Citation Nr: 20007771 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 14-07 173 DATE: January 29, 2020 ORDER Entitlement to an initial compensable evaluation for urticaria (also claimed as dermatitis) is granted at 10 percent from November 17, 2009. REMANDED Entitlement to service connection for skin disorders is remanded FINDING OF FACT Throughout the period on appeal the Veteran used antihistamines to control his symptoms of urticaria. CONCLUSION OF LAW The criteria for an initial compensable rating of 10 percent for urticaria has been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.6, 4.118, Diagnostic Code (DC) 7825. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably from January 1999 to May 1999 and from May 2002 to January 2010. This matter comes to the Board of Veteran’s Appeals (Board) on appeal from an October 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In September 2015, the Board remanded the claim to the Agency of Original Jurisdiction (AOJ) for additional development of the claim to assess the current nature and severity of the Veteran’s skin disability. The Veteran contends that his skin disability warrants a compensable rating. Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. See 38 C.F.R. § 4.7. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's urticaria is rated under 38 C.F.R. § 4.118, DC 7825. Recently, VA amended the criteria for rating the skin. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32.592 (July 13, 2018). Under the former version of DC 7825, applicable to urticaria, a 10 percent rating was warranted for recurrent episodes occurring at least four times during the past 12-month period, and; responding to treatment with antihistamines or sympathomimetics. A 30 percent rating was warranted for recurrent debilitating episodes occurring at least four times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control. A 60 percent rating was warranted for recurrent debilitating episodes occurring at least four times during the past 12-month period despite continuous immunosuppressive therapy. Under the new criteria, the terms “systemic” and “debilitating” have been removed from DC 7825. Instead, DC 7825 has been revised to address “chronic urticaria,” which is defined as “continuous urticaria at least twice per week, off treatment, for a period of six weeks or more.” Under the revised version of DC 7825, a 10 percent rating is warranted for chronic urticaria that requires first line treatment (antihistamines) for control. A 30 percent rating is warranted for chronic urticaria that requires second line treatment (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, or thyroid hormone) for control. A 60 percent rating is warranted for urticaria that requires third line treatment for control (e.g., plasmapheresis, immunotherapy, and or immunosuppressives) due to ineffectiveness with first and second line treatments. With regard to the effective date governing the new criteria, VA indicated in the Supplementary Information to the Final Rule that its “intent is that the 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.” The Veteran’s claim in this case was pending prior to the August 13, 2018 effective date of the new criteria. Therefore, the Board will consider both the old and new criteria and apply the more favorable. During the period on appeal, the Veteran has undergone two VA examinations to determine the severity of his service-connected skin condition. See September 2010 Disability Benefits Questionnaire (DBQ); see also, November 2015 DBQ and December 2015 DBQ. In a December 2015 VA examination, the Veteran reported recurrent rashes resulting in itchy red patches that occurs on his face, back, chest and shoulders. The examiner noted no scarring or disfigurement of the head, face or neck, no benign or malignant skin neoplasms and no systemic manifestations due to skin diseases. The Veteran had been prescribed topical corticosteroids for dermatitis for a duration of 6 weeks or more, but not constant, and did not have any debilitating or non-debilitating episodes in the previous 12 months. It was also noted that there are no visible skin conditions on exposed body area during the exam, does not have any additional findings pertinent to his skin condition and it does not impact the Veteran’s ability to work. In a September 2010 VA examination, the Veteran complained of lesions and blisters on his back, between his legs and on the left forearm while in service. He states that these outbreaks occur yearly and take around a month to clear up and had been given Benadryl, an antihistamine, for 1 to 6 weeks in the previous 12 months, in addition to hydrocortisone, a topical corticosteroid for 1 to 6 weeks in the previous 12 months. Less than 5 percent of the total body area is affected. A rating of 10 percent is warranted under the new rating criteria for DC 7285 for the period on appeal. The September 2010 VA examination notes the Veteran would take Benadryl, an antihistamine, to control his symptoms. There is additional evidence in his medical records that show additional prescriptions for antihistamines throughout the period on appeal. A rating in excess of 10 percent is not warranted for urticaria. First, the medical evidence demonstrates that the Veteran did not have “debilitating episodes” requiring hospitalization, emergency room visits, urgent care at clinics, or prescribed bed rest. Furthermore, there is no indication that the Veteran has chronic urticaria requiring second-line treatment for control. Therefore, an evaluation in excess of 10 percent is not warranted. 38 C.F.R. § 4.118, DC 7825. The Board has considered whether a higher rating is available under other potentially applicable diagnostic codes; however, the evidence of record does not demonstrate that the Veteran’s service-connected urticaria is manifested by scars or characteristics of disfigurements. 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7804, 7805. REASONS FOR REMAND The Veteran’s medical records document various conditions of the skin aside from his service-connected urticaria. Specifically, there is evidence of diagnoses of rosacea, seborrhea and contact dermatitis. See November 2015 DBQ; see also December 2015 DBQ. As these conditions could be separately rated, if service-connected, a remand for an addendum opinion and additional development is necessary. The matter is REMANDED for the following actions: 1. Update the record for additional VA or private treatment records. The most recent VA treatment records date to July 2019. 2. Schedule the Veteran for an examination by an appropriate clinician to clarify and identify each of the Veteran’s diagnoses for any skin disorder since the date of the claim (November 2009). The claims file must be reviewed, and the following questions must be addressed: 3. Identify all skin disorders from 2009 forward. 4. For each skin disorder, state whether it is as likely as not (50 percent or greater probability) that the currently diagnosed disorders (those diagnoses made since November 2009) had their onset in service, or are otherwise related to complaints of and the treatment for skin disorder treatment in service. 5. The examiner should provide reasons for all opinions. If the examiner cannot provide any requested opinion without resorting to speculation, he or she should state whether the inability is due to the limits of the examiner’s medical knowledge, or there is additional evidence, which if obtained, would permit the opinion to be provided. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kelsey Love, 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.