Citation Nr: 20007978 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 12-24 079 DATE: January 30, 2020 ORDER Entitlement to a rating in excess of 10 percent for a skin disability affecting the hands and feet, including dermatophytosis and tinea pedis (hereinafter skin disability) is denied. FINDING OF FACT The Veteran’s skin disability is not manifested by 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected or systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 10 percent for a skin disability have not been met. 38 U.S.C. §§ 1155, 1712, 5103, 5107; 38 C.F.R. §§ 3.102, 3.103, 3.303, 3.159, 3.321, 4.1, 4.3, 4.7, 4.10, 4.27, 4.118, 4.130, Diagnostic Code 7806. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1978 to September 1984. In July 2018, the Board of Veterans’ Appeals (Board) denied entitlement to a rating in excess of 20 percent for cervical strain with radiculopathy and remanded the issue of entitlement to a rating in excess of 10 percent for a skin disability. Remand directives ordered the Department of Veterans Affairs (VA) to obtain a recent VA examination to reevaluate the Veteran’s skin disability. Post-remand, the Veteran was afforded a VA examination in April 2019. The issue of entitlement to a rating in excess of 20 percent for cervical strain with radiculopathy is not before the Board. Entitlement to a rating in excess of 10 percent for a skin disability. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155: 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). The Veteran’s skin disability of the hands and feet is rated as 10 percent disabling under 38 C.F.R. § 4.118, Diagnostic Codes 7813-7806. First, the Board notes that the applicable rating criteria for skin disorders, found at 38 C.F.R. § 4.118, were amended effective August 30, 2002 (see 67 Fed. Reg. 49490-99 (July 31, 2002)) and again effective October 2008 (see 73 Fed. Reg. 54708 (September 23, 2008)). The October 2008 revisions are applicable to claims for benefits received by the VA on or after October 23, 2008, or if a Veteran makes a specific request to have his disability rated under the new criteria. However, the Board finds that these changes in the regulations do not affect the current appeal because these changes did not modify Diagnostic Code 7806. Under 38 C.F.R. § 4.118, Diagnostic Code 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. With the above criteria in mind, the Board notes that at the April 2019 VA examination the Veteran reported having a problem with itchy scaling skin with raised bumps. As to his treatment, it was reported that the Veteran constantly applied topical medications. On examination, it was opined that the service-connected skin disorder covered less than 5 percent of the entire body and less than 5 percent of exposed areas. Regarding treatment records, while they document the Veteran’s complaints and treatment for his skin disorder, the Board finds that nothing in these records show his symptoms to be worse than what was reported by the above VA examiners. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Tellingly, these treatment records are negative for any showing the percentage of the Veteran’s body affected by the skin disability contrary to the areas reported on examination or the use of intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, more frequent than reported at the above VA examinations. Id. As to the Veteran’s lay claims, the Board first finds that lay persons are competent to report on the symptoms they can see like a rash and bumps as well as what they feel like an itch. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). However, a review of the record on appeal does not reveal any statement by the Veteran or anyone else on his behalf as to the exact percentage of his entire body and/or the exact percentage of the exposed areas affected by his skin disorder. Therefore, the Board finds the percentage opinions provided by the VA examiners the most probative evidence of record. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). As to any lay claims regarding the Veteran’s use of oral corticosteroids or immunosuppressive drugs to treat the skin disability of the hands and feet, the Board finds the VA examiners opinion and the documentation found in the treatment records, which are negative for corticosteroids or immunosuppressive drug use, more probative that any claims to the contrary. The Board has reached this conclusion because objective medical records are more accurate than self-reported claims which are not always clear. See Owens, 7 Vet. App. at 433. Given the above evidence, the Board also finds that the most probative evidence of record shows that the Veteran skin disability of the hands and feet does not cover at least 20 to 40 percent of his entire body or 20 to 40 percent of the exposed areas affected because, at its worst, his VA examiners opined it only covers less than 5 percent of his entire body and less than 5 percent the exposed areas affected. Id. The Board also finds that the most probative evidence of record shows that the Veteran’s skin disability of the hands and feet does not require at least six weeks of systemic therapy during any 12-month period during the pendency of the appeal because at its worst the record shows and the VA examiners opined that he did not require any systemic therapy during any 12-month period during the pendency of the appeal. Id. Therefore, the Board finds that the Veteran does not meet the criteria for a rating in excess of 10 percent for his skin disability of the hands and feet at any period during the appeal. 38 C.F.R. § 4.118, Diagnostic Code 7806; See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura Cochran, 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.