Citation Nr: 21066825 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 17-48 014A DATE: November 2, 2021 ORDER A compensable rating for eczema is denied. Service connection for a left shoulder disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from April to August 1990, February 2009 to March 2010, and June 2012 to June 2013 with periods of Reserve duty. 2. Eczema is manifested by subjective complaints of itchiness and flaking; objective findings refect that it affects less than five percent of the exposed and total body areas and requires no more than constant use of topical medications. 3. A chronic left shoulder disorder was not shown in service; a current left shoulder disorder, diagnosed as shoulder strain, is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for eczema have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.59, 4.114, Diagnostic Code (DC) 7806 (2021). 2. A chronic left shoulder disorder was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS These appeals were previously remanded by the Board in August 2019. There has been substantial compliance with the remand directives and there is no bar to proceeding with the appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating for Eczema Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran's chronic skin disability, diagnosed as eczema, is rated at 0 percent under DC 7806. The Board will consider all relevant diagnostic codes. Under the relevant regulations, a higher rating will be warranted when the objective medical evidence shows the following: 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 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 (10 percent under DC 7806). On August 13, 2018, VA adopted new regulations for skin disorders. Under the new regulations, 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. 83 Fed. Reg. 32,592 (July 13, 2018). The new regulations create a bright-line definition of topical and systemic treatment therapies. Prior to this change, the regulations did not define topical or systemic treatment, and the determination of whether a Veteran received topical or systemic treatment was based on the factual circumstances of each case. Johnson v. Shulkin, 862 F.3d 1351, 1354-56. Turning to the medical evidence, at an October 2016 VA examination, the Veteran reported that eczema began as a foot rash, but now involved the feet, ear canals, and elbows. The examiner found no scarring or disfigurement of the head, face, or neck, and no systemic manifestations. The examiner found that the Veteran's eczema covered less than 5 percent of the total body area, and none of the exposed body area. It was also noted that the Veteran only treated with constant or near-constant use of the topical corticosteroid, triamcinolone 0.1% cream. At a February 2020 VA examination, the Veteran stated that his eczema had worsened over the years, with specific regard to his ear canal which was itchy and flaky. Once again, he reported the only treatment to be triamcinolone cream. The examiner noted that he continued to apply it topically and denied anything other than systemic or topical medications. The examiner found that the Veteran's eczema covered less than 5 percent of his total body area and less than 5 percent of his exposed body area. VA treatment notes reflect that the Veteran visited the dermatologist multiple times during the appeal period, but the evidence does not reflect manifestations of his skin disabilities more severe than found at the VA examinations. The noncompensable rating contemplates his use of topical medication only to treat symptoms affecting less than five percent of the exposed and total body areas. A rating in excess of 10 percent requires that at least five percent of the exposed or total body areas be affected and/or the use of systemic therapy; however, the skin disability was not productive of these manifestations at any time during the appeal period. Accordingly, the medical evidence does not support a compensable rating for a chronic skin disability. The Board has also considered the Veteran's lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his eczema according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of eczema has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The Veteran provided a history of treatment for his skin disorder involving creams dating back to service. He essentially argues that he seeks treatment for the skin disorders because without treatment they become worse. As discussed above, the type and frequency of treatment for skin disabilities is pertinent to the rating criteria; however, only systemic therapy warrants a compensable rating. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiners have the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and a compensable disability rating for the Veteran's chronic skin disability is denied. Service Connection for a Left Shoulder Disorder Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The Veteran asserts that he has a left shoulder disorder which is a result of his active duty. Specifically, he noted that while working out to maintain conditioning in 2009, he experienced a sharp pain during lifting weights. He noted that he was given a rubber band to exercise the shoulder and he did not seek further treatment. At a February 2020 VA examination, the Veteran was diagnosed with a left shoulder strain. Thus, a current diagnosis is shown, and the first element of service connection is met. As to an in-service incurrence, the service treatment records (STRs) do not reflect complaints of a shoulder disorder. Specifically, while voluminous in nature and reflective of treatment for multiple other ailments, there is no notation of shoulder pain. Additionally, the Veteran underwent several in-service medical examinations where he denied any joint or shoulder pain during his duty and Reserve service. Nonetheless, as he has addressed this issue by stating he did not actively seek treatment for shoulder pain, the Board will consider his lay statements of shoulder pain as sufficient to satisfy the second element of service connection. As to a medical nexus between in-service shoulder pain and current diagnosis, a February 2020 VA examiner, after examining the Veteran, reviewing the STRs and post-service medical records, and considering his lay assertions, opined it was less likely than not that the Veteran's left shoulder disorder was related to, or originated during, service. The examiner reasoned that on examination in 1994, the Veteran indicated he had painful joints but did not specify shoulder complaints, and there were no complaints of a left shoulder condition on the separation examination. The examiner noted that per the Veteran, he had an injury while working out resulting in a sharp pain and that he was given rubber bands for treatment. Additionally, the examiner referred to progress notes from 2015 which indicated a left shoulder overuse injury. The examiner noted that the while the Veteran's statements suggest a left shoulder condition during service with intermittent pain since 2009, medical records did not indicate treatment or description of a shoulder condition. Specifically, the examiner noted that there was no follow up, or continuation of treatment for the claimed condition and that a nexus was not established. The examiner also noted that the in-service injury was established only per the history provided by the Veteran. The Veteran's post-service treatment records were also reviewed. Importantly, there is very little treatment or complaint noted regarding his left shoulder in post-service records and there is no medical evidence which establishing or suggesting a relationship to service. This evidence weighs against the appeal. The Board finds that the examination was adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Further, there is no contradicting medical evidence of record. Therefore, the Board finds the VA examiner's opinion to be of great probative value. The Board has considered the Veteran's lay statements that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, 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.