Citation Nr: 21022852 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-41 881A DATE: April 19, 2021 REMANDED Entitlement to an initial rating in excess of 30 percent for eczema with post inflammatory hyperpigmentation of forehead, cheeks and neck (skin disability) is remanded. REASONS FOR REMAND The Veteran served in the Army from July 1987 to September 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). In April 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A hearing transcript will be associated with the claims file in due course. Entitlement to a rating in excess of 30 percent for a skin disability. The Veteran testified, before the undersigned Veterans Law Judge on April 13, 2021, that his skin disability has worsened since his last VA examination in December 2013. Statements from the Veteran reflect similarly. See Correspondence (September 2020). The Veteran testified that he uses medication, cortisone cream and lotion to keep his skin moist, but that his skin disability has also progressed to involve arms, elbows, thighs, calves, shins, back and chest; and that his skin appears red, very itchy and patchy. The available VA treatment records from August 2015 to September 2017 show hyperpigmented lichenified, scaly plaques with overlying excoriation on center back, chest, lower abdomen, distal to bilateral arms and legs as well as prurigo nodules on central back. See CAPRI (September 2019). Because this evidence suggests a material worsening of the Veteran’s skin symptoms since his last VA examination in December 2013, reexamination is necessary. See 38 C.F.R. §§ 3.326, 3.327 (reexaminations will be requested whenever VA determines there is a need to verify the current severity of a disability, such as when the evidence indicates there has been a material change in a disability or that the current rating may be incorrect); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Additionally, the Veteran’s skin disability is rated under 38 C.F.R. § 4.118, Diagnostic Code 7806. Ratings are assigned based on the percentage of skin involvement OR the time needed for systemic therapy such as corticosteroids or other immunosuppressive drugs. Under the criteria in effect prior to August 13, 2018, the use of a topical corticosteroid can be considered either systemic therapy or topical therapy based on the factual circumstances of each case. Johnson v. Shulkin, 862 F.3d 1351 (Fed Cir 2017). However, systemic therapy is not limited to corticosteroids or immunosuppressive drugs. Consideration is also given to whether a given treatment was “like” a corticosteroid or other immunosuppressive drug to determine whether such treatment constituted systemic therapy. Warren v. McDonald, 28 Vet. App. 194 (2016). For a treatment to be systemic, it must affect the entire body in its treatment of the condition. Consideration must be given on how a topical treatment works and how it affects the body as a whole, not the size of the skin area it is applied to. See Burton v. Wilkie, 30 Vet. App. 286 (2018). On remand, a VA examination can address whether that any treatment constitutes systemic therapy. Lastly, at his April 2021 hearing, the Veteran reported seeing a private physician for his skin disability. See Hearing Transcript (April 2021). Additionally, the September 2017 VA treatment record provides that the Veteran would see a civilian primary care physician if necessary. See CAPRI (September 2019). The Veteran should be afforded an opportunity to authorize release of all relevant outstanding private treatment records to VA. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from January 2019 to the Present. 2. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for his skin disability. Make two requests for the authorized records from all identified sources unless it is clear after the first request that a second request would be futile. 3. Thereafter, schedule the Veteran for an examination by an appropriate clinician, preferably a dermatologist, to determine the current manifestations and severity of his service-connected skin disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Obtain a complete medical history of skin disability symptoms and treatment. 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. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. The report of examination should clearly reflect the following: (a.) Identify all medications use to treat dermatitis since February 2013 along with the date span of their use. (b.) Indicate, for each medication used since February 2013, whether it represents a systemic therapy such as corticosteroids or other immunosuppressive drugs. (c.) Indicate whether any topical treatment used by the Veteran operates by affecting the body as a whole in treating skin disability. (d.) Indicate whether any medication used since February 2013 is “like” a corticosteroid or other immunosuppressive drug. Explain. 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. M. Pesin 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.