent if there is a fibrous union, 60 percent if there is nonunion or false flail joint, and 80 percent if there is loss the head of humerus, with flail shoulder. Again, the minor arm with those symptoms is evaluated as 10 percent less than the major arm evaluations. See 38 C.F.R. § 4.71a, Diagnostic Code 5202. Finally, Diagnostic Code 5203 provides a 10 percent evaluation for malunion of the clavicle or scapula or nonunion without loose movement. A 20 percent evaluation is warranted for nonunion of the clavicle or scapula with loose movement or dislocation of the clavicle or scapula. Major and minor arms are not evaluated differently under this Diagnostic Code. See 38 C.F.R. § 4.71a, Diagnostic Code 5203. Turning to the evidence of record, prior to his discharge from service, the Veteran underwent an April 2012 VA examination of his bilateral shoulder disabilities. During that examination, the Veteran reported bilateral shoulder pain daily, noting that his shoulders were equally painful; pain was located “deep inside” the superior joint region. He denied any flare-ups at that time. The Veteran was noted to be right-hand dominant at that time. On examination, the Veteran had right shoulder flexion to 140 degrees and abduction to 115 degrees with pain at 90 degrees and 100 degrees, respectively; he had left shoulder flexion to 165 degrees and abduction to 110 degrees with pain at 120 degrees and 95 degrees, respectively. The Veteran was noted to have 65 degrees of extension, 85 degrees of external rotation with pain at 60 degrees, and 40 degrees of external rotation in the right shoulder; he had 60 degrees, 80 degrees, and 60 degrees, respectively, of the left shoulder, without pain. The Veteran’s range of motion of his bilateral shoulders was unchanged after repetitive motion testing. The examiner noted that the Veteran had less movement than normal and pain on movement, bilaterally; the examiner concluded that there was no additional functional loss as a result of pain, fatigue, weakness, lack of endurance, or incoordination at that time. The Veteran did not have pain on palpitation or guarding of either shoulder. There was no ankylosis of either shoulder noted on examination and muscle strength testing was normal. Hawkins’ impingement, empty-can, external rotation/infraspinatus strength, and left-off subscapularis testing were all negative. The examiner noted that the Veteran did not have a history of mechanical symptoms, recurrent dislocation of the glenohumeral joint, or any impairment of the clavicle or scapula of his bilateral shoulders. X-rays demonstrated arthritis of the bilateral shoulders; the examiner noted that Magnetic Resonating Imaging (MRI) scans obtained during service showed labrum tears of the bilateral rotator cuffs. The Veteran sought treatment at Tricare for his shoulders in June 2013, at which time he was noted to have pain in his shoulders, which was dull to sharp and 3 out of 10 in severity. Although the Veteran was noted to have abnormal range of motion bilaterally, measurements of his range of motion were not obtained at that time. The Veteran was note shown to have clavicle impairments of either of his shoulders and he was diagnosed with bilateral rotator cuff tendonitis and instability of the right shoulder due to a labral tear. The Veteran underwent another VA examination of his shoulders in November 2013, at which time his diagnosed conditions were unchanged. The Veteran reported flare-ups at that time, stating that he was unable to use his arms over his head and that he had limited motion above his head during flare-ups; he could use his arms above head leave, but not overhead when not in flare-up. On examination, the Veteran had 140 degrees of flexion, 140 degrees of abduction, 70 degrees of external rotation, and 80 degrees of internal rotation of the right shoulder; he had 140 degrees, 135 degrees, 70 degrees, and 90 degrees (normal) of the left shoulder, respectively. The Veteran’s range of motion of his shoulders was unchanged after repetitive motion testing. The Veteran was noted to have painful motion and weight on weightbearing and non-weightbearing. The examiner additionally noted that the Veteran had less movement than normal and pain on movement, and further noted that the Veteran’s bilateral shoulders were limited to 90 degrees of flexion and abduction, bilaterally, due to pain, weakness, fatigue, lack of endurance, or incoordination; the examiner noted that the Veteran was unable to lift his arms over horizontal during flare-up. Muscle strength testing was normal, and there was no ankylosis of either shoulder noted on examination at that time. The examiner noted that the Hawkins’ impingement, empty-can, external rotation/infraspinatus strength, and crack apprehension and relocation tests were negative, although the lift-off subscapularis test was positive bilaterally. The Veteran was noted to have infrequent episodes on the right side of shoulder instability, dislocation, or labral pathology. There was no evidence of any clavicle or scapula impairments bilaterally, nor were there any impairments of the humerus noted on examination. The examiner concluded that the Veteran was unable to use his arms over head level to lift objects or place them on shelves above head level. In a June 2014 statement, the Veteran indicated he had decreased range of motion of his shoulders without any strength above the parallel level of the shoulder, along with subluxation of his right shoulder. Finally, the Veteran underwent a VA examination of his shoulders in April 2016, at which time his diagnosed conditions were unchanged. The Veteran was noted as right-hand dominant. The Veteran reported constant pain in his shoulders, right worse than left; pain was worsened with movement, positioning, and use. He reported being unable to lay on his shoulders at night and that he took Tylenol as needed. He additionally reported flare-ups that worsened his pain after physical activities or using a computer. On examination, the Veteran was noted to have 120 degrees of flexion, 120 degrees of abduction, 80 degrees of external rotation, and 90 degrees (normal) of internal rotation of the right shoulder; he had 130 degrees, 130 degrees, 80 degrees, and 90 degrees (normal) of the left shoulder, respectively. Pain was noted in all aspects on the left shoulder and all aspects except internal rotation on the right shoulder; there was no evidence of pain on weightbearing and crepitus bilaterally. The Veteran additionally was noted to have trouble reaching, lifting and overhead work due to his bilateral shoulder disability. The examiner noted that the Veteran’s range of motion was unchanged after repetitive motion testing; he additionally found that there was no additional functional loss due to pain, weakness, fatigue, lack of endurance, or incoordination during either repeated use or flare-ups. Muscle strength testing was normal without evidence of muscle atrophy, and there was no evidence of ankylosis bilaterally. The examiner noted that the Hawkins’ impingement, empty-can, and external rotation/infraspinatus strength tests were negative, although the lift-off subscapularis test was positive bilaterally; the Veteran was unable to perform the crack apprehension and relocation test, bilaterally. The examiner noted that the Veteran did not have a history of mechanical symptoms, recurrent dislocation of the glenohumeral joint, or any impairment of the clavicle or scapula of his bilateral shoulders. The Veteran additionally did not have any impairments of his humerus bilaterally. The examiner concluded that the Veteran should “avoid occupational activities such as overhead work, heavy lifting, and operating machinery” due to his shoulder disabilities. Analysis of Left Shoulder The Veteran filed his initial claim for service connection for a left shoulder disability on July 9, 2013; service connection has been awarded since that date. Throughout the appeal period, the Veteran has been awarded a 20 percent evaluation under Diagnostic Code 5003-5201 for that disability. The Veteran’s left shoulder is his minor extremity for evaluation purposes. Based on the foregoing evidence, the Board finds that an evaluation in excess of 20 percent is not warranted for the Veteran’s left shoulder disability throughout the appeal period. Specifically, the Board reflects that the Veteran’s left shoulder disability is not shown to have any impairments of the clavicle, scapula, or humerus throughout the appeal period. Likewise, the Veteran’s left shoulder is not shown to have ankylosis of the scapulohumeral articulation throughout the appeal period. Accordingly, Diagnostic Codes 5200, 5202, and 5203 are inapplicable in this case respecting the left shoulder. Finally, the Veteran’s left shoulder is shown to have trouble with work overhead and to be limited to horizonal movement with his shoulder or head throughout the appeal period. The Board notes that such is more closely approximate to limitation of motion to the shoulder level than to midway between shoulder level and the side. Accordingly, the Veteran’s 20 percent evaluation has been properly assigned throughout the appeal period under Diagnostic Code 5201. The Board must therefore deny the Veteran’s claim for an increased initial evaluation of his left shoulder based on the evidence of record at this time. See 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5201. Analysis of Right Shoulder The Veteran filed his initial claim for service connection for a right shoulder disability prior to discharge from service; service connection has been awarded August 1, 2012, the date following his date of discharge. Throughout the appeal period, the Veteran has been awarded a 20 percent evaluation under Diagnostic Code 5003-5203 for that disability. The Veteran’s right shoulder is his major extremity for evaluation purposes. Initially, the Board reflects that the Veteran is not shown to have any ankylosis of the scapulohumeral articulation of the right shoulder; Diagnostic Code 5200 is therefore inapplicable in this case. Likewise, although the Agency of Original Jurisdiction (AOJ) assigned the Veteran’s evaluations under Diagnostic Code 5203, the Board reflects that the Veteran is not shown to have any impairments of his right clavicle or scapula throughout the appeal period. Thus, the Board finds that the AOJ’s initial evaluation under that Diagnostic Code was not appropriate. See 38 C.F.R. § 4.71a, Diagnostic Code 5200, 5203. Rather, the Veteran’s right shoulder is shown to have a limitation to 90 degrees of motion after factoring in pain in the April 2012 VA examination; such limitation of motion is consistent throughout the appeal period as noted in the VA examination reports. Likewise, the examiners routinely indicate that the Veteran would be functionally limited in his work overhead; the Veteran is not shown to have a limitation of motion lower than shoulder level throughout the appeal period. Such evidence is more closely approximate to a limitation of motion to shoulder level, and such is commensurate to a 20 percent evaluation for a major extremity throughout the appeal period. See 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5201. As a final matter, the Board reflects that although one examiner noted that the Veteran had an impairment of the humerus with recurrent dislocation (subluxation) of the scapulohumeral joint, that examiner noted that the Veteran had infrequent episodes and guarding only to the shoulder level. The Veteran’s lay statements of record at consistent with these findings and the Board finds that such is the most probative evidence of record. Consequently, as such is commensurate to a 20 percent evaluation under Diagnostic Code 5202 for a major extremity, the Board finds that such does not warrant a higher evaluation and the Board finds that evaluation is more appropriate under Diagnostic Code 5201 rather than Diagnostic Code 5202. See 38 C.F.R. § 4.71a, Diagnostic Code 5202. Accordingly, the Board assigns a 20 percent evaluation, but no higher, for the Veteran’s right shoulder disability, beginning August 1, 2012; in all other aspects, the Veteran’s claim for increased evaluation in this case is denied. See 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5200-5203. Dermatitis Service connection has been established for the Veteran’s dermatitis effective August 1, 2012, the date following his discharge from service. Throughout the appeal period, the Veteran has been assigned a noncompensable evaluation prior to July 9, 2013, and a 30 percent evaluation since that date; such evaluations are assigned under Diagnostic Code 7806. Under Diagnostic Code 7806, dermatitis is assigned a 10 percent evaluation where there is involvement of at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent evaluation requires involvement of 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating is assigned with involvement of more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. During the pendency of the claim, effective August 13, 2018, Diagnostic Code 7806 was amended. The amendments did not change the substance of the criteria for evaluation in this case. See 38 C.F.R. 4.118; 83 Fed. Reg. 32592 (Jul. 13, 2018). Prior to discharge from service, in April 2012, the Veteran underwent a VA examination of his skin disability. At that time, he was diagnosed with dermatitis; the Veteran reported recurrence/flare-up of his dermatitis 2-3 times a year that lasted 7-10 days, which included red patches with clear sharp borders that were located all over his entire body. His last flare-up occurred in November 2011; he took a course of prednisone 2-3 times a year for his flare-ups. The examiner noted that the Veteran took systemic corticosteroids or immunosuppressive drugs (prednisone) for his dermatitis for less than 6 weeks over the last 12 months. On examination at that time, the Veteran did not have any total body or exposed body area affected by his dermatitis, and the examiner noted that there were no current lesions or skin changes consistent with dermatitis at that time. After filing his claim for increased evaluation in July 2013, the Veteran underwent a VA examination of his dermatitis disability in November 2013. At that time, the examiner noted that the Veteran took a 10-day cycle of prednisone to treat his dermatitis in June 2013; the examiner noted that he took systemic corticosteroids or immunosuppressive drugs for less than 6 weeks in the last 12 months; he additionally used lachydrin lotion 12 percent, a topical medication, daily for his skin disability. The examiner, on examination, at that time indicated that the Veteran’s dermatitis affected none of his total exposed area, but affected 20 to 40 percent of his total body area. The examiner finally found that the Veteran’s skin disability did not impact his ability to work. In a June 2014 statement, the Veteran indicated that his dermatitis affected 20 percent of his body with the use of prednisone every six months as the only resolution of any flare-ups/outbreaks. The Veteran finally underwent another VA examination of his skin disability in April 2016, at which time he was diagnosed with dermatitis. The examiner noted that the Veteran’s condition has “stayed the same.” The Veteran reported flare-ups of his skin disability 4 times a year, usually precipitated by illness or a decrease in his immune system. During a flare-up, he will have red blotchy rashes that cover his entire body, but not his face. Flare-ups last 1-2 weeks and are treated with oral and topical steroids. On examination, the examiner noted that the Veteran had not been treated with systemic corticosteroids or immunosuppressive drugs at any time during the last 12 months. The examiner, however, noted that the Veteran had 4 or more non-debilitating episodes of erythema multiforme in the last 12 months which required treatment with intermittent systemic immunosuppressive therapy. On examination, the examiner noted that the Veteran did not have any evidence of dermatitis on examination at that time. At that time, the examiner indicated that dermatitis was the wrong diagnosis and instead the Veteran had erythema multiforme. Based on the foregoing evidence, the Board finds that a 20 percent evaluation, but no higher, is warranted for the Veteran’s dermatitis beginning August 1, 2012. The Board initially reflects that throughout the appeal period, the Veteran is shown to require intermittent usage of prednisone, a systemic corticosteroid or immunosuppressive drug, although throughout the appeal period he is not shown to require at least 6 weeks of such treatment during a 12-month period. Nevertheless, although the April 2012 examiner noted that the Veteran did not have any total body or exposed body area affected by dermatitis, that examiner noted that the Veteran’s “entire body” was affected during flare-ups and no discussion of this fact is noted in that examination report. The November 2013 VA examiner’s opinion in this case was that the Veteran had 20 to 40 percent of his entire body area affected, although none of his exposed body area was affected by his dermatitis; such is commensurate to a 30 percent evaluation. The Board additionally finds that such is the most probative evidence throughout the appeal period, and outweighs the April 2012 VA examiner’s findings regarding area, as such opinion appears to have contemplated the area affected during flare-up and not on present examination. Additionally, the Veteran’s own statements and estimates—of 20 percent body area affected—are consistent with the November 2013 examiner’s findings. Although the April 2016 VA examiner did not specifically address the body area affected in this case, that examiner noted that the Veteran’s skin disability was stable and has “stayed the same.” The Veteran does not appear to dispute this finding at any time during the appeal period, as his arguments on appeal have consistently been that his skin disability should be evaluated the same from discharge from service as it was evaluated in July 2013. The Board reflects that insofar as the Veteran has raised arguments in this case, the Board’s award in this matter appears to be a full and complete grant of benefits sought by the Veteran on appeal. Finally, the Board acknowledges that April 2016 VA examiner’s change in diagnosis; there is no rationale for that opinion that the dermatitis diagnosis was initially incorrect. Nevertheless, both prior to and after the August 2018 amendments, Diagnostic Code 7827 requires symptomatology “despite ongoing immunosuppressive therapy.” Regardless of the symptomatology and manifestations in this case, the evidence throughout the appeal period is clear that the Veteran does not have ongoing immunosuppressive drug use/therapy. Accordingly, an evaluation in excess of 30 percent under Diagnostic Code 7827 cannot be awarded at any time in this case. See 38 C.F.R. § 4.118, Diagnostic Code 7827. In short, the Board finds that the Veteran’s total body area affected in this case throughout the appeal period is 20 to 40 percent; the Veteran is not, however, shown to have more than 40 percent of his total body or exposed body areas affected in this case, nor is he shown to require at least 6 weeks of systemic corticosteroid or immunosuppressive drug use, or any more than intermittent immunosuppressive therapy throughout the appeal period. Accordingly, a 30 percent evaluation, but no higher, for dermatitis is warranted beginning August 1, 2012, based on the evidence of record in this case. See 38 C.F.R. §§ 4.7, 4.118, Diagnostic Code 7806. GERD Service connection for the Veteran’s GERD has been effective as of August 1, 2012, the date following his discharge from service. Throughout the appeal period, the Veteran has been assigned a noncompensable evaluation prior to April 12, 2013, and a 10 percent evaluation since that date; such evaluations are assigned under Diagnostic Code 7346. Under Diagnostic Code 7346, a 10 percent evaluation is assigned with two or more of the symptoms for 30 percent evaluation of less severity. A 30 percent evaluation is assigned for symptoms of persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent evaluation is assigned for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. See 38 C.F.R. § 4.114, Diagnostic Code 7346. Prior to his discharge from service, the Veteran underwent an examination of his GERD in April 2012. At that time, the Veteran reported that he began having heartburn in the mid-1990’s, that he self-medicated with Tums, Maalox, Zantac, Tagamet, and other antacids; he sought treatment and was prescribed Nexium beginning in 2006. He reported improved heartburn with current treatment, although he had occasional breakthrough heartburn once a month, usually caused by certain foods. The Veteran was noted to take Nexium daily. On examination, the examiner noted that the Veteran only had reflux; he did not have persistently recurrent or infrequent episodes of epigastric distress, dysphagia, pyrosis (heartburn), regurgitation, substernal arm or shoulder pain, or sleep disturbances due to GERD. There was also no evidence of anemia, weight loss, nausea, vomiting, hematemesis, or melena. There was no evidence of esophageal stricture at that time. The examiner concluded that there was no impact on his occupational functioning as a result of his GERD. On March 27, 2013, the Veteran sought treatment with a private gastroenterologist for his GERD; he reported burning epigastric discomfort that radiated to his chest, moderate in severity, that was exacerbated by spicy foods, caffeine, and stress. The Veteran denied nausea, vomiting, unintentional weight loss, or gastrointestinal bleeding. He noticed, however, intermittent dysphagia, mainly to solid foods that seem to get hung up at the suprasternal notch with occasional regurgitation. The Veteran reported taking Tums currently for breakthrough symptoms, as well as ranitidine (Zantac) twice daily. The Veteran was diagnosed with GERD and dysphagia at that time, and it was recommended he undergo an upper endoscopy for a possible esophageal stricture at that time. On April 12, 2013, the Veteran underwent an upper endoscopy, which revealed an esophageal stricture, esophageal hiatal hernia, and erythema and congestion in the antrum. The Veteran underwent another VA examination of his GERD in November 2013, which indicated that he had GERD and a hiatal hernia. The examiner noted that the Veteran took Tums and Dexalant daily for his symptoms. On examination, the Veteran was noted to have dysphagia, pyrosis, reflux, and regurgitation, all less than once a day; there was no evidence of persistently recurrent or infrequent episodes of epigastric distress, substernal arm or shoulder pain, or sleep disturbances due to GERD. There was also no evidence of anemia, weight loss, nausea, vomiting, hematemesis, or melena. The examiner noted the upper endoscopy results. He concluded that the Veteran’s GERD with hiatal hernia did not have any impact on his occupational functioning. In a June 2014 statement, the Veteran indicated that he had dysphagia, epigastric pain and regurgitation in April 2013 after an endoscopy; he stated that he currently took Dexilant with mild relief, although he still had occasional breakthrough symptoms. He reported that he had increased regurgitation and dysphagia at night, and trouble sleeping at night, which cased excess tiredness during the day. Finally, the Veteran underwent a VA examination of his GERD and hiatal hernia in April 2016, in which it was noted that he took Dexilant daily and Tums and Maalox as needed. The examiner noted that the Veteran’s condition was the same, and noted that he reported heartburn and regurgitation that was relatively controlled by medication; he also had symptoms when he slept on his back. On examination, the Veteran was noted to have pyrosis and regurgitation; there was no evidence of persistently recurrent or infrequent episodes of epigastric distress, dysphagia, reflux, substernal arm or shoulder pain, or sleep disturbances due to GERD. There was also no evidence of anemia, material weight loss, nausea, vomiting, hematemesis, or melena. The examiner did not find that the Veteran’s GERD was productive of either a considerable or severe impairment of his health. He concluded that the Veteran’s GERD with hiatal hernia did not have any impact on his occupational functioning. Based on the foregoing evidence, the Board finds that a 10 percent evaluation, but no higher, is warranted throughout the appeal period. Although the April 2012 examiner noted that the Veteran had only reflux at that time, the Veteran reported having occasional heartburn with self-medication of symptoms. The Board finds that the Veteran’s GERD with hiatal hernia is more closely approximate to having symptoms of less severity than the criteria for a 30 percent in this case, including reflux and pyrosis. Throughout the appeal period, however, the Veteran is not shown to have persistently recurrent epigastric distress or substernal arm or shoulder pain, nor is his GERD shown by any medical professional to be a considerable impairment of health. Consequently, although a 10 percent evaluation for his GERD with hiatal hernia is warranted throughout the appeal period, an evaluation in excess of 10 percent is not warranted in this case and the Veteran’s claim for an evaluation higher than 10 percent is denied based on the evidence of record at this time. See 38 C.F.R. §§ 4.7, 4.114, Diagnostic Code 7346. In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Earlier Effective Date for Service Connection for Esophageal Stricture Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. However, if a claim of service connection for a disability is received within one year of separation from service, then the day following separation from service or date entitlement arose; otherwise, date of receipt of claim, or date entitlement arose, whichever is later. See 38 C.F.R. § 3.400(b)(2). After a review of the Veteran’s service treatment records, although the Veteran was diagnosed with and treated with GERD during military service, an esophageal stricture was not noted at any time during military service. The Board reflects that the Veteran initially filed a claim of service connection for esophageal stricture April 19, 2013, which is within one year of separation from active service. The first instance of any finding of an esophageal structure was in a March 27, 2013 private treatment record; the Veteran was referred for a private endoscopy at that time, which was performed on April 12, 2013, and confirmed the stricture diagnosis. Although the Veteran filed his claim for service connection within one year of military service, the Board reflects that an esophageal stricture is not shown during military service and is also not a chronic disease which is presumed related to military service if shown within one year of military service under 38 C.F.R. § 3.309(a). However, it is clear that the esophageal stricture was merely confirmed March 27, 2013. Thus, August 1, 2012 is the correct date of award of service connection. REASONS FOR REMAND Based on the Board’s award of an earlier effective date award for esophageal stricture, it would be premature for the Board to address the initial evaluation of that disability, as the AOJ has not assigned an initial evaluation for that period in the first instance at this time. Accordingly, in the interests of due process, a remand is necessary in order for the AOJ to implement the Board’s award of benefits in this case and assign an initial evaluation in the first instance. The matters are REMANDED for the following action: Following implementation of the Board’s award of benefits in this case and assignment of an initial evaluation for the Veteran’s esophageal stricture related to that award of benefits, the AOJ should review the claims file and readjudicate the Veteran’s claim for increased initial evaluation for esophageal stricture. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto before the case is returned to the Board. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel