Citation Nr: 21014178 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-34 409A DATE: March 11, 2021 ORDER Entitlement to a rating in excess of 30 percent for pseudofolliculitis barbae (PFB) is denied. REMANDED Entitlement to service connection for non-Hodgkin’s lymphoma (NHL) is remanded. FINDING OF FACT The Veteran’s PFB is not shown to have been manifested by visible or palpable tissue loss and either gross distortion or assymetry of two features or paired sets of features or more than three characteristics of disfigurement. CONCLUSION OF LAW A rating in excess of 30 percent for PFB is not warranted. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.71a, 4.118, Diagnostic Code (Code) 7800. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who had active service from July 1986 to September 1995, to include service in Southwest Asia. This case is before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 Department of Veterans Affairs (VA) rating decision. In August 2018, the matters were remanded for additional development. An August 2020 rating decision increased the rating for PFB to 30 percent, throughout. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. PFB is rated under Code 7800. A 30 percent rating is assigned for scarring with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement. A 50 percent rating is assigned for scarring with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement. An 80 percent rating is assigned for scarring with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement. Note (1): The 8 characteristics of disfigurement, for evaluation under § 4.118, 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.); skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Under Code 7805, any disabling effects not considered in a rating provided under Codes 7800-04 are evaluated under an appropriate Code. The Veteran’s treatment records do not show any symptoms or complaints related to PFB. On June 2011 VA examination of the Veteran, it was noted that there was evidence of post-inflammatory hyperpigmentation without any evidence of rash over the beard area. On October 2019 VA examination, the examiner indicated that the Veteran’s PFB affected from 5 to less than 20 percent of his total body area and 5 to less than 20 percent of exposed areas. It was noted that the PFB resulted in hyperpigmentation over the jawline and anterior neck area without cysts, discharge, or erythema. The examiner indicated that the total area of involvement covered was approximately 243 square centimeters, or approximately 15.6 centimeters by 15.6 centimeters. At the outset, the Board finds that there has been substantial compliance with the Board’s August 2018 remand instructions. The Veteran was afforded a VA examination (and the findings reported are adequate to rate the disability under governing criteria) and VA sought to obtain any outstanding medical records. The pertinent evidence is summarized above. The Veteran has been assigned a 30 percent rating based on his PFB resulting in two characteristics of disfigurement, hyperpigmentation in an area greater than 39 square centimeters. No examination during the evaluation period found the PFB to result in more than 3 characteristics of disfigurement (and there are no treatment records so indicating). Disabling effects that would warrant a separate rating (under an appropriate code) as provided under 7805 are not shown, and have not been specifically alleged. All manifestations of, and impairment due to PFB, are encompassed by the 30 percent rating that is now assigned, throughout. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claim for a rating higher than 30 percent for the PFB. Accordingly, the appeal in this matter must be denied. REASONS FOR REMAND Regarding the claim of service connection for NHL the Veteran has asserted that it was incurred in service, to include as due to exposures to lead, chemical warfare suits with charcoal, chemicals working on aircraft in Southwest Asia, and/or exposures to environmental hazards serving in Southwest Asia. He served in Southwest Asia from August 1990 to November 1995; service military records document that he worked around aircraft. On October 2019 VA examination, the examiner observed that exposure to lead was not known to cause NHL, but did not address whether exposures to fuels and chemicals around on aircraft or exposures to environmental hazards while serving in Southwest Asia during the Persian Gulf Era may have been factors for his development of NHL. As the opinion did not address all theories of entitlement raised, it is inadequate for rating purposes. Development for a fully adequate medical advisory opinion is necessary. The matter is REMANDED for the following: 1. With the Veteran’s assistance compile a listing of the chemicals/fuels he would have become exposed to while working on aircraft, as well as a listing of the environmental exposures to which he was likely exposed while serving in Southwest Asia. 2. Then arrange for the Veteran’s record (with the compiled listings of his environmental exposures in service, and in his service occupation) to be returned to the provider of the October 2019 advisory medical opinion (if that provider is unavailable, to another appropriate clinician) for review and an addendum opinion addressing the etiology of his NHL. On review of the record (including the August 2011 and October 2019 medical opinions), the consulting provider should respond to the following: (a) Is the Veteran’s NHL at least as likely as not (a 50 % or better probability) etiologically related to any of the various environmental hazards to which he was likely exposed while serving in Southwest Asia noted in the listing compiled? (b) If not, is it at least as likely as not that the NHL is etiologically related to the fuels and chemicals to which he was likely exposed while working on aircraft in service noted in the listing compiled. (c) If the NHL is determined to not be related to exposures to lead, environmental hazards while serving in Southwest Asia, or fuels and chemicals working on aircraft in service, identify the etiology for the NHL that is considered to be more likely, and explain why that it so. All opinions must include rationale that cites to supporting factual data and medical principles (and reflects familiarity with any pertinent NAS studies reports. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berryman, 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.