Citation Nr: 19166318 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 09-32 298 DATE: August 27, 2019 REMANDED Entitlement to a disability rating in excess of 30 percent for service-connected dermatitis, also claimed as Sweet’s syndrome, to include on an extraschedular basis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from November 1961 to October 1963. This matter before the Board of Veterans’ Appeals (Board) is on appeal from an October 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania (Agency of Original Jurisdiction (AOJ)). The Veteran testified at a Travel Board hearing before a Veteran’s Law Judge (VLJ) in November 2011. A transcript of the proceeding is of record. This matter has a lengthy procedural history. It was last before the Board in September 2017; at that time, the claim was denied. The Veteran appealed this decision to the Court of Appeals for Veterans’ Claims (the Court) for a second time (the first occurring in May 2017). In October 2018, the Court granted the parties’ Joint Motion for Remand and the case was subsequently sent back to the Board, where it is being addressed in the instant decision. 1. Entitlement to a disability rating in excess of 30 percent for service-connected dermatitis, also claimed as Sweet’s syndrome, to include on an extraschedular basis, is remanded. The Veteran is presently service-connected for dermatitis by analogy pursuant to 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806; his condition was evaluated as 30 percent disabling in an October 2008 rating decision. He contends that his condition, also claimed as Sweet’s syndrome, warrants a higher disability rating to include extraschedular consideration. Specifically, he explains that his skin condition includes symptoms that are not contemplated by the present schedular rating criteria. In correspondence entitled “Brief in Support of the Veteran’s Entitlement to Increased Rating for Dermatitis,” the Veteran’s representative presented evidence suggesting that the symptoms associated with the Veteran’s condition are not contemplated by his 30 percent disability rating. He reported that the Veteran presently suffers from the following symptoms: joint pain, malaise, constipation, diarrhea, fevers, night sweats, weight gain, lymphadenopathy, aches, and fatigue. Additionally, Sweet’s syndrome, he purports, is more than a skin disease; medical literature provided elsewhere in the record defines the condition as “characterized by the sudden onset of fever, leukocytosis [an elevated white blood cell count], and tender, erythematous, well-demarcated papules and plaques which show dense neutrophilic infiltrates on histologic examination.” The Veteran seeks a 60 percent rating under DC 7806 which requires a skin condition that covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. The evidence of record suggests that, save for a notation in an August 2008 VA examination that stated his skin condition covered “approximately 40 percent” of the Veteran’s entire body, the rash associated with his Sweet’s syndrome covers anywhere from 1 percent to under 5 percent of his body. However, the Veteran has presented evidence that symptoms associated with Sweet’s syndrome may be similar to those found in autoimmune diseases as the condition is “associated with hematologic disease (including leukemia) and immunologic disease (rheumatoid arthritis, inflammatory bowel disease).” In light of the foregoing, referral of this claim to the Director of Compensation and Pension for guidance on the most appropriate DC prior to its adjudication is warranted. The matter is REMANDED for the following action: 1. Associate with the claims folder records of the Veteran’s VA treatment since June 2016. 2. Then, refer the case to an appropriate medical specialist. The claims file must be made available to and be reviewed by the specialist. This specialist should explain what Sweet syndrome is and what symptoms are associated with it. Specifically, the specialist should consider the Veteran’s symptoms and provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such symptoms are attributable to his Sweet syndrome. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Thereafter, the Veteran’s claim should be forwarded to the Director of Compensation and Pension, for consideration of a more appropriate diagnostic code for his service-connected dermatitis with consideration given to all of the symptoms the Veteran experiences as a result of his skin condition that are not contemplated by the schedular rating criteria under DC 7806. 4. Thereafter, readjudicate the claim. If any benefit sought on appeal remains denied, furnish the Veteran and his representative, if any, a supplemental statement of the case and an appropriate period of time to respond. DAVID C. SPICKLER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Victoria A. Narducci, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.