Citation Nr: 18158797 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 17-03 712 DATE: December 17, 2018 ORDER A rating of 30 percent for pseudofolliculitis barbae (PFB), but no more, is granted for the entirety of the appeals period subject to the payment of monetary benefits. FINDINGS OF FACT 1. The Veteran had active service from September 1985 to March 1990. 2. For the entirety of the appeal, PFB was manifested by subjective complaints of irritation and intermittent flare-ups, with objective evidence of treatment through laser hair removal, as-needed systemic oral pills, and topical ointments. CONCLUSION OF LAW The criteria for a 30 percent rating, but no more, for PFB for the entirety of the appeals period, have been met 38 U.S.C. §§ 1155, 5107(a), 5107A (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.118, DC 7806 (2017) (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran was originally granted a noncompensable rating for PFB. During the pendency of the appeal, the Agency of Original Jurisdiction (AOJ) granted an increase to 30 percent effective May 23, 2016. The Veteran indicated in his Form 9 that he wanted to adjudicate his dependency status after adopting a child. No rating decision has been issued regarding dependency status, and thus it cannot presently be appealed to the Board. As the Board does not have jurisdiction over this issue, it is referred back to the AOJ for disposition. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. As noted, the Veteran is currently assigned a noncompensable rating for PFB prior to May 23, 2016, and a 30 percent rating thereafter. While this case was pending at the Board, new regulations regarding ratings for skin were promulgated and became effective on August 13, 2018. Given that this case was pending at the time, for the period following August 13, 2018, whichever ratings criteria is more favorable may be applied. However, for the period beforehand, specifically for the period in which his disability has a noncompensable rating, only the amended rating criteria may be used. Thus, first the entirety of the appeals period will be analyzed under the prior ratings criteria. To warrant a higher rating for PFB under DC 7806, the evidence must show: • dermatitis or eczema covering at least 5 percent, but less than 20 percent, of the entire body or exposed areas; (10 percent); • intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during the past twelve-month period (10 percent); • intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of more than six weeks, but not constantly during the past twelve-month period (30 percent); • constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required over the past twelve-month period (60 percent); • more than 40 percent of the entire body affected; or, (60 percent); or • more than 40 percent of the exposed areas of the body affected. (60 percent). A higher rating may also be warranted for disfigurement or scarring; however, the Veteran does not claim nor does evidence show either, and thus they are not for application. Turning to the evidence, neither June 2013 nor May 2016 VA examiners found that his disability covered any percentage of his body or exposed areas of his body, but rather that the outbreaks of PFB were controlled by medication. Similarly, private treatment records during the appeal period do not show any significant percentage of his body or exposed body affected by PFB. The Veteran has not claimed he has been treated at a VA facility, and thus there are no VA medical records other than the examination reports in his claims file. Therefore, the medical evidence does not support a higher rating for percentage of the body or exposed areas of the body affected. Next, the May 2016 VA examiner found that the Veteran was treated with an oral antibiotic for six weeks or more but not constantly and that it was systemic therapy. This was the finding that precipitated the rating increase to 30 percent from the date of the examination. The examiner also noted a host of other prescription remedies the Veteran used to treat PFB, including topical corticosteroids, and local anesthetics associated with laser hair removal. In contrast, the June 2013 VA examiner only noted that the Veteran received laser hair removal treatment for PFB. This is despite medical records from the private provider performing laser hair removal preceding the June 2013 VA examination detailing uses of the medications described by the May 2016 VA examiner. In short, the June 2013 VA examiner had access to treatment notes describing medication prescribed to treat the PFB but failed to note the medications in the examination report. The Veteran stated in his January 2017 Form 9 that his PFB symptoms and treatment have been unchanged since the date of his claim. No medical evidence in the record shows definitively that he was first prescribed an oral antibiotic in the period between the two VA examinations. As such, as a VA examiner has determined that the medication qualifies as systemic therapy and the Veteran is competent to report which medication he took to treat his disability, with all reasonable doubt resolved in his favor, the evidence shows that he has required an oral antibiotic (systemic therapy) to treat PFB for a total duration of more than six weeks in all relevant twelve-month periods since filing his claim, and a 30 percent rating is warranted for the entire period. However, at no point does the evidence show that he used constant or near-constant systemic therapy for any twelve-month period. The Veteran stated during the May 2016 VA examination he only used the oral antibiotic on an as-needed basis. The examiner also noted that a topical corticosteroid was used six weeks or more in the prior twelve-month period, but not constantly. The Veteran noted he used it to control skin inflammation when he had flare-ups from razor irritation, rather than something he uses daily. Given that he does not use it constantly or near-constantly, its use would not warrant a higher rating. As such, under the pre-amended regulations, the medical evidence warrants a 30 percent rating for the entirety of the appeals period, but no higher. For the period after August 13, 2018, DC 7806 evaluations are determined by the General Rating Formula for the Skin. To warrant a rating in excess of 30 percent, the evidence must show at least one of the following: • characteristic lesions involving more than 40 percent of the entire body or more than 50 percent of exposed areas affected; or, • constant or near-constant systemic therapy involving, 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. As noted above, the Veteran does not have lesions of affected areas of the skin of 40 percent of the entire body or 50 percent of the exposed areas affected. Thus, a higher rating due to percentage of the body affected is not warranted. Systemic therapy is described under the new criteria as treatment administered through any route other than the skin. As such, the topical corticosteroids that may arguably qualify under the pre-amended rating criteria would no longer do so. However, again, as examined above, no qualifying treatment rises to the frequency of constant or near-constant systemic therapy such to warrant a higher rating. As such, a higher rating under the amended rating criteria is not warranted. The Board has also considered the Veteran’s lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, Layno v. Brown, 6 Vet. App. 465, 470 (1994), he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. The Veteran has further claimed that he should be rated commensurate with the level of impairment caused by PFB during service. However, claims are rated according to their current level of disability. Such competent evidence concerning the nature and extent of his PFB symptoms has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiners have the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinion great probative value. As such, these records are more probative than the Veteran’s subjective evidence of complaints of increased symptomatology. In sum, after a careful review of the evidence of record, a 30 percent rating, but no more, is warranted for PFB during the period on appeal. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brendan A. Evans, Associate Counsel