Citation Nr: 21069549 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 15-00 342A DATE: November 18, 2021 ORDER Entitlement to a higher initial disability rating for posttraumatic stress disorder (PTSD), rated as 50 percent disabling before September 11, 2019 and as 70 percent disabling since then, is denied. Entitlement to an initial disability rating higher than 10 percent for chronic rhinosinusitis prior to March 13, 2019 is denied. Entitlement to a 30 percent disability rating for chronic rhinosinusitis from March 13, 2019 is granted. Entitlement to a 10 percent initial disability rating for chronic urticaria prior to May 26, 2015 is granted. Entitlement to a disability rating higher than 30 percent for chronic urticaria from May 26, 2015 is denied. FINDINGS OF FACT 1. A preponderance of the evidence indicates that PTSD did not cause deficiencies in most areas of the Veteran's life prior to September 11, 2019. 2. A preponderance of the evidence indicates that PTSD has not caused total impairment since September 11, 2019. 3. A preponderance of the evidence indicates that, prior to March 13, 2019, the Veteran's rhinosinusitis was mainly asymptomatic. 4. The evidence is in a state of relative equipoise regarding whether, from March 13, 2019, sinusitis caused more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 5. The evidence is in a state of relative equipoise regarding whether, prior to May 26, 2015, treatment for urticaria involved intermittent systemic therapy for a total duration less than six weeks over any previous 12-month period between 2010 and 2015. 6. Since May 26, 2015, the evidence has not indicated that urticaria has affected more than 40 percent of the entire body or more than 40 percent of exposed areas or has required constant or near-constant systemic therapy over any previous 12-month period between 2015 and 2021. CONCLUSIONS OF LAW 1. The criteria for a higher initial disability rating for PTSD are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130. 2. The criteria for a disability rating higher than 10 percent for chronic rhinosinusitis prior to March 13, 2019 are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.97. 3. The criteria for a 30 percent disability rating for chronic rhinosinusitis from March 13, 2019 are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.97. 4. The criteria for a 10 percent disability rating for chronic urticaria prior to May 26, 2015 are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118. 5. The criteria for a disability rating higher than 30 percent for chronic urticaria from May 26, 2015 are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1981 to November 1984. She also served on a period of active duty for training between April and August 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an August 2012 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran testified in a hearing before the Board. A copy of the hearing transcript is included in the record and has been reviewed. In October 2018 and March 2021, the Board remanded these claims for additional development. The case is again before the Board for appellate review. Claims for higher disability ratings The Veteran claims entitlement to higher disability ratings for PTSD, rhinosinusitis, and urticaria. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When 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. "Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The applicable law and regulations concerning effective dates state in relevant part that, except as otherwise provided, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. An exception to the general rule under 38 C.F.R. § 3.400 is detailed under 38 C.F.R. § 3.400 (o)(2). This provision allows VA to assign an effective date for increased rating up to one year prior to the date of claim where medical evidence indicates an increase in disability during that time period. When medical records indicate an increase in a disability, receipt of such medical records may be used to establish effective date(s) for retroactive benefits based on facts found of an increase in a disability only if a complete claim or intent to file a claim for an increase is received within 1 year of the date of the report of examination, hospitalization, or medical treatment. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Symptomatology attributed to a nonservice-connected disability cannot be differentiated from symptomatology attributed to a service-connected disability unless medical evidence does so. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). In the absence of such medical evidence, the reasonable doubt doctrine dictates that all symptoms be attributed to the service-connected disability. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. PTSD On November 5, 2010, the Veteran filed a petition to reopen a previously denied claim of entitlement to service connection for PTSD. The RO denied the original claim in an unappealed July 2008 rating decision. In the October 2012 rating decision on appeal, the RO granted the claim and assigned a 50 percent initial rating effective the date of petition to reopen. The Veteran appealed the assigned initial rating. During the appeal period the RO granted a higher rating of 70 percent from September 11, 2019. Rating criteria for psychiatric disabilities such as PTSD are detailed under the General Rating Formula for Mental Disorders of 38 C.F.R. § 4.130. Thereunder, ratings of 0, 10, 30, 50, 70, and 100 percent are authorized for various levels of disability. PTSD is rated under DC 9411 of 38 C.F.R. § 4.130. Inasmuch as PTSD has been rated as at least 50 percent disabling from the date of the petition to reopen in November 2010, the Board will address whether the higher ratings of 70 or 100 percent have been warranted since then. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. See 38 C.F.R. § 4.130. The "such symptoms as" language of the diagnostic codes for mental disorders in 38 C.F.R. § 4.130 means "for example" and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The evidence for this claim consists of lay assertions from the Veteran, VA and private treatment records, and VA compensation examination reports dated in June 2012, September 2019, and March 2021. This evidence indicates that a rating higher than 50 percent was not warranted prior to September 11, 2019 and that a rating higher than 70 percent has not been warranted since then. Prior to September 11, 2019: The evidence dated between November 5, 2010 and September 11, 2019 indicates that while PTSD reduced reliability and productivity, the disorder did not cause deficiencies in most areas of the Veteran's life. During the May 2018 Board hearing, the Veteran described hypervigilance, diminished memory, sleep disturbances, being confrontational, difficulty with social and work relationships, lack of trust in other people, and that symptoms interfered with her ability to concentrate in school, which she then attended full time. The VA and private treatment records dated during this period note complaints of low mood, anxiety, sleep problems, and intrusive memories of an in-service assault. But these records also repeatedly indicate that the Veteran was fully oriented, coherent, cooperative, attentive, and without any suicidal thoughts or ideations. The June 2012 VA report notes the Veteran as having PTSD and a depressive disorder for which symptoms could not be differentiated. The report notes monthly nightmares, weekly flashback, intrusive thoughts/memories a few times weekly, anxiety around triggers, avoidant behavior, diminished interest in significant activities, detachment from others, restricted affect, sleep impairment, irritability, poor insight, difficulty concentrating, hypervigilance, depression, suspiciousness, difficulty establishing, adapting to, and maintaining effective work and social relationships. But the report also noted the Veteran as oriented, alert, linear, goal-directed, groomed, cooperative, with adequate eye contact, fair judgment, sufficient concentration and memory, normal speech, a congruent mood and affect, without evidence of a thought disorder, and without evidence of suicidal or homicidal ideations. Based on this evidence, an initial rating higher than 50 percent is unwarranted prior to September 11, 2019. See 38 C.F.R. § 4.130, DC 9411. The evidence shows that the Veteran had experienced depression, anxiety, sleep disturbance and a flat affect, and perhaps had exhibited poor insight into the nature of her psychiatric state. But the evidence dated before September 2019 would not support the assignment of an initial 70 percent rating. The evidence indicates an absence of suicidal ideation or "obsessional rituals" and shows that the Veteran's speech was logical, clear, and relevant. The Veteran did not report panic attacks during this time period, and the evidence did not indicate that her depressed moods were "near-continuous" and affecting her ability to function "independently, appropriately, and effectively" during the relevant time period. The evidence shows irritability and anger, but not an impaired impulse control leading to periods of violence. And the VA medical professionals who interacted with the Veteran during this period described her as fully oriented and adequately attired and groomed. Since September 11, 2019: The RO assigned a 70 percent rating effective September 11, 2019. On that date, the Veteran underwent VA examination pursuant to the Board's remand. Based on the examination findings, the RO found that PTSD had been causing deficiencies in most areas of the Veteran's life. The question before the Board is whether the next-highest rating of 100 percent has been warranted at any time since September 11, 2019. The September 2019 and March 2021 VA reports, and VA treatment records dated until July 2021, do indicate a worsening of the Veteran's symptoms. But this evidence does not indicate total social and occupational impairment. The evidence has not indicated gross impairment in thought processes and communication. Rather, the evidence has shown that the Veteran has been communicative, alert, cooperative, and attentive, not only with her treatment for PTSD, but for other medical problems as well, as evidenced by the treatment records addressing a variety of medical issues. The evidence indicates that she has continued to be oriented, and has not experienced hallucinations, delusions, or psychosis. The March 2021 VA report indicates onset of panic attacks. And the report indicates irritability and worsening impulse control, but not to such an extent that she has been in persistent danger of hurting herself or others. In the September 2019 and March 2021 VA reports, she indicated having thoughts of harming herself and another person, but that she has continued to deny active suicidal and homicidal ideations. The evidence shows she has been able to perform activities of daily living to include personal hygiene requirements. The evidence indicates somewhat impaired but nevertheless generally intact memory, judgment, and insight. In short, despite the Veteran's severe symptoms, she has not exhibited during the appeal period the type of emotional and cognitive impairment reserved for a total rating. During the appeal period, she has been coherent and in self-control. See 38 C.F.R. § 4.130, DC 9411. As such, the preponderance of the evidence is against the assignment of a higher rating for PTSD. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim for a higher rating must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. Rhinosinusitis In a July 2008 unappealed rating decision, the RO denied a petition to reopen a claim of entitlement to service connection for a sinus disorder. The RO then construed a November 5, 2010 statement regarding headaches as another petition to reopen the claim. In the October 2012 rating decision on appeal, the RO granted the petition and the underlying claim and assigned a 10 percent initial rating effective the date of petition to reopen. The Veteran appealed the assigned initial rating. During the appeal period the RO granted a higher rating of 30 percent from September 18, 2019. The rating criteria for nasal and sinus disability are addressed under 38 C.F.R. § 4.97. The RO rated the disorder here under DC 6510-6513. Sinusitis is rated under a general rating formula for sinus disabilities noted under DCs 6510 through 6514. This formula authorizes compensable disability ratings of 10, 30, and 50 percent. A noncompensable rating is warranted when sinusitis is detected by x-ray only. A 10 percent rating is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is warranted for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent rating is warranted following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. An incapacitating episode is one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97. The evidence for this claim consists of lay assertions from the Veteran, VA and private treatment records, and VA compensation examination reports dated in July 2012, September 2019, and April 2021. This evidence indicates that a rating higher than 10 percent was not warranted prior to March 13, 2019 but that a 30 percent rating has been warranted since then. Prior to March 13, 2019: The evidence dated between November 5, 2010 and March 13, 2019 does not indicate three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The VA and private treatment records dated prior to March 13, 2019 note that the Veteran had been diagnosed with sinusitis. But the records are largely silent for sinus symptoms until August 2015 when, according to VA records, the Veteran complained of symptoms "off and on." The records indicate symptoms "at least monthly for variable duration." The Veteran described "nasal obstruction, facial pain, draining yellow-green vs. clear mucous." She denied fevers/chills and indicated relief from "alternative therapies" such as "aromatherapy, lemons/citrus, warm compresses, hot teas." Records dated until 2016 reiterate these comments. From then until 2019, the records are largely silent again regarding sinus problems. Then on March 13, 2019, the Veteran reported to a VA emergency room for treatment of continuous sinus problems. The records indicate that the Veteran reported shortness of breath, inability to breathe through nose, mouth breathing, and congestion. Records dated in April 2014 indicate tender bilateral maxillary and frontal sinuses and indicate "had sinus infection for weeks. now taking antibiotic (augmentin) but prior to that she thinks there was a delay in taking antibiotic and that might have contributed to her symptoms[.]" Based on this information, the increase in rating to 30 percent should take effect March 13, 2019 rather than September 18, 2019, the current effective date for increase, and the date of the VA report discussed below. The VA treatment records from March 2013 detail the increased symptoms noted later in the September 2019 VA report. In sum, this evidence indicates approximation in March 2019 of criteria indicating frequent non-incapacitating episodes involving such symptoms as headaches, pain, and purulent discharge or crusting. See 38 C.F.R. § 4.97, DC 6510. The next-highest and maximum rating of 50 percent has not been warranted during the appeal period, however. The evidence has not shown radical surgery with chronic osteomyelitis or near constant sinusitis after repeated surgeries. See 38 C.F.R. § 4.97. During the Board hearing, the Veteran described her symptoms as sporadic, sometimes occurring once every two weeks, but other times only once every six months. She described varying degrees of severity with breathing and sleep difficulty, congestion, sputum, headaches, and purulent discharge. She also stated that she missed work approximately six times in the previous six years. The VA treatment records dated after 2019 note continuing symptoms of sinusitis. But none indicates surgical treatment or chronic osteomyelitis. A May 2019 CT scan showed "minimal" sinus mucosal thickening and a deviated septum. A September 2019 nasal endoscopy indicated swollen turbinates, nasal obstruction, but no nasal polyps. The September 2019 VA report indicates no surgery for sinusitis. The report notes diagnosis of sinusitis, allergic rhinitis, deviated septum, and hypertrophy of nasal turbinates. The examiner noted daily headaches, tenderness, and crusting, and noted at least seven non-incapacitating episodes of the disorder per year. The examiner indicated use of antibiotics approximately once per year to treat "sinus infections." The examiner indicated no incapacitating episodes, no evidence of prior surgery, no osteomyelitis, and found no evidence of nasal polyps. Similarly, the April 2021 VA report indicates nasal passage swelling, nasal congestion, post-nasal drip, and headaches. The examiner noted the deviated septum but found no nasal obstruction and found no evidence of surgery or osteomyelitis, or of nasal polyps. In sum, a rating increase to 50 percent under the general rating formula of 38 C.F.R. § 4.97 is not warranted for sinusitis simply put, the evidence has not shown radical surgery with chronic osteomyelitis or near constant sinusitis after repeated surgeries. The Board has considered whether a higher rating has been warranted for symptoms associated with allergic rhinitis and deviated septum. The Veteran has been service connected not merely for sinusitis, but for rhinosinusitis. Moreover, these symptoms overlap as do those commonly associated with a deviated septum. See Mittleider, supra. Ratings of 10 and 30 percent are authorized for allergic rhinitis under DC 6522 of 38 C.F.R. § 4.97. This DC would not lead to a higher rating from March 13, 2019. And the evidence would not support a 30 percent rating under this DC prior to that date. To warrant a 30 percent rating for allergic rhinitis, nasal polyps must be evidenced. As indicated earlier, the evidence shows an absence of nasal polyps. So, DC 6522 cannot be used to assign a higher rating. With regard to the deviated septum, a sole rating of 10 percent is authorized under DC 6502 of 38 C.F.R. § 4.97. This DC would not lead to a higher rating either. The evidence supports an effective date of March 13, 2019 for the assignment of a 30 percent rating for rhinosinusitis. But a preponderance of the evidence is against the assignment of a higher rating prior to or after that date. As the preponderance of the evidence is against the claim for a higher rating, the benefit-of-the-doubt doctrine does not apply, and the claim for a higher rating must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. Urticaria The Veteran has been service connected for chronic urticaria since March 1986. The disorder was rated 0 percent disabling on November 5, 2010, when she filed a claim of entitlement to an increased rating. The RO denied the claim in the October 2012 rating decision on appeal. During the appeal period the RO granted a higher rating of 30 percent from May 26, 2015. Skin disorders are rated under 38 C.F.R. § 4.118. Urticaria is not a listed disorder under this provision. As such, the RO rated the disorder under DC 7899-7806 of 38 C.F.R. § 4.118. The use of two rating codes and a "99" denotes a rating by analogy. 38 C.F.R. §§ 4.20, 4.27. Diagnostic Code 7806 addresses symptoms associated with dermatitis or eczema. VA amended the criteria for rating skin disabilities effective from August 13, 2018. The new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after 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. Inasmuch as the service-connected skin problem addressed here is not on the head, face, or neck, the Board will focus on rating criteria for skin disorders on the body below the neck. Under DC 7806 prior to August 13, 2018, a noncompensable rating is warranted for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12 months. 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 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 warranted 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 warranted 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. 38 C.F.R. § 4.118, DC 7806. For claims filed prior to August 13, 2018, a systematic therapy is one that that affects the entire body in its treatment of the condition at issue. In assessing whether a topical treatment is systemic, the Board must determine (1) whether a topical treatment affects the body as a whole; and (2) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug." Burton v. Wilkie, 30 Vet. App. 286 (2018). Effective August 31, 2018, VA regulations explicitly state that 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. 38 C.F.R. § 4.118 (a). Effective August 13, 2018, skin disorders such as the one addressed here are rated under a new General Rating Formula for the Skin. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is warranted for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least 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, 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 assigned at least one of the following: characteristic lesions involving more than 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 assigned for at least one of the following: 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, 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, General Rating for the Skin. The evidence for this claim consists of lay assertions from the Veteran, VA and private treatment records, and VA compensation examination reports dated in September 2019, April 2021, and June 2021. This evidence indicates that an increased rating to 10 percent was warranted prior to May 26, 2015 but that a rating higher than 30 percent has not been warranted since then. The VA treatment records dated prior to May 26, 2015 repeatedly note the diagnosis of urticaria. The records also note diagnoses of eczema, dermatitis, and shingles. Inasmuch as the evidence does not differentiate symptoms of the various skin disorders, the Board will consider each in this decision. See Mittleider, supra. The records mostly indicate that these disorders were asymptomatic, with the exception of several complaints of rashes or outbreaks on the flank, hip, arm, or back over the several-year period between November 2010 and May 2015. The records do not contain information indicating the percentage of the body area covered by the rashes. Nevertheless, in several visits during this period the Veteran discussed the use of oral medications to treat them and received prescriptions for such medicines (e.g., antihistamines and cetirizine). The records also indicate that the Veteran complained on several occasions of the side-effects from the oral medications, and that she would discontinue using them. Regardless, the evidence indicates "intermittent" systemic therapy "for a total duration of less than six weeks" per year between 2010 and 2015. As such, a 10 percent rating is warranted prior to May 26, 2015, when the RO assigned a 30 percent rating. The next-highest rating of 60 percent is unwarranted from May 26, 2015, however. None of the evidence indicates either skin problems covering over 40 percent of the entire body or the exposed areas, or "constant or near-constant" systemic therapy required over any 12-month period between 2015 and 2021. The VA treatment records dated after 2015 continue to note occasional complaints of rashes, and occasional attempts to use medicine to treat symptoms. The September 2019 VA reports indicates the same. The report indicates asymptomatic urticaria with complaints of rashes about once a month with an episode the previous month that left her with darkened spots on the arm, for which she used a topical medication. The examiner found that urticaria affected less than 5 percent of total body area and less than 5 percent of exposed areas. The report also indicated use of an oral antihistamine for less than six weeks in the previous 12 months. She also used the topical medication zinc oxide for her skin. The April 2021 VA report indicates more severe symptoms. The report notes constant/near constant use of topical cream hydrophilic topical cream, Trimacinolone Acetonide, and zinc oxide. The report noted evidence of skin rashes on the left arm and lower back, "[f]lat annular hypopigmented area." The examiner found no exposed rashes and rashes affecting less than 5 percent of the total body. The June 2021 VA report noted the Veteran's complaints of urticaria flare ups about 5 days a week lasting from 20 minutes to hours and involving electric shocks, burning, itching, welts, redness, anywhere in the body to include the back of the neck. The examiner noted constant/near constant use of topical hydrocortisone cream, topical petroleum lotion, and topical hydrophilic (Eucerin) cream. On examination, however, the examiner noted no exposed areas affected, and less than 5 percent of the total body affected. Lastly, the record contains lay statements from the Veteran indicating that she has had skin problems on her head, face, and neck. She described such lesions during the May 2018 hearing. Diary excerpts submitted in May 2018 also detail asserted skin eruptions on the head and face between August 2017 and January 2018. The Board has considered this information. But this lay evidence will not lead to an increased rating here. First, the Veteran is not service connected for skin problems on the head, face, or neck. The January 1987 rating decision that granted service connection for chronic urticaria noted a history of body rashes and relied on DC 7806 rather than the DC addressing skin problems on the head, face, and neck DC 7800. 38 C.F.R. § 4.118. Moreover, later rating decisions including the one on appeal did not address DC 7800. Second, none of the medical evidence of record supports her assertions that she has skin problems on the head, face, or neck. As detailed above, the VA treatment records and VA reports do not indicate such chronic problems. Further, the private treatment records in the claims file do not indicate chronic skin problems on the head, face, or neck. The Veteran is competent to report observable symptomatology such as skin eruptions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the medical evidence dated between 2010 and 2021 preponderates against her assertions. The medical evidence is based either on in-person treatment of the Veteran or on review of the claims file and examination and interview of the Veteran. Moreover, the medical evidence is consistent with regard to the nature and severity of skin problems since 2010, with the exception of the evidence indicating increased use of topical creams for body rashes in 2021. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). Indeed, the objective medical evidence since 2010 is more credible than the Veteran's assertions regarding severity. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder). As such, her statements regarding skin problems on the head, face, and neck are outweighed by the medical evidence dated throughout the appeal period. An increased rating will not be assigned here based on DC 7800. 38 C.F.R. § 4.118. In sum, the evidence supports the assignment of a 10 percent rating prior to May 26, 2015 for urticaria. But a preponderance of the evidence is against the assignment of the next-highest rating of 30 percent prior to that date. The evidence prior to May 2015 did not indicate 20 to 40 percent of the entire body or exposed areas affected, or that systemic therapy was required for six weeks or more over the period of a year. Rather, the evidence indicates that the skin disorder was mostly asymptomatic and that the Veteran used oral medications briefly. A preponderance of the evidence is also against the assignment of a rating higher than 30 percent after May 26, 2015. For most of the period between 2015 and 2021, the evidence indicates quiescent skin problems and infrequent use of oral medications. The April 2021 VA report indicates worsening symptoms, with the Veteran using constant or near constant topical therapy in certain bodily areas. But this evidence does not indicate that over 40 percent of the entire body, or of the exposed areas, were affected, or that the problems required constant or near-constant systemic therapy whether oral or topical creams over any 12-month period between 2015 and 2021. As the preponderance of the evidence is against any claim for a rating higher than the one granted here, the benefit-of-the-doubt doctrine does not apply, and the claim for a higher rating must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.