Citation Nr: 18155732 Decision Date: 12/06/18 Archive Date: 12/04/18 DOCKET NO. 16-59 684 DATE: December 6, 2018 REMANDED The appeal for an initial compensable evaluation for pseudofolliculitis barbae is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1980 to September 1992. This appeal comes to the Board from a June 2016 rating decision by a VA Regional Office. The Veteran contends he is entitled to an initial compensable evaluation for his pseudofolliculitis barbae. He notes that this disability makes it difficult to shave, is itchy, and makes him self-conscious about his appearance when at its worse. The Veteran’s pseudofolliculitis barbae is evaluated under the rating criteria for dermatitis or eczema. 38 C.F.R. § 4.118, Code 7806. These criteria have changed as of August 13, 2018. Under the previous version of the criteria, which might continue to be applicable to the Veteran’s appeal for part or all of rating period, systemic therapy such as the use of corticosteroids may result in a compensable rating. The Federal Circuit has held that depending on the facts of an individual case, even the use of a topical corticosteroid may constitute systemic therapy. Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017). Consequently, the Board is required to make a factual determination whether the use of a topical corticosteroid equates to systemic therapy in each decision. Mere reliance on a box checked on a VA examination form that does not provide a supporting rationale is inadequate. In this case, the Veteran was afforded a VA examination for skin diseases in March 2016. The examiner checked the box stating that the Veteran had been treated with topical corticosteroids during the past 12 months. She stated that the medication was hydrocortisone 1%, and checked the box that it had been used for six weeks or more but not the box indicating constant or near-constant use. The examination report does not include any additional information regarding the effects of the hydrocortisone cream or a rationale as to why it was considered topical and not systemic. This information is not included in the VA treatment records, and the Veteran did not describe any effects of his medication in his written statements. Therefore, give the requirements of Johnson, the Veteran should be scheduled for a new VA examination that addresses these deficiencies. The matter is REMANDED for the following actions: 1. Obtain all VA treatment records pertaining to treatment of the Veteran’s pseudofolliculitis barbae dating from May 2016 to the present and associate them with the record. 2. Contact the Veteran and invite him to provide a description of the side effects, if any, due to his hydrocortisone 1% cream. Notify him that if he fails to reply, it will be assumed that there are no such side effects. After any VA records or lay statements have been received and associated with the claims file because of the actions requested above, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected pseudofolliculitis barbae. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should identify any symptoms and functional impairments due to pseudofolliculitis barbae alone and discuss the effect of the Veteran’s pseudofolliculitis barbae on any occupational functioning and activities of daily living. In addition to the above, the examiner must review the record and provide an opinion whether the Veteran’s use of hydrocortisone 1% cream for the period prior to August 13, 2018 was either merely topical or if it constituted systemic therapy. The examiner must provide a rationale for their opinion. In doing, the examiner is to address factors such as whether the use of this medication was limited to and affected only the areas with pseudofolliculitis barbae (topical), or if the use of the medication has or had side effects experienced by the Veteran that were not localized to the area that was treated (systemic). In considering the impact of the hydrocortisone, the examiner should offer an opinion that responds to the following: (a) The side effects, found generally across prescribed patients, associated with hydrocortisone. (b) The specific side effects of hydrocortisone, the frequency of any such side effects, and the severity of any such side effects experienced by the Veteran in this case. In providing this opinion and rationale, the examiner must not and cannot rely on the definitions provided in the regulations that became effective on August 13, 2018, which define topical therapy as treatment administered through the skin, and systemic therapy as treatment administered through any other route (orally, injection, etc.). If it is not possible to provide a specific measurement, or an opinion regarding symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. L. Prichard, Counsel