Citation Nr: 21073962 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 16-53 398 DATE: December 13, 2021 ORDER Entitlement to an initial compensable rating for pseudofolliculitis barbae (PFB) prior to November 12, 2020, and a rating in excess of 30 percent since that date is denied. FINDINGS OF FACT 1. Prior to November 12, 2020, the Veteran's PFB affected less than 5 percent of his entire body and less than 5 percent of the exposed area; the Veteran's PFB has not required the use of any systemic therapy. 2. Since November 12, 2020, the Veteran's PFB scars have been manifested by three characteristics of disfigurement. CONCLUSIONS OF LAW 1. Prior to November 12, 2020, the criteria for an initial compensable rating for PFB are not met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.118, Diagnostic Codes 7806, 7813 (2020) 2. Since November 12, 2020, the criteria for an initial 30 percent rating for PFB are not met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.118, Diagnostic Code 7800 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Navy from January 1981 to January 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the Veteran's claim for additional development in June 2020. The case has now been returned to the Board for further appellate action. The Veteran also appealed the issue of entitlement to service connection for hemorrhoids. In a November 2020 rating decision, the agency of original jurisdiction (AOJ) granted service connection for hemorrhoids, which constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, that matter is no longer in appellate status. See Grantham, 114 F.3d at 1158 Of note, the rating assigned for the Veteran's PFB was increased to 30 percent effective November 12, 2020. However, as a higher rating is available for the Veteran's service-connected PFB, this issue remains in appellate status. See A.B. v. Brown, 6 Vet. App. 35, 38 (1993). Additionally, in the November 2020 rating decision, the AOJ granted service connection for painful scars as a residual of PFB and assigned a rating of 10 percent effective November 12, 2020. The Veteran has not disagreed with the rating or effective date assigned for this issue. The AOJ inexplicably included this issue in the most recent supplemental statement of the case (SSOC) dated in December 2020 as well as the issue of entitlement to a 10 percent rating for multiple noncompensable ratings prior to November 12, 2020. The Board notes that neither of these issues were perfected as appellate issues and appear to have been included in the SSOC in error. As such, the Board does not have jurisdiction of these issues and neither will be a subject of this decision. Increased Ratings - PFB The Veteran contends that his service-connected PFB warrants higher initial ratings. During a VA skin examination in May 2015, the Veteran reported that he had PFB during service when he shaved, and he wore a short beard to combat this problem. Since service, he has not required treatment, but he endorsed flare-ups of PFB if he shaved too closely. The examiner indicated that the Veteran's PFB did not cause scarring or disfigurement of the head, face, or neck. He did not have any benign or malignant skin neoplasms and he did not have any systemic manifestations due to any skin diseases. He did not require the use of any oral or topical medications in the past 12 months or any other treatments or procedures in the past 12 months. He had no debilitating or non-debilitating episodes of any skin disorders in the past 12 months. Clinical evaluation did not reveal any visible skin conditions. The examiner noted that the Veteran had small areas of very mild (visible only up close) follicle hypertrophy in the beard area under the mandibles bilaterally (surface area of approximately 30 centimeters (cm) squared on the right submandibular region and 15 cm squared on the left submandibular area). The Veteran also had a small lesion (area of approximately 0.25 cm squared) to the left of his mouth in the beard area. All involved skin areas were less than 5 percent of the total body surface area and less than 5 percent of the exposed body surface area. None of the areas produced scarring or disfigurement, and the submandibular areas were only seen on close examination. There were no current areas of active areas or acute problems related to the Veteran's history of PFB. During a March 2018 VA skin examination, the examiner indicated that the Veteran's skin was the same and there was no change in the treatment or course of the diagnosis. The examiner noted no disfigurement of the head, face, or neck. He did not have any benign or malignant skin neoplasms and he did not have any systemic manifestations due to any skin diseases. The Veteran had not been treated with oral or topical medications in the past 12 months for any skin conditions or any other treatments or procedures for any skin conditions. He had no debilitating or non-debilitating episodes of any skin disorders in the past 12 months. Clinical evaluation did not reveal any visible skin conditions. The Veteran was assessed with PFB. During a November 2020 VA skin examination, the Veteran had not been treated with oral or topical medications in the past 12 months for any skin conditions or any other treatments or procedures for any skin conditions. Clinical evaluation revealed that the Veteran's PFB affected 0 percent of the total body area and 5 to less than 20 percent of the exposed area. The examiner indicated that the Veteran had multiple small scattered dark colored bumps under his neckline. He had 2 to 3 small flesh colored bumps to the left cheek frown line and several scattered small flesh colored bumps proximate to the lateral mouth. The Veteran reported that he had issues with razor bumps after shaving. He indicated that he got bumps in his frown line and it looked like he had scattered crater areas in the beard area. He noted that the bumps occasionally got large and sore, and he had to pull the hairs out which caused pain. He indicated that he did not have any prescribed treatment for his razor bumps but he avoided shaving and let the hairs grow out so he could pick the hair out of the bumps. During a November 2020 VA scars examination, the Veteran was assessed with scattered hyperpigmented bumps underneath his chin line as a residual of his PFB. The examiner indicated that the scars were too numerous to count underneath his neckline. The examiner reported that the Veteran's razor bumps got inflamed and sore because the hair was trying to go back into the bumps. The scars measured 18 cm by 2.5 cm. There was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue. The scars were described as hyperpigmented and tender to palpation but were not unstable. The total area of the scars measured 45 cm squared. There was no gross distortion or asymmetry of facial features or visible or palpable tissue loss. The scars did not result in limitation of function or motion. The Veteran's service-connected PFB has been rated under the provisions of Diagnostic Code 7806 prior to November 12, 2020, and under the provisions of Diagnostic Code 7800 since that date. For the period prior to November 12, 2020, the Veteran's PFB affected less than 5 percent of the total body surface area and less than 5 percent of the exposed body surface area, and he did not use any systemic medication to treat his PFB. Additionally, none of the areas were productive of scarring or disfigurement, and the submandibular areas were only seen on close examination at the 2015 examination and there were no visible skin conditions present at the 2018 examination. These findings are tantamount to no more than a noncompensable rating under the provisions of Diagnostic Code 7806 and 7800. 38 C.F.R. § 4.118. For the period since November 12, 2020, the Veteran's PFB affected 5 to less than 20 percent of the exposed area and did not require the use of systemic medication. These findings are tantamount to a 10 percent rating pursuant to Diagnostic Code 7806. However, the Veteran was granted a 30 percent rating pursuant to Diagnostic Code 7800 based on the 2020 VA examination which revealed that the Veteran had three characteristics of disfigurement. Specifically, the scars were described as hyperpigmented, measured 18 cm by 2.5 cm, and the total area of the scar measured 45 cm squared. In order to warrant the next higher 50 percent rating there must be visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips; or when there are four or five characteristics of disfigurement, none of which has been shown in this case. With regard to the characteristics of disfigurement, the surface contour of the scars was not elevated or depressed on palpation, the scars were not adherent to underlying tissue, skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six sq. in. (39 sq. cm.), the underlying soft tissue was not missing in an area exceeding six sq. in. (39 sq. cm.), and the skin was not indurated and inflexible in an area exceeding six sq. in. (39 sq. cm.). As such, a rating is excess of 30 percent is not warranted. The Board has considered whether a higher rating is warranted under any other Diagnostic Codes pertaining to scars. However, Diagnostic Codes 7801-7802 are not applicable insofar as they apply to scars not of the face, head, or neck. Diagnostic Code 7804 pertains to five or more scars that are unstable and painful, which is not shown on examination. Finally, Diagnostic Code 7805 pertains to any disabling effects not considered in a rating provided under diagnostic codes 7800-7804. However, the PFB scars were not shown result in limitation of function or motion. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim for an initial compensable rating for PFB prior to November 12, 2020, and in excess of 30 percent for PFB since that date must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Cryan, 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.