Citation Nr: 18152608 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 16-31 736 DATE: November 23, 2018 ORDER Entitlement to service connection for mild degenerative disc disease at L2-L3 and L3-L4 levels, is granted. Entitlement to service connection for a left knee condition is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a bilateral foot condition, to include plantar fasciitis, is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for depression, to include as secondary to tinnitus or pseudofolliculitis barbae (PFB), is granted. Entitlement to service connection for sleep apnea is granted. Entitlement to service connection for headaches, to include as secondary to tinnitus or sleep apnea, is granted. Entitlement to service connection for mild degenerative joint disease (DJD), right ankle, is denied. Entitlement to service connection for tinea cruris is denied. Entitlement to an initial compensable evaluation for tinea pedis and calluses, bilateral feet, is denied. Entitlement to an initial compensable evaluation for PFB prior to June 25, 2012, is denied. Entitlement to a disability evaluation in excess of 30 percent for PFB from June 25, 2012, is denied. Entitlement to an effective date prior to August 19, 2011, for the grant of service connection for PFB is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his mild degenerative disc disease at L2-L3 and L3-L4 levels is at least as likely as not related to his service. 2. The preponderance of the evidence is against finding that the Veteran’s left knee condition began during active service, or is otherwise related to an in-service injury, event, or disease. 3. The preponderance of the evidence is against finding that the Veteran’s right knee condition began during active service, or is otherwise related to an in-service injury, event, or disease. 4. The Veteran’s bilateral foot condition was noted at entry to service and the evidence does not support a finding that it was aggravated by service. 5. The Veteran does not have a bilateral hearing loss disability for VA purposes. 6. The Veteran’s depression is related to his service. 7. Resolving reasonable doubt in the Veteran’s favor, his sleep apnea is at least as likely as not related to his service. 8. The Veteran’s headaches are proximately due to his service-connected tinnitus and sleep apnea. 9. The preponderance of the evidence is against finding that the Veteran has mild DJD, right ankle, due to his service. 10. The preponderance of the evidence is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of tinea cruris. 11. The Veteran’s tinea pedis covers less than 5 percent of the entire body, less than 5 percent of the exposed area affected, and required no more than topical therapy during the past 12-month period. 12. For the period prior to June 25, 2012, the Veteran’s PFB covered less than 5 percent of the entire body, less than 5 percent of the exposed area affected, and required no more than topical therapy during the past 12-month period. 13. From June 25, 2012, the Veteran’s PFB covers 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected. 14. The Veteran’s claim for entitlement to service connection for PFB was received by the RO on August 19, 2011. CONCLUSIONS OF LAW 1. The criteria for service connection for mild degenerative disc disease at L2-L3 and L3-L4 levels are met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a left knee condition are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a right knee condition are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.306. 5. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.385. 6. The criteria for service connection for depression are met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). 7. The criteria for service connection for sleep apnea are met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for headaches are met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). 9. The criteria for service connection for mild DJD, right ankle, are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for service connection for tinea cruris are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 11. The criteria for an initial compensable rating for tinea pedis are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Code (DC) 5284-7813. 12. The criteria for an initial compensable rating prior to June 25, 2012, for PFB are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.118, DC 7813-7806. 13. The criteria for a rating in excess of 30 percent from June 25, 2012, for PFB are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.118, DC 7813-7806. 14. The criteria for an effective date prior to August 19, 2011, for the award of service connection for PFB are not met. 38 U.S.C. §§ 5107, 5110, 5121; 38 C.F.R. §§ 3.102, 3.151, 3.155, 3.160, 3.400, 3.816(c), 3.1000. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1979 to February 1987. The issues of entitlement to service connection for mild degenerative disc disease at L2-L3 and L3-L4 levels and depression come before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a notice of disagreement (NOD) in January 2015. The issues of entitlement to service connection for a left knee condition, right knee condition, bilateral foot condition, and bilateral hearing loss come before the Board from a March 2012 rating decision of a VA RO. The Veteran filed another claim for these conditions in January 2013, which the Board construes as a NOD. The issue of entitlement to service connection for headaches comes before the Board from an April 2015 rating decision of a VA RO. The Veteran filed a NOD in December 2015. The issue of entitlement to service connection for mild DJD, right ankle, comes before the Board from a March 2012 rating decision of a VA RO. The Veteran filed a NOD in June 2012. The issues of entitlement to service connection for sleep apnea and tinea cruris come before the Board from an October 2012 rating decision of a VA RO. The Veteran filed a NOD in August 2013. The issue of entitlement to an initial compensable rating for the Veteran’s service connected tinea pedis comes before the Board from an October 2012 VA RO decision granting service connection at a noncompensable rating. The Veteran filed a NOD in August 2013. For the above listed issues, the RO issued a statement of the case (SOC) in May 2016. The Veteran filed a VA Form-9 in June 2016 and elected not to appear before the Board for an optional hearing. The issues of entitlement to an initial compensable rating prior to June 25, 2012, and entitlement to a rating in excess of 30 percent thereafter for the Veteran’s service-connected PFB come before the Board from a VA RO decision in March 2012 which granted service connection for PFB as noncompensable, effective August 19, 2011. In a subsequent May 2016 RO decision, the disability rating was increased to 30 percent for the Veteran’s service-connected PFB, effective June 25, 2012. The Veteran filed a NOD in July 2016, disagreeing with the disability evaluation as well as the effective date for the grant of service connection for PFB. A SOC was issued in August 2016; the Veteran filed a VA Form-9 in September 2016 and elected not to appear before the Board for an optional hearing. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. 1110; 38 C.F.R. 3.303(a). Establishing service connection requires (1) evidence of a presently existing disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). If there is no evidence of a chronic disease during service or an applicable presumption period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing the second and/or third element of a service connection claim. Continuity of symptomatology after service may be established if a claimant can demonstrate (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013) (holding that continuity of symptomatology applied only to the diseases explicitly recognized in 38 U.S.C. § 1101 as “chronic”). Service connection may also be established on a secondary basis for: (1) a disability that is proximately due to or the result of a service-connected disease or injury; or, (2) any increase in the severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease or injury. 38 C.F.R. §§3.310 (a)-(b); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993) (explaining 38 C.F.R. §3.310 (a)); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (explaining 38 C.F.R. §3.310 (b)). In order to establish service connection for a disability on a secondary basis, there must be (1) medical evidence a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection, or link between, the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not prove or disprove the claim satisfactorily. It is a substantial doubt and one within range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. §3.102. While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on behalf of the Veteran. Gonzalez v. West, 218 F. 3d 1378 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). 1. Entitlement to service connection for mild degenerative disc disease at L2-L3 and L3-L4 levels The Veteran contends that he suffers from mild degenerative disc disease at L2-L3 and L3-L4 levels as a result of his service. The Board concludes that the Veteran has a current diagnosis of degenerative arthritis of the spine that is related to his 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). A December 2013 VA back conditions examination shows that the Veteran has a current diagnosis of degenerative arthritis of the spine. Additionally, a June 2016 private physician opined that it is as likely as not that the Veteran’s back issues began in service and have continued uninterrupted to the present. The private physician based his conclusion on the Veteran’s reports that he served in tanks and slept on hard surfaces in service. Lay statements from the Veteran’s friend noting the Veteran entering the service without any issues and coming home with severe back pain were also considered by the physician. The Board finds that with the resolution of reasonable doubt in favor of the Veteran, he is entitled to service connection for mild degenerative disc disease at L2-L3 and L3-L4 levels. The Board finds that the private opinion provided in June 2016 establishing a continuity of symptomatology for the Veteran’s back condition since his time in service was supported by the evidence of record. Although the Veteran’s medical record includes a December 2013VA opinion noting that it would be mere speculation to state whether the Veteran’s current back problem was incurred in service, the Board finds that the Veteran has put this issue in equipoise. Resolving all reasonable doubt in the Veteran’s favor, entitlement to service connection for mild degenerative disc disease at L2-L3 and L3-L4 levels is warranted here. 2. Entitlement to service connection for a left and right knee condition The Veteran contends that he suffers from a left and right knee condition as a result of his service. The Veteran’s service treatment records are silent for any signs or symptoms of a knee condition. Specifically, the Veteran’s May 1979 enlistment examination and February 1985 periodic examination both contain “normal” results for “lower extremities.” The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of mild osteoarthritis in his knees, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 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), (d). As noted above, the Veteran’s service treatment records are silent for any signs or symptoms of a left or right knee disability. Additionally, there is no medical evidence in the record that otherwise links the Veteran’s left or right knee conditions to service, or that establishes that either of the conditions were manifested within the first post-service year. Based on the evidence of record, the Board concludes that entitlement to service connection for a left knee condition and a right knee condition cannot be awarded. The left and right knee conditions have not been related directly to service, nor were they present to a compensable degree within one year of separation. 3. Entitlement to service connection for a bilateral foot condition, to include plantar fasciitis The Veteran contends that his bilateral foot condition, to include plantar fasciitis, is attributable to his service. The Veteran’s service treatment records show that upon entry to active duty in May 1979, he was noted to have pes planus, mild, asymptomatic. In November 1979, the Veteran complained of pain in the bottom of his feet and was diagnosed with callouses and athletes foot. The Veteran’s post-service treatment records show that he was provided a VA foot examination in April 2012. The VA examiner diagnosed the Veteran with bilateral pes planus. The Veteran reported that he had chronic pain in both feet that started 5-10 years ago. The examiner noted no other foot conditions. The examiner opined that the Veteran’s bilateral pes planus, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. She added that she was not able to identify any service treatment records documenting the evaluation/management for complaints related to flatfoot condition and there is no history of injury to the feet in service. The examiner noted that the Veteran reported symptoms beginning 5-10 years ago, which is many years after the Veteran separated from the military. She added that his morbid obesity is what aggravates his pes planus condition. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306 (b). Accordingly, service connection for a bilateral foot condition, to include plantar fasciitis, is not warranted, as the condition of pes planus was noted at entry into service and was not shown to be aggravated by service. Moreover, the weight of the competent medical opinion is that that the current bilateral foot condition is not attributable to the Veteran’s service. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz, 274 F.3d at 1364; Gilbert, 1 Vet. App. at 55-57; 38 C.F.R. § 3.102. Regrettably, for these reasons, the claim is denied. 4. Entitlement to service connection for bilateral hearing loss The Veteran contends that he suffers from bilateral hearing loss as a result of his service. The Veteran’s service treatment records are silent for any signs or symptoms of bilateral hearing loss. Specifically, the Veteran’s May 1979 enlistment examination and February 1985 periodic examination both indicate “normal” results for “ears-general.” The Veteran’s enlistment examination in May 1979 included audiometric testing revealing the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 10 10 LEFT 10 10 15 10 10 An August 1982 audiological examination revealed the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 15 10 10 LEFT 5 15 15 5 10 A September 1983 audiological examination revealed the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 20 10 20 LEFT 0 10 15 10 20 A January 1985 audiological examination revealed the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 20 10 30 LEFT 10 15 20 10 15 An October 1986 audiological examination revealed the following: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 20 20 25 LEFT 10 15 20 10 15 The Veteran’s post-service treatment records include a VA hearing loss examination from November 2011 which produced the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 20 20 20 LEFT 15 20 20 20 20 The Veteran’s speech recognition scores, using the Maryland CNC Test, were 94 percent in the right ear and 96 percent in the left ear. The VA examiner diagnosed the Veteran with sensorineural hearing loss bilaterally, noting that the Veteran may have hearing loss at a level that is not considered to be a disability for VA purposes. The examiner opined that the Veteran’s bilateral hearing loss was at least as likely as not caused by his service. The Veteran was most recently provided a VA hearing loss examination in January 2014 where pure tone testing yielded inconsistent responses and could not be tested. The VA examiner noted that the DPOAEs were bilaterally consistent with normal outer hair cell function up to 4000 Hz. The examiner noted bilateral sensorineural hearing loss, adding that the Veteran may have hearing loss at a level that is not considered to be a disability for VA purposes. The examiner opined that the Veteran’s bilateral hearing loss was not at least as likely as not related to service because the Veteran reported civilian noise exposure as a heavy equipment operator. The examiner noted that the Veteran was very inconsistent with voluntary responses as compared to involuntary responses, ipsilateral reflexes, contralateral reflexes, and distortion product otoacoustic emissions, which are consistent with the last audiogram in November 2011. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Based on the November 2011 and January 2014 VA examinations as discussed above, the Board finds that service connection is not warranted for bilateral hearing loss. A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Shedden, Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, as just discussed, there is no clinical evidence of bilateral hearing loss for VA purposes at any time during the pendency of this appeal. Accordingly, service connection for bilateral hearing loss must be denied. The preponderance of the evidence is against the claims and the benefit of the doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for depression, to include as secondary to tinnitus or PFB The Veteran contends that he has depression as a result of his service. The Board concludes that the Veteran has a current diagnosis of major depressive disorder (MDD), recurrent, moderate, that is related to his 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). A June 2016 private mental disorders examination show that the Veteran has a current diagnosis of MDD and the private examiner opined that the Veteran’s MDD more likely than not began in service, has continued uninterrupted to the present and is aggravated by his service-connected tinnitus and PFB. The private examiner referenced statements from friends and family endorsing that the Veteran’s MDD symptoms are a result of his military service and have exacerbated since military separation. The examiner also referenced literature detailing the emergence of mental health symptoms within active duty servicemen. He also referenced literature detailing a connection between medical issues, specifically studies that confirm the existence of neural circuits that are activated in both depression and tinnitus. He added that individuals with medical issues like MDD become disabled due to the holistic effect of medical and psychiatric disturbances, just like the tinnitus, PFB, and secondary MDD endured by the Veteran. Accordingly, based on the June 2016 private medical opinion linking the Veteran’s MDD to his service as well as his tinnitus and PFB, the Board finds that service connection for depression is warranted. See 38 C.F.R. §3.309(e). 6. Entitlement to service connection for sleep apnea The Veteran contends that he suffers from sleep apnea that is related to symptoms he had while in service. The Board concludes that the Veteran has a current diagnosis of sleep apnea that is related to his 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). An October 2012 VA sleep apnea examination shows that the Veteran has a current diagnosis of obstructive sleep apnea (OSA). Additionally, a June 2016 private physician opined that the Veteran’s OSA is related to his military service. The private physician provided the rationale that the Veteran’s sleep apnea did not start the day it was diagnosed. Almost everyone who has sleep apnea has the condition for quite some time before it is accurately diagnosed. After a review of the medical records including lay statements from the Veteran’s family members, the private examiner stated that it is as likely as not that the Veteran did have sleep apnea in service and it has continued uninterrupted to the present. He was noted in service to have shortness of breath while sleeping, and statements confirm symptoms of sleep apnea that began in service. The Board finds that with the resolution of reasonable doubt in favor of the Veteran, he is entitled to service connection for sleep apnea. The Board finds that the private opinion provided in June 2016 establishing a link between the Veteran’s sleep apnea and his service was supported by an adequate rationale. Although the Veteran’s medical record includes an October 2012 VA medical opinion noting that it would be mere speculation to state whether the Veteran’s current OSA was caused or aggravated to any degree by the documented episodes of shortness of breath while sleeping during service or otherwise caused or aggravated to any degree by his military service or any exposures therein, the Board finds that the Veteran has put this issue in equipoise. Resolving all reasonable doubt in the Veteran’s favor, entitlement to service connection for sleep apnea is warranted here. 7. Entitlement to service connection for headaches, to include as secondary to tinnitus or sleep apnea The Veteran contends that he has headaches as a result of his service. The Board concludes that the Veteran has a current diagnosis of tension headaches that is secondary to his service-connected tinnitus and sleep apnea. 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), 3.310(a). A June 2016 private headaches examination shows that the Veteran has a current diagnosis of tension headaches and the private examiner opined that the Veteran’s headaches are as likely as not caused by his service-connected tinnitus as well as sleep apnea. The headaches started when he was in service and have been a continuous problem ever since. The private examiner noted that it is known that damage to the auditory system resulting in tinnitus also causes headaches. Another contributing factor to the cause of the Veteran’s headaches is sleep apnea because the Veteran is not getting the proper full night sleep, aggravating his headaches. In conclusion, the examiner noted that because the Veteran is constantly straining to hear due to his tinnitus and is not getting the proper amount of sleep due to his sleep apnea, these conditions are causing his headaches. Accordingly, based on the June 2016 private medical opinion linking the Veteran’s headaches to his service-connected tinnitus and sleep apnea, the Board finds that service connection for headaches is warranted. See 38 C.F.R. §3.309(e). 8. Entitlement to service connection for mild DJD, right ankle The Veteran contends that he suffers from mild DJD in his right ankle as a result of his service. The Veteran’s service treatment records show that in January 1985 he twisted his right ankle walking on ice. The pain was localized and was more noticeable when pressure was exerted on the right ankle. At a February 1985 periodic examination, the Veteran’s “feet” and “lower extremities” were marked as “normal.” The Veteran’s post-service treatment records include a November 2011 VA ankle conditions examination where the Veteran reported intermittent pain in the right ankle. He reported that he was a tanker, which required bending knees and ankles, which is what he thinks caused his condition. The VA examiner provided a diagnosis of mild DJD of the right ankle and opined that it was less likely than not incurred in or caused by his service. The reported injuries during active military service would not be expected to result in a chronic right ankle condition or residuals. The service treatment records show history of twisted right ankle, pain in the feet after playing sports, and no history of significant acute trauma or fracture. In a March 2014 VA ankle conditions examination, a diagnosis for right ankle degenerative disease was noted by the VA examiner. The examiner opined that the right ankle degenerative disease is not caused by his right ankle sprain in the military. The examiner added that the right ankle condition is most likely caused from morbid obesity and not from the military. Upon review of the foregoing evidence, the Board concludes that the Veteran is not entitled to service connection for a right ankle condition. As an initial matter, the Board notes that the Veteran has been diagnosed with mild DJD in his right ankle. As such, the Board finds that the current disability element is established. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Thus, the issue turns upon whether there is evidence of an event, injury, or disease in service. If so, evidence of a nexus between the claimed in-service disease or injury and the present disability is required for the establishment of service connection. The Board finds the November 2011 and March 2014 VA medical opinions to be highly probative in this case. The VA examiners opined that the Veteran’s right ankle condition is less likely than not related to his service. The examiners thoroughly reviewed the Veteran’s record and provided adequate rationales to their conclusions. While the Board is sympathetic to the Veteran’s claim, considering all the relevant evidence of record, the preponderance of the evidence is against a finding of an etiological relationship between the Veteran’s right ankle condition and his military service. Accordingly, the Board finds that the claim of entitlement to service connection for mild DJD, right ankle, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. §5107 (b); 38 C.F.R. §3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 9. Entitlement to service connection for tinea cruris The Veteran contends that he suffers from tinea cruris as a result of his service. The Veteran’s service treatment records are silent for any signs or symptoms of tinea cruris. Specifically, the Veteran’s May 1979 enlistment examination and February 1985 periodic examination both indicate “normal” results for “G-U system,” and “skin lymphatics.” The Veteran’s post service treatment records do not contain any treatment for or diagnosis of tinea cruris. See November 2011 and October 2012 VA skin disease examinations. Upon review of the foregoing evidence, the Board concludes that the Veteran is not entitled to service connection for tinea cruris. The Board finds that the Veteran does not have a presently existing disability diagnosed as tinea cruris and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). While the Veteran believes he has a current disability diagnosed as tinea cruris, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board assigns no probative weight to the Veteran’s assertions. Because the preponderance of the evidence is against the claim, service connection for tinea cruris is denied. Increased Ratings In general, disability evaluations are assigned by applying a schedule of ratings that represent, as far as can be determined, the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria that must be met for specific ratings. The regulations require that, in evaluating a given disability, the disability be viewed in relation to its whole recorded history. 38 C.F.R. § 4.2; see also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. See Francisco v. Brown, 7 Vet. App. 55 (1994). In Hart v. Mansfield, 21 Vet. App. 505 (2007), the Court held that “staged” ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The evidence of a factually ascertainable increase warranting a staged increased rating need not itself demonstrate that the scheduler criteria for an increased rating are met if additional later evidence otherwise satisfies the scheduler criteria. See Swain v. McDonald, 27 Vet. App. 219, 224-25 (2015). The criteria for rating skin disabilities have changed during the period covered by this appeal, effective August 13, 2018. See 83 Fed. Reg. 32,592 (July 13, 2018). When a law or regulation changes during the pendency of a Veteran’s appeal, the version most favorable to the Veteran applies, absent congressional intent to the contrary. The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made. See 38 U.S.C. § 5110 (g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Thus, the Veteran is entitled to application of the criteria that are most favorable to his claim, except that an award based on the amended regulations may not be made effective before the effective date of the change. 10. Entitlement to an initial compensable rating for tinea pedis and calluses, bilateral feet The Veteran contends that his tinea pedis is more severe than what is represented by a noncompensable rating. The Veteran’s service-connected tinea pedis is currently evaluated with a noncompensable disability rating, effective June 25, 2012, under 38 C.F.R. § 4.118, DC 5284-7813. See 38 C.F.R. § 4.118, DC 5284-7813. 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. The additional code is shown after the hyphen. 38 C.F.R. § 4.27. Under DC 7813, dermatophytosis can 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. As in effect from August 30, 2002, DC 7806 provides for a noncompensable evaluation when dermatitis or eczema involves less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and no more than topical therapy has been required during the past 12-month period. A 10 percent rating is warranted when affecting at least 5 but less than 20 percent of the entire body, or at least 5 percent but less than 20 percent of exposed areas; or where 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 or 20 to 40 percent of exposed areas are affected; or where 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 was warranted when more than 40 percent of the entire body or more than 40 percent of exposed areas are affected; or where constant or near constant systemic therapy such as corticosteroids or other immunosuppressive drugs are required during the past 12-month period. The Federal Circuit addressed the meaning of “systemic” and “topical” for rating skin disabilities under the regulatory criteria prior to August 31, 2018. See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). For these purposes, systemic therapy means treatment pertaining to or affecting the body as a whole, whereas topical therapy means treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. Id. at 1355. The Federal Circuit acknowledged that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, but the Court emphasized that this possibility does not mean that all applications of topical corticosteroids amount to systemic therapy. Id. Rather, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the facts of each case. Id. at 1356. Effective August 31, 2018, VA regulations explicitly state that for the purposes of the skin disability ratings, “systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin.” 38 C.F.R. § 4.118 (a) (2018). Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to DCs 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118 (2018). Under this formula, a maximum 60 percent rating under this formula requires at least one of the following: (1) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (2) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Id. A 30 percent rating requires at least one of the following: (1) characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (2) systemic therapy such as those listed under the 60 percent criteria required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. Id. A 10 percent rating requires at least one of the following: (1) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (2) at least 5 percent, but less than 20 percent, of exposed areas affected; or (3) intermittent systemic therapy such as those listed under the 60 percent criteria required for a total duration of less than 6 weeks over the past 12-month period. Id. A noncompensable (0 percent) rating is assigned where there is no more than topical therapy required over the past 12-month period and at least one of the following: (1) characteristic lesions involving less than 5 percent of the entire body affected; or (2) characteristic lesions involving less than 5 percent of exposed areas affected. Id. The Veteran was provided with a VA skin diseases examination in October 2012 where he was diagnosed with tinea pedis and callouses of the bilateral feet. The skin condition did not cause scarring or disfigurement of the head, face, or neck. There were no benign or malignant neoplasms. There were no systemic manifestations due to any skin diseases. The Veteran was noted to have been treated with topical corticosteroids and antifungals for his feet on a constant/near constant basis. The Veteran did not have any debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. The VA examiner noted that the Veteran’s tinea pedis was 0 percent exposed and less than 5 percent total skin area was irritated with cracked painful skin between all toes of both feet with underlying erythematous base. The bilateral foot calluses were 0 percent exposed and less than 5 percent of total skin area with tender thickened cracked callouses involving heels and metatarsal pads especially 5th of both feet. Considering the medical evidence discussed above, the Board finds that at no point during the appellate period has the Veteran’s tinea pedis warranted a compensable rating. The Veteran’s treatment records do not show that at least 5 percent of the body was affected by his condition. In fact, the VA skin disease examination from October 2012 showed tinea pedis and foot calluses covering 0 percent of exposed skin and less than 5 percent of total body surface area. Additionally, the evidence of record does not show that the Veteran was provided with intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs. The October 2012 VA skin examination showed that the Veteran was treated with topical corticosteroids only. The topical corticosteroids were noted to be used for hyperkeratosis of the feet. They were not administered on a large scale, and there is no indication that they affected more than the feet. Thus, they do not constitute systemic therapy under the criteria prior to August 13, 2018. Additionally, under the rating criteria effective August 31, 2018, the Veteran is not warranted a compensable rating because less than 5 percent of total body surface area was affected and there is no evidence of intermittent systemic therapy. 38 C.F.R. § 4.118 (a). Therefore, this treatment only supports a 0 percent rating under the General Rating Formula for DC 7806. See 38 C.F.R. § 4.118, General Rating Formula for the Skin (2018). As the October 2012 VA examiner noted that there was no disfigurement of the head, face or neck, a rating under DC 7800 does not apply here. Additionally, there is nothing in the medical record to suggest that the Veteran has suffered from scarring resulting from his tinea pedis in order to rate him under DCs 7801, 7802, 7803, 7804, or 7805. Accordingly, the Board finds that the Veteran is not entitled to a compensable rating from August 19, 2011, to June 24, 2012, for his tinea pedis and calluses, bilateral feet. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 11. Entitlement to a compensable rating for PFB from August 19, 2011 to June 24, 2012 The Veteran contends that his PFB is more severe than what is represented by a noncompensable rating. The Veteran’s service-connected PFB is currently evaluated with a noncompensable disability rating from August 19, 2011, to June 24, 2012 under 38 C.F.R. § 4.118, DC 7813-7806. See 38 C.F.R. § 4.118, DC 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. The additional code is shown after the hyphen. 38 C.F.R. § 4.27. The Veteran was provided with a VA skin diseases examination in November 2011 where he was diagnosed with PFB. The Veteran reported that when he shaves he gets blisters. The skin condition did not cause scarring or disfigurement of the head, face, or neck. There were no benign or malignant neoplasms. There were no systemic manifestations due to any skin diseases. The Veteran was not treated with any oral or topical medications in the past 12 months. The Veteran did not have any debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. The VA examiner noted that the skin exam revealed very scattered, small papules in the neck area, affecting less than 5 percent of the exposed skin of face and neck. Considering the medical evidence discussed above, the Board finds that the Veteran’s PFB does not warrant a compensable rating for the period from August 19, 2011 to June 24, 2012. The November 2011 VA examination does not show that at least 5 percent of the body was affected by his condition. In fact, the November 2011 examination shows PFB affecting less than 5 percent of the exposed skin of face and neck. Additionally, the evidence of record does not show that the Veteran was provided with any oral or topical medications in the past 12 months. Thus, the Veteran’s PFB does not warrant a compensable rating under the criteria prior to August 13, 2018. Additionally, under the rating criteria effective August 31, 2018, the Veteran is not entitled to a compensable disability rating for his PFB as it affected less than 5 percent of the exposed skin of face and neck and there is no evidence of intermittent systemic therapy. 38 C.F.R. § 4.118 (a). As the November 2011 VA examiner noted that there was no disfigurement of the head, face or neck, a rating under DC 7800 does not apply here. Additionally, there is nothing in the medical record to suggest that the Veteran has suffered from scarring resulting from his PFB in order to rate him under DCs 7801, 7802, 7803, 7804, or 7805. Accordingly, the Board finds that the Veteran is not entitled to a compensable rating for his PFB from August 19, 2011, to June 24, 2012. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 12. Entitlement to a disability rating in excess of 30 percent for PFB from June 25, 2012 The Veteran contends that his PFB is more severe than what is represented by a 30 percent rating. The Veteran’s service-connected PFB is currently evaluated with a 30 percent disability rating from June 25, 2012, under 38 C.F.R. § 4.118, DC 7813-7806. See 38 C.F.R. § 4.118, DC 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. The additional code is shown after the hyphen. 38 C.F.R. § 4.27. The Veteran was provided with a VA skin conditions examination in October 2012 for his PFB. The skin condition did not cause scarring or disfigurement of the head, face, or neck. There were no benign or malignant neoplasms. There were no systemic manifestations due to any skin diseases. The Veteran was noted to have been treated with medicated shave cream for his PFB on a constant/near-constant basis. The Veteran did not have any debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. The VA examiner noted that the Veteran’s PFB was 10 percent of exposed skin of face and neck and less than 5 percent of total skin area with tender erythematous papules of bearded areas of face and neck with some minimal drainage. The Veteran was provided with another VA skin conditions examination in April 2013 for his PFB. The skin condition did not cause scarring or disfigurement of the head, face, or neck. There were no benign or malignant neoplasms. There were no systemic manifestations due to any skin diseases. The Veteran was not treated with oral or topical medications in the past 12 months. The Veteran did not have any debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. The VA examiner noted that the Veteran’s PFB lesions on the face and neck affected 20 percent of the exposed skin area. Considering the medical evidence discussed above, the Board finds that from June 25, 2012, the Veteran’s PFB is adequately compensated by a 30 percent rating. The Veteran’s treatment records do not show more than 40 percent of the entire body or more than 40 percent of exposed areas were affected to warrant a rating of 60 percent. Additionally, the evidence of record does not show that the Veteran was provided with intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs. The October 2012 VA skin examination showed that the Veteran was treated with topical medicated shave cream. The shave cream was not administered on a large scale, and there is no indication that it was used on anything more than the PFB on his face. Thus, it does not constitute systemic therapy under the criteria prior to August 13, 2018. Additionally, under the rating criteria effective August 31, 2018, the Veteran is not warranted a rating in excess of 30 percent because at most, only 20 percent of the exposed skin area was affected by PFB and there is no evidence of intermittent systemic therapy. 38 C.F.R. § 4.118 (a). Therefore, this treatment only supports a 30 percent rating under the General Rating Formula for DC 7806. See 38 C.F.R. § 4.118, General Rating Formula for the Skin (2018). As the October 2012 and April 2013 VA examiners noted that there was no disfigurement of the head, face or neck, a rating under DC 7800 does not apply here. Additionally, there is nothing in the medical record to suggest that the Veteran has suffered from scarring resulting from his PFB in order to rate him under DCs 7801, 7802, 7803, 7804, or 7805. Accordingly, the Board finds that the Veteran is not entitled to a rating in excess of 30 percent from June 25, 2012, for his PFB. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Effective Date In general, the effective date of an evaluation and award of 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. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. The amendments also, inter alia, eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155 (2016). The amended regulations, however, apply only to claims filed on or after March 24, 2015. Because this claim was initiated prior to that date, the former regulations apply. In some cases, a report of examination or hospitalization may be accepted as an informal claim for benefits. 38 C.F.R. § 3.157(b) (2014). The date of outpatient or hospital examination or date of admission to a VA hospital will be accepted as the date of receipt of a claim when such reports relate to examination or treatment of a disability for which service connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. 38 C.F.R. § 3.157(b) (2014). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. If the evidence for and against a claim is in equipoise, then the claim will be granted. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). The evidence below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show. The Veteran should not assume that the Board has overlooked pieces of evidence that are not specifically discussed herein. See Timberlake v. Gober 14 Vet. App. 122 (2000). The law requires only that the Board provide reasons for rejecting evidence favorable to the Veteran. 13. Entitlement to an effective date prior to August 19, 2011 for service-connected PFB The Veteran seeks an earlier effective date for the award of service connection for his PFB. The Veteran filed a claim for entitlement to service connection for PFB in August 2011. The Veteran was provided with a VA skin disease examination in November 2011 where the Veteran was diagnosed with PFB. As an initial matter, the Board notes that the Veteran did not file a claim within one year after separation from service. Therefore, he is not entitled to an effective date from the day following separation from military service. The Board has thoroughly reviewed the evidence of record to determine if the Veteran filed a claim, an informal claim, or expressed a written intent to file a claim for service connection for PFB. The Board notes that even if medical records related to PFB were associated with the claim prior to August 19, 2011, such records cannot constitute and informal claim under 38 C.F.R. § 3.155, because treatment records alone do not indicate an intent to apply for service connection benefits. 38 C.F.R. § 3.155(a). Although 38 C.F.R. § 3.157(a) provides for a report of examination or hospitalization by VA to be accepted as an informal claim for benefits (without any indication of intent to apply for benefits) in certain instances, none of these instances are applicable here. As previously mentioned, the mere mention of a condition in a medical record alone cannot be construed as a claim for service connection. See MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006). Based on the foregoing, the Board finds that the VA received a formal or informal claim for PFB on August 19, 2011. As previously noted, an effective date is assigned based on the date of the claim or the date entitlement arose, whichever is later. In the present case, the date of the claim on August 19, 2011, is later than the date entitlement arose. (Continued on next page) Accordingly, the Board concludes that August 19, 2011, is the proper effective date for the award of service connection for PFB and the claim for an earlier effective date must be denied. In reaching this conclusion, the benefit of the doubt doctrine was considered. However, as a preponderance of evidence is against the claim, this doctrine is not for application. See 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 38 U.S.C. § 5107(b). DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Morrad, Associate Counsel