Citation Nr: 21070882 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 18-29 309 DATE: November 26, 2021 ORDER Entitlement to an increased evaluation of 30 percent, but no higher, for pseudofolliculitis barbae with disfigurement due to scarring is granted. Entitlement to a special monthly pension is denied. REMANDED Entitlement to service connection for a mental health condition is remanded. Entitlement to service connection for right foot gout is remanded. Entitlement to an aid and attendance allowance for a dependent spouse is remanded. FINDINGS OF FACT 1. The Veteran's pseudofolliculitis barbae predominant disability is disfigurement of the head, face, and neck. 2. The Veteran's pseudofolliculitis barbae results in 2 characteristics of disfigurement, but not visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features or more than 3 characteristics of disfigurement. 3. The Veteran has failed to provide the necessary evidence to establish eligibility for a special monthly pension. CONCLUSIONS OF LAW 1. The criteria for a 30 percent rating, but no higher, for pseudofolliculitis barbae are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes (DCs) 7800, 7813. 2. The criteria for entitlement to payment of a special monthly pension are not met. 38 U.S.C. § 1521; 38 C.F.R. §§ 3.3, 3.23, 3.271, 3.272, 3.277. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from August 1974 to October 1975. This case comes before the Board of Veterans' Appeals (Board) on appeal from May 2014 and June 2015 rating decisions issued by a Department of Veterans Affairs (VA) regional office (RO). In July 2021, the Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge, and a transcript of that hearing has been associated with the electronic claims file. I. Higher Rating 1. Entitlement to a rating in excess of 10 percent for pseudofolliculitis barbae with disfigurement due to scarring. Law and Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. The evaluation of a service-connected disorder requires a review of a veteran's entire medical history regarding that disorder. 38 U.S.C. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, 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. Evidence to be considered in an appeal from an initial disability rating was not limited to that reflecting the then current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. Fenderson, 12 Vet. App. at 126-27; Hart v. Mansfield, 21 Vet. App. 505 (2007). Such separate disability ratings are known as staged ratings. If two disability evaluations are potentially applicable, 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. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be "staged." Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings). Where entitlement to compensation has already been established, as is the case here, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran's pseudofolliculitis barbae with disfigurement due to scarring is rated under DC 7813-7800. DC 7813 is used to rate dermatophytosis and states to evaluate the condition under General Rating Formula for the Skin. 38 C.F.R. § 4.118, DC 7813. The Formula provides these conditions should be rated according to the Formula, as disfigurement of the head, face, or neck (DC 7800), or as scars (DCs 7801-7805), depending upon the predominant disability. 38 C.F.R. § 4.118 Under the General Rating 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. Id. 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. Id. 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. Id. Effective August 13, 2018, VA amended the criteria for rating the skin. Under the new criteria, 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." Under the General Rating 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. Id. 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. Id. 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. Id. With regard to the meaning of "systemic therapy" prior to the new definition of the term in the revised criteria, the United States Court of Appeal for Veterans Claims (Court) in Johnson v. McDonald, 27 Vet. App. 497, 505 (2016) held that use of a topical steroid constituted "systemic therapy" within the meaning of DC 7806. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit reversed this decision and determined that "constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs" under DC 7806 is generally not inclusive of topical corticosteroids. The Federal Circuit found that "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." Thus, according to the Federal Circuit, all applications of topical corticosteroids do not constitute systemic therapy. The Federal Circuit also held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Burton v. Wilkie, 30 Vet. App. 286 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects. However, the Veteran's disability is currently rated under the criteria for DC 7800 for scars of the head, face, or neck based on the predominant disability. Under DC 7800, which was unchanged by the 2018 amendments, a 10 percent disability rating is warranted for scarring with one characteristic of disfigurement. 38 C.F.R. § 4.118, DC 7800. A 30 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or two or three of the characteristics of disfigurement. Id. A 50 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or four or five characteristics of disfigurement. Id. An 80 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or six or more characteristics of disfigurement. Id. The eight characteristics of disfigurement for the purposes of rating under 38 C.F.R. § 4.118 are: scar of 5 inches (in.) or more (13 or more centimeters (cm.)) in length; scar at least 1/4 in. (0.6 cm.) wide at its widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding 6 square inches (39 square cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square in. (39 square cm.); underlying soft tissue missing in an area exceeding 6 square in. (39 square cm.); and skin indurated and inflexible in an area exceeding 6 square in. (39 square cm.). Id., Note (1). Id. Prior to August 13, 2018, DC 7801 provided disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, DC 7801 (2017). In contrast, the amended DC 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801 (August 13, 2018). Both the old and new criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square in. (39 square cm.) but less than 12 square in. (77 square cm.). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square in. (77 square cm.) but less than 72 square in. (456 square cm.). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square in. (456 square cm.) but less than 144 square in. (929 square cm.). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square in. (929 square cm.) or greater. 38 C.F.R. § 4.118, DC 7801. Note (1) to the pre-amended DC 7801 stated that a deep scar is one associated with underlying soft tissue damage. Id. Prior to August 13, 2018, DC 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, DC 7802 (2017). The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. Id. Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square in. (929 square cm.) or greater. Id. Under both the old and new rating criteria, DC 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. 38 C.F.R. § 4.118, DC 7804. A 20 percent rating is warranted for three or four scars that are unstable or painful. Id. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Id. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. Id. Under the old rating criteria, DC 7805 provided that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an appropriate DC. 38 C.F.R. § 4.118, DC 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase "(including linear scars)" with "and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804." Id. Significantly, with regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its "intent is that the 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." The Veteran's claim in this case was pending prior to the August 13, 2018 effective date of the new criteria, and therefore the Board will consider both the old and new criteria and apply the more favorable. However, the Federal Circuit's interpretation of the term "systemic therapy" in the old criteria applies throughout the entire period prior to the August 13, 2018 effective date of the new criteria. Rivers v. Roadway Express, 511 U.S. 298, 312-13 (1994) ("[j]udicial construction of a statute [or regulation] is an authoritative statement of what the statute [or regulation] meant before as well as after the decision of the case giving rise to that construction"); Jordan v. Nicholson, 401 F.3d 1296, 1298-99 (Fed. Cir. 2005) (a new interpretation of a statute retroactively affects decisions still open on direct review); Threatt v. McDonald, 28 Vet. App. 56, 63 (2016) (noting the "normal principle at this Court that judicial decisions operate retrospectively"). Factual Background and Analysis In December 2013, the Veteran filed a new claim seeking an evaluation in excess of 10 percent for pseudofolliculitis barbae with disfigurement due to scarring. During the July 2021 Board hearing, the Veteran described the pseudofolliculitis barbae as affecting his entire neck and face, including his ears. He reported that it is irritating, painful, and itches if he shaves his face too close. He also reported that he believes he lost job opportunities due to having a beard when he was younger and feeling self-conscious about the about his appearance and claimed to have a mental health condition as a result of the pseudofolliculitis barbae. The Veteran denied experiencing flareups of this condition. Prior to the appeal period, the Veteran was afforded VA skin and scar examinations in regard to the pseudofolliculitis barbae in July 2012. The Veteran reported that the condition had not worsened since a December 2010 VA examination and that it does not affect the beard area. He also reported using oral antibiotics for treatment. He denied experiencing problems in his beard area since discontinuing use of razors for shaving. The examiner reported that the pseudofolliculitis barbae was present in two areas of the Veteran's face on both cheeks, one 1.5 cm. by 2 cm. and the other 2 cm. by 2.5 cm. The examiner also reported that the areas include tiny pits of skin, depressed on palpation, hyperpigmentation, and abnormal texture. The examiner denied the presence of the other characteristics of disfigurement and the use of intermittent systemic therapy including, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs, for treatment. The examiner noted that the Veteran felt he was unable to get jobs because of having a beard and that he is now concerned over his facial appearance. Pursuant to the claim on appeal, the Veteran was afforded another VA scar examination in April 2014. The Veteran reported using clippers and scissors for his facial hair and denied experiencing painful scars. The examiner reported that the pseudofolliculitis barbae was present in two areas of the Veteran's face above his beard, both approximately 2 cm. by 2 cm. The examiner also reported that the areas are tiny, hyperpigmented, pitted scars and cover less than 2 percent of his exposed surface area. The examiner denied the presence of the other characteristics of disfigurement. The examiner found that the scars were not painful or unstable. The examiner also found that the condition does not result in functional impairment. The Veteran was afforded another skin examination in May 2018. The Veteran reported having continued problems with the condition and using topical medications. The examiner reported the presence of pseudofolliculitis barbae on 5 percent to less than 20 percent of the Veteran's total body area and exposed body area. The examiner also reported the use of topical medications Clindamycin and Betamethasone Valerate for less than 6 weeks in the past year, but denied the use of systemic therapy including, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs, for treatment. The Board finds that a 30 percent rating, but no higher, is warranted for pseudofolliculitis barbae. In this regard, the VA scar examiners found that the condition is greater than 0.6 cm. in width and is depressed on palpation, which are two characteristics of disfigurement. However, while the pseudofolliculitis barbae also is hyperpigmented and of an abnormal texture, both examiners found that it was less than 39 square cm. in area. The Board has considered rating this condition under DC 7813. However, the evidence shows that the disfiguring aspect of the pseudofolliculitis barbae is the predominant disability in this case. In this regard, the Veteran indicated during the July 2012 examination and July 2021 Board hearing that the effect on his appearance is the most concerning aspect of the condition. In addition, the examiners denied that the condition is present on more than 40 percent of this total body area or exposed body area and the use of constant or near constant systemic therapy for treatment. Furthermore, the examination reports indicate that the size, stability, lack of pain, and number of locations where the pseudofolliculitis barbae is present would not warrant a rating in excess of 30 percent under DCs 7801-7805. See 38 C.F.R. § 4.118. The Board has also considered the potential application of other various provisions, including 38 C.F.R. § 3.321 (b)(1), for exceptional cases where schedular evaluations are found to be inadequate. See Schafrath, 1 Vet. App. 589. Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate a veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether a veteran's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, a veteran's disability picture requires the assignment of an extraschedular rating. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular evaluation for the Veteran's service-connected pseudofolliculitis barbae is inadequate. A comparison between the level of severity and symptomatology of the Veteran's disability with the established criteria shows that the rating criteria more than reasonably describe the Veteran's disability level and symptomatology. The criteria specifically provide for evaluation of the disability based upon the size and scope of head, face, and neck disfigurement, and they practicably represent the average impairment in earning capacity resulting from the Veteran's service-connected disability. See 38 C.F.R. § 4.1. The Board notes that the Veteran reported psychological difficulties related to the cosmetic aspects of this condition. While the rating schedule does not specifically address this symptom in connection with DC 7800, the Board finds that the natural consequences of disfigurement contemplated by DC 7800 are likely to result in anxiety regarding personal appearance. Furthermore, to the extent that the Veteran experiences a psychiatric disability due to the disfiguring aspect of pseudofolliculitis barbae, the Veteran has filed a separation service connection claim for such disability and it is remanded below for additional development. The Board, therefore, has determined that an extraschedular rating pursuant to 38 C.F.R. § 3.321 (b)(1) is not warranted. The weight of evidence reflects that there is not such an exceptional disability picture that the available schedular evaluation for the service-connected pseudofolliculitis barbae is inadequate. Consequently, the Board finds that entitlement to an increased 30 percent evaluation, but no higher, for pseudofolliculitis barbae entitlement is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, DCs 7800, 7813. II. Pension 2. Entitlement to a special monthly pension. Law and Regulations Basic entitlement to pension exists if, among other things, the claimant's income is not in excess of the maximum annual pension rate (MAPR) specified in 38 C.F.R. § 3.23. 38 U.S.C. § 1521; 38 C.F.R. § 3.3(a)(3). The MAPR is revised every December 1st and is applicable for the following 12-month period. The MAPR shall be reduced by the amount of the countable annual income of the claimant. 38 U.S.C. §§ 1503, 1521; 38 C.F.R. §§ 3.3, 3.23(b). In determining annual income, all payments of any kind or from any source (including salary, retirement or annuity payments, one-time lump sum payments or similar income, even if waived) shall be included during the 12-month annualization period in which received, except for income specifically excluded. 38 U.S.C. § 1503(a); 38 C.F.R. §§ 3.271(a), 3.272. Gross income received is counted rather than the amount of the payment a beneficiary receives, except where certain expenses are allowed to be deducted (e.g., necessary operating expenses are deductible from business, farm or professional income and medical, legal or other expenses incident to an injury or death or expenses incident to the collection or recovery of the amount of an award or settlement for an injury or death are deductible from compensation received for an injury or death). The amount of recurring and irregular income anticipated or received by a beneficiary shall be added to determine the beneficiary's annual rate of income for a 12-month annualization period commencing at the beginning of the 12-month annualization. 38 C.F.R. § 3.273(d). The amount of nonrecurring income (e.g., an inheritance) received by a beneficiary shall be added to the beneficiary's annual rate of income for a 12-month annualization period commencing on the effective date on which the nonrecurring income is countable. 38 C.F.R. § 3.273(c). For purposes of calculating countable income, total income may be reduced by amounts paid by a claimant for unreimbursed medical expenses that are "in excess of 5 percent of the applicable maximum annual pension rate or rates...as in effect during the 12-month annualization period in which the medical expenses were paid." 38 C.F.R. § 3.272 (g)(1)(iii). In order to be excluded from income, these medical expenses must be paid during the time period at issue, regardless of when they were incurred. In addition, they must be out-of-pocket expenses, for which the claimant received no reimbursement, such as from an insurance company. However, medical insurance premiums themselves, including Medicare Plan B premiums deducted from Social Security Administration (SSA) benefits, may be applied to reduce countable income. For the purpose of determining initial entitlement, or for resuming payments on an award that was previously discontinued, the monthly rate of pension shall be computed by reducing the applicable maximum pension rate by the beneficiary's countable income on the effective date of entitlement and dividing the remainder by twelve. 38 C.F.R. § 3.273(a). In essence, VA subtracts the total amount of countable income in one year from the MAPR for that year; then, if a positive amount remains, the rest is divided by 12 to determine the monthly pension benefit. When a change in the MAPR occurs, VA repeats the calculation with the new MAPR as the starting amount on the effective date of the change, typically December 1st. 38 C.F.R. § 3.273(b)(1). Whenever there is a change in a beneficiary's countable income, VA will repeat the calculation using the beneficiary's new countable income effective the date of the change in the amount of income. 38 C.F.R. § 3.273(b)(2). As a condition of granting or continuing pension, VA may require from an applicant for or a recipient of pension such information, proofs, and evidence as is necessary to determine the annual income and the value of the corpus of the estate of such person, and of any spouse or child for whom the person is receiving or is to receive increased pension. 38 C.F.R. § 3.277(a). VA may require an individual who applies for or receives pension to, as a condition of receipt or continued receipt of benefits, furnish an eligibility verification report upon request. 38 C.F.R. § 3.277(c)(3). If VA requests that a claimant or beneficiary submit an eligibility verification report, but he or she fails to do so within 60 days of the date of request, VA shall suspend the award or disallow the claim. 38 C.F.R. § 3.277(d). Factual Background and Analysis In a January 2015 statement, the Veteran requested a special monthly pension based on the need for aid and attendance. In a February 2015 correspondence, the RO requested the Veteran submit income and net worth information as well as medical evidence regarding the need for aid and attendance. However, the Veteran did not respond to this correspondence or submit any of the requested information. In a June 2015 decision, the RO denied the pension claim because the Veteran failed to submit the necessary information to establish eligibility for pension benefits. In this case, the Board finds that the Veteran failed to provide the necessary evidence to establish eligibility for a special monthly pension. In this regard, pension benefits are limited to claimants that meet income and net worth requirements. During the hearing, the undersigned inquired as to whether additional information could be submitted in support of the claim, but the representative essentially conceded that the Veteran does not meet the income and net worth requirements. Under the circumstances, eligibility to pension benefits is not established. REASONS FOR REMAND 1. Entitlement to service connection for a mental health condition. The Veteran is seeking service connection for a mental health condition. During the July 2021 Board hearing, he stated that he was not able to advance in the military due to his pseudofolliculitis barbae and that this was very frustrating to him. He also stated that he began to drink excessively at this time and continued to do so after discharge. He further stated that he has been treated for mental health conditions due to pseudofolliculitis barbae. The Veteran's service treatment records (STRs) show that he was treated for pain in his chest in July 1975. A treatment provider noted that chest x-rays, laboratory testing, and a physical examination were all normal. The provider noted an impression of anxiety. The Veteran denied experiencing frequent trouble sleeping, depression, excessive worry, and nervous trouble of any sort in a May 1975 report of medical history. The Board finds that a remand is necessary to afford the Veteran an examination to determine the nature and etiology of all current psychiatric conditions. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to service connection for right foot gout. The Veteran is seeking service connection for right foot gout. During the July 2021 Board hearing, he stated that he sought medical treatment during service for right foot symptoms. He also stated that he has right foot gout due to training and running during service. The Veteran's service treatment records (STRs) do not include reports of or treatment for right foot symptoms. He denied experiencing lameness, arthritis, rheumatism, and foot trouble in a May 1975 report of medical history. The Veteran's lower extremities were found to be normal during a May 1975 examination report. The Board finds that a remand is necessary to afford the Veteran an examination to determine the nature and etiology of his right foot gout. See McLendon, 20 Vet. App. at 81. 3. Entitlement to an aid and attendance allowance for a dependent spouse. The Veteran is seeking additional compensation due to his spouse's need for aid and attendance. During the July 2021 Board hearing, the Veteran stated that his wife is receiving Social Security Administration (SSA) disability compensation and is nearly blind. The Board finds that a remand is necessary to afford the Veteran's spouse an examination to determine if she requires aid and attendance. See McLendon, 20 Vet. App. at 81. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the etiology of the current acquired psychiatric disorder(s). The examiner should determine the nature, extent of severity, and etiology of any psychiatric disorder(s) which may have been present at any time during the pendency of this appeal. The examiner should provide a diagnosis for any psychiatric disorder that existed during the pendency of this claim (since January 2015). Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any diagnosed psychiatric disorder is related to any incident of the Veteran's active duty service. The examiner should also provide an opinion as to whether if it is at least as likely as not (at least a 50 percent probability) that any diagnosed psychiatric disability is caused or aggravated by the service connected pseudofolliculitis barbae disability. Aggravation means an increase in severity beyond the natural progress of the disease. If the examiner finds that the Veteran has a psychiatric disability that has been aggravated by his pseudofolliculitis barbae, to the extent feasible, the degree of worsening should be identified. All opinions expressed by the examiner must be accompanied by a complete rationale. 2. Schedule the Veteran for a VA examination to determine the etiology of the claimed right foot gout. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any diagnosed right foot gout is related to any incident of the Veteran's active duty service, to include training and running. All opinions expressed by the examiner must be accompanied by a complete rationale. 3. Schedule the Veteran's spouse for an aid and attendance examination by an appropriate clinician. The examiner must opine on whether it is at least as likely as not that the Veteran's spouse's disabilities, to include impaired vision, prevent her from performing functions of self-care to include her ability to dress or undress herself, to keep herself ordinarily clean and presentable, adjusting any special prosthetic or orthopedic applications that normal people would be able to adjust without aid, to feed herself, and to attend to the wants of nature. The examiner must also opine on whether it is at least as likely as not that the Veteran's spouse has physical or mental incapacity due any disability that renders her unable to protect herself from hazards or dangers incident to her daily environment. 4. Thereafter, the RO must readjudicate the issues on appeal. If any benefit is not granted, the Veteran must be furnished with a supplemental statement of the case, with a copy to his representative, and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jimerfield, David 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.