Citation Nr: 18154940 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 15-06 262 DATE: December 4, 2018 REMANDED The claim of entitlement to a higher disability rating for dyshidrotic eczema (previously diagnosed as hyperhidrosis, bilateral hands), rated as noncompensable prior to April 21, 2015, and 10 percent thereafter, is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Coast Guard from August 1974 to August 1978. In February 2015, the Veteran requested a Board hearing, however, he withdrew his request in November 2015. Entitlement to a higher disability rating for dyshidrotic eczema, rated as noncompensable prior to April 21, 2015, and 10 percent thereafter, is remanded. Initially, the Board notes that the Veteran’s service-connected skin disorder of the hands is rated under Diagnostic Code 7832-7825. 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 (2018). Diagnostic Code 7832 is used to rate hyperhidrosis and Diagnostic Code 7825 is used to rate chronic urticaria. A review of the claims file shows that the Veteran’s service-connected skin disorder of the bilateral hands was previously diagnosed as xerosis; however, the diagnosis was changed to hyperhidrosis following the findings in the February 2012 VA examination report. VA treatment records during the appeal period show that the Veteran’s skin disorder of the bilateral hands was diagnosed as dyshidrotic eczema and hand dermatitis. VA dermatology records do not show any treatment for hyperhidrosis or urticaria. The April 2015 VA examiner diagnosed dyshidrotic eczema. In May 2015, the VA examiner provided an addendum opinion and explained that dyshidrotic eczema was the proper diagnosis of the Veteran’s skin disorder of the bilateral hands. The VA examiner stated that the diagnosis of dyshidrotic eczema is not a progression of hyperhidrosis and that the February 2012 VA examiner incorrectly changed the diagnosis from xerosis to hyperhidrosis. It was explained that hyperhidrosis involved the secretion of sweat in amounts greater than physiologically needed for thermoregulation and generally developed in childhood or adolescence. Xerosis is abnormal dryness of skin which is a component of dyshidrotic eczema. Dyshidrotic eczema is a recurrent, pruritic vesicular eruption affecting the palms, soles, or both. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). Following a review of the record, the Board finds that the Veteran’s skin disorder is more appropriately rated under Diagnostic Code 7806, for dermatitis or eczema. The criteria for rating dermatitis or eczema under Diagnostic Code 7806 are based on the percentage of the entire body or exposed areas affected, as well as the frequency and type of treatment used. The Veteran most recently underwent a VA examination in April 2015. The examination report indicated that the Veteran was treated with constant/near-constant topical corticosteroids. In light of the Court’s decision and recent developments in case law regarding skin disorders, the Board finds additional development is necessary to make an informed decision on the Veteran’s appeal. Specifically, the Board finds medical evidence is necessary to guide its analysis of whether any of the Veteran’s past or current treatments for dyshidrotic eczema constitute “systemic therapy such as corticosteroids or other immunosuppressive drugs” within the meaning of Diagnostic Code 7806, to include both the pre- and post-August 13, 2018 version of the diagnostic code. See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017); Burton v. Wilkie, No. 16-2037, 2018 U.S. App. Vet. Claims LEXIS 1314 (Vet. App. Sept. 28, 2018); Warren v. McDonald, 28 Vet. App. 194 (2016). The matter is REMANDED for the following action: 1. The RO or the AMC should undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claim, to include updated VA treatment records. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, the RO or AMC should afford the Veteran a VA examination by an examiner with sufficient expertise to determine the current severity of his service-connected dyshidrotic eczema. The electronic records should be made available to and reviewed by the examiner. Any indicated studies should be performed. The RO must ensure that all information required for rating purposes is provided. The examiner must specifically address whether the medications used to control the Veteran’s dyshidrotic eczema throughout the appeal period constitute systematic therapy like a corticosteroid or other immunosuppressive drug. For topical treatments, the examiner must state (a) whether the treatment operates by affecting the body as a whole to treat dyshidrotic eczema and (b) whether the treatment is like a corticosteroid or other immunosuppressive drug. If the treatment is clearly systemic, the examiner must only address whether the treatment is like a corticosteroid or other immunosuppressive drug. 3. Then, the RO or the AMC should readjudicate the issue on appeal. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. N. Nolley, Associate Counsel