Citation Nr: 18153554 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 16-24 507A DATE: November 28, 2018 ORDER Entitlement to an annual VA clothing allowance for the year 2015 due to the use of diabetic shoes is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of diabetic custom insoles / orthotics is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a skin medication (hydrocortisone cream) is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a skin medication (Urea cream) is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a skin medication (terbinafine HCL cream) is granted. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a skin medication (triamcinolone acetonide cream) is granted. FINDINGS OF FACT 1. The Veteran is service-connected for the following disabilities relevant to the present clothing allowance appeal: type II diabetes mellitus (20 percent disabling); peripheral neuropathy of the left lower extremity (20 percent disabling); peripheral neuropathy of the right lower extremity (20 percent disabling); eczema (10 percent disabling); and hemorrhoids (0 percent disabling). The Veteran is also service-connected for various disabilities not relevant to the present clothing allowance appeal. 2. The Veteran does not have loss or loss of use of a hand or foot due to any of his service-connected disabilities. 3. The Veteran’s shirts and pants qualify as distinct items of “clothing” or “outergarments” that can be worn or torn by a qualifying appliance or device or irreparably damaged or stained by skin creams. 4. The Veteran’s diabetic shoes and diabetic custom insoles / orthotics are items found not to produce wear and tear on “clothing” according to the Veterans Health Administration (VHA) Handbook 1173.15 and according to a designee of the Under Secretary for Health. 5. Neither shoes nor socks are classified as articles of “clothing” that can be damaged by wear and tear or by stains for purposes of a VA clothing allowance. 6. The Veteran’s underwear does not qualify as an “outergarment” that can be irreparably damaged or stained by skin creams. Underwear is not the type of clothing for which a clothing allowance is permitted. 7. Although one of the Veteran’s skin medications (hydrocortisone cream) is prescribed for his service-connected hemorrhoids, the weight of the evidence does not show that the hydrocortisone cream results in irreparable damage (staining) to his outergarments such as shirts or pants. 8. Although one of the Veteran’s skin medications (Urea cream) is prescribed for his service-connected eczema, the weight of the evidence does not show that the Urea cream results in irreparable damage (staining) to his outergarments such as shirts or pants. 9. Two skin medications (terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream) are prescribed by VA physicians for the treatment of the Veteran’s service-connected eczema. 10. There is an approximate balance of favorable and unfavorable evidence as to whether two of the Veteran’s VA-prescribed skin medications (terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream) result in irreparable damage (staining) to distinct outergarments such as his pants and shirts. CONCLUSIONS OF LAW 1. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of diabetic shoes. 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017); VHA Handbook 1173.15 paragraphs 2(b), 8(b) (May 14, 2015). 2. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of diabetic custom insoles / orthotics. 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017); VHA Handbook 1173.15 paragraphs 2(b), 8(b) (May 14, 2015). 3. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of a skin medication (hydrocortisone cream). 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017). 4. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of a skin medication (Urea cream). 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017). 5. Resolving all reasonable doubt in his favor, the criteria are met for an annual VA clothing allowance for the year 2015 due to use of a skin medication (terbinafine HCL cream (Lamisil)). 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017). 6. Resolving all reasonable doubt in his favor, the criteria are met for an annual VA clothing allowance for the year 2015 due to use of a skin medication (triamcinolone acetonide cream). 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service in the United States Army from June 1969 to December 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 decision issued by the Prosthetics & Sensory Aids Service (PSAS) of the Department of Veterans Affairs (VA) Medical Center (VAMC) in North Little Rock, Arkansas. This appeal was processed using both a paper-based claims file and an electronic Veterans Benefits Management System (VBMS). I. VA’s Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA’s duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). The Board is granting in full two of the VA clothing allowances that are on appeal – for terbinafine HCL cream and for triamcinolone acetonide cream. Moreover, neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist for the other clothing allowance issues being denied. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). In addition, a review of the Veteran and his representative’s submissions reflects that the Veteran was aware of the various requirements for showing entitlement to an annual clothing allowance. See e.g., Short Bear v. Nicholson, 19 Vet. App. 341, 343-45 (2005). II. Clothing Allowance for Appliances A veteran who has a service-connected disability, or a disability compensable under 38 U.S.C. § 1151 as if it were service-connected, is entitled, upon application therefore, to an annual clothing allowance as specified under 38 U.S.C. § 1162 and 38 C.F.R. § 3.810. One annual clothing allowance per year is payable in a lump sum, when the following eligibility criteria are satisfied: (1) A VA examination or examination report from a private physician as specified in 38 C.F.R. § 3.326(c) discloses that the veteran wears or uses certain prosthetic or orthopedic appliances which tend to wear or tear clothing (including a wheelchair) because of such service-connected disability or disabilities and such service-connected disability is the loss or loss of use of a hand or foot compensable at a rate specified in 38 C.F.R. § 3.350(a), (b), (c), (d), or (f); or (2) The Undersecretary for Health or a designee certifies that, because of such service-connected disability or disabilities, a prosthetic or orthopedic appliance is worn or used which tends to wear or tear the veteran’s clothing, or that because of the use of a physician-prescribed medication for a skin condition that is due to the service-connected disability or disabilities, irreparable damage is done to the Veteran’s outer garments. 38 U.S.C. § 1162 (2012); 38 C.F.R. § 3.810(a) (2017) (emphasis added). Effective August 1, 1972, the initial lump-sum clothing allowance is due and payable for Veterans meeting the eligibility requirements of paragraph (a) of this section as of that date. Subsequent annual payments for those meeting the eligibility requirements of paragraph (a) of this section will become due on the anniversary date thereafter, both as to initial claims and recurring payments under previously-established entitlement. 38 C.F.R. § 3.810(b). Prosthetic / orthopedic appliances are defined as aids, parts or accessories required to replace, support, or substitute for impaired or missing anatomical parts of the body. See VHA Handbook 1173.15 paragraph 2(a) (May 14, 2015). An outergarment is defined as a type of garment worn over other garment (e.g., shirt, blouse, pants, skirt, coat, jacket, blazer). See VHA Handbook 1173.15 paragraph 2(b). In determining whether a clothing allowance is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). At the outset, the Veteran is service-connected for the following disabilities relevant to the present clothing allowance appeal: type II diabetes mellitus (20 percent disabling); peripheral neuropathy of the left lower extremity (20 percent disabling); peripheral neuropathy of the right lower extremity (20 percent disabling); eczema (10 percent disabling); and hemorrhoids (0 percent disabling). The Veteran is also service-connected for various disabilities not relevant to the present clothing allowance appeal. The Veteran has a combined 100 percent schedular rating for his service-connected disabilities, effective March 31, 2000. And due to the extreme severity of his service-connected disabilities, the Veteran is in receipt of a permanent and total (P&T) rating for his service-connected disabilities, effective March 31, 2000. The Veteran has claimed entitlement to VA clothing allowances for the year 2015 because his service-connected type II diabetes mellitus with peripheral neuropathy of the lower extremities necessitates that prosthetic or orthopedic appliances (diabetic shoes and diabetic custom insoles / orthotics) are worn or used. The diabetic shoes, in turn, tend to wear or tear or damage his socks and the bottom of his pants. The diabetic custom orthotics, in turn, tend to wear and tear his socks and shoes. He desires an annual clothing allowance payment from VA to cover the additional cost of his damaged pants, shoes, and socks. See March 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 Notice of Disagreement (NOD). Upon review, the Board finds annual VA clothing allowances for the year 2015 to the use of diabetic shoes and diabetic custom insoles / orthotics are not warranted. Initially, a February 2015 VHA Request for Quotation from the Chief of VA’s Prosthetic Treatment Center confirms diabetic shoes and diabetic custom insoles / orthotics were ordered for the Veteran due to impairment from his service-connected type II diabetes mellitus with peripheral neuropathy of the lower extremities. Thus, his service-connected disabilities necessitate the use of these particular orthopedic appliances. See 38 C.F.R. § 3.810(a)(1). This fact is undisputed. The Veteran is therefore at least “eligible” for a VA clothing allowance on the basis of the impact of his service-connected disabilities, but not necessarily “entitled” to the same benefit without meeting further criteria in VA regulations. The Veteran has not been adjudicated as having loss or loss of use of a foot or hand at a compensable rate due to any of her service-connected disabilities as specified in 38 C.F.R. § 3.50(a) - (f). Therefore, under 38 C.F.R. § 3.810(a)(1)(ii), the Veteran can qualify for entitlement to a clothing allowance if the diabetic shoes or diabetic custom insoles / orthotics are certified by the Under Secretary for Health or designee (e.g. Chief of Prosthetics or Sensory Aids Service) to cause wear and tear to articles of his clothing. In the present case, the Board can serve as the designee based on the fact that the VHA Prosthetics Representative decisions were appealed to the Board. The Board still requires probative clinical or lay evidence of record to support any favorable findings. In this case, in the July 2015 VAMC decision on appeal and in the April 2016 Statement of the Case (SOC), the Chief of Prosthetics or Sensory Aids Service and a Prosthetics Representative have reviewed the Veteran’s claim to determine whether such a certification could be made for his diabetic shoes or diabetic custom insoles / orthotics. Following review, they concluded that the Veteran did not meet the criteria for approval of annual VA clothing allowances in 2015 because the Veteran’s diabetic shoes and diabetic custom insoles / orthotics are listed in the VHA Handbook as items that do not tend to wear and tear clothing. The VHA Handbook was discussed by the Chief of Prosthetics as a pertinent factor in denying the clothing allowance claim. Importantly, the VHA Handbook provides that shoes and shoe inserts and soft orthotics are examples of items that do not tend to tear and wear clothing. See VHA Handbook 1173.15 paragraph 8(b) (emphasis added). In addition, as to what qualifies as “outergarments” for VA clothing allowance purposes that can be damaged by qualifying appliances or by skin medications under 38 C.F.R. § 3.810(a), the VHA Handbook 1173.15 paragraph 2(b) defines an outergarment as a type of garment worn over another garment (e.g., a shirt, blouse, pants, skirt, coat, jacket, blazer) (emphasis added). Thus, the Veteran’s pants would be considered an outergarment that could theoretically be damaged by his shoes. But his socks are not included as a type of clothing or as a type of outergarment that can be damaged. In fact, the March 2015 Application for Annual Clothing Allowance (VA Form 21-8678) advised the Veteran that “[c]lothing such as shirts, blouses, pants, skirts, shorts and similar garments permanently damaged by qualifying appliances and/or medications are considered in clothing allowance decisions. [But] shoes, hats, scarves, underwear, socks, and similar garments are not included.” (emphasis added). Therefore, to the extent that the Veteran’s shoes and custom insoles have caused wear and tear to his socks, socks are not an “outergarment” as the term is used in the applicable VA regulation, as socks are covered over by shoes or by other footwear. That is, the characterization of an outergarment is reserved for clothing that is not covered by other clothing or material. See Short Bear v. Nicholson, 19 Vet. App. 341, 344 (2005) (discussing that a clothing allowance cannot be granted for irreparable damage to underwear). With regard to lay evidence, the Veteran as a layperson is competent to report whether his diabetic shoes or diabetic custom insoles / orthotics results in wear and tear to any clothing, as these are observable circumstances. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). See also Layno v. Brown, 6 Vet. App. 465, 469 (1994) (noting competent lay evidence requires facts perceived through the use of the five senses). However, simply stated, his shoes and socks do not qualify as clothing that can be worn and torn and thus reimbursed by VA for any damage done to them. The Board acknowledges the Veteran’s argument in his June 2016 VA Form 9 that it is “unfair” for VA to utilize the VHA Handbook 1173.15 to deny his clothing allowance claim. The Veteran feels that because he filed his claim for a VA clothing allowance in March 2015, prior to the VHA Handbook 1173.15 being rewritten and published in May 2015, it is unfair to apply the unfavorable “change in the regulations.” In this regard, the Board is aware that if a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); VAOPGCPREC 3-2000. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003. But in the present case, the guidance contained in the VHA Handbook 1173.15 for adjudicating a VA clothing allowance claim does not have the same authority as a VA statute or a VA regulation. The purpose of the VHA Handbook is to define and describe the procedures to administer the annual clothing allowance benefit to veterans. See VHA Handbook 1173.15 paragraph 1. The VHA Handbook merely serves as interpretative or clarifying guidance to the ultimate legal authority the Board is bound by - 38 U.S.C. § 1162 and 38 C.F.R. § 3.810. In this regard, the substance of 38 U.S.C. § 1162 and 38 C.F.R. § 3.810 have remained unchanged throughout the Veteran’s appeal. As such, the Board is not bound by the VHA Handbook 1173.15, but is free to consider its guidance. See 38 C.F.R. § 19.5 (2017) (stating that “[t]he Board is not bound by Department manuals, circulars, or similar administrative issues”). For the reasons set forth above, the Board concludes that the preponderance of the evidence is against the Veteran’s claims of entitlement to annual VA clothing allowances for the year 2015 due to use of diabetic shoes and diabetic custom insoles / orthotics. Thus, the benefit of the doubt rule does not apply for these particular claims. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). III. Clothing Allowance for Skin Medications Once again, one annual clothing allowance per year is payable in a lump sum, when the Undersecretary for Health or a designee certifies that, because of the use of a physician-prescribed medication for a skin condition that is due to a service-connected disability or disabilities, irreparable damage is done to the Veteran’s outergarments. 38 U.S.C. § 1162; 38 C.F.R. § 3.810(a)(1). An outergarment is defined as a type of garment worn over other garment (e.g., shirt, blouse, pants, skirt, coat, jacket, blazer). An undergarment is defined as a garment worn under outergarments next to the skin (e.g., stockings, panties, boxers, briefs, trunks, bra, bathing suit). A skin medication is defined as a cream, salve, ointment, lotion, or semisolid medicine that is used to treat, prevent, heal, protect and alleviate symptoms from a skin condition. See VHA Handbook 1173.15 paragraphs 2(b) and 2(c) and 2(d) (May 14, 2015). To determine that a veteran is entitled to the allowance, the Under Secretary for Health designee must find and document that the skin medication(s) causes irreparable damage (e.g., permanent irreversible staining, bleeding, or damage not removable with laundering or dry cleaning) to the Veteran’s outergarments. See VHA Handbook 1173.15 paragraph 5(c)(3). The VBA Live Manual emphasizes that “[i]rreparable damage does not include stains that are removable through regular laundering or dry cleaning.” See M21-1, IX.i.7.2.b. (September 27, 2016). The VHA handbook also provides that: A guide and updated listing created by the Prosthetic and Pharmacy workgroup identifies skin medications, ointments, or lotions that may cause irreparable staining, discoloration, bleeding, and damage not removable by laundering or dry cleaning. It is available under the Clothing Allowance folder on the Prosthetic and Sensory Aids SharePoint at: http://vaww.infoshare.va.gov/sites/prosthetics/default.aspx. NOTE: This is an internal VA Web site and is not available to the public. Skin medications not included in the guide should be reported to VHA’s Rehabilitation and Prosthetics Services (10P4R). The Prosthetic and Pharmacy workgroup will review the skin medication to determine its impact on clothing. Consultation with a local VHA Pharmacist can substitute when a prompt decision is needed. This list is updated by the Prosthetic and Pharmacy workgroup on a semi-annual basis, provided any new skin medication, ointment, or lotion may qualify for the clothing allowance. Over-the-counter skin medications, ointments and lotions that are prescribed by a VHA physician are to meet the same criteria in paragraph 5 of this Handbook. See VHA Handbook 1173.15 paragraph 8(c) (May 14, 2015). In determining whether a clothing allowance is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). The Veteran is currently service-connected for two disabilities pertinent to the present appeal for skin medications – eczema (10 percent disabling) and hemorrhoids (0 percent disabling). As noted above, the Veteran also is service-connected for various other disabilities not relevant to the current appeal for skin medications. A. Hydrocortisone Cream The Veteran contends that he uses hydrocortisone cream to treat his service-connected hemorrhoids, which has caused irreparable damage to clothing. He has not indicated what article of clothing has been damaged. But he says the stains are permanent from his hydrocortisone cream. He desires an annual VA clothing allowance payment from VA for the year 2015 to cover the additional cost of his permanently damaged clothing. See March 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 NOD; March 2017 IHP from representative. At the outset, the evidence of record confirms the Veteran uses hydrocortisone cream to treat his service-connected hemorrhoids. Both clinical and lay evidence of record supports this finding. The Veteran is therefore at least “eligible” for a VA clothing allowance on the basis of the impact of his service-connected hemorrhoids disability, but not necessarily “entitled” to the same benefit without meeting further criteria in VA regulations. But on this issue, on multiple occasions, the VAMC’s Chief of Prosthetics and Sensory Aids Service and a Prosthetics Representative have reviewed the Veteran’s claim to determine whether such a certification could be made for the Veteran’s hydrocortisone cream. See July 2015 VAMC decision on appeal; April 2016 SOC. Following review, the VAMC Chief of Prosthetics and Sensory Aids Service and a Prosthetics Representative concluded that the Veteran did not meet the criteria for approval of an annual VA clothing allowance in 2015 based on the use of hydrocortisone cream because this skin cream did not cause irreparable damage or staining to the Veteran’s outergarments. 38 C.F.R. § 3.810(a)(1)(ii)(B). The VAMC cited the Pharmacy and Prosthetic workgroup’s identification of which particular skin medications, ointments, or lotions may cause irreparable staining, discoloration, bleeding, and damage not removable by laundering or dry cleaning. The Veteran’s skin medications were listed as not causing clothing stains. Upon review, the Board finds an annual clothing allowance for the year 2015 due to the use of a skin medication (hydrocortisone cream) is not warranted. First, the Board observes that the Veteran’s particular skin medication - hydrocortisone cream, is specifically listed as a skin medication that would not stain or damage clothing, according to the list available on the VA Patient Care Services Prosthetic and Sensory Aids Service website. See http://vaww.infoshare.va.gov/sites/prosthetics/Clothing%20Allowance/Guides/MEDS%20THAT%20STAIN%20CLOTHING11172016.xls. In particular, skin medications listed that do not stain or damage clothing include various forms of hydrocortisone cream. Second, and most importantly, even if the Veteran’s hydrocortisone cream did for the sake of argument permanently stain any article of his clothing, the only probable item of clothing it could stain would be his “undergarments.” This is because the Veterans uses the hydrocortisone cream to treat his service-connected hemorrhoids. In this regard, under VA regulation, only “outergarments” irreparably damaged or stained by a skin medication can qualify as for a VA clothing allowance. See 38 C.F.R. § 3.810(a)(1)(ii)(B). As to what qualifies as “outergarments” for VA clothing allowance purposes that can be irreparably damaged under 38 C.F.R. § 3.810(a), the VHA Handbook 1173.15. paragraph 2(b) defines an outergarment as a type of garment worn over another garment (e.g., a shirt, blouse, pants, skirt, coat, jacket, blazer). In contrast, an “undergarment” is defined as a garment worn under outergarments next to the skin (e.g., stockings, panties, boxers, briefs, trunks, bra, bathing suit). See VHA Handbook 1173.15 paragraph 2(d). It follows that common sense would dictate the Veteran’s use of hydrocortisone cream on his service-connected hemorrhoids only has the potential of staining his undergarments. “Underwear” is not the type of clothing for which a clothing allowance is permitted, when the damage is due to the use of skin medication. Short Bear v. Nicholson, 19 Vet. App. 341, 344 (2005); 135 CONG. REC. H9095, H9111 (daily ed. Nov. 20, 1989) (statement of Rep. Montgomery) (“The term ‘outergarments’ is intended to exclude cases in which damage is done only to underwear”). Moreover, the March 2015 Application for Annual Clothing Allowance (VA Form 21-8678) advised the Veteran that “underwear” and similar garments are not included as clothing considered in a clothing allowance claim. Furthermore, a “VHA Clothing Allowance Frequently Asked Questions (FAQ)” document dated September 30, 2014 on the VHA Intranet advises that underwear is excluded from “articles of clothing.” With regard to lay evidence, the Veteran has not provided any specific lay description or detail as to which particular outergarments or articles of clothing his hydrocortisone cream permanently damages, and if so, how this permanent damage (staining) occurs. Thus, the hydrocortisone cream skin medication cannot be a basis for awarding VA clothing allowance benefits under 38 C.F.R. § 3.810(a)(1)(ii)(B). For the reasons set forth above, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to an annual VA clothing allowance for the year 2015 due to use of a skin medication (hydrocortisone cream). Thus, the benefit of the doubt rule does not apply for this issue. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. Urea Cream The Veteran contends that he uses Urea cream (generic name: carbamide) to treat his service-connected eczema on his hands, feet, and full body, which has caused irreparable damage to outergarment clothing. He has implied that the outergarment clothing affected consists of his pants and shirts. He says the stains are permanent. He desires an annual VA clothing allowance payment from VA for the year 2015 to cover the additional cost of his permanently damaged clothing. See March 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 NOD; March 2017 IHP from representative. At the outset, the evidence of record confirms the Veteran uses Urea cream to treat his service-connected eczema. Both clinical and lay evidence of record supports this finding. The Veteran is therefore at least “eligible” for a VA clothing allowance on the basis of the impact of his service-connected eczema disability, but not necessarily “entitled” to the same benefit without meeting further criteria in VA regulations. But on this issue, on multiple occasions, the VAMC’s Chief of Prosthetics and Sensory Aids Service and a Prosthetics Representative have reviewed the Veteran’s claim to determine whether such a certification could be made for the Veteran’s Urea cream. See July 2015 VAMC decision on appeal; April 2016 SOC. Following review, the VAMC Chief of Prosthetics and Sensory Aids Service and a Prosthetics Representative concluded that the Veteran did not meet the criteria for approval of an annual VA clothing allowance in 2015 based on the use of Urea cream because this skin cream did not cause irreparable damage or staining to the Veteran’s outergarments. 38 C.F.R. § 3.810(a)(1)(ii)(B). The VAMC cited the Pharmacy and Prosthetic workgroup’s identification of which particular skin medications, ointments, or lotions may cause irreparable staining, discoloration, bleeding, and damage not removable by laundering or dry cleaning. The Veteran’s skin medications were listed as not causing clothing stains. As to what qualifies as “outergarments” for VA clothing allowance purposes that can be irreparably damaged under 38 C.F.R. § 3.810(a), the VHA Handbook 1173.15. paragraph 2(b) defines an outergarment as a type of garment worn over another garment (e.g., a shirt, blouse, pants, skirt, coat, jacket, blazer) (emphasis added). Thus, the Veteran’s shirts and pants would be considered outergarments, but not his socks or underwear. Moreover, the March 2015 Application for Annual Clothing Allowance (VA Form 21-8678) advised the Veteran that “[c]lothing such as shirts, blouses, pants, skirts, shorts and similar garments permanently damaged by qualifying appliances and/or medications are considered in clothing allowance decisions. Upon review, the Board finds an annual clothing allowance for the year 2015 due to the use of a skin medication (hydrocortisone cream) is not warranted. Significantly, upon review, the Board observes that the Veteran’s particular skin medication - Urea cream, is specifically listed as a skin medication that would not stain or damage clothing, according to the list available on the VA Patient Care Services Prosthetic and Sensory Aids Service website. See http://vaww.infoshare.va.gov/sites/prosthetics/Clothing%20Allowance/Guides/MEDS%20THAT%20STAIN%20CLOTHING11172016.xls. In particular, skin medications listed that do not stain or damage clothing include various forms of Urea cream. The Veteran has not presented any medical treatise evidence to the contrary for Urea cream. Therefore, this clinical evidence outweighs the Veteran’s lay allegations to the contrary that his Urea cream permanently damages any outergarments. In short, the Urea cream is not clinically shown to permanently damage outergarments such as shirts or pants. Thus, the Urea cream skin medication cannot be a basis for awarding VA clothing allowance benefits under 38 C.F.R. § 3.810(a)(1)(ii)(B). For the reasons set forth above, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to an annual VA clothing allowance for the year 2015 due to use of a skin medication (Urea cream). Thus, the benefit of the doubt rule does not apply for this issue. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). C. Terbinafine HCL Cream and Triamcinolone Acetonide Cream The Veteran contends that he uses both terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream to treat his service-connected eczema on his hands, feet, and full body, which has caused irreparable damage to outergarment clothing. He has implied that the outergarment clothing affected consists of his pants and shirts. He says the stains are permanent. He desires two annual VA clothing allowance payments from VA for the year 2015 to cover the additional cost of his permanently damaged clothing. See March 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 NOD; March 2017 IHP from representative. To avoid repetition, the Board incorporates undisputed sections of the analysis above for skin medications into the present analysis, concluding that the evidence of record confirms the Veteran uses both terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream to treat his service-connected eczema. In addition, the Veteran’s pants and shirts qualify as “outergarments” for VA clothing allowance purposes that can be permanently stained. These facts are undisputed. Upon review, the Board finds that two annual VA clothing allowances for the year 2015 due to the use of two skin medications (terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream) are warranted. These two skin medications prescribed by medical personnel cause irreparable damage to the Veteran’s pants and shirts. On this finding, the Board disagrees with the negative conclusions reached by the Chief of Prosthetics and Sensory Aids Service and the Prosthetics Representative at the VAMC. Notably, the evidence of record on this issue is mixed. With regard to the unfavorable evidence, clinical evidence of record on VBMS fails to mention any damage or stains to clothing. Also of importance, the Veteran’s two VA-prescribed skin medications - (terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream), are both specifically listed as skin medications that would not stain or damage clothing, according to the list available on the VA Patient Care Services Prosthetic and Sensory Aids Service website. See http://vaww.infoshare.va.gov/sites/prosthetics/Clothing%20Allowance/Guides/MEDS%20THAT%20STAIN%20CLOTHING11172016.xls. The Board now turns to the favorable evidence. A June 2011 VA aid and attendance examiner observed the Veteran has dyshidrotic type eczema on his lower extremities below his knees. As a layperson, the Veteran has also credibly described this same eczema on his full body and upper extremities at times. The Board makes the logical deduction that these are areas of the body in contact with his shirts and pants. With regard to the favorable evidence, the Board has also considered medical treatise evidence from the Internet referencing the potential for stains to clothing due to terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream. This Internet evidence was submitted by the Veteran’s representative in a March 2017 IHP. Medical treatise evidence can provide probative support for a VA claim in certain instances. Mattern v. West, 12 Vet. App. 222, 228 (1999). The Board is permitted to supplement the record with any recognized medical treatise without the necessity for a remand or referral, especially if it weighs in favor to the Veteran. See 38 C.F.R. § 19.9(d)(5). With regard to the favorable lay evidence, the Veteran is competent to describe the use of skin medications on his service-connected eczema - the Court has held that a skin condition is the type of condition lending itself to lay observation. McCartt v. West, 12 Vet. App. 164, 167 (1999). What’s more, the Board finds the Veteran’s description of staining of his outergarments by his terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream to be credible, in light of the corroboration by medical treatise evidence on the Internet. See Barr v. Nicholson, 21 Vet. App. 303, 307-09 (2007). As currently codified, VA law defines the “benefit of the doubt” doctrine as: When, after consideration of all evidence and material of record in this case before the Department with respect to benefits under laws administered by the Secretary, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination in the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b). See also 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Here, there is an approximate balance of the positive and negative evidence as to the issue of entitlement to two annual VA clothing allowances for the year 2015 due to the use of terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream. Certain elements of both the favorable and unfavorable clinical and lay evidence in this case, as well as the medical treatise evidence, are probative. The clinical and lay evidence of record has its respective flaws as well. But there is no apparent basis for wholly rejecting the favorable clinical and lay evidence of record on these particular clothing allowance issues. In light of the contrasting, yet equally probative clinical and lay evidence in the present case, in such situations, the benefit of the doubt is resolved in the Veteran’s favor. Accordingly, the criteria for the award of two VA clothing allowances for the year 2015 due to the use of multiple skin medications (terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream) are met. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.810(a). (On a side note, the award of multiple (two) VA clothing allowances in 2015 is permitted in the present case for both skin medications (terbinafine HCL cream (Lamisil) and triamcinolone acetonide cream), because VA regulation provides for more than one clothing allowance for each skin medication that affects a distinct   type of outergarment – i.e., his pants and shirts. See 38 C.F.R. § 3.810(a)(2); Sursely v. Peake, 551 F.3d 1351 (Fed. Cir. 2009)). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. Rubin, Counsel