Citation Nr: 18156722 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 16-15 719 DATE: December 11, 2018 ORDER Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a LEFT ankle foot orthosis (AFO) is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a RIGHT ankle foot orthosis (AFO) is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of custom insoles / foot orthotics is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a skin medication (Clindamycin Phosphate 1% Topical Solution) is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of a skin medication (Tretinoin 0.1% Topical Gel) is denied. Entitlement to an annual VA clothing allowance for the year 2015 due to the use of skin medications (Melaquin HP 4% Cream (generic hydroquinone 4% cream) and Benzoyl Peroxide 10% Lotion) is granted. FINDINGS OF FACT 1. The Veteran is service-connected for the following disabilities relevant to the present clothing allowance appeal: chloracne of the skin (50 percent disabling); RIGHT foot bunionectomy residuals (10 percent disabling); LEFT foot bunionectomy residuals (10 percent disabling); RIGHT ankle arthritis (10 percent disabling); and LEFT ankle arthritis (10 percent disabling). The Veteran is also service-connected for posttraumatic stress disorder (PTSD) (100 percent disabling), but this PTSD disability is 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. 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. 4. The Veteran’s bed linens do not qualify as an “outergarment” that can be irreparably damaged or stained by skin creams. Bed linens are not a type of clothing or outergarment worn by the Veteran, such that a clothing allowance is not permitted for them. 5. The Veteran’s particular left and right foot AFOs are considered “soft orthotics,” which are listed in the Veterans Health Administration (VHA) Handbook 1173.15 as items that do not tend to wear and tear clothing. 6. The Veteran’s custom insoles for his shoes are considered “shoe inserts” or “soft orthotics,” which are listed in the VHA Handbook as items that do not tend to wear and tear clothing. 7. The Veteran’s shirts qualify as an item of “clothing” or “outergarment” that can be worn or torn by a qualifying appliance or device or irreparably damaged or stained by skin creams. 8. Although two of the Veteran’s skin medications (Clindamycin Phosphate 1% Topical Solution and Tretinoin 0.1% Topical Gel) are prescribed for his service-connected chloracne to the chest and back, the weight of the evidence does not show that either of these skin medications results in irreparable damage (staining) to his outergarments such as shirts. 9. However, two of the Veteran’s skin medications (Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion) prescribed by VA physicians for the treatment of one service-connected disability – his chloracne, result in irreparable damage (staining) to outergarments (his shirts). CONCLUSIONS OF LAW 1. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of a LEFT foot AFO. 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017); VHA Handbook 1173.15 paragraph 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 a RIGHT foot AFO. 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017); VHA Handbook 1173.15 paragraph 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 custom insoles / shoe orthotics. 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017); VHA Handbook 1173.15 paragraph 8(b) (May 14, 2015). 4. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of a skin medication (Clindamycin Phosphate 1% Topical Solution). 38 U.S.C. §§ 1162, 5107 (2012); 38 C.F.R. §§ 3.102, 3.810 (2017). 5. The criteria are not met for an annual VA clothing allowance for the year 2015 due to use of a skin medication (Tretinoin 0.1% Topical Gel). 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 skin medications (Melaquin HP 4% Cream (generic hydroquinone 4% cream) and Benzoyl Peroxide 10% Lotion). 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 November 1982 to September 1994. 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 one VA clothing allowance issue that is on appeal – for Melaquin HP 4% Cream and for Benzoyl Peroxide 10% Lotion. 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: chloracne of the skin (50 percent disabling); RIGHT foot bunionectomy residuals (10 percent disabling); LEFT foot bunionectomy residuals (10 percent disabling); RIGHT ankle arthritis (10 percent disabling); and LEFT ankle arthritis (10 percent disabling). The Veteran is also service-connected for PTSD (100 percent disabling), but the PTSD disability is not relevant to the present clothing allowance appeal. The Veteran has a combined 100 percent schedular rating for his service-connected disabilities, effective October 7, 2006. And due to the extreme severity of his service-connected disabilities, in particular his PTSD, the Veteran is in receipt of a permanent and total (P&T) rating for his service-connected disabilities, effective October 7, 2006. A. Left and Right Foot AFOs The Veteran has claimed entitlement to VA clothing allowances for the year 2015 because his service-connected bilateral feet and bilateral ankle disabilities necessitate the wearing of a prosthetic or orthopedic appliance – left and right foot AFOs. The left and right foot AFOs, in turn, tend to wear or tear articles of clothing - his shoes and socks. He says his AFOs “stretch and tear” his shoes and socks. On a side note, the Veteran has never alleged that his pants are worn and torn by his right and left foot AFOs. In any event, he desires an annual clothing allowance payment from VA to cover the additional cost of his damaged shoes and socks due to wear and tear caused by his left and right foot AFOs. The Veteran was previously awarded VA clothing allowances by VA for his left and right foot AFOs in previous years (2012, 2013, and 2014). See June 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 Notice of Disagreement (NOD); February 2016 VA Form 9. Initially, VA treatment records and a May 2012 VA ankle examination report on VBMS confirm the Veteran regularly wears ASO gauntlet style ankle braces (DonJoy stabilizing plastic), which were ordered by VA to treat impairment from his service-connected bilateral foot and bilateral ankle disabilities. 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 his 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 left and right foot AFOs are certified by the Under Secretary for Health or designee (e.g. Chief of Prosthetics and 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. Upon review, the Board finds annual VA clothing allowances for the year 2015 due to use of left and right foot AFOs are not warranted. First, in the July 2015 VAMC decision on appeal and in the February 2016 Statement of the Case (SOC), the 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 his left and right foot AFOs. Following review, they concluded that the Veteran did not meet the criteria for approval of an annual VA clothing allowance in 2015 because the Veteran’s left and right foot AFOs are considered soft orthotics, which 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. In this regard, the Board sees that the VHA Handbook provides that soft orthotics and braces with plastic stays covered in fabric are examples of items that do not tend to tear and wear clothing. See VHA Handbook 1173.15 paragraph 8(b) (emphasis added). The Board recognizes it is not bound by the VHA Handbook 1173.15, but it is still 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”). Second, 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). But the Veteran has never alleged that an outergarment such as his pants are worn and torn by his left and right foot AFOs. Instead, he has identified his worn and torn clothing as socks and shoes. See August 2015 NOD. Importantly, however, his socks and shoes are not included as a type of clothing or as a type of outergarment that can be damaged. On this issue, the June 2015 Application for Annual Clothing Allowance (VA Form 21-8678) specifically advised the Veteran that “shoes, hats, scarves, underwear, socks, and similar garments are not included” as an article of clothing that can be permanently damaged by qualifying appliances in clothing allowance decisions. Therefore, this evidence weighs against the Veteran’s clothing allowance claim. Third, although the Veteran was previously awarded VA clothing allowances in 2012, 2013, and 2014 for left and right foot AFOs, the VHA Handbook 1173.15 was rewritten and published in May 2015, providing new guidance on which prosthetic appliances are eligible for a clothing allowance. Fourth, VA treatment records and VA examinations and private treatment records fail to document any damage or wear or tear to eligible clothing due to the Veteran’s left and right foot AFOs. But on this point, the Board has also considered that wear and tear to clothing is not something routinely established in VA treatment records or VA examinations or private treatment records, which are instead created for purposes of documenting complaints, treatment, and diagnoses for various disabilities. See also AZ v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (citing FED. R. EVID. 803(7) for the proposition that “the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded”). Thus, these clinical records only provide limited evidence against the clothing allowance claim. Fifth, the VHA Handbook references a guide and updated listing created by the Orthotic and Prosthetic (O&P) Field Advisory Committee. This guide identifies prostheses and orthotics that may cause wear and tear to outergarments. It is titled “Recommended HCPC’s eligible for Clothing Allowance.” This guide states that the “following list represents HCPC codes that may indicate eligibility for clothing allowance awards. The codes in this list are not intended to give an automatic approval, but are to be used as a guide as to when an item should be considered.” But significantly, the HCPC guide does not list the Veteran’s particular AFO as an orthotic that may cause wear and tear to outergarments. Therefore, this evidence weighs against the Veteran’s clothing allowance claim. Sixth, with regard to lay evidence, the Veteran as a layperson is competent to report whether wearing his left and right foot AFOs 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. In addition, neither the Veteran nor his representative has identified any other specific article of clothing damaged by his left and right foot AFOs. In light of the above, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to annual VA clothing allowances for the year 2015 due to use of left and right foot AFOs. Thus, the benefit of the doubt rule does not apply for these issues. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. Custom Insoles / Foot Orthotics The Veteran has claimed entitlement to a VA clothing allowance for the year 2015 because his service-connected bilateral feet and bilateral ankle disabilities necessitate the wearing of a prosthetic or orthopedic appliance – custom molded insoles (CMIs) / shoe orthotics. The custom insoles, in turn, tend to wear or tear articles of clothing - his shoes and socks. On a side note, the Veteran has never alleged that his custom insoles wear and tear his pants. In any event, he desires an annual clothing allowance payment from VA to cover the additional cost of his damaged shoes and socks due to wear and tear caused by his custom insoles. The Veteran was previously awarded VA clothing allowances by VA for his custom insoles in previous years (2012, 2013, and 2014). See June 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 NOD; February 2016 VA Form 9. Initially, VA treatment records confirm custom insoles / orthotics were ordered for the Veteran due to impairment from his service-connected bilateral foot and bilateral ankle disabilities. Thus, his service-connected disabilities necessitate the use of his custom insoles. 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 his 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 custom insoles 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. Upon review, the Board finds an annual VA clothing allowance for the year 2015 due to use of custom insoles is not warranted. First, in the July 2015 VAMC decision on appeal and in the February 2016 SOC, the 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 his custom insoles / orthotics. Following review, they concluded that the Veteran did not meet the criteria for approval of an annual VA clothing allowance in 2015 because the Veteran’s 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 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). The Board recognizes it is not bound by the VHA Handbook 1173.15, but it is still 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”). Second, 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). But the Veteran has never alleged that an outergarment such as his pants are worn and torn by his custom insoles. Instead, he appears to imply his socks and shoes are worn and torn by his custom insoles. See August 2015 NOD. Importantly, however, his socks and shoes are not included as a type of clothing or as a type of outergarment that can be damaged. On this issue, the June 2015 Application for Annual Clothing Allowance (VA Form 21-8678) specifically advised the Veteran that “shoes, hats, scarves, underwear, socks, and similar garments are not included” as an article of clothing that can be permanently damaged by qualifying appliances in clothing allowance decisions. Therefore, this evidence weighs against the Veteran’s clothing allowance claim. With regard to his socks in particular, to the extent that the Veteran’s 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). Third, although the Veteran was previously awarded VA clothing allowances in 2012, 2013, and 2014 for custom insoles, the VHA Handbook 1173.15 was rewritten and published in May 2015, providing new guidance on which prosthetic appliances are eligible for a clothing allowance. Fourth, VA treatment records and VA examinations and private treatment records fail to document any damage or wear or tear to eligible clothing due to the Veteran’s custom insoles. But on this point, the Board has also considered that wear and tear to clothing is not something routinely established in VA treatment records or VA examinations or private treatment records, which are instead created for purposes of documenting complaints, treatment, and diagnoses for various disabilities. See also AZ v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (citing FED. R. EVID. 803(7) for the proposition that “the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded”). Thus, these clinical records only provide limited evidence against this clothing allowance claim. Fifth, with regard to lay evidence, the Veteran as a layperson is competent to report whether wearing his custom insoles 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 by his custom insoles. In addition, neither the Veteran nor his representative has identified any other specific article of clothing damaged by his custom insoles. In light of the 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 the use of custom insoles / shoe orthotics. 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). 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 also 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). A. Clindamycin Phosphate and Tretinoin The Veteran contends that he uses both Clindamycin Phosphate 1% Topical Solution and Tretinoin 0.1% Topical Gel to treat his service-connected chloracne on his back and chest, which has caused irreparable damage to outergarment clothing on a daily basis. He has stated that the outergarment clothing affected consists of his shirts and bed linens. He says the stains are permanent. He is unable to remove the stains with laundering or dry cleaning. He desires annual VA clothing allowance payments from VA for the year 2015 to cover the additional cost of his permanently damaged clothing. The Veteran was previously awarded VA clothing allowances by VA for his Tretinoin 0.1% Topical Gel in previous years (2012, 2013, and 2014). See June 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 NOD; February 2016 VA Form 9. At the outset, the evidence of record confirms the Veteran uses Clindamycin Phosphate 1% Topical Solution and Tretinoin 0.1% Topical Gel to treat his service-connected chloracne. Both clinical and lay evidence of record supports this finding. See VA treatment records dated from 2012 to 2016; February 2016 VA medication worksheet. The Veteran is therefore at least “eligible” for a VA clothing allowance on the basis of the impact of his service-connected chloracne 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 Clindamycin Phosphate and Tretinoin. See July 2015 VAMC decision on appeal; February 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 either Clindamycin Phosphate or Tretinoin because these skin medications 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 would be considered outergarments, but not his bed linens. Bed linens are not a type of outergarment worn by the Veteran, such that a clothing allowance is not permitted for them. 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 annual clothing allowances for the year 2015 due to the use of skin medications (Clindamycin Phosphate 1% Topical Solution and Tretinoin 0.1% Topical Gel) are not warranted. Significantly, upon review, the Board observes that these particular skin medications - Clindamycin Phosphate 1% Topical Solution and Tretinoin 0.1% Topical Gel, are 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. In particular, skin medications listed that do not stain or damage clothing include various forms of Clindamycin Phosphate and Tretinoin. The Veteran has not presented any clinical evidence to the contrary for these particular skin medications. Therefore, this clinical evidence outweighs the Veteran’s lay allegations to the contrary that his Clindamycin Phosphate and Tretinoin permanently damages any outergarments. In this regard, the Board can discount lay evidence in its role as factfinder if it weighs the evidence, finds the clinical evidence more probative, and provides an explanation with supporting reasons or bases. English v. Wilkie, No. 17-2083, 2018 U.S. App. Vet. Claims LEXIS 1464 (Nov 1, 2018). Here, the Prosthetic and Pharmacy workgroup has tested and reviewed the Clindamycin Phosphate and Tretinoin to determine their impact on clothing. Both were specifically found not to stain clothing after testing. In short, the Clindamycin Phosphate and Tretinoin are not clinically shown to permanently damage outergarments such as shirts. Thus, the Clindamycin Phosphate and Tretinoin skin medications cannot be a basis for awarding VA clothing allowance benefits under 38 C.F.R. § 3.810(a)(1)(ii)(B). And although the Veteran was previously awarded VA clothing allowances in 2012, 2013, and 2014 for his Tretinoin Gel, the VHA Handbook 1173.15 was rewritten and published in May 2015, providing new guidance by way of the updated listing created by the Prosthetic and Pharmacy workgroup on which skin medications are eligible for a clothing allowance. For the reasons set forth above, the Board concludes that the preponderance of the evidence is against the Veteran’s claim of entitlement to annual VA clothing allowances for the year 2015 due to use of skin medications (Clindamycin Phosphate 1% Topical Solution and Tretinoin 0.1% Topical Gel). Thus, the benefit of the doubt rule does not apply for these issues. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. Melaquin HP Cream and Benzoyl Peroxide Lotion The Veteran contends that he uses both Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion to treat one disability - his service-connected chloracne on his back and chest, which has caused irreparable damage to outergarment clothing on a daily basis. He has stated that the outergarment clothing affected consists of his shirts and bed linens. He says the stains are permanent. He is unable to remove the stains with laundering or dry cleaning. 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 June 2015 Application for Annual Clothing Allowance (VA Form 21-8678); August 2015 NOD; February 2016 VA Form 9. 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 Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion to treat one disability - his service-connected chloracne. This skin condition is present on his back and chest. In addition, the Veteran’s shirts qualify as “outergarments” for VA clothing allowance purposes that can be permanently stained. But not his bed linens, because they are not classified as outergarments. Upon review, the Board finds that one annual VA clothing allowance for the year 2015 due to the use of two skin medications (Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion) is warranted. These two skin medications prescribed by medical personnel cause irreparable damage to the Veteran’s 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. With regard to the favorable clinical evidence, the Board observes that both skin medications at issue here - Melaquin HP 4% Cream and Benzoyl Peroxide 10%, are listed by the by the Prosthetic and Pharmacy workgroup as skin medications that would in fact 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 short, these two skin medications are clinically shown to permanently damage outergarments such as the Veteran’s shirts. Thus, these two skin medications can be a basis for awarding VA clothing allowance benefits under 38 C.F.R. § 3.810(a)(1)(ii)(B). With regard to the favorable lay evidence, the Veteran is competent to describe the use of skin medications on his service-connected chloracne - 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 outergarment shirts by his Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion to be credible, in light of the corroboration by the Prosthetic and Pharmacy workgroup’s guide. See Barr v. Nicholson, 21 Vet. App. 303, 307-09 (2007). The fact that the Veteran did not list the two skin medications at issue (Melaquin HP 4% Cream and Benzoyl Peroxide 10%) on his initial June 2015 clothing allowance application is irrelevant here because he added them during the course of the appeal in his NOD. Moreover, contemporary VA treatment records confirm that he was using these particular skin medications to treat his service-connected chloracne. Accordingly, the criteria for the award of one VA clothing allowance for the year 2015 due to the use of multiple skin medications (Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion) are met. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.810(a). (On a side note, the award of two VA clothing allowances for the year 2015 is not permitted in the present case based on the use of both skin medications (Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion). In this regard, the Board is cognizant VA regulation provides for multiple clothing allowances if the combined effects of more than skin medication irreparably damage a single type of outergarment at a greater rate than either would independently. See 38 C.F.R. § 3.810(a)(3); Sursely v. Peake, 551 F.3d 1351 (Fed. Cir. 2009). It follows that the Board has considered whether the combination of both Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion irreparably damage the Veteran’s shirts at an increased rate, thus permitting the award of two clothing allowances for 2015. However, the same regulation also provides that two clothing allowances are warranted only if the Veteran uses multiple skin medications “for more than one skin condition.” 38 C.F.R. § 3.810(a)(3) (emphasis added). In the present case, the Veteran uses both skin medications for only one service-connected skin condition – chloracne. He has no other service-connected skin conditions.   Therefore, the award of multiple clothing allowances for the year 2015 is not available here for the Veteran’s Melaquin HP 4% Cream and Benzoyl Peroxide 10% Lotion. He is only entitled to one clothing allowance award for that year). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. Rubin, Counsel