Citation Nr: 21008230 Decision Date: 02/12/21 Archive Date: 02/12/21 DOCKET NO. 16-37 156 DATE: February 12, 2021 ORDER Entitlement to an initial compensable rating of 10 percent, but no higher, prior to January 10, 2020 for service-connected dermatitis is granted; however, a rating higher than 10 percent is not warranted at any time during the appeal period. FINDINGS OF FACT 1. Affording the Veteran the benefit of the doubt, prior to January 10, 2020, his dermatitis most nearly approximated systemic therapy for less than six weeks in a 12-month period. 2. After January 10, 2020, the Veteran’s dermatis affected more than 5 percent, but less than 20 percent, of his entire body and required topical cream six weeks or more, but did not require the use of systemic therapy for a total duration of six weeks or more, over a 12-month period. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for dermatitis prior to January 10, 2020 have been met. 38 U.S.C. § 1110, 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.21, 4.118, Diagnostic Code (DC) 7806. 2. The criteria for a rating in excess of 10 percent for dermatitis have not been met. 38 U.S.C. § 1110, 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.21, 4.118, Diagnostic Code (DC) 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from December 1967 to November 1970, with service in the Republic of Vietnam. He is the recipient of a Vietnam Service Medal and Vietnam Campaign Medal. This case comes before the Board of Veterans’ Appeals (Board) from an appeal of a March 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing in June 2019. A transcript of the hearing has been associated with the file. The Veteran’s appeal has previously been before the Board in August 2009, May 2010, September 2011, August 2013, March 2014, and July 2019. In July 2019, the Board remanded for additional development, to include a new VA examination to determine the current severity of his skin condition. A careful review of the file shows that there has been substantial compliance with the Board’s July 2019 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). A supplemental statement of the case was issued in September 2020, denying entitlement to a compensable rating prior to January 10, 2020. The matter now returns to the Board. This appeal has been advanced on the docket, pursuant to 38 C.F.R. § 20.900. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Entitlement to a compensable rating for service-connected dermatitis prior to January 10, 2020 and in excess of 10 percent thereafter The Veteran contends that he is entitled to higher disability ratings than those assigned for his dermatitis. See Notice of Disagreement, January 2015; Informal Hearing Presentation, January 2021. The Board finds the Veteran is entitled to a 10 percent disability rating prior to January 10, 2020, however, the preponderance of the evidence is against a finding that a rating in excess of 10 percent thereafter is warranted for dermatitis under Diagnostic Code 7806. The reasons follow. In the March 2014 rating decision, the RO granted service connection for variously diagnosed skin disability, identified as dermatitis (previously claimed as xerodermatitis, actinic keratosis and infected hands) at an initial noncompensable evaluation, effective July 5, 2005 (the date of the original claim) under Diagnostic Code 7899-7800. A September 2020 rating decision increased his dermatitis evaluation to 10 percent disabling, effective January 10, 2020, under DC 7806. 38 C.F.R. § 4.118. Hyphenated Diagnostic Codes are used when a rating under one code requires use of an additional code to identify the basis for the assigned rating; the additional code is shown after the hyphen. The provisions of 38 C.F.R. § 4.27 provide that unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and 99. As such, the previous hyphenated Diagnostic Code indicates that it was rated as analogous to a skin disorder (Diagnostic Code 7899) under the criteria for infections of the skin not listed elsewhere in the Rating Schedule. The Board notes that the criteria for rating skin disabilities have changed during the period covered by this appeal, effective August 13, 2018. Under the regulations in effect prior to August 13, 2018, Diagnostic Code 7806 provided a 10 percent rating for dermatitis or eczema affecting at least 5 percent, but less than 20 percent, of the entire body or of the exposed areas, or required intermittent systemic therapy such as corticosteroids or immunosuppressive drugs for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is assigned for dermatitis or eczema affecting 20 to 40 percent of the entire body or of the exposed areas, or required 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 maximum 60 percent rating is assigned for dermatitis or eczema affecting more than 40 percent of the entire body or of the exposed areas, or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. See 38 C.F.R. § 4.118, DC 7806. Effective August 13, 2018, a new General Rating Formula for the Skin applies to DC 7806. A noncompensable rating is assigned when there is no more than topical therapy required over the past 12-month period and at least one of the following: (1) characteristic lesions involving less than 5 percent of the entire body affected; or (2) characteristic lesions involving less than 5 percent of exposed areas affected. 38 C.F.R. § 4.118, DC 7806. A 10 percent rating requires at least one of the following: (1) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (2) at least 5 percent, but less than 20 percent, of exposed areas affected; or (3) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than six weeks over the past 12-month period. A 30 percent rating requires at least one of the following: (1) characteristic lesions involving 20 to 40 percent of the entire body; or (2) 20 to 40 percent of exposed areas affected; or (3) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, over the past 12-month period. A maximum 60 percent rating requires at least one of the following: (1) characteristic lesions involving more than 40 percent of the entire body; or (2) more than 40 percent of exposed areas affected; or (3) 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. Relevant to the instant case, VA regulations now also explicitly state that for the purposes of skin disability ratings, “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.” Id. § 4.118(a). With regard to the meaning of “systemic therapy” prior to the new definition of the term in the revised criteria, in Johnson v. McDonald, the United States Court of Appeals for Veterans Claims (CAVC) held that use of a topical steroid constituted “systemic therapy” within the meaning of DC 7806. Johnson v. McDonald, 27 Vet. App. 497, 505 (2016). However, in Johnson v. Shulkin, the Federal Circuit reversed this decision and determined that “constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs” under DC 7806 is generally not inclusive of topical corticosteroids. Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). The Federal Circuit found that “systemic therapy” means “treatment pertaining to or affecting the body as a whole,” whereas topical therapy means “treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied.” Thus, according to the Federal Circuit, all applications of topical corticosteroids do not constitute systemic therapy. The Federal Circuit also held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Burton v. Wilkie, CAVC held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects. Burton v. Wilkie, 30 Vet. App. 286 (2018). Significantly, with regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its “intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied.” As the Veteran’s claim was pending prior to August 13, 2018, the Board will consider both the old and new criteria and apply the more favorable. However, the Federal Circuit’s interpretation of the term “systemic therapy” in the old criteria applies throughout the entire period prior to the August 13, 2018 effective date of the new criteria. Rivers v. Roadway Express, 511 U.S. 298, 312-13 (1994) (“[j]udicial construction of a statute [or regulation] is an authoritative statement of what the statute [or regulation] meant before as well as after the decision of the case giving rise to that construction”); Jordan v. Nicholson, 401 F.3d 1296, 1298-99 (Fed. Cir. 2005) (a new interpretation of a statute retroactively affects decisions still open on direct review); Threatt v. McDonald, 28 Vet. App. 56, 63 (2016) (noting the “normal principle at this Court is that judicial decisions operate retrospectively”). In making all determinations, the Board must fully consider the lay assertions of record. The Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). In this case, the Veteran is competent to report symptoms of his dermatitis. The Veteran is competent to describe his symptoms and their effects on employment or daily activities. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Board will consider not only the criteria of the currently assigned diagnostic code, but also the criteria of other potentially applicable diagnostic codes. The General Rating Formula for the Skin also provides that skin disabilities may be rated as scars (Diagnostic Codes 7801, 7802, 7804, 7805) or disfigurement of the head, face, or neck (Diagnostic Code 7800), depending on the predominant disability. 38 C.F.R. § 4.118. Other disability ratings may be assigned only if the symptomatology for the disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Analysis Having reviewed the evidence of record, the Board finds that a 10 percent rating is warranted for the Veteran’s dermatitis prior to January 10, 2020 because his dermatitis required intermittent systemic therapy including corticosteroids for a total duration of less than six weeks over a 12-month period. Although his treatment has varied during the appeal period, there is evidence that he was prescribed oral steroids prior to January 10, 2020. Resolving all reasonable doubt in his favor, his symptoms more nearly approximated those associated with a 10 percent rating, and no higher, prior to January 10, 2020. The record does not show that the Veteran’s dermatitis warrants a rating higher than 10 percent after January 10, 2020, because he does not have characteristic lesions involving 20 to 40 percent of the entire body or exposed areas, nor did his dermatitis require systemic therapy for a total duration of six weeks or more, but not constantly, over the past 12-month period. Turning to the medical evidence of record, a medical record from October 2004 noted the Veteran presented to the Emergency Room complaining of 4-day worsening/swelling of his hands bilaterally, accompanied by pruritic rash. Recurrent episodes of subacute onset of edema with bullae formation on his hands bilaterally was noted, with this episode present for 4 days. The examiner noted his hands very much resemble cellulitis, although the presence of bilateral symptoms and recurrence point more toward a systemic etiology. The Veteran complained of having similar problems every five years, since 1978. Small scars covering both arms were noted. The Veteran reported they were the result of previous bullae. He was referred to Dermatology for a consultation. He was treated with Vancomycin. A medical progress note from October 2004 noted swelling and pruritus in the Veteran’s hands and an active prescription for diphenhydramine HCL, oral capsule was prescribed for itching. A Dermatology Clinic Note from January 2005 noted intermittent bullous eruptions of dorsal hands every three to four years. The use of steroid taper and topical steroids was reported. However, upon examination, his hands were clear, so no treatment was provided. Some scarring was noted. During an Agent Orange examination in May 2005, the examiner diagnosed the Veteran with contact dermatitis and actinic keratosis. His chief complaints were a rash on his hands since 2004, contact dermatitis and scaly lesions on his hands present since 1976, actinic keratosis, and was being treated for such. Upon examination, his extremities showed no edema, his skin showed no signs of contact dermatitis at present, but did present lesions of actinic keratosis in hands and distal forearms. The Veteran was advised to see his doctors for followup on those conditions. A medical record from August 2005 showed a clinic visit with the chief complaint of severe rash, both hands. It was noted he finished his Medrol Dosepak and now his hands are peeling and cracked. Active medications included Eucerin Cream, issued in May 2005, to apply topically twice a day for dry skin; Fluocinonide 0.05 percent cream, to apply topically twice a day for skin rash, with an issue date of October 2004; and Methylprednisolone 4 MG tablet Dosepak, 21 day dose, to take by mouth, for severe rash. Dermatitis was noted as an active medical problem. The Veteran was afforded a Skin Diseases Compensation and Pension (C&P) examination in September 2009. The examiner diagnosed (1) recurrent cellulitis of the hands and forearms of varying etiologies, after service, healed; (2) multiple dorsal forearm scaring; (3) episodic seizure disorder related to alcohol use, in service; and (4) facial wound infection/cellulitis, in service, resolved without residuals. No evidence of actinic keratosis was noted at the time. The VA examination did not note any systemic therapy such as corticosteroids or other immunosuppressive medications. The Veteran’s dry skin was treated with steroid creams and over-the-counter moisturizers and he stated his wife makes his topical medicinal lotion now. The Veteran reported 3-4 milder episodes per year of redness and puffiness of hands and forearms, worse with sun exposure. He had several references to dry skin dermatitis, all treated with antibiotics. Upon physical examination, the Veteran’s skin was noted as warm, with good skin color (sun tanned skin). Several areas of ecchymosis on the dorsal forearms consistent with repetitive trauma were noted. Multiple hypopigmented predominately linear, nontender scars on dorsal forearms and hands only. No keloids, tissue loss, induration, blisters, pustules, vesicles, or other lesions were noted. During the examination, the Veteran reported that he had porphyria cutanea tarda (PCT) caused by Agent Orange exposure. Upon review of his relevant medical history, the examiner noted an episode of facial cellulitis in service, as secondary to lacerations and abrasions becoming infected, therefore, not PCT. In May 1980, he was hospitalized and treated for a chemical burn, also not PCT. Despite a diagnosis of possible PCT, he never had elevation of his liver function tests, even in the face of significant alcohol intake. The examiner opined “there is simply not evidence to support the diagnosis of PCT. However, even a presumptive diagnosis would be outside the window or occurrence from Agent Orange exposure.” In July 2010, the Veteran’s former employer submitted a letter stating that when the Veteran came to work for him in May 1990, he had a skin condition on his arms that would make his hands and arms swell. When they would swell, the Veteran could not work, and would have to take a few days off. Pursuant to the May 2010 Board remand, the Veteran was afforded a Skin Diseases C&P examination in February 2011. During the examination, the examiner identified cellulitis, an avulsion of the left forearm, dyshidrosis, and atopic dermatitis as current disabilities, though they were all characterized as resolved. Various former diagnoses were noted, including a May 1980 diagnosis of cellulitis and pyoderma of right arm, October 2004 diagnosis of dyshidrosis of the hands, February 2006 diagnosis of cellulitis right forearm with Cephalexin prescription, and an April 2006 diagnosis of atopic dermatitis, with a prescription of Lidex to apply topically. The Veteran reported episodic intermittent symptoms over the years he described as “breaking out on both my arms” with last episode in May 2010. He was prescribed Silvadene cream, however, due to an adverse reaction, he did not use the prescription. He reported Doxycycline helped significantly with complete resolution of the rash within 3-4 days. In addition, topical steroid creams have helped and a homemade remedy including several over-the-counter creams mixed together offers good relief and complete resolution of the skin rash within 3-4 days. Oral Prednisone had not worked in the past. He denied any reoccurrence since the May 2010 breakout. The Veteran described his symptoms occurring episodically, approximately 2-4 times per year, with a duration of 3-4 days. During break-outs, he reported moderate to severe symptoms of pruritic blisters on both arms/hands which open with clear, serous drainage. Upon examination, the Veteran’s skin was noted as warm and dry with good skin color and normal turgor without ecchymosis, jaundice, or breakdown. No rashes, acne, or chloracne were noted. Residual scattered hypopigmented scarring was noted along both dorsal forearms, which the Veteran reported as residuals from May 2010 VA treatment of Avulsion. The left dorsum forearm, residual triangular-shaped hypopigmented scarring, status post Avulsion, 0 percent exposed body surface area and 0.25 percent of total body surface area. Bilateral forearm dorsum residual hypopigmented scarring status post cellulitis: 0 percent exposed body surface area and 2 percent total body surface area. The examiner noted that, despite subjective complaints, there was no objective evidence of PCT, actinic keratosis, eczema, impetigo, pyoderma, and xerodermatitis. The examiner noted the dyshidrosis (pompholyx) hands, atopic dermatitis, and excision of epidermal inclusion cyst left upper arm were all resolved, with no residuals, and were not caused or related to service. His recurrent cellulitis and pyoderma of the arms were both listed as resolved, and not caused or related to service. During a March 2012 VA Skin Diseases C&P examination, no skin condition diagnoses were noted and no treatment in the past 12 months for any skin condition was documented. The examiner opined that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was that the Veteran’s skin was normal upon examination and there was no diagnosis to sustain a claim of a skin condition. All studies for disturbances of porphyrin metabolism were negative which denies the presence of the claimed porphyria cutanea tarda (PCT). Pathology reports of biopsies taken in two different rash episodes in the past were both negative for porphyria related conditions. In addition, the examiner noted that the Veteran was competent to report of continuity; however, documented evidence demonstrated that all incidents had different etiologies and were not related to PCT. The Veteran noted skin episodes where he develops “itching, then swelling, and finally blisters” on his skin. He was treated with Benadryl during these episodes and also was given a cream with Bacitracin and Preparation H mixture that helped his rash. He noted his last episode was in 2010 and his first episode was in 1979. Multiple episodes of dermatitis were noted, from different etiologies that included among other things: exposure to a chemical, active keratosis, and insect bite. No scarring was noted. In August 2013, the case was referred to the Veteran’s Health Administration (VHA) for a medical expert opinion. In October 2013, a medical opinion was obtained and in November 2013, an addendum medical opinion was rendered. The medical expert opined that, based on clinical presentation, evaluation, photographs, and biopsy results, the Veteran did not have a diagnosis of porphyria cutanea tarda (PCT); however, his symptoms were consistent with dermatitis (eczema) and that it was less likely than not that the claimed skin condition was secondary to any events or conditions in military service. Additionally, a 24-hour urinalysis did not support a diagnosis of porphyria. A review of the records showed notations of chronic rash, dermatitis, allergic contact dermatitis, actinic keratosis, impetigo, pyoderma, and cellulitis. In July 2019, the Veteran was afforded a Scars Disability Benefits Questionnaire (DBQ). The examiner noted that for the VA established diagnosis of variously diagnosed skin disabilities, identified as dermatitis (previously claimed as xerodermatitis, actinic keratosis, and infected hands), there was no change in the diagnosis. The diagnosis was confirmed on examination. The examiner noted a diagnosis of scars on the bilateral forearms, scars on the left upper arm, scar on the right lower leg lateral, all with a diagnosis of 2019. Medical history notes the condition began in 1969 with skin irritation on his arms and legs due to Agent Orange exposure. He was given topical cream for the condition. No scars were noted as painful or unstable. Numerous scars on his right forearm, totaling 17 x 8 cm. Five left upper extremity scars were reported, in centimeters, as: (1) 20 x 9; (2) 3 x 0.2; (3) 2 x 2; (4) 3 x 0.5; and (5) 3 x 0.1. Right lower extremity had one scar, totaling 6 x 2.5 cm. In August 2019, the Veteran was afforded a VA Skin Diseases DBQ. His 2019 dermatitis diagnosis was noted. For the VA established diagnosis of dermatitis, there was no change in the diagnosis, and it was confirmed on this examination. Dermatitis was reported as affecting less than 5 percent of the total body area and none of the exposed body area. His condition was described as starting in 1970 with swelling, blisters, pain, and oozing from skin lesions on his arms and legs. He was given topical creams and antibiotic topical creams at the time. He currently has no symptoms, but during flare-ups, he cannot function due to swelling, blisters, pain, and skin break downs. During flare-ups, his condition affects his ability to work. No treatment in the past 12 months for any skin condition was noted. The Veteran was afforded a VA Skin Diseases DBQ examination in January 2020. The examiner noted a complete review of the electronic folder was conducted. A current diagnosis of dermatitis was noted, with a 2005 diagnosis date. Scars from his dermatitis were evident and additional evidence on his scars could be found on the Scars DBQ. Upon physical examination, the Veteran’s dermatitis was noted on greater than 5 percent, but less than 20 percent of the total body area and none on exposed areas. The Veteran has been treated with “unknown cream” for porphyria cutanea tarda in the past 12 months with topical medication, six weeks or more, but not constant. The history of the Veteran’s current skin condition was described as beginning in 1979 and symptoms included blisters, skin swelling, and sores on his arms, hands, and all over his body and neck. This resulted in redness, itching, and swelling. The condition was treated with hospitalizations and antibiotics. The current symptoms are rash after sun exposure, so since approximately 2015, the Veteran has avoided sun exposure. Last bad outbreak was noted in approximately 2015. The Veteran did have a mild episode on his hands about one month ago. The current treatment is hospitalization (approximately four times, most recently in 2015). The impact of this condition is the Veteran cannot work in the sun or his hands and arms will swell, blister, peel, and he cannot use them. The Veteran noted the skin condition resulted in scars on his arms and left lower leg. The Veteran also underwent a Scars DBQ in January 2020. The examiner noted scars on the skin of the arms and left lower leg, both diagnosed in 2005. No scars of the trunk or extremities were noted as painful or unstable. The length and width of the Veteran’s scars, in centimeters, for his right upper extremity was noted as contiguous scarring of dorsum right arm totalling approximately 18 x 8, for a combined total area in centimeters of approximately 144cm. For his left upper extremity, 5 scars were noted. The length and width of the scars, in centimeters, were as follows: (1) the first was contiguous scarring of dorsum left arm totaling approximately 20 x 9; (2) 3 x 0.2; (3) 2 x 2; (4) 3 x 0.5; and (5) 3 x 0.1, for a combined total area in centimeters of approximately 185.86 cm. The right lower extremity was not affected, but the left lower extremity was noted as having one scar, mid lateral aspect of left lower leg, measuring 6 x 2.5cm. For a combined total area in centimeters of approximately 150 cm. Based off a review of the relevant medical and lay evidence, the Board finds that a 10 percent rating is warranted for the Veteran’s dermatitis prior to January 10, 2020. Per various medical records and the Veteran’s statements, the record reflects intermittent systemic treatment during this period on appeal sufficient to meet the criteria for an initial 10 percent rating. An Emergency Room record from October 2004 noted a prescription for Vancomycin, due to worsening swelling and rash on the Veteran’s hands. In 2005, a prescription for Methylprednisolone 21-day Dosepak for severe rash was noted. During the September 2009 VA examination, various episodes of dermatitis were noted as being treated with “antibiotics,” steroid creams, and over-the-counter moisturizers. Per the February 2011 VA examination, Doxycycline, an oral corticosteroid immunosuppressive drug used to treat dermatitis was noted as being prescribed in the past. These instances are sufficient for a compensable rating under Diagnostic Code 7806. An initial rating in excess of 10 percent prior to January 10, 2020 is not warranted. The Board reviewed the record for additional treatments of Doxycycline and other corticosteroids to assess whether a higher rating is warranted for systemic treatment. However, at no point throughout the appeal, does the evidence show, nor does the Veteran claim, physician-prescribed corticosteroids or immunosuppressants for more than six weeks in a 12-month period. Accordingly, the Board finds that he is not entitled to a disability rating higher than 10 percent prior to January 10, 2020 by systemic treatment criteria. Nor is a higher rating warranted for percentage of total or exposed body area affected. The probative evidence during this period of the appeal indicates that the Veteran’s dermatitis did not cover at least 20 to 40 percent of his exposed or entire body area, as required for a higher rating for percentage of total or exposed body area affected. The Board notes throughout the pendency of this appeal, the Veteran has reported continuity of symptoms, which the Board finds as credible. His statements are bolstered by lay statements from the Veteran’s wife, family, friends, and former employer, which all indicate the onset and symptoms of his skin conditions. The Board has considered the statements of the Veteran and his friends and family in support of his claim. Therefore, prior to January 10, 2020, a disability rating of 10 percent, but no higher, is warranted. Having reviewed both the lay and medical evidence, the Board finds that after January 10, 2020, the preponderance of the evidence does not demonstrate that the Veteran’s dermatitis rose to the level of severity that is contemplated by the 30 percent rating. The Veteran’s dermatitis does not affect 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period to warrant a 30 percent rating. The January 2020 examiner determined, upon physical examination, that the Veteran had characteristic lesions involving at least 5 percent, but less than 20 percent of the total body area. Additional symptoms included no more than topical therapy required over the past 12-month period. These findings correspond to no more than a 10 percent disability rating under DC 7806. The preponderance of the evidence is against a finding that the Veteran’s dermatitis meets the criteria for a 30 percent rating, after January 10, 2020. Whether a disability meets the schedular criteria for the assignment of a higher rating is a factual determination by the Board based on the complaints, coupled with the medical evidence. Here, although the Veteran believes that he meets the criteria for a higher disability rating, his complaints and the medical findings do not meet the schedular requirements for the higher rating, as explained and discussed above. He is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. In this case, both the lay and the medical evidence are probative. However, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, completed necessary testing, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own report regarding the severity of such condition. Therefore, his symptoms do not more nearly reflect the criteria for a higher rating under the assigned diagnostic code. Therefore, the Veteran does not meet or nearly approximate the criteria for a rating higher than 10 percent, after January 10, 2020. (Continued on the next page)   Based on the foregoing, the Board finds that an initial rating of 10 percent for dermatitis, prior to January 10, 2020, is warranted. DC 7806. After January 10, 2020; however, the Board finds that the Veteran is not entitled to a rating in excess of 10 percent for dermatitis. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Krista Johnson, 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.