Citation Nr: 21077517 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 16-61 189 DATE: December 30, 2021 ORDER A disability rating greater than 30 percent for the service-connected chronic skin lesions (now also claimed as skin rash and itchy skin bumps) is denied. FINDING OF FACT The Veteran's service-connected skin disorder has not been manifested by 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 during any 12-month period. CONCLUSION OF LAW The criteria for a disability rating greater than 30 percent for the service-connected chronic skin lesions have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7806. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1987 to October 1995. This current matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In January 2019, the Board denied the issues of entitlement to service connection for other disabilities then on appeal and remanded the remaining issues for further development. In a June 2020 rating decision, the AOJ granted service connection for tinea unguium of the right foot. Thus, that issue is no longer before the Board. In July 2021, the Board remanded the matter for compliance with the prior remand. The record reflects substantial compliance with the remand requests. Dyment v. West, 13 Vet. App. 141 (1999). In an August 2021 rating decision, the AOJ increased the rating for chronic skin lesions to 30 percent effective April 25, 2014, the date of receipt of claim. Increased RatingSkin Disorder The Veteran filed his current claim for an increased rating for his skin disorder on April 25, 2014. The medical evidence of record shows that he has chronic skin lesions diagnosed as dermatitis and intertrigo. Effective August 13, 2018, VA revised the regulations pertaining to the evaluation of skin disabilities including dermatitis and eczema. 83 Fed. Reg. 32597 (July 13, 2018). Claims pending prior to the effective date are to be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. Under former Diagnostic Code 7806, a 60 percent rating is warranted for dermatitis or eczema with more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or requiring constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during the past 12-month period. A 30 percent rating is warranted for dermatitis or eczema with 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or requiring systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 10 percent rating is warranted for dermatitis or eczema with 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 requiring intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during the past 12-month period. Under the revised regulations, effective August 13, 2018, dermatitis or eczema is to be evaluated under the General Rating Formula for the Skin. 38 C.F.R. § 4.118. Under the General Rating Formula for the Skin, a 60 percent rating is warranted 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. A 30 percent rating is warranted for at least one of the following: 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. The revised regulations specified that 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. Where the law or regulation changes after a claim has been filed or reopened but before the administrative process has been concluded, VA must decide which version is applicable unless Congress provided otherwise. However, the effective date of a liberalizing law or VA issue may be no earlier than the date of the law or VA issue. 38 U.S.C. § 5110. As can be seen, the substance of the rating criteria for both the currently assigned 30 percent rating and the higher 60 percent rating remains the same under both versions. Thus, to warrant a higher 60 percent rating, the Veteran's skin disorder must involve more than 40 percent of the entire body or more than 40 percent of exposed areas or require constant or near-constant systemic therapy. While the Veteran has been provided with several VA examinations during the course of this appeal, none of them has shown that his skin disorder has involved more than 40 percent of his entire body or exposed areas or has required systemic therapy. At most, his skin disorder has involved at least 5 percent, but less than 20 percent, of his entire body or exposed areas, and that was at the most recent July 2021 examination. None of the examinations has shown that he has required systemic therapy. While VA and private treatment records show treatment for skin problems, it has only consisted of topical therapy, and the treatment records do not contain findings specific to percentage of body involvement. With regard to the Veteran's assertions that his skin disorder covers more than 40 percent of exposed areas, the Board notes that the Veteran is competent to give evidence about observable symptoms such as skin rashes and lesions. Layno v. Brown, 6 Vet. App. 465 (1994). The Board has reviewed all the evidence of record, including the Veteran's photographs, but cannot find that his skin disorder has involved more than 40 percent of his entire body or exposed areas. In any event, the Board will defer to the VA examiners' assessments, all of which indicate involvement of less than 40 percent of his entire body or exposed areas. While the Board is sympathetic to the Veteran's situation, a higher 60 percent rating for the service-connected skin disability is not warranted. In reaching this conclusion, the Board notes the Veteran's assertion that he is entitled to a higher rating based on scarring or disfigurement of the face due to his skin disability. To warrant a compensable rating under Diagnostic Code 7800, which is specific to scars and disfigurement of the head, face or neck, there must be at least one characteristic of disfigurement. 38 C.F.R. § 4.118. The 8 characteristics of disfigurement are: scar 5 or more inches (13 or more cm.) in length, scar at least one-quarter inch (0.6 cm.) wide at 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 six square inches (39 sq. cm.), skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.), underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.), and skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Here, none of the examinations or other medical evidence of record reflects any of the characteristics of disfigurement to warrant a separate compensable or higher rating under this code. Accordingly, the Board concludes that a disability rating greater than 30 percent for the service-connected chronic skin lesions diagnosed as dermatitis and intertrigo is not warranted. As the preponderance of the evidence is against this claim, the appeal must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. W. Kim, 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.