Citation Nr: 20004201 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 17-56 267A DATE: January 16, 2020 REMANDED Entitlement to a disability rating in excess of 0 percent for tinea cruris is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1975 to December 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. Entitlement to a disability rating in excess of 0 percent for tinea cruris is remanded. Upon review of the claim file, the Board finds the appeal must be remanded for a new VA examination. In this regard, under 38 C.F.R. § 4.118, DC 7806, a 10 percent rating is warranted where the skin disability covers at least 5 percent, but less than 20 percent of the entire body, or at least 5 percent, but less than 20 percent of the exposed areas affected, or, intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past 12-month period; a 30 percent rating is assigned when the disorder covers 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or by systemic therapy being required for a total duration of six weeks or more, but not constantly, during the past 12-month period; and a 60 percent rating is assigned when the disorder covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or by constant or near-constant systemic therapy being required during the past 12-month period. The Board notes that the 60 percent rating criteria was changed on August 13, 2018, after the Veteran’s claim for an increased rating. Since August 13, 2018, 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 affected; or 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. Claims pending prior to the effective date of the new 60 percent rating, such as in the present case, shall be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. There is evidence that during the time on appeal, the Veteran used various topical medications to treat his disability. In a January 2016 VA examination, the examiner noted that the Veteran was using ketoconozole cream and nystatin cream on a constant/near constant basis over the past 12 months to treat his tinea cruris. A June 2019 VA examination noted the constant or near constant use of clotrimazole and nystatin over the previous 12 months to treat tinea cruris. While outside the period on appeal, a June 2007 VA examination stated that the Veteran was treated with a number of drugs for his tinea cruris and its related complications, including dysthymic Lamisil, triamcinolone, intramuscular Kenalog, minocycline, hydrocortisone, and Loprox. His CAPRI Medical Records list several prescribed medications, but it is unclear which are for his tinea cruris. Additionally, a June 2003 assessment plan stated that the Veteran would be treated with systemic and local antifungals for his tinea cruris. See June 2003 Medical Treatment Record. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Warren v. McDonald, 28 Vet. App. 194, 197 (2016), the Court held that the types of systemic treatment that are compensable under Diagnostic Code 7806 are not limited to “corticosteroids or other immunosuppressive drugs;” rather, compensation is available for “all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs.” Finally, in Burton v. Wilkie, 30 Vet. App. 286, 291 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects. Accordingly, the Board must consider whether the Veteran’s use of ketoconozole cream, nystatin cream, and clotrimazole may be considered systemic therapies. Finally, as this matter is being remanded, the Veteran’s updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records and associate such with the file. 2. Schedule the Veteran for a medical examination by an appropriately qualified clinician to evaluate the current nature and severity of his service-connected tinea cruris. The examination should be conducted in accordance with the current disability questionnaire, to include addressing whether this disability requires systemic therapy as that term has been defined by the courts in the above cases, including Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), and Burton v. Wilkie, 30 Vet. App. 286 (2018). The VA examiner should note the Veteran’s past and current tinea cruris medications throughout the period on appeal, to include ketoconozole cream, nystatin cream, and clotrimazole. After identifying all medications used by the Veteran for the service-connected skin disorder during the period on appeal, the examiner should indicate whether any topical therapy such as ointments are systemic in its scale, method, or side effects. A full rationale for any opinion rendered must be provided. 3. If upon completion of the above action the claim remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Mohammad 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.