Citation Nr: 18103755 Decision Date: 05/21/18 Archive Date: 05/19/18 DOCKET NO. 14-43 444 DATE: May 21, 2018 ORDER Service connection for a left ankle disorder is denied. Prior to October 22, 2014, a compensable rating for psoriasis is denied. Since October 22, 2014, a 10 percent rating, but no higher, for psoriasis is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. The Veteran served on active duty from February 1988 to November 2012. 2. A left ankle disorder has not been shown. 3. Prior to October 22, 2014, psoriasis was manifested by subjective complaints of skin lesions; objective findings included lesions affecting less than five percent of the total body and requiring daily treatment with topical corticosteroids. 4. Since October 22, 2014, psoriasis has been manifested by subjective complaints of skin lesions; objective findings included lesions affecting slightly more than five percent of the total body and requiring daily treatment with topical corticosteroids and intermittent phototherapy. CONCLUSIONS OF LAW 1. A left ankle disorder was not incurred in service. 38 U.S.C. §§ 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. Prior to October 22, 2014, the criteria for a compensable rating for psoriasis had not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.118, Diagnostic Code (DC) 7816 (2017). 3. Since October 22, 2014, the criteria for a 10 percent rating, but no higher, for psoriasis have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.118, DC 7816 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Briefly, the Board acknowledges that there is a separate appeal pending for entitlement to service connection for sleep apnea. As this appeal originates from a different Agency of Original Jurisdiction (AOJ) than those addressed herein, these appeals may not be merged. As such, a separate decision addressing the sleep apnea appeal will be issued at a later date. See Board Directive 8430, ¶ 14. The Veteran claimed entitlement to a rating in excess of 10 percent for osteoarthritis of the right and left knees in June 2014. As this issue has not yet been adjudicated by the Agency of Original Jurisdiction (AOJ), the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). Service Connection for a Left Ankle Disorder Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The first element of service connection is a current disability. Review of the evidence reflects that the Veteran has not been diagnosed with a left ankle disorder at any time during the pendency of this appeal. In this regard, the Veteran has reported that he has been diagnosed with left ankle tendonitis; however, VA and private treatment records note only his statements to this effect. At no time has a medical professional rendered a diagnosis, particularly following physical examination or diagnostic testing. In an October 2012 VA ankle examination, he was diagnosed with a ligament tear of the right ankle but there was no diagnosis with respect to the left ankle. On physical examination, the left ankle range of motion was normal, there was no pain in the left ankle and muscle testing was normal. As the Veteran lacks the requisite medical training and expertise to competently offer a medical diagnosis, the Board affords greater probative value to the medical evidence of record in finding that no disability exists. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). The Board has considered the Veteran’s statements regarding ongoing left ankle pain. The recent holding of Saunders v. Wilkie, No. 2017-1466, 2016 U.S. App. LEXIS 8467 (Fed. Cir. Apr. 3, 2018), established that pain, productive of functional impairment, qualifies as a disability for VA purposes. However, he has not alleged any functional impairment due to his left ankle pain. Accordingly, the record does not establish such a pattern of functional impairment as to classify the Veteran’s pain as a disability. In the absence of a current disability, further inquiry into an in-service event or a nexus thereto is not required. As the preponderance of the evidence weighs against the claim, the appeal is denied. Increased Rating Disability ratings are determined by the applications of the VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. For a compensable rating to be warranted, the evidence must show: • psoriasis affecting at least 5 percent, but less than 20 percent, of the entire body, or when at least 5 percent, but less than 20 percent, of exposed areas affected, or; when intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period (10 percent). Systemic therapy means “treatment pertaining to or affecting the body as a whole,” whereas topical therapy means “treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied.” Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). Upon review of the evidence, the Board finds that staged ratings are appropriate in this case. First, a noncompensable rating is warranted for the period prior to October 22, 2014. During this time, the Veteran presented with varying lesions of his elbows, scalp, legs, back, head, stomach, and ears. An October 2012 VA examiner estimated that these lesions affected less than five percent of the total body area, and none of the exposed area. These lesions were treated with the constant use of topical corticosteroids over the affected areas, but the need for intermittent systematic immunosuppressive therapy was denied. No additional symptoms, including scarring, were reported at any time. Such a disability picture is best embodied in the criteria for a noncompensable rating, such that the appeal is denied to this extent. Since October 22, 2014, the evidence reflects a worsening of the disability. Upon examination, the Veteran presented with psoriasis affecting “a little more” than five percent of the total body surface. These symptoms were treated with the ongoing use of topical corticosteroids and phototherapy, which were not fully successful. Such a disability picture has been endorsed by the Veteran, who reported on his October 2014 substantive appeal that his psoriasis affected more than five percent of his body. His related symptoms prevented him from wearing shorts and going swimming because he felt self-conscious of his legs, chest, and back. Considering the October 2014 treatment record and the Veteran’s own observations, and in the absence of contradictory evidence, the disability picture more nearly approximates a 10 percent rating, but no more, since October 22, 2014. The appeal is granted to this extent. 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 K. Kovarovic, Associate Counsel