Citation Nr: 21067003 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-02 070 DATE: November 3, 2021 REMANDED Entitlement to a compensable disability rating (in excess of 0 percent) for right great toe onychomycosis with right palm contact dermatitis/tinea manum (skin condition) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1980 to August 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In July 2013, the Veteran disagreed with this decision. This case was previously before the Board in October 2018. At that time, the Board remanded the case for additional development. Unfortunately, for the reasons discussed below, another remand is required. See Stegall v. West, 11. Vet. App. 268 (1998). Entitlement to a compensable disability rating (in excess of 0 percent) for a skin condition is remanded. In a June 2021 VA examination report, the Veteran was diagnosed with dermatophytosis and onychomycosis right great toe with contact dermatitis/tinea manum right palm. The VA examiner noted that the Veteran was treated with medication in the past 12 months, and was specifically treated with corticosteroids or other immunosuppressive medications. This medication was administered topically. The Veteran took this medication for 6 or more weeks, but not constantly. The Board notes that the Veteran filed his claim for an increased rating for his service-connected skin condition in July 2011. On August 13, 2018, the criteria for skin conditions was updated. 38 C.F.R. § 4.118, General Rating Formula for the Skin, Diagnostic Code 7806. Because the Veteran's claim was filed prior to August 13, 2018, whichever criteria is more favorable to the Veteran, the pre-2018 criteria or the post-2018 criteria, will be applied to this claim for the period for which it is in effect. The pre-2018 regulations did not contain a definition of topical or systemic, or topical or systemic therapy. Id. Under Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017), the Federal Circuit held that topical corticosteroid use may constitute systemic therapy under Diagnostic Code 7806. The Federal Circuit determined that there was no clear binary choice between topical and systemic therapy and that the answer depended on the facts of the particular case. In its decision, the Federal Circuit found that a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances. When the regulations changed on August 13, 2018, topical and systemic were given definitions. 38 C.F.R. § 4.118. Systemic therapy was defined as 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. Id. Under the current regulations, because the Veteran's corticosteroids or other immunosuppressive medications were administered topically, he would not be entitled to a compensable disability rating (higher than 0 percent). 38 C.F.R. § 4.118, General Rating Formula for the Skin, Diagnostic Code 7806. However, under the pre-August 13, 2018 criteria, the Veteran's corticosteroid or other immunosuppressive medications could potentially entitle him to a higher rating. Under the pre-August 13, 2018 criteria, in the June 2021 VA examination report, the VA examiner was required to provide a rationale for the topical versus systemic determination. Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017). In the June 2021 VA examination report, the examiner did not provide a rationale as to why the Veteran's corticosteroids or other immunosuppressive medications were administered topically. Because of this, the June 2021 VA examination report is inadequate, and a new VA opinion is necessary to provide a rationale as to why the Veteran's corticosteroids or other immunosuppressive medications are either topical or systemic. The matters are REMANDED for the following actions: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), contact the Veteran for additional information about treatment for his condition and make efforts to obtain all VA and private treatment records concerning this claim. 2. Arrange for the Veteran's file to be forwarded to a VA examiner for a clarifying addendum opinion regarding whether the corticosteroids or other immunosuppressive medications the Veteran took are "topical" or "systemic." The examiner or consulting physician must review the entire record (including all updated records obtained pursuant to the above development order), and specifically the June 2021 VA examination report. Based on his or her review, the examiner or consulting physician should provide an opinion as to whether the Veteran's use of corticosteroids or other immunosuppressive medications qualifies as "topical" or "systemic." A detailed explanation (rationale) is requested for why the Veteran's therapy is or is not "systemic." (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Abrams, 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.