Citation Nr: 18161150 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-57 517 DATE: December 28, 2018 ORDER Entitlement to service connection for a facial chemical burn is denied. Entitlement to service connection for a fatty liver is denied. Entitlement to service connection for sleep apnea, secondary to coronary artery disease, is granted. Entitlement to service connection for headaches, secondary to hypertension and tinnitus, is granted. Entitlement to service connection for an acquired psychological disability including anxiety, secondary to tinea versicolor, is granted. Entitlement to a compensable rating for right knee patellofemoral syndrome, not in excess of 10 percent, is granted. Entitlement to an increased rating, in excess of 30 percent, for coronary artery disease is denied. Entitlement to an increased rating, in excess of 60 percent, for tinea versicolor is denied. Entitlement to an earlier effective date for a 30 percent rating for tinea versicolor, effective August 7, 2012, is granted. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a facial chemical burn. 2. The preponderance of the evidence is against finding that the Veteran has a fatty liver due to a disease or injury in service, to include specific in-service event, injury, or disease. 3. The Veteran’s sleep apnea is proximately due to/aggravated beyond its natural progression by his service-connected coronary artery disease. 4. The Veteran’s headaches are proximately due to/aggravated beyond its natural progression by his service-connected hypertension, and tinnitus. 5. The Veteran’s acquired psychological disability including anxiety is proximately due to/aggravated beyond its natural progression by his service-connected tinea versicolor. 6. The Veteran’s right knee pain creates a functional loss to warrant a compensable rating. 7. The Veteran’s coronary artery disease has not had more than one episode of congestive heart failure, workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or, left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 8. The Veteran is already in receipt of the maximum rating assignable for tinea versicolor (i.e. 60 percent). 9. From August 7, 2012, the Veteran’s tineas versicolor covered 30 to 40 percent of his total body area. CONCLUSIONS OF LAW 1. The criteria for service connection for a facial chemical burn are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a fatty liver are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for secondary service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 4. The criteria for secondary service connection for headaches are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 5. The criteria for secondary service connection for acquired psychological disability including anxiety are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 6. The criteria for a compensable rating for right knee patellofemoral syndrome, not in excess of 10 percent, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 7. The criteria for to an increased rating, in excess of 30 percent, for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102. 4.3, 4.7, 4.10, 4.104 Diagnostic Code 7005. 8. The criteria for an increased rating, in excess of 60 percent, for tinea versicolor have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7800; 38 C.F.R. §§ 3.655, 4.118 Diagnostic Code 7806. 9. The criteria to an earlier effective date for a 30 percent rating for tinea versicolor, effective August 7, 2012, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.7, 4.15, 4.16(b), 4.18, 4.19. 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1983 to February 1989. The Veteran appeals March 2013 and August 2014 rating decisions from the Department of Veteran Affairs (VA) Regional Offices (RO) in Detroit, Michigan, and Newnan, Georgia, respectively. The Board notes that in a September 2016 rating decision, the RO increased the disability rating for the Veteran’s coronary artery disease to 30 percent effective August 17, 2016, and tinea versicolor to 60 percent effective June 15, 2015. The Veteran declined a Board hearing in his November 2016, and May 2017 VA Form 9. The Veteran’s representative submitted an appellate brief in September 2017. Service Connection The Veteran contends that his fatty liver, sleep apnea, acquired psychological disability including anxiety, facial chemical burn, and headaches are connected to the Veteran’s time in-service either directly or secondarily. Direct service connection is warranted where the evidence of record establishes that a particular injury or disease results in a present disability that incurred in the line of duty during active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). Entitlement to service connection for a facial chemical burn The evidence of record is silent to the presence of a current disability related to a facial chemical burn. To be considered for service connection, a claimant must first have a disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, without a current disability, service connection for a facial chemical burn is not warranted. Entitlement to service connection for a fatty liver The Veteran contends that his fatty liver is a result of Nizoral, which was prescribed to him in the service to treat his tinea versicolor. The Veteran was afforded a VA examination in February 2013. During the examination, the Veteran stated that he was prescribed Nizoral to treat his tinea versicolor. The Veteran contends that a military doctor told him that Nizoral can have “bad effects on the liver.” The Veteran stated that the liver did not get severe until 2009. The VA examiner noted that the Veteran was diagnosed with fatty liver in 2009. The VA examiner observed that the Veteran had right upper quadrant pain daily. The Veteran did not have hepatitis C, and did not have incapacitating episodes due to his liver condition. The VA examiner noted that the Veteran did not have cirrhosis of the liver. The VA examiner opined that the Nizoral could have effects on the liver. However, the VA examiner stated that Nizoral’s effects were usually reversible upon discontinuation of the medicine. Additionally, the VA examiner stated that, “there is no credible medical literature which states Nizoral causes a fatty liver years after treatment.” The VA examiner opined that a fatty liver can be caused by overuse of alcohol, genetics, middle-age, and obesity. The VA examiner opined that the Veteran’s obesity is most likely the cause for his fatty liver because his doctors put him on a diet to try to lose weight. Therefore, the Veteran’s fatty liver was not caused by the Veteran’s tinea versicolor treatment in service. The Board finds the 2013 VA examination probative. The VA examiner based her medical opinion on the VA claims folder, and an in-person examination. Next, the VA examiner’s opinion is not conclusory. Her opinion is based on the medical evidence on record, and medical literature. For example, the VA examiner outlined other possible causes for a fatty liver such as the Veteran’s obesity (and being put on a diet). Further, the VA examiner opined that medical literature weighed against Nizoral causing fatty liver nearly two decades between treatment and diagnosis of fatty liver. Consequently, the Board finds that service connection for a fatty liver is not warranted. Entitlement to service connection for sleep apnea, secondary to coronary artery disease Entitlement to headaches, secondary to hypertension and tinnitus Entitlement to an acquired psychological disability including anxiety, secondary to tinea versicolor The Veteran contends that his sleep apnea, headaches, and acquired psychological disability including anxiety are either caused or aggravated by his service connected CAD, hypertension, and tinea versicolor. Secondary service connection requires: (1) a service connected disability; (2) a nonservice connected disability; and (3) evidence that the nonservice connected disability is either (a) proximately due to or the result of the service-connected disability or (b) aggravated (increased in severity) by the service-connected disability. See 38 C.F.R. § 3.310. Regarding sleep apnea, the Veteran was diagnosed with central sleep apnea in December 2009. A December 2016 Sleep Apnea Disability Benefits Questionnaire (DBQ) opined that the Veteran’s psychological stress, cardiovascular disease, and use of opiate pain medication contribute significantly to the onset and permanent aggravation of sleep-disordered breathing. Further, the December 2016 Sleep Apnea DBQ noted a 2008 American Thoracic Society report that documented heart disease affecting sleep-disordered sleeping. As such, the physician opined that the Veteran’s central sleep apnea is more likely than not caused/permanently aggravated by the Veteran’s service connected CAD. Therefore, the Board finds that service connection for sleep apnea, secondary to CAD, is granted. Regarding headaches, the Veteran was diagnosed with migraines in a December 2016 Headaches DBQ. The Veteran’s headaches present constant head pain, pain on both sides of the head, and worsens with physical activity. In the December 2016 Headaches DBQ, the Veteran reported that his headaches are “significantly worsened” during times of increased stress. The December 2016 DBQ noted that medical literature shows a cause-and-effect relationship between headaches and stress. Further, one study showed hypertension as a risk factor leading to the exacerbation of the frequency and severity of both migraine and tension type headaches. Finally, a 1992 International Journal of Audiology report documented that the frequency of headaches is strongly correlated with the severity of tinnitus. As such, the physician opined that the Veteran’s headaches are more likely than not caused and aggravated by hypertension, and tinnitus. Therefore, service connection for headaches, secondary to hypertension and tinnitus, is granted. Regarding acquired psychological disability including anxiety, the Veteran’s wife asserts that the Veteran’s service connected tinea versicolor affects the Veteran’s anxiety. See January 2011 and June 2015 Correspondence. The Veteran’s wife reported that the Veteran is extremely embarrassed by his tinea versicolor, and is afraid that his tinea versicolor would be visible to his friends and other people. See January 2011 Correspondence. Further, the Veteran’s desire to be outdoors is overshadowed by his anxiety of having a flare up of tinea versicolor. See June 2015 Correspondence. The Veteran was diagnosed with an anxiety disorder in a March 2016 Anxiety DBQ. During the examination, the Veteran stated his “physical conditions impact his mood; social isolation and withdrawal, nervous all the time, embarrassed because . . . [he] feels people notice his condition.” The Veteran added that he feels overwhelmed and frustrated. The March 2016 DBQ noted that medical literature found correlates between depression, anxiety, and ongoing medical condition. As such, the physician opined that the Veteran’s tinea versicolor was more likely than not causing his anxiety disorder. Therefore, service connection for an acquired psychological with an anxiety disorder, secondary to tinea versicolor, is granted. The nature and extent of this problem is not before the Board at this time. Increased Rating The Veteran contends that he is warranted to increased ratings for his right knee patellofemoral syndrome, coronary artery disease (CAD), and tinea versicolor. Disability evaluations are determined by comparing the Veteran’s present symptomatology with the criteria set forth in the VA’s Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Higher ratings are assigned if the disability more nearly approximates the criteria for that rating; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence, the benefit of the doubt is to be resolved in the Veteran’s favor. 38 U.S.C. § 5107(b). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Entitlement to a compensable rating for right knee patellofemoral syndrome The Veteran asserts that his right knee patellofemoral syndrome pain warrants a compensable rating. The Veteran’s right knee disability is rated under Diagnostic Code 5257. See 38 C.F.R. § 4.71a. Under Diagnostic Code 5257, slight impairment of either knee, including recurrent subluxation or lateral instability, warrants a 10 percent evaluation. A 20 percent evaluation requires moderate impairment, while a 30 percent evaluation requires severe impairment. 38 C.F.R. § 4.71a. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. In that regard, painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; see Burton v. Shinseki, 25 Vet. App. 1 (2011). The Veteran underwent a Knee DBQ in April 2012. The Veteran reported no flare ups for his right knee condition. The Veteran’s initial range of motion for the right knee flexion ended at 140 degrees or greater, with no objective evidence of painful motion. The Veteran’s initial range of motion for the right knee extension ended at 0 degrees, with no objective evidence of painful motion. There was no change in the Veteran’s range of motion after post-repetitive motion testing. The examiner noted that the Veteran did not have any additional functional loss or limitations on range of motion of the right knee after repetitions. The Veteran’s stability tests were normal, and his right knee did not show a history of recurrent subluxation and dislocation. The Veteran did not have a meniscal condition, and did not require the use of assistive devices. An April 2012 MRI of the right knee indicated chronic right knee pain, but showed no evidence of fractures, dislocations, or subluxations. The Veteran underwent another Knee DBQ in September 2016. The Veteran did not report flare ups of the right knee. The Veteran’s initial range of motion for the right knee flexion and extension ended at 130 degrees, with no objective evidence of painful motion. The examiner noted that the Veteran did not have any additional functional loss or limitations on range of motion of the right knee after repetitions. The examiner noted that pain, weakness, fatigability, or incoordination do not significantly limited the Veteran’s functional ability. The Veteran’s right knee muscle strength was normal, his right knee did not have ankylosis, nor was his right knee instable. The examiner noted that the Veteran used a brace, and cane regularly. The examiner opined that the Veteran’s decreased range of motion imposed functional limitation in prolonged standing, and climbing. Based on the above, the Board finds that the Veteran is warranted a rating not in excess of 10 percent under 38 C.F.R. §§ 4.40, 4.45, 4.59. The September 2016 Knee DBQ noted that the Veteran’s decreased range in motion imposed a functional limitation in prolonged standing, and climbing. Further, the Veteran regularly uses a brace, and cane. The April 2012 MRI noted the presence of chronic right knee pain. Combined, the functional loss caused by the decreased range of motion in the right knee, and the use of assistive devices point to fatigue and weakness creating a functional loss. A rating in excess of 10 percent is not warranted because the evidence of record does not indicate the Veteran’s right knee has a moderate recurrent subluxation or lateral instability. Further, the Veteran does not have ankylosis of the right knee; locking, pain, and effusion into the joint, and an impaired tibia or fibula. Finally, the evidence of record is silent to the Veteran meeting the requirements under limitation of flexion, or extension of leg. While the Veteran clearly has problems with the knee, this is the basis for the 10 percent finding. Entitlement to an increased rating, in excess of 30 percent, for coronary artery disease The Veteran asserts that he is warranted an increased rating in excess of 30 percent for his CAD. The Veteran’s CAD is rated under Diagnostic Code 7005. See 38 C.F.R. § 4.104. Under Diagnostic Code 7005, a 60 percent rating is warranted where there is more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A rating of 100 percent requires chronic congestive heart failure, or; a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. The Veteran underwent a VA examination in April 2012. The Veteran did not have congestive heart failure. During the cardiac functional assessment, the Veteran denied experiencing dyspnea, fatigue, angina, dizziness, or syncope with any level of physical activity. The VA examiner noted that the Veteran’s CAD required continuous medication. The Veteran’s left ventricular ejection fraction (LVEF) was 55 to 60 percent. The VA examiner noted that the Veteran did not have another heart condition beyond CAD. The Veteran was afforded another VA examination in August 2016. The Veteran requires continuous medication. The Veteran does not have congestive heart failure, cardiac arrhythmia, or a heart valve condition. The Veteran’s CAD presents fatigue with a workload of 5 METs but not greater than 7 METs. Further, the Veteran’s LVEF was 60 percent. Based on the above, the Veteran is not warranted a rating in excess of 30 percent. The Veteran does not have congestive heart failure, nor a workload greater than 3 METs but not greater than 5 METs. Additionally, the Veteran’s LVEF is not between 30 to 50 percent. Finally, the evidence of record is silent as to the presence of another heart condition that could warrant a higher rating under 38 C.F.R. § 4.104. Consequently, an increased rating in excess of 30 percent for CAD is denied. As with the knee, the Board’s findings do not, in any way, suggests the Veteran does not have problems with his CAD. It is important for the Veteran to understand that a disability rating at any level will cause the Veteran problems. The only question is the degree of the problems based on the criteria above. Entitlement to an increased rating, in excess of 60 percent, for tinea versicolor The Veteran asserts that he is warranted to an increased rating, in excess of 60 percent, for his tinea versicolor. The Board notes that the criteria for the skin were revised, effective August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32592 (July 13, 2018) (to be codified at 38 C.F.R. 4). The Veteran’s tinea versicolor is rated under Diagnostic Code 7806. Under the previous rating criteria, a 10 percent rating is warranted for dermatitis or eczema in which at least 5 percent, but less than 20 percent, of the entire body or at least 5 percent, but less than 20 percent of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks during the last 12-month period. A 30 percent rating is assigned for dermatitis or eczema in which 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating is warranted when more than 40 percent of the entire body or more than 40 percent of exposed areas are affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs are required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. Under the amended rating, skin conditions under Diagnostic Code 7806 are rated under the General Rating Formula for Skin. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32592 (July 13, 2018) (to be codified at 38 C.F.R. 4). In the new General Rating Formula for Skin a 10 percent rating is warranted for characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body; or for at least 5 percent, but less than 20 percent, of exposed areas; or for intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is warranted for characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas; or for systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas; or for constant or near-constant systemic therapy including, 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. Under the new 38 C.F.R. § 4.118, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32,592 (July 13, 2018) (to be codified at 38 C.F.R. pt. 4). A March 2012 VA examination found that the Veteran’s skin condition did not cause scarring, or disfigurement of the head, neck, or face. The Veteran did not have neoplasms. The Veteran’s tinea versicolor required constant/near-constant topical corticosteroid for treatment. The VA examiner noted that the Veteran’s tinea versicolor affected less than 5 percent of his total body area, but did not affect his exposed areas. An August 2012 private treatment note stated that the Veteran’s tinea versicolor affected 30 to 40 percent for his total body. In a July 2014 private treatment note, a private physician noted that the Veteran’s tineas versicolor had worsened to the point that 40 to 50 percent of his body was now affected. The Veteran’s skin condition required more aggressive treatment of oral medication, and topical ointments. In June 2015 private treatment note, a private physician stated that the Veteran’s tineas versicolor covered more than 40 percent of his body. The physician noted that the Veteran was being treated with creams and oral medication. The Veteran underwent another VA examination in July 2015. The Veteran’s tineas versicolor did not cause scarring or disfigurement of head, face, or neck. Also, the Veteran does not have any neoplasms. The Veteran takes Lamisil tablets off and on, and topical cream as needed for less than six weeks. Tineas versicolor, at the time of the VA exam, affected 5 to 20 percent of the Veteran’s total body, but less than 5 percent of the exposed area. Based on the above, the Board finds that an increased rating in excess of 60 percent for the Veteran’s tinea versicolor is not warranted. The Veteran’s tineas versicolor is currently rated at 60 percent. Under both previous Diagnostic Code 7806 criteria, and the new General Rating Formula for Skin, a 60 percent rating is the maximum rating assignable. As such, a rating in excess of 60 percent is not permitted. The Veteran’s tineas versicolor does not cause and disfigurement to the head, face, or neck to warrant a rating under Diagnostic Code 7800. Further the evidence of record is silent to presence of erythroderma. As such, the Veteran is not warranted a higher rating under Diagnostic Code 7817. Consequently, an increased rating in excess of 60 percent for tineas versicolor is denied. Once again, the Board’s findings do not, in any way, suggests the Veteran does not have problems with his tineas versicolor. It is important for the Veteran to understand that a disability rating at any level will cause the Veteran problems. The only question is the degree of the problems based on the criteria above. Early Effective Date The Veteran contends that he is warranted to an earlier effective date for a 30 percent disability rating currently effective August 30, 2012. The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if the application is received within one year from such date; otherwise, it is the date of receipt of the claim. 38 U.S.C. § 5110(a), (b)(2); 38 C.F.R. § 3.400(o). However, if it is factually ascertainable that an increase in disability occurred within the one-year prior to filing the claim, the effective date will be the date the increase was shown. 38 C.F.R. § 3.400(o)(2). See also Hazan v. Gober, 10 Vet. App. 511, 519 (1992); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (noting that “the relevant temporal focus” in an increased rating claim is on “the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim”). Entitlement to an earlier effective date for a 30 percent rating for tinea versicolor, effective August 30, 2012 The Veteran asserts that he is entitled to an earlier effective date for his 30 percent rating for tinea versicolor prior to August 30, 2012. A March 2013 rating decision granted an increased rating of 30 percent for the Veteran’s tineas versicolor. The RO set the effective date as August 30, 2012, the date the Veteran submitted an informal claim for an increased rating for tineas versicolor. However, an increase in the tineas versicolor can be ascertained within a year that the VA received the Veteran’s informal claim. An August 7, 2012 private treatment note stated that the Veteran’s tinea versicolor affected 30 to 40 percent for his total body. Under the previous Diagnostic Code 7806 criteria (see prior section), a 30 percent rating was warranted when 20 to 40 percent of the entire body was affected. Therefore, the Board can ascertain that the Veteran’s tineas versicolor increased in severity within a year before applying for an increased rating for tineas versicolor. Consequently, an earlier effective date is granted, and set at August 7, 2012. JOHN J CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Timothy A. Campbell, Associate Counsel