Citation Nr: 18152385 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 17-57 120 DATE: November 21, 2018 ORDER A compensable rating for a rash in the groin area (tinea cruris) is denied. A maximum schedular rating of 50 percent for headaches is granted throughout the appeal period. REMANDED Service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. FINDINGS OF FACT 1. The Veteran’s rash does not affect at least five percent of the entire body or exposed areas; and does not require intermittent systemic therapy or other immunosuppressive drugs for a total duration of less than six weeks during the past 12-month period. 2. Resolving reasonable down the Veteran’s favor, his headaches are characterized by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for a rash in the groin area have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7813-7806. 2. The criteria for a maximum schedular rating of 50 percent for headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1971 to February 2001. Increased Rating Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. If two disability evaluations are potentially applicable, the higher evaluation 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. Reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 1. Rash The Veteran contends that his groin rash has worsened and warrants a compensable rating, and further points to the use of topical steroids for treatment purposes in furtherance of a compensable rating. The Veteran has a noncompensable rating for his rash under Diagnostic Code 7813-7806. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, Diagnostic Code 7813 (dermatophytosis, to include tinea cruris) instructs that based on the predominant disability, the condition is to be rated as one of the following: a disfigurement of the head, face, or neck, (Diagnostic Code 7800), scars (Diagnostic Codes 7802, 7803, 7804, and 7805), or dermatitis (Diagnostic Code 7806). 38 C.F.R. § 4.118, Diagnostic Code 7813. Under Diagnostic Code 7806 (dermatitis), a noncompensable rating is warranted when less than five percent of the entire body or less than five percent of exposed areas affected, and; no more than topical therapy was required during the past 12-month period. A 10 percent rating is warranted when at least 5 percent, but less than 20 percent of the entire body is affected; or at least 5 percent but less than 20 percent of exposed areas are affected; or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is warranted when 20 to 40 percent of the entire body is affected; 20 to 40 percent of exposed areas are affected; or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating is warranted when more than 40 percent of the entire body or more than 40 percent of exposed areas are affected; or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs are required during the past 12-month period. The Board finds the record does not support that the Veteran’s rash covered at least five percent of his body or that he was prescribed systemic corticosteroids or other immunosuppressive medications for his rash. During the January 2016 VA skin examination, the Veteran reported that his rash had worsened. The examiner found that the rash, which was described as a slightly erythematous and scaly lesion on the groin, covered less than five percent of the Veteran’s unexposed body area. It was reported that topical corticosteroids had been prescribed for less than six weeks in the past 12-month period, but were not at constant or near constant use. The Board finds that the examination findings are based on accurate facts and supported by medical treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Reonal v. Brown, 5 Vet. App. 458 (1993). Moreover, VA treatment records are not indicative that the Veteran’s rash warrants a compensable rating. As a result, the evidence as a whole does not more closely approximate the criteria for a compensable rating at any time during the period on appeal. There is no indication that at any time during the appellate period the Veteran’s rash affected a percentage of his body, or required treatment as contemplated in the higher ratings under Diagnostic Code 7806. The Board can find no basis for a higher rating, including under different diagnostic codes, as the other diagnostic codes are not applicable. The Board has considered the Veteran’s lay testimony, and he is competent to report the observable symptoms of his rash. However, whether a disability meets the schedular criteria for the assignment of a higher rating is a factual determination by the Board based on the Veteran’s complaints coupled with the medical evidence of record. The Veteran’s complaints of worsening were adequately considered by the January 2016 VA examiner, as well as the use of topical cream. However, the manifestations of his rash and course of treatment are adequately contemplated by the diagnostic criteria and are afforded a noncompensable rating under the governing regulations as set forth above. Although the Veteran believes that he meets the criteria for a higher rating, his complaints along with the medical findings do not meet the schedular requirements for a higher rating at any time during the appeal period. Moreover, to the extent that the Veteran argues his symptomatology is more severe than that shown at the VA skin examination, his statements must be weighed against the other evidence of record, and the specific examination findings of trained health care professionals are of greater probative weight than his lay assertions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, the preponderance of the evidence is against assignment of a compensable rating for the Veteran’s service-connected rash, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Headaches The Veteran contends that his headaches are worse than currently rated. As per the August 2016 notice of disagreement, the Veteran seeks the maximum schedular rating for headaches. During the pendency of this appeal, the Veteran’s headaches were initially rated as noncompensable under Diagnostic Code 8045-8100 (reflecting a separately evaluated residual of the Veteran’s service-connected residuals of head injury, see 38 C.F.R. § 4.124a, Diagnostic Code 8045 and February 2016 rating decision); and later on rated as noncompensable under Diagnostic Code 8100. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27; see also 38 C.F.R. § 4.124a, Diagnostic Code 8045 (residuals of traumatic brain injury). Under Diagnostic Code 8100, a noncompensable rating for headaches is warranted with less frequent attacks. A 10 percent rating is warranted for headaches with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A maximum rating of 50 percent is awarded when headaches are characterized by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The phrase “characteristic prostrating attacks” means migraine attacks that typically produce powerlessness or a lack of vitality. Johnson v. Wilkie, No. 16-3808, slip op. at 9 (Vet. App. Sept. 19, 2018). In other words, the term “prostrating” takes on its plain meaning of “lacking in vitality or will: powerless to rise: laid low.” Id. (citation omitted). Moreover, lay evidence may be probative of the frequency, prolongation, and severity of headaches. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). The Board resolves reasonable doubt in the Veteran’s favor and finds that the Veteran’s headaches are best approximated by the findings from the April 2018 VA Headache Examination. See 38 C.F.R. § 4.3. The examiner found that the Veteran had characteristic prostrating attacks of headache pain once every month, and that these attacks were productive of severe economic inadaptability. He ultimately concluded that the Veteran was unable to work due to his headaches. His medical opinion was based on an in-person interview and consideration of the claims file. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Reonal v. Brown, 5 Vet. App. 458 (1993). Additionally, an April 2018 VA TBI Residual Examination found resulting occupational impairment due to the Veteran’s headaches consistent with that of the VA Headache Examination. Notably and highly probative to the instant decision, these examinations were conducted by different examiners. Furthermore, the Board has considered the evidence in the record regarding the Veteran’s lay reports of his headaches. In sum, the Board resolves reasonable doubt and finds that a maximum schedular rating of 50 percent is warranted throughout the appeal period; this satisfies the Veteran’s appeal. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 3. Hypertension The Veteran contends that his hypertension started during military service and is aggravated by his service-connected PTSD. The Veteran submitted a timely notice of disagreement to the February 2016 rating decision, but a statement of the case has not yet been issued. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matter is REMANDED for the following action: 1. Send the Veteran and his representative a statement of the case that addresses service connection for hypertension, to include as secondary to service-connected PTSD. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issue should be returned to the Board for further appellate consideration. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Dellarco, Associate Counsel