Citation Nr: 21074356 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 19-03 065 DATE: December 15, 2021 REMANDED An initial compensable rating for pseudofolliculitis barbae (PFB). REASONS FOR REMAND The Veteran served on active duty from August 1999 to March 2005. The case is on appeal from a June 2016 rating decision. In August 2021, the Veteran testified at a Board hearing. The record was held open for 30 days. No evidence was received. An initial compensable rating for PFB. The Veteran is seeking an increased rating for his service-connected skin condition, and contends the current noncompensable rating does not reflect the severity of his PFB. At the August 2021 Board hearing, the Veteran asserted that his condition is better now simply because he does not shave, and never uses razors. He contends that prior dermatologists indicated he would need injections or laser treatment if the condition worsened by shaving. The Veteran stated that even though he does not shave, he still has "spots that will break out," irritation, scars and eruptions, and uses hydrocortisone and other prescribed medications. In March 2016, the Veteran submitted correspondence from his dermatologist that stated that upon examination of the Veteran, his face was marked by many follicular papules associated with pruritus. He advised the Veteran to avoid close shaving, use of topical hydrocortisone and/or alclometasone, and a brushing technique to alleviate ingrown hairs. The Veteran was first afforded a VA examination in May 2016. It was acknowledged that the condition had improved because he does not shave, and found no current scarring, disfigurement, use of oral, topical or systemic treatment, and his PFB comprised less than 5 percent of exposed body area. In February 2020, a new VA skin disability benefits questionnaire was completed. The Veteran reported symptoms of burning of the skin and scars from "bumps and holes" in the face. He stated the condition was treated with systemic fluocinonide. The examiner then indicated "NO" to treatment with medication in the past 12 months, and that the PFB was less than 5 percent of the exposed area. The Board finds that another VA medical examination is necessary to determine the severity of the Veteran's PFB, including whether he uses systemic therapy and/or other treatment for his skin disability. The Board notes that the Veteran does not shave to prevent flareups of his PFB, and did not shave before the examinations. Thus, it is likely that the May 2016 and February 2020 examinations did not take place at a time when the Veteran's disability was most disabling. See Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017) Ardison v. Brown, 6 Vet. App. 405 (1994) (holding that "it is the frequency and duration of the outbreaks and the appearance and virulence of them during the outbreaks that must be addressed"). On remand, the Veteran should be afforded another VA examination, if possible, during an active phase of his skin disorder. If the examination cannot be conducted at such time, it is imperative that the VA examiner review the Veteran's documented medical history and consider the Veteran's lay statements as to the severity, so an estimate can be rendered as to the percentage that could be affected during a period of flareup, and to distinguish any distinction in severity, frequency, and duration of symptomatology when he does shave versus when he does not shave his face. Another examination is also required to determine if the Veteran's topical medication constitutes systemic therapy pursuant to Burton v. Wilkie, 30 Vet. App. 286 (2018). While both VA examiners indicated no use of medications in the prior 12 months, the Veteran indicated that he used topical creams at the February 2020 VA examination and during his August 2021 Board hearing. Additionally, while VA treatment records do not include treatment or additional information as to the Veteran's PFB, the Veteran indicated at his Board hearing that he has seen different physicians and dermatologists for treatment of the condition. It does not appear that private treatment records have been requested, are potentially relevant to the Veteran's claim, and an attempt to obtain any identified treatment records regarding the Veteran's skin condition is necessary so that the adjudication of the Veteran's claim is a fully informed one. 38 C.F.R. § 3.159(c). The matters are REMANDED for the following action: 1. Ask the Veteran to identify any private treatment providers relevant to his PFB claim, and to provide authorization to VA to request the records. Request any so identified records, and associate them with the claims file if they exist. 2. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to assess the severity of his service-connected skin condition. To the extent reasonable and practicable, coordinate with the Veteran to schedule the examination during an active stage of the disease. The examiner should address: (1) the type of treatment for the condition, including whether it is topical, whether it is a corticosteroid, and whether it is systemic and/or immunosuppressive in nature or the equivalent (e.g., a topical medication that affects the entire body as a whole in its treatment of the skin condition); (2) the percentage area covered for PFB; (3) any disfigurement of the face; and (4) any associated scarring. The examiner is asked to consider and address: (1) the Veteran's lay statements of severity during flareups and frequency of use of medication; (2) the February 2020 examination report of systemic treatment use of fluocinonide; and (3) any distinction in severity, frequency, and duration of symptomatology when he does shave versus when he does not shave his face. If the examination is not during a flareup, the effects of a flareup should be estimated to the extent reasonably possible. If they cannot be, it should be explained why this is so. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Morford, Associate 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.