Citation Nr: 20051232 Decision Date: 08/03/20 Archive Date: 08/03/20 DOCKET NO. 14-25 872 DATE: August 3, 2020 ORDER Entitlement to an initial rating in excess of 10 percent for residuals of a right ankle sprain (hereinafter a “right ankle disability’) is denied. Entitlement to an initial rating in excess of 10 percent for residuals of a left ankle sprain (hereinafter a “left ankle disability’) is denied. Entitlement to an initial compensable rating for left hand dermatitis is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s right ankle disability manifested, at most, in a moderate limitation of range of motion even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without ankylosis of the ankle or subastragalar or tarsal joint, malunion of os calcis or astragalus, or an astragalectomy. 2. For the entire period on appeal, the Veteran’s right ankle disability manifested, at most, in a moderate limitation of range of motion even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without ankylosis of the ankle or subastragalar or tarsal joint, malunion of os calcis or astragalus, or an astragalectomy. 3. The Veteran’s left-hand dermatitis affects less than five percent of the entire body and less than five percent of exposed areas and has not involved treatment from corticosteroids or other immunosuppressive drugs approximating systemic therapy. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for a right ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5271. 2. The criteria for an initial rating in excess of 10 percent for a left ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5271. 3. The criteria for entitlement to an initial compensable rating for left hand dermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from April 1998 to March 2012. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2013rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. Jurisdiction of this appeal is currently with the RO in St. Paul, Minnesota. This case was most recently before the Board in September 2018, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. In May 2017, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Increased Rating Disability evaluations 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 his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant’s current symptoms. See Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claims. 1. Right and Left Ankle Disabilities The Veteran asserts that he is entitled to a higher rating for his right and left ankle disabilities as his symptoms are more severe than contemplated by the currently assigned ratings. In that regard, in his September 2013 Notice of Disagreement, the Veteran asserted that his bilateral ankle symptoms included pain, inability to walk for more than 15 minutes, feelings of pins and needles, being woken up due to the pain, in ability to drive, and being unable to walk, jog, or run. Moreover, the Veteran asserted in his June 2014 VA Form 9 that his ankles’ range of motion does not explain, nor appropriately rate, his severe pain. The Veteran has been assigned a 10 percent rating for his right and left ankle disabilities each, under Diagnostic Code 5271. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. Under Diagnostic Code 5271, a rating of 10 percent is warranted when limitation of motion of the ankle is moderate. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. The maximum rating of 20 percent disabling is available under Diagnostic Code 5271 where the limitation of motion in the ankle is marked. Id. Normal ankle motion is dorsiflexion to 20 degrees, and plantar flexion to 45 degrees. 38 C.F.R. § 4.71a, Plate II. Notably, the terms “moderate” and “marked” are not defined under VA regulations. Those terms also do not appear to have a generally accepted medical definition. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. It should also be noted that use of terminology such as “moderate” by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Also included within 38 C.F.R. § 4.71a are multiple Diagnostic Codes that evaluate ankle disabilities based on other manifestations, including Diagnostic Code 5270 (ankylosis of the ankle), Diagnostic Code 5272 (ankylosis of the subastragalar or tarsal joint), Diagnostic Code 5273 (malunion of the os calcis or astragalus), and Diagnostic Code 5274 (astragalectomy). When an evaluation of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable DC, any additional functional loss the Veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). Turning to the evidence of record, at his May 2017 Board hearing, the Veteran testified that his ankle symptoms included daily pain, to include as due to prolonged standing; recurrent pain shortly after taking over the counter pain medication; and “popping” when flexing the ankle. He denied the use or orthotics, but indicated he had previously been issued orthotics that were worn out. He testified he was not issued replacement orthotics. He endorsed the use of restrictive wraps when his ankles were extremely painful, but that it did not help alleviate the pain. He testified that the pain was ever present, to include during rest, and that he had been woken up in his sleep due to the pain. The Veteran testified that the ankle area would go a little numb, and that he would not be able to do anything until the numbness ended. He testified that the ankle pain prevented prolonged standing, walking, and movement. He stated that physical therapy worsened his pain, and that he had limited range of motion that he could function with. However, any use of his ankle resulted in pain. At a June 2013 VA examination for ankle conditions, the Veteran reported current symptoms included pain, even at rest. He denied flare-ups of the ankles. Range of motion measurements were as follows: plantar flexion was to 45 degrees or greater bilaterally, with no objective evidence of painful motion; and dorsiflexion was to 20 degrees or greater bilaterally, with no objective evidence of painful motion. The Veteran was able to perform repetitive-use testing bilaterally, and there was no additional loss of range of motion after repetition. The Veteran did not have any functional loss and/or functional impairment of the ankle. There was no localized tenderness or pain on palpation of either ankle. Muscle strength testing was normal, and there was no muscle atrophy. There was no ankylosis bilaterally. The Veteran did not have or ever had “shin splints,” stress fractures, Achilles tendonitis, Achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), nor had the Veteran had a talectomy (astragalectomy). There were no other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions found. He denied the use of any assistive device as a normal mode of locomotion. Functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. The examiner noted the Veteran’s ankle disabilities did not impact his ability to work. At a June 2019 VA examination for ankle conditions, the Veteran reported current symptoms included bilateral pain and a burning sensation with walking. He denied instability, clicking, and swelling. He reported that he “self-pops” the ankle, and that this would alleviate the pain for a few minutes; and that pain medication was not particularly helpful. He indicated that CBD oil helped for approximately 20 minutes. He endorsed flare-ups of the ankles that required elevation of the feet and laying down, and was described as hypersensitivity to touch. During flare-ups, he reported difficulty walking and standing. Duration of the flare-ups lasted 2 to 3 hours at a time. Functional loss or functional impairment reported included difficulty walking and standing. Range of motion measurements were as follows: dorsiflexion was to 20 degrees bilaterally; and plantar flexion was to 45 degrees bilaterally. Pain was not noted on examination. There was objective evidence of mild localized tenderness or pain on palpation located at the bilateral medial deltoid ligament area that was related to ankle sprain. There was no evidence of pain with weight-bearing, nor was there evidence of crepitus. There was no additional loss of function or range of motion on repetition. The Veteran was not examined immediately following repetition nor during a flare-up; and the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss after repetitive-use or during a flare-up. Additional factors contributing to the disability included pain without any expected change in range of motion after repetition or during a flare-up. Additional factors contributing to the right and left ankle disabilities included disturbance of locomotion; interference with sitting; interference with standing; flares with repeated use that caused interference with sitting, standing, and disturbance of locomotion due to pain. Muscle strength testing was normal, and there was no muscle atrophy. There was no ankylosis bilaterally. There was no ankle instability or dislocation suspected with either ankle. The Veteran did not have or ever had “shin splints,” stress fractures, Achilles tendonitis, Achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), nor had the Veteran had a talectomy (astragalectomy). There were no other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions found. He denied the use of any assistive device as a normal mode of locomotion. Functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. The examiner noted the Veteran’s left ankle impacted her ability to work in that pain interfered with standing and lifting requiring breaks. There was no objective evidence of pain with nonweight-bearing nor with passive range of motion testing bilaterally; and passive range of motion was the same as active range of motion. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his right and left ankle disabilities. A review of the treatment notes of record does not show the Veteran to have symptoms of an ankle disability worse than those reported at the VA examinations of record. For the foregoing reasons, the Board finds that the Veteran is not entitled ratings in excess of 10 percent, for his right and left ankle disabilities. In this regard, there is simply no evidence of record to suggest that the Veteran suffered from marked limitation of the right or left ankle; as such, a rating of 20 percent is not warranted. At his June 2013 VA examination, the Veteran reported pain, but was not shown to have a functional loss. At his June 2019 VA examination, the Veteran reported that he had pain, and reported functional loss as difficulty walking and standing due to pain. Moreover, there was no additional loss of function or range of motion found after repetitive use testing. He denied instability, clicking, and swelling. Further, the June 2019 VA examiner noted the pain was mild bilaterally, and there was no evidence of pain with weight-bearing. In addition, at both VA examinations it was noted that muscle strength testing was normal and without muscle atrophy. In addition, the clinical records do not reflect marked limitation of motion. Accordingly, the Board finds that the Veteran’s right and left ankle disabilities manifested, at most, in a moderate limitation of range of motion even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. The Veteran’s belief that he is entitled to higher ratings for his right and left ankle disabilities is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. Ultimately, on objective examination, range of motion measurements showed normal range of motion of both ankles. Moreover, to the extent that the Veteran alleges that he is entitled to a higher rating due to pain, burning, and occasional numbness, the Board notes that such symptoms are contemplated under the current rating. The Board has also considered whether a staged rating under Hart, supra, is appropriate for the Veteran’s service-connected right and left ankle disabilities; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning a staged rating for such disability is not warranted. Further, the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In addition, the Board has considered whether a higher or separate rating could be awarded under an alternative diagnostic code for the Veteran’s right and left ankle disabilities. 38 C.F.R. § 4.71a, Diagnostic Codes 5270 to 5274. In the June 2019 VA examination, the examiner found that the Veteran does not exhibit ankylosis in the ankle. As such, Diagnostic Code 5270 does not appear to apply. Similarly, it was not shown that the Veteran had, and has never been diagnosed with, either os calcis or astragalus, nor has he ever undergone an astragalectomy. These findings preclude consideration of Diagnostic Codes 5272, 5273, and 5274, respectively. Under 38 C.F.R. § 4.71a, there are no other diagnostic codes available to evaluate disabilities of the ankle. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court of Appeals for Veterans Claims (Court) holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board notes that the VA examiners indicated there was no interference with weight-bearing and pain was noted on examination and that the effect of pain on range of motion is described above. Regarding repeated use over time, the Board notes that June 2013 and June 2019 VA examiners conducted repetitive-use testing and concluded that there was no additional limitation in range of motion; and that additional limitation in range of motion was not expected after repetition nor during a flare-up. Therefore, the Board finds that all information required for rating purposes was provided. The examiners clearly noted that the Veteran specifically reported increased pain with movement and on rest; and that the Veteran did not have interference or pain shown with weight-bearing. Accordingly, the Board finds that a preponderance of the evidence is against a rating in excess of 10 percent for a right ankle disability and against a rating in excess of 10 percent for a left ankle disability, and the claims are denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Left Hand Dermatitis The Veteran asserts that he is entitled to a higher rating for his left-hand dermatitis as his symptoms are more severe than contemplated by the currently assigned rating. In that regard, in his September 2013 Notice of Disagreement, the Veteran asserted that his left-hand dermatitis had spread across his palm and altered his fingerprints. See also June 2014 VA Form 9. The Veteran’s dermatitis is currently rated as noncompensable under 38 C.F.R. § 4.118, Diagnostic Code 7806. The applicable rating criteria for skin disorders, found at 38 C.F.R. § 4.118, were amended effective August 13, 2008. See 83 Fed. Reg. 32,592 (July 13, 2018). “VA’s 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.” 83 Fed. Reg. 32,592 (July 13, 2018). Under the new criteria, a note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, “systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.” Diagnostic Code 7806 continues to apply to dermatitis or eczema, but is rated under the general rating formula for the skin. Under the new criteria, a 10 percent rating is warranted where at least one of the following is present: characteristic lesions involving at least five percent, but less than 20 percent, of the entire body affected; or at least five percent, but less than 20 percent, of exposed areas affected; or intermittent 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 for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is warranted where at least one of the following is present: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, over the past 12-month period. 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, PUVA, or other immunosuppressive drugs required over the past 12-month period. Under the former criteria, a 10 percent rating is warranted for at least five percent, but less than 20 percent, of the entire body, or at least five percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating applies where 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating applies where more than 40 percent of the entire body or more than 40 percent of exposed areas are affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs is required during the past 12-month period. With regard to the meaning of “systemic therapy” prior to the new definition of the term in the revised criteria, the Court in Johnson v. McDonald, 27 Vet. App. 497, 505 (2016) held that use of a topical steroid constituted “systemic therapy” within the meaning of Diagnostic Code 7806. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit reversed this decision and determined that “constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs” under Diagnostic Code 7806 is generally not inclusive of topical corticosteroids. The Federal Circuit found that “systemic therapy” means “treatment pertaining to or affecting the body as a whole,” whereas topical therapy means “treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied.” Thus, according to the Federal Circuit, all applications of topical corticosteroids do not constitute systemic therapy. The Federal Circuit also 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 Burton v. Wilkie, No. 16-2037, 2018 U.S. App. Vet. Claims Lexis 1314 (Sept. 28, 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. The Veteran’s claim in this case was pending prior to the August 13, 2018 effective date of the new criteria, and therefore the Board will consider both the old and new criteria and apply the more favorable. However, the Federal Circuit’s interpretation of the term “systemic therapy” in the old criteria applies throughout the entire period prior to the August 13, 2018 effective date of the new criteria. Rivers v. Roadway Express, 511 U.S. 298, 312-13 (1994) (“[j]udicial construction of a statute [or regulation] is an authoritative statement of what the statute [or regulation] meant before as well as after the decision of the case giving rise to that construction”); Jordan v. Nicholson, 401 F.3d 1296, 1298-99 (Fed. Cir. 2005) (a new interpretation of a statute retroactively affects decisions still open on direct review); Threatt v. McDonald, 28 Vet. App. 56, 63 (2016) (noting the “normal principle at this Court that judicial decisions operate retrospectively”). Turning to the evidence of record, at his May 2017 Board hearing, the Veteran testified that his left-hand dermatitis spread to his entire palm, but not his wrist; and resulted in disfigurement of his fingerprints, interfered with fingerprinting requirements for employment. He testified that symptoms included tingling, including pins and needles; intermittent pus; peeling; pain; interference with dexterity and grip; and itching. He testified he used lotion to treat his symptoms. At a June 2013 VA examination, the Veteran reported that his condition began in 2008, and he was not taking any medication for this condition. Physical examination showed dermatitis that affected less than 5 percent of the total body area and less than 5 percent of the exposed area. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms found. The examiner noted the Veteran’s condition did not impact his ability to work. A March 2015 VA treatment record indicates the Veteran was seen for a dermatology outpatient visit. At that time, the Veteran complained of dermatitis that began on his left thumb and spread to his entire left palm. He stated it was dry, flaky, and had small blisters that would erupt and go away. He reported little to no itching, pain, burning, weakness, or tingling. He reported his fingerprints were not legible for job applications. He indicated he had difficulty with gripping weights at the gym. He denied seeing skin issues elsewhere on his body. He endorsed the use of emollients twice a day for the past 6 months without improvement. At a June 2019 VA examination, the Veteran reported current symptoms included cracked skin around the thumb; occasional pain; decreased sensitivity to temperature; and decreased grip strength. He endorsed the intermittent use of an antifungal cream. He had been treated with a topical antifungal cream for less than 6 weeks in the past 12 months. Physical examination showed dermatitis that affected less than 5 percent of the total body area and less than 5 percent of the exposed area. Visual appearance was described as more erythematous left hand than the right hand; healed vesicles of 1 millimeter or less scattered around his palm; white scaling in the palm that was worse in thenar eminence; without nail pitting; and normal dorsal surface of the hand. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms found. The examiner noted the Veteran’s condition did not impact his ability to work. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his left-hand dermatitis. A review of the treatment notes of record does not show the Veteran to have symptoms of a skin disability worse than those reported at the VA examinations of record. For the foregoing reasons, the Board finds that the Veteran is not entitled to an initial compensable rating for his left-hand dermatitis. In this regard, the Board finds that while the Veteran was prescribed topical antifungal cream for treatment of his skin disorder, there is no evidence that his treatment resulted in “systemic therapy” to support a compensable rating. The use of the topical corticosteroid prescribed to the Veteran was applied to less than five percent of his entire body for less than 6 weeks. This more closely approximates “topical therapy” as the corticosteroid used pertains to a certain area of the Veteran’s skin and affects only the area to which it is applied. Such treatment has not been administered on a large enough scale such that it affected the Veteran’s body as a whole. As noted above the affected area is less than five percent of exposed skin and less than one percent of the entire body. Accordingly, an initial compensable rating is not warranted for dermatitis under the old or new criteria pertaining to the skin. The Veteran’s belief that he is entitled to higher ratings for his left-hand dermatitis is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. Ultimately, on objective examination, his dermatitis was shown to affect less than 5 percent of his total body, less than 5 percent of the total exposed area, and did not require the use of “systemic therapy.” Moreover, to the extent that the Veteran alleges that he is entitled to a higher rating due to pain, the spread of dermatitis from his thumb to his palm, and fingerprint deformity, the Board notes that such symptoms are contemplated under the current rating. The Board has also considered whether a staged rating under Hart, supra, is appropriate for the Veteran’s service-connected left-hand dermatitis; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning a staged rating for such disability is not warranted. Further, the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Accordingly, the Board finds that a preponderance of the evidence is against an initial compensable rating for left hand dermatitis, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.