Citation Nr: 20006491 Decision Date: 01/28/20 Archive Date: 01/27/20 DOCKET NO. 18-54 410 DATE: January 28, 2020 ORDER Entitlement to service connection dermatographia, dry skin, and dermatographic urticaria is granted. FINDING OF FACT The Veteran served in the Southwest Asia theater of operations and his current dermatographia, dry skin, and dermatographic urticaria is a diagnosed illness without conclusive pathophysiology or etiology that has been manifest for more than six months and has required first line treatment (antihistamines) for control. CONCLUSION OF LAW The criteria for service connection for dermatographia, dry skin, and dermatographic urticaria have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317, 4.118, Diagnostic Code 7825. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1987 to September 1991, to include service in the Southwest Asia theater of operations. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran seeks service connection for a skin disorder, which he relates to his service in the Southwest Asia theater of operations. It is undisputed that the Veteran’s current skin disorder, which has been diagnosed as dermatographia, dry skin, and dermatographic urticaria, has been present throughout the pendency of the appeal. See, e.g., VA examination (February 2018). The evidence of record, most recently the February 2018 VA examination report, shows that the disorder has been treated with constant or near constant antihistamines since as early as 2011. Id.; Statement (June 6, 2017); VA examination (February 2018). As the Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Under those provisions, service connection for disability due to undiagnosed illness and medically unexplained chronic multi symptom illness is warranted where the disability manifest to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). To determine whether the illness is manifested to a degree of 10 percent or more the condition must be rated by analogy to a disease or injury in which the functions affected, anatomical location or symptomatology are similar. See 38 C.F.R. § 3.317(a)(5); see also Stankevich v. Nicholson, 19 Vet. App. 470 (2006). A “medically unexplained chronic multisymptom illness” means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.” 38 C.F.R. § 3.317 (a)(2)(ii). Signs or symptoms that may be manifestations of medically unexplained chronic multisymptom illness include signs or symptoms involving skin. 38 C.F.R. § 3.317(b). For purposes of section 3.317, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317 (a)(4). Here, the evidence shows that the Veteran’s dermatographia, dry skin, and dermatographic urticaria is a diagnosed illness without conclusive pathophysiology or etiology. In this regard, the February 2018 VA examiner explained that “the specific etiology of this condition is not well understood. It is generally thought to involve mast cells but an exact pathophysiology has not been established. The cause is equally unknown among veterans and non-veterans.” Indeed, VA adjudicators may rely on a medical examiner’s evaluation of whether a veteran’s condition qualifies as a diagnosed illness without conclusive pathophysiology or etiology. See Goodman v. Shulkin, 870 F.3d 1383, 1387 (Fed. Cir. 2017). The evidence also shows that the Veteran’s dermatographia, dry skin, and dermatographic urticaria became manifest to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317 (a)(1). In this regard, as the Veteran’s condition is a type of urticaria, it would be rated analogous to urticaria in light of the functions affected, anatomical location, and symptomatology. See 38 C.F.R. § 3.317(a)(5). Under 38 C.F.R. § 4.118, Diagnostic Code 7825, chronic urticaria warrants a 10 percent when it requires first line treatment (antihistamines) for control. Therefore, since the February 2018 VA examination report clearly indicates that the condition has required antihistamine for control, the condition has manifest to a degree of at least 10 percent under Diagnostic Code 7825. Finally, the evidence shows that the Veteran’s dermatographia, dry skin, and dermatographic has existed for six months or more. In this regard, the February 2018 VA examination report explains that the condition has been present since its initial diagnosis in 2011. 38 C.F.R. § 3.317(a)(4). In sum, the Veteran served in the Southwest Asia theater of operations and his current dermatographia, dry skin, and dermatographic urticaria is a diagnosed illness without conclusive pathophysiology or etiology that has been manifest for more than six months and has required first line treatment (antihistamines) for control. For these reasons, service connection for dermatographia, dry skin, and dermatographic urticaria is warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joshua R. Castillo, 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.