Citation Nr: 21071415 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 18-48 522 DATE: November 30, 2021 ORDER An effective date of April 6, 2016 for the assignment of a 10 percent rating for scars, cystic acne face and neck associated with cystic acne face and neck to include left lower nasal fold scar is granted, subject to the laws and regulations governing the award of monetary benefits. REMANDED The claim for service connection for a bilateral lower extremity neurological disorder (claimed as peripheral neuropathy and sciatica), to include as secondary to bilateral ankle disabilities is remanded. The claim for a rating in excess of 10 percent for cystic acne of the face and neck, to include the left lower nasal fold for the period from April 6, 2016 to October 23, 2017, and in excess of 30 percent therefrom is remanded. FINDINGS OF FACT 1. An intent to file (ITF) for VA benefits for a skin disability was received on April 6, 2016 with a formal claim for service connection for a skin disability (i.e., acne) received on June 14, 2016. 2. By the appealed September 2016 rating action, the RO granted service connection for cystic acne scars, on face and neck, and assigned an initial noncompensable rating, effective April 6, 2016. 3. By a January 2021 rating decision, the RO assigned a 10 percent rating to the service connected scars, cystic acne face and neck associated with cystic acne face and neck to include left lower nasal fold scar with an effective date of December 22, 2020. 4. It was factually ascertainable by April 6, 2016, that the Veteran met the criteria for a 10 percent award for scars, cystic acne face and neck associated with cystic acne face and neck to include left lower nasal fold scar. CONCLUSION OF LAW The criteria for an effective date of April 6, 2016, for the assignment of a 10 percent rating for scars, cystic acne face and neck associated with cystic acne face and neck to include left lower nasal fold scar have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.156, 3.157, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service with the United States Army from April 1979 to April 1981. He seeks an effective date earlier than December 22, 2020 for the assignment of a 10 percent rating for his service-connected scars, cystic acne face and neck associated with cystic acne face and neck to include left lower nasal fold scar. The effective date of an award based on an original claim shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400; Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999). An effective date for increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability occurred, if application is received within one year from such date. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). An effective date for an increased rating should not be assigned mechanically. Rather, all of the facts should be examined to determine the date that the disability first manifested. Accordingly, the effective date for an increased rating as well as for an initial rating or for staged ratings is predicated on when the increase in the level of disability can be ascertained. Swain v. McDonald, 27 Vet. App. 219, 224 (2015). An effective date of April 6, 2016 for a 10 percent rating for the service-connected scars, cystic acne face and neck associated with cystic acne face and neck to include left lower nasal fold scar is granted. The Veteran contends that April 6, 2016, the date VA received his ITF, should be the effective date of the 10 percent rating that is currently assigned for his service-connected scars, because the scars have remained essentially unchanged since that time. Transcript (T.) at page (pg.) 13)). In a September 2016 rating action, the RO granted service connection for scars, cystic acne, face and neck associated with cystic acne face and neck to include left lower nasal fold scar, and assigned an initial noncompensable rating, effective April 6, 2016, the date of receipt of the ITF. A formal claim for compensation was received on June 14, 2016. By a January 2021 rating action, the RO granted a 10 percent rating for the scars, effective December 22, 2020, the date of a VA examination report reflecting that the Veteran had one or two cystic acne scars of the face and neck that were unstable or painful. 38 C.F.R. § 4.114, Diagnostic Code 7804. The VA examiner specifically indicated that the Veteran's scars had remained unchanged since his military service. See December 2020 VA Scars examination report at pg.7. Thus, given the VA examiner's statement that the Veteran's scars had remained unchanged since military service in conjunction with his testimony echoing the same, and that the Board determined in its November 2020 remand that VA examinations of the skin, performed in July 2016 and October 2017, were inadequate for adjudication purposes (see, November 2020 Board remand at page (pg.) 22), an effective date of April 6, 2016 for the 10 percent rating, is warranted. Because Apri 6, 2016, is the later of the date of claim or date entitlement arose, the 10 percent rating is assignable from that date. As such, the Board finds that an effective date of April 6, 2016, is warranted for the award of a 10 percent disability rating for cystic acne scars of the face and neck. To that extent, the appeal is granted. REASONS FOR REMAND Service connection for bilateral lower extremity neurological disorder (claimed as peripheral neuropathy and sciatica), to include as secondary to bilateral ankle disabilities is remanded. The Veteran seeks service connection for bilateral lower extremity neurological disorder (claimed as peripheral neuropathy and sciatica) and was awarded service connection for bilateral ankle disabilities during the pendency of the appeal. The Board acknowledges that the medical evidence of record shows that the Veteran has been diagnosed with herniated discs of the cervical and thoracic spine with radiculopathy; arthritis; and sciatica spinal cord compression. The Veteran has not, however, been provided a VA examination for his claimed bilateral lower extremity neurological disabilities. The Board finds that a VA examination is necessary to provide clarity and to properly diagnose the claimed neuropathic disabilities of the lower extremities, and their relationship, if any, to the service-connected bilateral ankle disabilities that were granted during the pendency of the appeal. A rating in excess of 10 percent for cystic acne of the face and neck, to include the left lower nasal fold for the period from April 6, 2016 to October 23, 2017, and in excess of 30 percent therefrom is remanded. During the hearing before the undersigned, the Veteran testified that his acne had not changed from 2016 to 2020, and that the 30 percent rating should be assigned for the entire appeal period. T. at pg. 15. The Veteran reported that he had sought treatment for his acne from a private dermatologist, Dr. Yungmann. T. pg. 9. A review of the Veteran's record reflects that none of these private medical records have been obtained. Thus, a remand is warranted to try and obtain these records. The Veteran's service-connected cystic acne of the face and neck, to include the left lower nasal fold is rated under Diagnostic Code 7828 (acne). DC 7828 specifically provides that acne can alternatively be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DC 7802, 7803, 7804, or 7805), depending upon the predominant disability. 38 C.F.R. § 4.118, DC 7828. Here, while the Veteran was provided a VA Scar examination in December 2020 and findings relative to the scars were provided, the examiner also noted that the Veteran was not taking any medication to treat his skin. Conversely, during the hearing before the undersigned, the Veteran indicated that he washed his skin with daily benzoyl peroxide washes and that he occasionally used antibiotics during a flare-up. T. at pg. 9. Thus, upon remand, the Veteran should be afforded with a new examination that renders specific findings with respect to the existence and extent of manifestations associated with the Veteran's recurrent cystic acne, such as systemic therapy including, but not limited to, corticosteroids or other immunosuppressive drugs so that the Board may properly adjudicate the Veteran's claim. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran's file, the private medical records that pertain to treatment of the Veteran's skin disability from Dr. Yungmann as referenced at his hearing in February 2021. 2. Schedule the Veteran for a VA neurological examination to diagnose and determine the nature and etiology of the claimed bilateral lower extremity neuropathy. The examiner is asked to do the following: (i) Diagnose each neurological disability associated with the Veteran's bilateral lower extremities. (ii) Then provide opinions to the following questions: (a) Is it at least as likely as not (50 percent or greater probability) that any diagnosed neurological disability of the right and/or lower extremity began in or was otherwise caused by the Veteran's active military service, or manifested with one year after separation from service? Why or why not? (b) Is it at least as likely as not (50 percent probability or greater) that any diagnosed neurological disability of the right and/or lower extremity was caused by the service-connected bilateral ankle disabilities? Why or why not? (c) Is it at least as likely as not (50 percent probability or greater) that any diagnosed neurological disability of the right and/or lower extremity was aggravated (made worse) by the service-connected bilateral ankle disabilities? Why or why not? 3. Arrange for the Veteran to undergo a VA skin examination to assess the symptoms and severity of the Veteran's recurrent furunculosis and cystic acne with scarring. (Continued on the next page) The examiner should describe each medication used for cystic acne and any associated scars or scarring (i.e., whether the medication is topical, corticosteroid, etc.), and the duration for which each medication is required during the past 12-month period. The examiner should comment upon the impact, if any, the Veteran's recurrent furunculosis and cystic acne with associated scars or scarring has on his activities of daily living and/or occupational functioning. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Carole Kammel, 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.