Citation Nr: 21003276 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 12-03 572 DATE: January 21, 2021 ORDER Entitlement to an initial compensable rating for service-connected hypertension, is denied. Entitlement to an increased rating exceeding 10 percent, prior to October 8, 2020, and exceeding 30 percent thereafter, for service-connected tinea versicolor with tinea corporis ("skin disability"), is denied. FINDINGS OF FACT 1. The Veteran’s hypertension requires continuous medication for control throughout the appeal period but he does not have blood pressure levels that are, historically or otherwise, predominantly 100 or more for diastolic pressure or 160 or more for systolic pressure. 2. Prior to October 8, 2020, the Veteran’s skin disability has manifested, at worse, to an affected area of at least 5 percent but not more than 20 percent of the entire body or requiring no more than topical treatment during any 12-month period 3. Beginning October 8, 2020, the Veteran’s skin disability has manifested, at worse, to an affected area of 20 to 40 percent of the total body or requiring no more than topical treatment during any 12-month period. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial compensable rating for service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7101. 2. The criteria for entitlement to an increased rating exceeding 10 percent, prior to October 8, 2020, and exceeding 30 percent thereafter, for service-connected tinea versicolor with tinea corporis ("skin disability") 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 (DC) 7813-7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1985 to October 1997, from January 2003 to February 2004, from March 2004 to August 2004, from September 2004 to September 2006, and from September 2007 to January 2010. This case comes before the Board of Veterans’ Appeals (Board) on appeal from the April 2010 and September 2011 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In January 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a live Board Hearing. A transcript of the hearing is of record. These matters were previously before the Board in July 2015, September 2017, and May 2019, where they were remanded for additional development. The Board notes that there was substantial compliance with its May 2019 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Increased Rating Disability ratings are determined by applying the criteria set forth in the schedule of ratings. The percentage ratings are based on the average impairment of earning capacity, and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When a question arises as to which of two ratings apply under a single diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. As such, the Board must consider all potentially applicable diagnostic codes when rating a Veteran’s disability. However, evaluation of the same manifestation of the same disability under various diagnoses, otherwise known as “pyramiding” is to be avoided. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261 (1994). Where the Veteran challenges the initial rating of a disability for which he has been granted service connection, the Board considers all evidence of severity since the effective date for the award of service connection. See generally Fenderson v. West, 12 Vet. App. 119 (1999). However, whether the issue is an initial increase or not, consideration of the appropriateness of a “staged rating” is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Additionally, if the positive evidence supporting a claim and the negative evidence indicating a denial of the claim is relatively equal, the Veteran is entitled to the benefit of the doubt. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 4.3. Accordingly, any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. Id. 1. Entitlement to an initial compensable rating for service-connected hypertension. Service connection for the Veteran’s hypertension was granted in an April 2010 rating decision, with a noncompensable evaluation given effective February 1, 2010. However, the Veteran contends that his hypertension warrants a compensable rating throughout the entire period on appeal, as his symptoms have worsened. The Veteran’s hypertension is currently rated as noncompensable under the appropriate DC 7101. Under 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent rating is warranted for diastolic pressure predominantly 120 or more; and the highest rating of 60 percent is warranted for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. Medical treatment records throughout the appeal period reflect that the Veteran requires continuous medication for control of his hypertension; however, the evidence does not indicate blood pressure levels that are, historically or otherwise, predominantly 100 or more for diastolic pressure or 160 or more for systolic pressure. VA examinations of record throughout the appeal period reflect that the Veteran’s current treatment plan includes taking continuous medication for hypertension; however, blood pressure readings did not reflect blood pressure levels that were predominantly 100 or more for diastolic pressure or 160 or more for systolic pressure. See C&P Exams, September 2009, June 2015, November 2018, and October 2020. Based on the above the evidence is against an initial compensable rating for hypertension, as the Veteran’s blood pressure readings did not reflect blood pressure levels that were predominantly 100 or more for diastolic pressure or 160 or more for systolic pressure. Accordingly, the Board finds that a compensable rating for hypertension is not warranted during the period on appeal. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7101. 2. Entitlement to an increased rating exceeding 10 percent, prior to October 8, 2020, and exceeding 30 percent thereafter, for service-connected tinea versicolor with tinea corporis ("skin disability"). Service connection for the Veteran’s skin disability was granted in an April 2010 rating decision, with a noncompensable evaluation given effective February 1, 2010. Subsequently, the RO granted an increased rating of 10 percent effective February 1, 2010, and 30 percent effective October 8, 2020. However, the Veteran contends that his skin disability warrants increased ratings throughout the entire period on appeal, as his symptoms have worsened. As noted above, the Veteran’s skin disability is currently rated as 10 percent disabled, prior to October 8, 2020, and 30 percent disabled thereafter, under the provisions of DC 7813-7806. The Board notes that hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned. See 38 C.F.R. § 4.27. Under DC 7813, dermatophytosis (ringworm: of body, tinea corporis; of head, tinea capitis; of feet, tinea pedis; of beard area, tinea barbae; of nails, tinea unguium; of inguinal area, (jock itch), tinea cruris) is rated as disfigurement of the head, face, or neck (DC 7800), scars (DCs 7801, 7802, 7803, 7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the predominant disability. The record reveals that the Veteran’s skin disability has been rated under DC 7806, based upon the predominant disability being dermatitis or eczema. The Board notes that the rating criteria for evaluating skin were amended, effective August 13, 2018. See 83 Fed. Reg. 32592 (July 13, 2018). This amendment resulted in a change in the criteria for DC 7806. Prior to August 13, 2018, under DC 7806, a 10 percent rating was warranted if at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent but less than 20 percent of exposed areas was affected, or; if intermittent system 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 was warranted if 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas was affected, or; if systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. The highest rating of 60 percent was warranted if more than 40 percent of the entire body or more than 40 percent of exposed areas was affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past 12-month period. See 38 C.F.R. § 4.118, DC 7806, as in effect prior to August 13, 2018. Effective August 13, 2018, under DC 7806, a 10 percent rating is warranted if there is one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected or at least 5 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 less than 6 weeks over the past 12-month period. A 30 percent rating is warranted if there is one of the following: characteristic lesions involving 20 to 40 percent of the entire body affected or 20 to 40 percent of exposed areas affected; or 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 6 weeks or more, but not constantly, over the past 12-month period. A maximum 60 percent rating is warranted if there is at least one of the following: characteristic lesions involving more than 40 percent of the entire body affected 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, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. 38 C.F.R. § 4.118, DC 7806. 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.” See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). In a September 2009 VA examination, the examiner found tinea versicolor on the Veteran’s chest, arms, and back; with crusting and hyperpigmentation of less than 6 square inches. The Veteran’s skin disability covered about 5 percent of the total body area and 0 percent of the exposed area. See C&P Exam, September 2009. In a September 2015 VA examination, the examiner noted that the Veteran’s skin disability has been treated with antifungal topical medications with improvement but not resolution since it started in 2009. Upon examination, the examiner found that the Veteran’s condition did not cause scarring or disfigurement of the head, face, or neck, and was not benign or malignant; however, the Veteran required topical medications constantly or near-constantly in the past 12 months. The Veteran’s skin disability covered at least 5 percent but less than 20 percent of the total body area and 0 percent of the exposed area. See C&P Exam, September 2015. In a November 2018 VA examination, the examiner noted that the Veteran’s skin disability had an increased number of hyperpigmented areas with a varying number of new patches on the arms, chest, and back; however, no episodes of tinea corporis in the last 18 months but he still continues treatment. Upon examination, the examiner found that the Veteran’s condition did not cause any scarring or disfigurement of the head, face, or neck, and was not shown to be benign or malignant, or have any systemic manifestations. Additionally, the Veteran has not been treated with medication in the past 12 months or had any treatments or procedures other than systemic or topical medications in the past 12 months. The Veteran’s skin disability covered at least 5 percent but less than 20 percent of the total body area and 0 percent of the exposed area. See C&P Exam, November 2018. In December 2019, a VA medical opinion was issued to address the discrepancy of treatments noted in the November 2018 VA examination. Upon review, the examiner opined that the Veteran’s claims file did not reflect that he received treatment for his skin disability within the last 12 months of the examination date (noting that the claims file shows the last prescription of topical medication was in March 2011); however, further opined that the Veteran is currently using topical lotion for treatment. See C&P Exam, December 2019. In an October 2020 VA examination, the examiner noted that the Veteran has been on the same topical agent since being diagnosed in 2009. Upon examination, the examiner found that the Veteran’s condition did not cause any scarring or disfigurement of the head, face, or neck, and was not shown to be benign or malignant, or have any systemic manifestations. Additionally, the Veteran has not been treated with medication in the past 12 months or had any treatments or procedures other than systemic or topical medications in the past 12 months. The Veteran’s skin disability covered 20 to 40 percent of the total body area and 0 percent of the exposed area. See C&P Exam, October 2020. Based on the above, the Board finds that an increased rating is not warranted during any period on appeal. Prior to October 2020, the Veteran’s skin disability has manifested, at worse, to an affected area of at least 5 percent but not more than 20 percent of the entire body or requiring no more than topical treatment during any 12-month period; which is commensurate of a 10 percent rating under DC 7806. Thereafter, the Veteran’s skin disability has manifested, at worse, to an affected area of 20 to 40 percent of the total body or requiring no more than topical treatment during any 12-month period; which is commensurate of a 30 percent rating under DC 7806. Therefore, as there is no additional probative evidence to the contrary that would result in higher ratings, the Board concludes that an increased rating exceeding 10 percent, prior to October 8, 2020, and exceeding 30 percent thereafter, for service-connected skin disability, to include consideration of separate compensable ratings, is not warranted; and the claim is denied. The Board has considered the doctrine of giving the benefit of the doubt to the Veteran, under 38 U.S.C. § 5107 and 38 C.F.R. § 3.102, but does not find the evidence is of such approximate balance to warrant its application. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). The appeal is denied. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, 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.