Citation Nr: 21002971 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 93-24 337 DATE: January 19, 2021 REMANDED Entitlement to a rating in excess of 30 percent for a skin disability is remanded. REASONS FOR REMAND The Appellant is the surviving spouse of a Veteran who served on active duty from March 1964 to March 1966. The Veteran died while the appeal was pending before the Board. The Appellant was properly substituted within one year of the Veteran's death and is recognized as a valid substitute appellant. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2003 rating decision of the New York, New York, Regional Office (RO) of the Department of Veterans Affairs (VA) which denied an increased rating for a skin disability characterized as multiple sebaceous cysts with hidradenitis suppurativa. In June 2006, the Board remanded the claim to schedule a hearing. The Veteran appeared at a January 2007 hearing before the undersigned Veterans Law Judge at the RO. A hearing transcript is of record. In June 2007, May 2009, April 2011, and May 2017, the Board remanded the claim to the RO for additional development. In September 2017, the Board remanded the claim to the RO for additional development of the record, to include scheduling the Veteran for a new VA examination. Unfortunately, the Veteran died prior to the examination. Entitlement to a rating in excess of 30 percent for a skin disability is remanded. Although the Board sincerely regrets the additional delay, remand is necessary to ensure that there is a complete record upon which to decide the claim so that the Veteran is afforded every possible consideration. The criteria for rating skin disabilities have changed three times during the period covered by this appeal, effective August 30, 2002; October 23, 2008; and 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. The record does not contain sufficient information for the Board to determine the past severity of the Veteran's skin disability. VA's duty to assist may include a need to obtain a "retrospective medical opinion" to ascertain past severity of a disability where a rating must be assigned for a long-ago period and insufficient evidence is presented to support rating the disability over that period. Chotta v. Peake, 22 Vet. App. 80 (2008). On remand, the RO should obtain a retrospective opinion concerning the severity of the Veteran's service-connected skin disability, to include any residuals, from May 10, 2000, to the Veteran’s death. The matters are REMANDED for the following action: 1. Notify the Appellant that she may submit lay statements from herself and from other individuals who have first-hand knowledge, or were contemporaneously informed of the nature, extent, and severity of the Veteran's skin disability symptoms from May 10, 2000, to October 19, 2017. The Appellant should be provided an appropriate amount of time to submit any lay evidence. 2. Then, arrange to obtain a retrospective opinion from a VA physician with the appropriate expertise. The examiner must review the claims file and should note that review in the report. The RO should provide the examiner with the applicable rating criteria during the relevant time periods. Based on a review of all pertinent lay and medical evidence, the examiner must, to the extent possible, provide estimates regarding the severity of the service-connected sebaceous cysts with hidradenitis suppurativa, which have been rated by analogy under the criteria for psoriasis. The examiner is asked to distinguish, to the extent possible, the symptoms and severity of symptoms associated with the service-connected skin disabilities, including any determined to be part of those disabilities, from any symptoms associated with any nonservice-connected skin disabilities. If it is not possible to separate that symptomatology, the examiner should so state. The examiner must explain the rationale for all opinions, citing to supporting factual data where possible. The examiner should provide specific findings as to whether, during the period from May 10, 2000, through October 19, 2017, service-connected sebaceous cysts with hidradenitis suppurativa were manifested by constant exudation or itching, extensive lesions, marked disfigurement, ulceration, extensive exfoliation or crusting, or systematic or nervous manifestations; and whether the skin disability was exceptionally repugnant. The examiner should also provide specific findings as to whether, during the period from August 30, 2002, through October 19, 2017, the service-connected sebaceous cysts with hidradenitis suppurativa cumulatively involved more than 40 percent of the entire body or exposed areas, or required constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs during a 12-month period. The total percent of body/exposed areas and duration of any systemic therapy should be identified. The examiner should specifically discuss the treatment provided and whether it constituted systemic therapy. The examiner should clearly indicate whether, at any point during the period from May 10, 2000, through October 19, 2017, the record shows any change in the severity of the Veteran's skin disability; and, if so, the approximate date of any such change, and the severity of the disability before and after each change. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals 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.