Citation Nr: 21024730 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 17-50 047 DATE: April 26, 2021 ORDER Entitlement to a rating of 50 percent, but not higher, for pseudofolliculitis barbae (PFB), to include residual scarring, for the entire period on appeal is granted. FINDING OF FACT For the entire period on appeal, the Veteran’s PFB has been manifested by residual scarring productive of 4-5 characteristics of disfigurement. CONCLUSION OF LAW The criteria for a rating of 50 percent, but not higher, for PFB with residual scarring have been met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Codes 7800, 7806, 7813 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from May 1992 to August 1995. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in September 2019. A transcript of that hearing has been added to the record. This case was previously before the Board in January 2020, at which time it was remanded to the agency of original jurisdiction (AOJ) for additional development. The case has now been returned to the Board for further appellate action. The Veteran has asserted that he should have higher ratings for his PFB as his symptoms are worse than those contemplated by the currently assigned ratings. At a July 2015 VA examination, the Veteran reported that whenever he tried to shave, he broke out in painful, raised bumps. He reported that he did shave for the examination that day so that his skin would be visible, but that he generally maintained a heavy beard since separating from active service. The examiner noted that the Veteran did not have scarring or disfigurement as a result of his PFB. The examiner noted that on physical examination, the Veteran had slightly raised areas covering most of the beard area on his face. The examiner noted that the areas were irritated, that there were pustules present throughout the facial area, and that the irritated areas were tender to the touch. The examiner did not provide information regarding the percentage of skin affected by the Veteran’s PFB. Further, the Veteran was not afforded a scar examination at that time. At a January 2020 scar examination, the Veteran was noted to have scars on the head, face, and neck. The Veteran reported that he currently experienced irritation and frequent facial bumps. He reported that he treated his PFB by using a warm cloth, dove soap, and keeping his skin moist. The Veteran was noted to have multiple scars on his face as a result of his PFB. He had one scar on the right check, above the beard line, that was noted to cause disfigurement, and measured 8 centimeters (cm) by 4.5 cm; he had a second scar on the left cheek, above the beard line, that was noted to cause disfigurement, and measured 8 cm by 7 cm; he had a third scar on the right side of the neck, below the beard line, that measured 8 cm by 7 cm; and he had a fourth scar on the left side of the neck, below the beard line, that measured 6 cm by 5.5 cm. The two disfiguring scars located on the cheeks, above the beard line, were noted to be underlying to soft tissue. The two scars that were located on the neck, below the beard line, were noted to be hyperpigmented. The total area of the head, face, or neck with hyperpigmented scarring was noted to measure 89 square cm. The total area of the head, face, or neck, with missing underlying soft tissue was noted to measure 68 square cm. At a January 2020 VA skin examination, the Veteran reported that he did not shave prior to the VA examination, as the last time he did that it was very painful and took approximately one month for his skin to recover. He reported that his condition was so severe at that time, that he did not want to touch his face as a result, and that he did not want to risk going through that again to shave for the current examination. The Veteran reported that he did not take prescribed treatment for his PFB, but rather used over-the-counter remedies. He denied systemic therapy of any kind to treat his PFB. The Veteran was noted to have scattered, dome shaped papules that were skin colored, or slightly darker, that affected the bearded areas of the face. The examiner noted that the Veteran’s PFB affected less than 5 percent of the total body area, and less than 5 percent of the exposed area. The Board finds that the Veteran is entitled to a 50 percent rating for PFB for the entire period on appeal. In this regard, the Board finds that the January 2020 scar examination is the most probative evidence when considering the severity of the Veteran’s PFB with residual scarring. The Board acknowledges that the July 2015 VA examiner noted that the Veteran did not have any scarring or disfigurement as a result of his PFB. However, the Board finds that the July 2015 examination reports has less probative value than the January 2020 VA scar examination report. In this regard, the July 2015 VA examiner failed to provide detailed information regarding the percentage of exposed areas affected by the Veteran’s PFB. Further, the examiner specifically noted that the Veteran’s face was irritated and covered in pustules as a result of shaving two days prior. As such, it would have been difficult to accurately identify any scarring or disfigurement of the fact that may have been present and visible had the Veteran’s skin not been otherwise irritated. There is also no indication from the record that the Veteran was afforded a VA scar examination prior to January 2020. Additionally, as the Veteran has been experiencing issues with his PFB since his time in active service, and has taken pains to avoid skin eruptions since his separation from service, the Board finds it likely that the scarring and disfigurement identified at the January 2020 VA examination has likely been present for at least the entire period on appeal. As such, when determining the Veteran’s disability picture as a whole, the Board finds that the severity of his PFB more closely approximates that contemplated by the 50 percent rating assigned for scarring and disfigurement for the entire period on appeal. 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7806, 7813. Consideration has been given to assigning a rating in excess of 50 percent for the Veteran’s PFB. However, there is no indication that the Veteran has six or more characteristics of disfigurement as a result of his facial scarring; or that his PFB affects more than 40 percent of the entire body or the exposed areas, or that he requires constant or near-constant systemic therapy over the past 12-month period. In fact, the Veteran has only been shown to have 4-5 characteristics of disfigurement at the time of the January 2020 VA examination, and there is no indication from the record that his PFB affects more than 5 percent of the total body area or exposed areas affected. Further, the Veteran himself has consistently reported that he does not receive treatment for his PFB, but rather, manages his symptoms with over-the-counter remedies and by not shaving. There is certainly no indication from the record that the Veteran is in receipt of any systemic therapy for his PFB. Therefore, the Board finds that a rating in excess of 50 percent is not warranted. 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7806, 7813. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Andrew Ledman II 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.