Citation Nr: 21023611 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-38 732A DATE: April 21, 2021 REMANDED Entitlement to an initial compensable disability rating for service-connected onychomycosis of the bilateral feet is remanded. Entitlement to an initial disability rating in excess of 10 percent for tinea pedis, tinea corporis of the face, and pseudofolliculitis barbae (PFB) is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from June 1986 to October 1997. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2017 rating decision of a Department of Veterans Affairs (VA) regional office. The Veteran testified at a hearing with the undersigned Veterans Law Judge in February 2021. The disabilities at issue are generally rated based on the area involved or treatment for the disorders, to include whether systemic therapy such as corticosteroids or other immunosuppressive drugs is required. See 38 C.F.R. § 4.118, Diagnostic Code 7806 (2017), § 4.118, General Rating Formula for the Skin (2020). For claims filed prior to August 13, 2018, the United States Court of Appeals for Veterans Claims held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran’s skin condition; and (2) whether the given treatment is “like” a corticosteroid or other immunosuppressive drug. Burton v. Wilkie, 30 Vet. App. 286 (2018). Effective August 13, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). Regarding the facts in this case, the Veteran was provided VA examinations in March 2017, May 2017, December 2017, and March 2019 to assess the severity of his skin conditions. The March 2017 VA examiner noted diagnoses of tinea pedis, tinea corporis, and onychomycosis. The conditions did not cause scaring or disfigurement of the head, face or neck. The Veteran used oral Terbinafine (an antifungal) for his onychomycosis as well as Terbinafine cream and Pimecrolilus cream (which appears to be a reference to Pimecrolimus, an immunosuppressant, which is shown as prescribed to the Veteran in VA treatment records) for PFB and tinea pedis. On examination, the skin infections were observed to cover less than 5 percent of the total body area and 5 to less than 20 percent of the exposed area (face, neck, and hands). The May 2017 VA examiner noted diagnoses of tinea pedis and onychomycosis. The conditions did not cause scaring or disfigurement of the head, face or neck. The Veteran used Terbinafine orally for these conditions for a period of less than 6 weeks in the last year. Topical Triamcinole (which appears to be a reference to Triamcinolone acetonide, a corticosteroid, which is shown in VA treatment records as prescribed to the Veteran) was used for tinea pedis for 6 weeks or more in the last year but not constantly. He also used Econazole cream (an antifungal) constantly or near constantly for his tinea pedis. On examination, the skin infections were observed to cover less than 5 percent of the total body area and none of the exposed area. The December 2017 VA examiner noted diagnoses of tinea pedis, tinea corporis, and onychomycosis. The Veteran used Terbinafine orally for his tinea for a period of less than 6 weeks in the last year. He also used topical Terbinafine and topical Elidel (an immunosuppressant and a brand of Pimecrolimus) for his tinea pedis and tinea corporis. On examination, the skin infections were observed to cover 5 to less than 20 percent of the total body area and less than 5 percent of the exposed area. The March 2019 VA examiner noted diagnoses of PFB, tinea corporis face, and tinea pedis. The Veteran used Terbinafine orally for his tinea of the feet for a period of 6 weeks or more, but not constantly, over the last year. He also used Lubriderm (a moisturizing lotion), Lidex (a corticosteroid), and Pimeunolimus (which appears to be a reference to Pimecrolimus, an immunosuppressant, which is shown as prescribed to the Veteran in VA treatment records), all topically, for less than 6 weeks in the last year. The examiner found that the PFB affected less than 1 percent of the total body or exposed areas, as did tinea corporis. The tinea pedis affected less than 1 percent of the total body and no exposed areas. Adjudicators are not allowed to make medical findings. In this case it is unclear if some of the medications taken by the Veteran are systemic or if they are like or similar to corticosteroids or other immunosuppressive drugs. These inquiries are best addressed by someone with medical training. Thus, remand is necessary for a medical opinion. The matters are REMANDED for the following action: The claims file should be sent to an appropriate examiner for an opinion regarding the Veteran’s service-connected onychomycosis, tinea pedis, tinea corporis of the face, and pseudofolliculitis barbae. For each of the medications required for these disabilities – to specifically include oral Terbinafine, topical Terbinafine, topical Triamcinolone acetonide, topical Econazole, topical Elidel/Pimecrolimus, and topical Lidex – the examiner is asked to address the following: (a) Whether the medication affects the entire body in its treatment of the condition; and, (b) Whether the medication is like of similar to a corticosteroid or other immunosuppressive drug. The need for an examination is left to the discretion of the examiner. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. J. Kim, 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.