Citation Nr: 20046887 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 11-00 946 DATE: July 14, 2020 ORDER A rating of 30 percent, but no higher, for residuals of scrotal crural dermatitis for the period on appeal beginning April 7, 2014 through June 22, 2014 is granted, subject to the laws and regulations governing payment of monetary benefits. A rating in excess of 10 percent for residuals of scrotal crural dermatitis for the period prior to April 7, 2014; a rating in excess of 10 percent for the period beginning June 23, 2014 until July 14, 2017; and a rating in excess of 60 percent beginning July 14, 2017 and thereafter, is denied. FINDING OF FACT The Veteran underwent UVB phototherapy for his scrotal crural dermatitis from April 7, 2014 until June 23, 2014. During 2012 and 2015, the Veteran had intermittent use of topical creams for his scrotal crural dermatitis, which equated to less than a six week time period over a 12-month time period. The Veteran was found to have constant or near-constant use of a topical corticosteroid cream for his scrotal crural dermatitis by a VA examiner in a July 14, 2017 VA examination. CONCLUSION OF LAW The criteria for a rating of 30 percent, but no higher, for residuals of scrotal crural dermatitis for the period on appeal beginning April 7, 2014 through June 23, 2014, have been met; but the criteria for a rating in excess of 10 percent for residuals of scrotal crural dermatitis for the period prior to April 7, 2014, a rating in excess of 10 percent from June 23, 2014 until July 14, 2017, and a rating in excess of 60 percent beginning July 14, 2017 and thereafter, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Code 7817. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from March 1966 to February 1968 and from April 1970 to November 1971. The period of service from April 1970 to November 1971 is considered dishonorable for VA purposes. The matter is on appeal before the Board from an August 2010 rating decision. The Board notes that the matter has been remanded by the Board twice previously for further development. Increased Rating Scrotal Crural Dermatitis The Veteran filed a claim for an increased rating for his scrotal crural dermatitis (dermatitis) in July 2009. For the period on appeal, the Veteran’s dermatitis is rated at 10 percent for the period prior to July 14, 2017, and 60 percent for the period thereafter. The Veteran’s dermatitis is rated under Diagnostic Code 7817. VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. 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 Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Prior to August 13, 2018 under Diagnostic Code 7817, a 10 percent rating was assigned when there was any extent of involvement of the skin, and; systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long- wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy required for a total duration of less than six weeks during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7817. A 30 percent rating is warranted with any extent of involvement of the skin, and; systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA or UVB treatments, or electron beam therapy required for a total duration of six weeks or more, but not constantly, during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7817. A 60 percent rating is warranted with generalized involvement of the skin without systemic manifestations, and; constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA or UVB treatments, or electron beam therapy required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7817. A 100 percent rating is warranted with generalized involvement of the skin, plus systemic manifestations (such as fever, weight loss, and hypoproteinemia), and; constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA or UVB treatments, or electron beam therapy required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7817. For claims filed prior to August 13, 2018, the Court held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a Veteran’s skin condition; and (2) whether the given treatment is “like” a corticosteroid or other immunosuppressive drug.” Burton v. Wilkie, 30 Vet. App. 286 (2018). Only the second question need be addressed if the treatment is clearly systemic. Id. As of August 13, 2018, under Diagnostic Code 7817, a 60 percent rating is warranted with generalized involvement of the skin without systemic manifestations and one of the following: constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy required over the past 12-month period; or no current treatment due to a documented history of treatment failure with 1 treatment regimen. 38 C.F.R. § 4.118, Diagnostic Code 7817. A 100 percent rating is warranted with generalized involvement of the skin with systemic manifestations (such as fever, weight loss, or hypoproteinemia) AND one of the following: constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA (psoralen with long-wave ultraviolet-A light), UVB (ultraviolet-B light) treatments, biologics, or electron beam therapy required over the past 12 month period; or no current treatment due to a documented history of treatment failure with 2 or more treatment regimens. 38 C.F.R. § 4.118, Diagnostic Code 7817. A note to Diagnostic Code 7817 reflects that treatment failure is defined as either disease progression, or less than a 25 percent reduction in the extent and severity of disease after four weeks of prescribed therapy, as documented by medical records. 38 C.F.R. § 4.118, Diagnostic Code 7817. Effective August 31, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). Over the course of the period on appeal, the Veteran underwent two VA examinations pertaining to his dermatitis, one in April 2010 and one in July 2017. In addition, a VA medical opinion was rendered in December 2019 pertaining to the Veteran’s dermatitis. At the April 2010 VA examination, the Veteran reported having occasional itching in the groin area mainly during the summer months. He denied using any creams or ointments for his skin condition, and denied any systemic symptoms or impairment of function. The examiner reported that the Veteran’s symptoms were nonprogressive and intermittent. After an examination of the Veteran’s skin in the groin area, the examiner noted there to be light hyperpigmentation of the skin in the inner thigh area. The examiner found there to be no lesions present, and there to be no tinea cruris at the time. At the July 2017 VA examination, the examiner did not report the Veteran to have any systemic manifestations due to any skin diseases. The examiner found that the Veteran had been treated with topical corticosteroids during the prior 12 months on a constant or near-constant basis. The examiner did not report the Veteran to have had any treatments or procedures other than systemic or topical medication in the past 12 months for his dermatitis. The Veteran’s skin condition did not cause scarring of the head, face, or neck. He did not have any benign or malignant skin neoplasms. Within the prior 12 months he had not had any debilitating episodes of urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis. The examiner reported that the Veteran’s dermatitis covers approximately five to less than 20 percent of his total body area, none of which is in an exposed area. The December 2019 VA medical opinion pertained to a question remanded by the Board in May 2018, which was whether phototherapy that the Veteran had undergone constituted systemic therapy and if so what period of time it was required for the Veteran’s condition. The VA examiner only responded that the Veteran had been treated in 2015 and had a history of response to UV therapy, but that there was no data of record since then of any systemic therapy. A review of the Veteran’s VA treatment record reflects that the Veteran began undergoing UVA and UVB phototherapy on April 7, 2014 for his dermatitis. He continued to have phototherapy twice a week until June 25, 2014. At his June 25, 2014 appointment, the Veteran was found to have skin erosions, and therefore his appointment for phototherapy was cancelled. The Veteran’s last phototherapy appointment was on June 23, 2014. In addition, a notation from September 2014 reflects that the Veteran’s rash had resolved, and that phototherapy would be discontinued for the time being. At no other time during the entire period on appeal, does the Veteran’s record reflect that he underwent any phototherapy treatments. In November 2015 the Veteran considered restarting phototherapy, however, he decided against it. As to the use of topical creams and corticosteroids, the record reflects that the Veteran utilized them intermittently in 2012 and 2015, however, the record does not reflect that the use was ever for more than six weeks during either 2012 or 2015. The Veteran did not begin to regularly utilize topical creams for his dermatitis until 2017, as was noted above at his July 2017 VA examination. Based upon the foregoing, a rating of 30 percent, but no greater, for the period beginning April 7, 2014 through June 23, 2014 is warranted due to the Veteran having undergone UVB phototherapy for a period of greater than 6 weeks but not constantly. (Continued on the next page)   For the rest of the period on appeal, a rating in excess of 10 percent prior to April 7, 2014 is not warranted, as the Veteran’s record only reflects intermittent use of topical creams for his dermatitis, which equates to less than six weeks during a 12-month time period. A rating in excess of 10 percent for the period beginning June 24, 2014 until July 14, 2017 is not warranted, as the Veteran’s record also only reflects intermittent use of topical creams for his dermatitis, which equates to less than six weeks during a 12-month time period. The Veteran was not found to have constant or near-constant use of a topical corticosteroid cream for his dermatitis by a VA examiner until his July 14, 2017 VA examination. A rating in excess of 60 percent as of July 14, 2017 and thereafter is not warranted, as the record does not reflect the Veteran to have systemic manifestations such as fever, weight loss, and hypoproteinemia due to his dermatitis. In addition, the Veteran has not been shown to have a documented history of treatment failure with any treatment regimen. Accordingly, a rating of 30 percent, but no higher, for residuals of scrotal crural dermatitis for the period on appeal beginning April 7, 2014 through June 22, 2014 is granted. However, a rating in excess of 10 percent for residuals of scrotal crural dermatitis for the period prior to April 7, 2014; a rating in excess of 10 percent for the period beginning June 23, 2014 until July 14, 2017; and a rating in excess of 60 percent beginning July 14, 2017 and thereafter, is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Lutgens-Staley, 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.