Citation Nr: 21015800 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 18-38 356A DATE: March 18, 2021 ORDER Entitlement to an initial rating higher than 10 percent for tinea cruris is denied. FINDING OF FACT The Veteran’s tinea cruris has not affected 20 to 40 percent of the entire body or 20 to 40 percent of the exposed skin area, and it has not required systemic therapy such as corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs, or any topical treatment which operates by affecting the body like a corticosteroid or immunosuppressive drug. CONCLUSION OF LAW The criteria for an initial rating higher than 10 percent for tinea cruris have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 7806 (2020); 38 C.F.R. § 4.118, Diagnostic Code 7806 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1981 to November 1995. For his period of service from June 1981 to November 1992, the Veteran received an honorable discharged. For his period of service from November 1992 to November 1995, he received an other than honorable discharge, and he is barred from VA benefits related to this period. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office. The case was previously remanded in February 2020 and October 2020. Tinea Cruris The Veteran contends that his service-connected tinea cruris warrants an initial rating higher than 10 percent. The Veteran’s tinea cruris is rated under Diagnostic Code 7806, which rates dermatitis or eczema. The regulations for skin disorders were revised, effective August 13, 2018. The current regulations state that a 10 percent rating is warranted when there are characteristic lesions involving 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; or, when intermittent systemic therapy including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs, is required for a total duration of less than 6 weeks during a 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. A 30 percent rating is warranted when there are characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas; or, when systemic therapy including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs is required for a total duration of 6 weeks or more, but not constantly, during a 12-month period. Id. A note preceding 38 C.F.R. § 4.118 explains that for the purposes of this section, “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.” Prior to August 13, 2018, a 10 percent rating was assigned for at least 5 percent, but less than 20 percent, of the entire body affected, or at least 5 percent, but less than 20 percent, of exposed areas affected; or, when intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of less than 6 weeks during a 12-month period. A 30 percent rating was warranted for 20 to 40 percent of the entire body or 20 to 40 percent exposed areas affected; or, systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of 6 weeks or more, but not constantly, during a 12-month period. See 38 C.F.R. § 4.118, Diagnostic Code 7806 (2018). Where a law or regulation changes during the pendency of a case, the version most favorable to the appellant will generally be applied. See West v. Brown, 7 Vet. App. 70, 76 (1994). In this case, the Board has considered both the prior and revised versions of the VA regulations, but does not find that either version allows for a rating higher than 10 percent at any time. The Veteran attended a VA examination in July 2015. The Veteran reported having an intermittent pruritic skin rash around his navel, groin, and upper thighs. He stated that the rash had been more prominent during the hot summer months in Florida. He reported that he used a topical cream and a powder, with relief. The examiner found an extensive confluent, hyperpigmented, somewhat shiny skin rash located peri-umbilically, extending downwards to the groin, thighs, and buttocks. It affected 0 percent of the exposed body area and 10 percent of the total body area. The Veteran most recently attended a VA examination in November 2020. The Veteran reported that he had a rash on his inguinal area and buttocks. He stated that he used a cream prescribed by VA. The examiner did not find any current acute or chronic tinea cruris or residuals. The skin examination was normal. The examiner found that the Veteran had not been treated with medication or procedures in the past 12 months for his rash. The examiner found no objective evidence or documentation to support that the Veteran’s rash had ever covered or affected 20 percent or more of his exposed body area, and there was no evidence or documentation to support that his cream medication was ever used to such an extent that it could be considered a “systemic treatment,” noting that there was no actual conversation formula or scientific was to determine this. The examiner wrote that the Veteran had used the systemic medication Lamisil in 2010, but this was for onychomycosis, and not for tinea cruris. The Veteran’s VA treatment records show that he has been prescribed hydrocortisone cream for treatment of skin problems. The Veteran was treated several times in 2012 for a rash in his groin area. In November 2017, the Veteran reported that he had a rash on his genitals. Based on all of the evidence of record, the Board finds that there is no indication that the Veteran’s tinea cruris ever affected his exposed body area, and it was never found to affect at least 20 percent of his total body area. There is also no indication that the Veteran has required systemic therapy, such as corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs for a total duration of 6 weeks or more. In regard to the meaning of “systemic therapy” under the previous criteria effective before August 13, 2018, in Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit determined that “constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs” under the previous Diagnostic Code 7806 is generally not inclusive of topical corticosteroids. Instead, “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’.” Johnson, 862 F.3d at 1355. The Federal Circuit concluded that the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of the case. Id., at 1356. When determining whether topical treatment for a skin disorder constitutes systemic therapy such as corticosteroids or other immunosuppressive drugs, it must be determined whether the topical treatment operates by affecting the body, and whether the given treatment is “like” a corticosteroid or immunosuppressive drug. Burton v. Wilkie, 30 Vet. App. 286 (2018). The record shows that the Veteran has been prescribed hydrocortisone, a topical cream, but there is no indication that he has had any other treatment that would qualify as a corticosteroid or immunosuppressive drug. The November 2020 VA examiner specifically addressed whether the Veteran’s topical cream could be considered “systemic treatment,” but he found no evidence or documentation that would support a finding that the cream had been used to such an extent that it could be considered systemic treatment. There is no other evidence indicating that the Veteran’s use of a topical cream was used to such an extent that it affected the body as a whole or was like a corticosteroid or immunosuppressive drug. The record shows that the use of the topical cream is only instructed to be used twice a day, and only to the areas of the body affected. The Board does not find that the topical application of the Veteran’s hydrocortisone cream qualifies as systemic therapy, and the factual circumstances of this case do not meet the criteria for systemic therapy as included in the Schedule. There are no other diagnostic codes which would be appropriate to apply in this case. The Veteran’s head, face, and neck are not affected by his tinea cruris, and there is no indication that he has any scars or other residuals associated with tinea cruris. In sum, the Veteran’s tinea cruris has not affected at least 20 percent of the exposed skin area or total skin area, and has not required system therapy treatment. Accordingly, an initial rating higher than 10 percent for tinea cruris is not warranted. (Continued on the next page) In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable.  38 U.S.C. § 5107(b).  DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, 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.