Citation Nr: 21006240 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 05-33 030 DATE: February 3, 2021 REMANDED Entitlement to an initial rating in excess of 30 percent for pseudofolliculitis barbae (PFB) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1991 to November 1999. At a February 2011 hearing, the Veteran testified before the undersigned Acting Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. This matter was most recently before the Board in September 2020 at which time it was remanded for further evidentiary development. Although the Board regrets the additional delay, remand is again needed before a decision may be rendered on the claim. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to an initial rating in excess of 30 percent for PFB is remanded. In several prior remands, the Board requested that the Agency of Original Jurisdiction (AOJ) obtain VA medical opinions to determine whether the various skin medications used to treat the Veteran’s PFB throughout the appeal period constitute topical or systemic therapies. His medications include Retin A/tretinoin, Bactroban, triamcinolone cream, benzoyl peroxide facial wash, benzoyl peroxide cream, and Minocin/Minocycline. A December 2019 VA examiner concluded that Retin A/tretinoin, Bactroban, triamcinolone cream, benzoyl peroxide facial wash, and benzoyl peroxide cream are topical treatments that do not affect the body as a whole. As such, they were determined not to be systemic therapies. The examiner stated that Minocin/Minocycline was not topical. The September 2020 remand directed the AOJ to obtain a VA medical opinion as to whether Minocin/Minocycline constitutes topical or systemic therapy, whether it was administered on a large enough scale so as to affect the body as a whole, or whether the topical treatment worked by circulating through the blood stream instead of by direct contact with the skin. If Minocin/Minocycline was identified as systemic, the examiner was asked to determine whether that systemic treatment was like a corticosteroid or other immunosuppressive drug. A VA opinion was obtained in September 2020. The clinician determined that Minocin/Minocycline was neither topical nor systemic. In support, she stated that Minocin came in tablets, capsules, and/or liquid and was an antibiotic. The Board finds that an addendum medical opinion is needed. The fact that Minocin came in tablets, capsules, and/or liquid is an adequate rationale as to why Minocin/Minocycline is not a topical medication. However, it does not provide any information as to why it is not a systemic therapy. The fact that the medication was parental does not indicate whether or not it constitutes systemic therapy, as defined in VA laws and regulations. Over the course of the appeal period, the diagnostic code under which the Veteran’s PFB is rated, 38 C.F.R. § 4.118, DC 7806, was amended. Prior to August 13, 2018, a systemic therapy was one that affected the entire body in its treatment of the condition at issue. To determine whether ratings based on systemic therapy are warranted under the pre-amended DC 7806, it must be determined whether the treatment affected the body as a whole and whether the given treatment was “like” a corticosteroid or other immunosuppressive drug.” Burton v. Wilkie, 30 Vet. App. 286 (2018). As such, the examiner’s rationale that Minocin/Minocycline was an orally administered antibiotic and therefore not systemic does not meet VA standards for determining whether a given treatment constitutes systemic therapy. Indeed, VA amended the relevant criteria effective August 13, 2018, to explicitly state that systemic therapy is treatment that is administered through any route other than the skin. 38 C.F.R. § 4.118(a). As such, the September 2020 opinion does not provide an adequate basis to determine the claim. Accordingly, the Board finds that a new opinion is needed which provides an adequate rationale as to why Minocin/Minocycline is or is not a treatment that affects the body as a whole and whether it is like a corticosteroid or other immunosuppressive drug. The matters are REMANDED for the following action: 1. Obtain an addendum VA opinion from an appropriate medical professional as to the nature of the Veteran’s PFB treatment. The clinician is specifically asked to address: (a.) Whether the prescribed Minocin/Minocycline, which has been determined to be an antibiotic which is administered in tablets, capsules, and/or liquid, constitutes systemic therapy. Systemic therapy is defined as treatment that affects the entire body in its treatment of the condition at issue. (b.) Whether the prescribed Minocin/Minocycline is like a corticosteroid or other immunosuppressive drug. (c.) The clinician is asked to provide a complete rationale and to explain the reasons behind any opinions expressed and conclusions reached. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. K.A. KENNERLY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Rachel E. Jensen, 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.