Citation Nr: 21064323 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 16-00 393 DATE: October 19, 2021 ORDER Entitlement to an initial compensable rating for pseudofolliculitis barbae (PFB) is denied. FINDING OF FACT During the entire appeal period, the Veteran's PFB was manifested by characteristic lesions involving less than 5 percent of the entire body or exposed areas affected and required no more than topical therapy; his PFB during the appeal period was not manifested by characteristic lesions involving at least 5 percent of the entire body or exposed areas affected, did not require systemic therapy such as corticosteroids or other immunosuppressive drugs, and did not involve symptoms and functional impairment not contemplated by the schedular rating criteria. CONCLUSION OF LAW The criteria for an initial compensable disability rating for PFB have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 3.159, 4.118, Diagnostic Code 7806 (2018, 2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1999 to December 2003 and December 2004 to September 2004. He appeals a June 2013 rating decision denying entitlement to an initial compensable rating for his service-connected PFB. The Board of Veterans' Appeals (Board) remanded this claim in November 2018 and, most recently, in July 2021. The appeal is now back before the Board. Disability ratings are determined by applying a schedule of ratings based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. When considering the propriety of the evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The regulations pertaining to rating skin disabilities were revised, effective August 13, 2018. Claims, such as this, pending prior to the effective date will be considered under both old and new rating criteria from that date, and whatever criteria is more favorable to the Veteran will be applied from the effective date of the new rating criteria. The Veteran was rated under Diagnostic Code 7806 for his PFB, which began in service. See 38 C.F.R. § 4.118, Diagnostic Code 7806. He contends his noncompensable rating "is inadequate for the condition, pain, and discomfort [he] endured over [his] time in uniform." See September 2021 Veteran letter. During the appeal period, the Veteran has consistently noted the pain and discomfort he suffered during service from being forced to shave. See, e.g., August 2011 VA Form 21-526 ("my ingrown hairs on my face and neck are due to shaving which I was required to do in basic training...laser hair removal treatment was unsuccessful...I still grow hair and suffer from ingrown hairs"). In his July 2013 notice of disagreement, the Veteran stated he still has to shave even though his in-service laser hair removal was supposed to be permanent, and noted the numerous photographs and medical records on file reflect the Veteran's condition. The record corroborates the Veteran's PFB in service and that he had laser hair removal of the neck and face to treat his ingrown hairs and bumps. See June 2003 and October 2003 service treatment records (STRs). There is no question the Veteran suffered discomfort, pain, and ingrown hairs while serving in the Marines. However, the purpose of VA compensation benefits and the schedular disability rating criteria is to compensate the Veteran for the average impairment of earning capacity resulting from service-connected disability in civil occupations, after separation from service. 38 U.S.C. § 1155. The principal factor in assigning schedular disability ratings is the loss of industrial capacity and the degree of disability specified to compensate veterans for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. See 38 C.F.R. §§ 3.321(a), 3.340, 4.1; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Thus, the Veteran cannot be compensated for his in-service symptoms of PFB and is solely compensated for the PFB symptoms from his August 2011 date of claim. Under the old Diagnostic Code 7806, a 10 percent rating is warranted for 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 (head, face, neck, hands) 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 is assigned for 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. A 60 percent rating is assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or, constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Under the new Diagnostic Code 7806, the condition is evaluated under the new General Rating Formula for the Skin (Formula). Under the Formula, a 10 percent rating is warranted where at least one of the following is present: 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 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 6 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. Thus, the old rating criteria and new Formula have the same criteria regarding percentages of total exposed area and body area but differ regarding the use and definitions of topical versus systemic therapy. See 38 C.F.R. § 4.118, Diagnostic Code 7806. Under the new Formula, 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." Whereas, under the old rating criteria, systemic therapy is defined as "pertaining to or affecting the body as a whole" and "therapy" is defined as "treatment of diseases." Johnson v. Shulkin, 862 F.3d 1351, 1355 (2017). Thus, under the old rating criteria, topical ointments could be considered systemic if they were applied on a large enough scale and if the method by which they work treats the medical condition and affects the entire body. Burton v. Wilkie, 30 Vet. App. 286, 290 (2018). For instance, if the topical ointment works by circulating through the bloodstream, it could be considered systemic therapy for ratings purposes. Id. at 291. Whereas, under the new Formula systemic therapy is any treatment not applied topically. The Veteran's PFB is limited to his neck and face and occurs whenever he shaves with a razor, which the record reflects the Veteran has not done during the appeal period. See, e.g., May 2013 and August 2021 VA examination reports. At a May 2013 VA examination, the Veteran stated he was provided a cream to alleviate his pain and discomfort during in-service laser hair removal, but the VA examiner noted the Veteran had not used any creams, or other topical or oral medication in the past year. A September 2019 VA examiner noted the Veteran used over the counter topical medication near-constantly for his PFB; however, by the August 2021 VA examination, the Veteran had not used any medication, topical or oral, to treat PFB in the past twelve months. The Board notes a July 2020 VA examiner found the Veteran used Lotrimin as a topical medication, but this was in reference to the Veteran's "cracked skin, redness, pain, irritation and recurring calluses" of the feet, not PFB. See July 2020 VA examination report; August 2020 rating decision (service connection for foot infection). The September 2019 VA examiner found the Veteran constantly used over the counter topical medication, which under both the old rating criteria and new Formula would not warrant a compensable rating as the cream would be applied topically to the Veteran's ingrown hairs directly and was not an immunosuppressive drug or corticosteroid. Additionally, the Veteran's records do not note any specific medication for treatment of PFB. For example, the Veteran's Dr. G.J.R. treatment records note daily use of Gris for a foot condition, and current medication lists of record note no treatment with topical or oral corticosteroids or immunosuppressive drugs. See September 2013 Dr. G.J.R. records; August 2017 Williamsburg Square Family Practice (WSFP) records (no skin conditions; only taking blood pressure medication and vitamin D supplements). Thus, as the Veteran's PFB did not require the use of systemic treatment during the appeal period under the old or new Formula, he does not meet the criteria for a compensable rating in this regard. Additionally, the Veteran is not entitled to a compensable rating as he does not meet the criteria requiring characteristic lesions involving at least 5 percent of the entire body or exposed areas affected. In the May 2013 VA examination report, photographs reflect no bumps or skin irritation around the Veteran's neck where it appears he recently shaved; however, they do possibly display a red patch and ingrown hairs within the Veteran's beard, directly under his chin. A June 2013 physician, Dr. K.S., reviewed the May 2013 VA examination report along with the photographs and estimated that less than one percent of the Veteran's entire body had PFB characteristic lesions. The Board finds these photographs also reflect less than 5 percent of exposed areas affected as the potential red patch and ingrown hairs in the photographs are roughly the size of a quarter. Thus, the record reflects the Veteran's PFB affected less than 5 percent of the entire body or exposed areas during the entire appeal period. See September 2019 and August 2021 VA examination reports; see also September 2021 Veteran letter. Overall, the record reflects the Veteran cannot use a razor to shave or else his PFB will cause irritation and bumps, but he uses an electric razor when needed. Id. The Veteran stated he does not shave regularly because he is "no longer required to do so" and, thus, he has not used medication recently and does not have characteristic lesions from PFB. Id. He also noted that razor bumps do not require medication and "can be treated by simple habits of cleaning your face, using facial scrubs, and shaving less, all things [he] has done and continues to do on a regular basis;" the Veteran also submitted a supporting medical article. See September 2021 Veteran letter and medical article. The Veteran noted his condition was worse when he filed his claim in August 2011, which the Board finds credible. Unfortunately, there is no evidence of record reflecting that the Veteran's PFB lesions covered over 5 percent of his exposed body area or required the use of systemic treatment prior to the May 2013 VA examination. These are the criteria required for a compensable rating under Diagnostic Code 7806. Additionally, the record reflects no scarring or disfigurement from his PFB, so no rating shall be considered under alternate diagnostic codes. See May 2013 and August 2021 VA examination reports. In summation, the preponderance of the evidence reflects the Veteran's service-connected PFB does not meet the criteria for a compensable initial rating as his PFB was not manifested by characteristic lesions involving at least 5 percent of the entire body or exposed areas, and did not require systemic therapy during any 12-month period of the appeal. As such, the Veteran's claim for entitlement to an initial compensable disability rating for PFB is denied. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.