Citation Nr: 21009296 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 16-58 412 DATE: February 22, 2021 REMANDED Entitlement to an initial compensable rating for Dercum’s Disease is remanded, to include whether an extraschedular rating is warranted. REASONS FOR REMAND The Veteran served in the United States Army from June 1983 to July 1993. By way of history, the Veteran was originally granted service connection for lipomas through a rating decision dated November 2014 and assigned a non-compensable rating. Thereafter, the Veteran appealed the effective date and initial rating. Through a November 2016 rating decision, the Veteran was granted an earlier effective date to January 11, 2001 which was a full grant of benefits. The Veteran appealed the continued denial of a compensable rating to the Board of Veterans’ Appeals (Board) and requested a hearing. In November 2019, the Veteran withdrew his request for a hearing. The Veteran requested copies of documents in his file, but in September 2020 withdrew his request. 1. Entitlement to an initial compensable rating for Dercum’s Disease, to include consideration of an extraschedular rating, is remanded The Veteran contends that he should be awarded a compensable rating for his service-connected Dercum’s Disease. In support thereof, the Veteran asserts that he has had to get over 60 excisions for his lipomas because they grow back once excised. Further, the lipomas are painful, swell up upon formation causing pain, interfere with his sleep, and cause symptoms akin to fibromyalgia. See Correspondence received July 21, 2020, page 1 of 6. The Veteran’s most recent VA examination was in October 2016. He previously had examinations in July 2002 and October 2014. The Veteran has had additional excisions for his lipomas, most recently in August 2019. As this would have left an additional scar, at a minimum, the Veteran’s condition has worsened since this VA examination and a remand for a new examination is required. See Green v. Derwinski, 1 Vet. App. 121 (1991); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Further, the Board finds that an examination with a dermatologist is preferred. The Veteran has submitted correspondence and medical records explaining that Dercum’s Disease is a rare skin disorder. The Board notes that his prior VA examinations were not with a dermatologist, but rather general practitioners. The Board notes that while Dercum’s Disease could be evaluated under Diagnostic Codes 7819 (benign skin neoplasm) and 7821 (Cutaneous manifestations of collagen-vascular disease not listed elsewhere), these Diagnostic Codes direct the Veteran’s condition to rated under the General Rating Formula for the Skin. However, that formula does not contemplate the symptomology or the repeated surgical procedures required by the Veteran. Given this, the Veteran’s claim for an increased rating is being remanded and referred to VA’s Director of Compensation Service for extraschedular consideration. Thun v. Peake, 22 Vet. App. 111, 115-16 (2008). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by a dermatologist if possible to determine the current severity of his service-connected Dercum’s Disease. Given the rare condition at issue, if a dermatologist is not available, such should be noted in the record, and another appropriate physician requested. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. a. Specifically, the examiner should determine whether the Veteran has had characteristic lesions and what percent of the entire body and/or exposed areas are affected. b. The examiner should consider whether the therapies prescribed to the Veteran, to include his pain medication, are systemic “like or similar to corticosteroids or other immunosuppressive drugs”. Further, the clinician should note the frequency and length of time the Veteran has been prescribed such treatment. c. The examiner should consider whether the therapies prescribed to the Veteran, to include his pain medication, are topical therapy and whether the treatment is of sufficient scale to affect the body as a whole. Further, the clinician should note the frequency and length of time the Veteran has been prescribed such treatment. d.The examiner should determine whether it is at least as likely as not that the Veteran’s contended symptoms of interference with his sleep and symptoms akin to fibromyalgia are related to the service-connected disability. 2. If symptoms outside of those contemplated by the diagnostic criteria for the skin are found to be related to the Veteran’s service-connected disability, refer the Veteran’s claim for an increased rating for Dercum’s Disease to VA’s Director of Compensation Service for extraschedular consideration (e.g., the claimed interference with his sleep and symptoms akin to fibromyalgia). The Director should specifically consider the correspondence and medical records submitted July 21, 2020. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. M. Hitchcock 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.