Citation Nr: 21025256 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-12 408A DATE: April 27, 2021 ORDER 1. Entitlement to service connection for urinary incontinence (claimed as bladder disorder) to include as secondary to contaminated water at Camp Lejeune (CWCL), is denied. 2. Entitlement to service connection for hyperhidrosis is denied. 3. Entitlement to service connection for a headache disorder is denied. 4. Entitlement to service connection for a kidney disorder is denied. 5. Entitlement to a rating in excess of 10 percent for tinnitus is denied. REMANDED 6. Entitlement to service connection for bilateral hearing loss is remanded. 7. Entitlement to service connection for a variously diagnosed psychiatric disability, to include anxiety and depression, is remanded. 8. Entitlement to a compensable rating for dermatitis is remanded. FINDINGS OF FACT 1. The Veteran’s urinary incontinence was not manifested in service, and a preponderance of the evidence is against a finding that it is related to his service, to include as due to exposure to contaminated drinking water therein or was caused or aggravated by a service-connected disability. 2. The Veteran’s hyperhidrosis was not manifested in service and is not otherwise shown to be etiologically related to his service. 3. The Veteran’s headache disorder was not manifested in service and is not otherwise shown to be etiologically related to his service. 4. The Veteran is not shown to have a kidney disability. 5. Throughout, the Veteran’s tinnitus has been rated 10 percent (the maximum schedular rating for tinnitus); factors warranting an extraschedular rating are not shown. CONCLUSIONS OF LAW 1. Service connection for urinary incontinence is not warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. Service connection for hyperhidrosis is not warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. 3. Service connection for a headache disorder is not warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. 4. Service connection for a kidney disability is not warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303. 3.304. 5. A rating in excess of 10 percent for tinnitus is not warranted. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321(b), 4.1, 4.87, Code 6260; Smith v. Nicholson, 19 Vet. App. 63 (2005) rev’d, 451 F.3d 1344 (Fed. Cir. 2006). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1974 to February 1981. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision. A February 2016 rating decision proposed to sever service connection for dermatitis. The Veteran has disagreed with the proposal. However, a severance has not been implemented to date, and therefore consideration of the propriety of any severance now would be premature. That matter is not before the Board; the matter of the initial rating for dermatitis remains before the Board. As the record shows various psychiatric diagnoses, the scope of the claim of service connection for a psychiatric disability encompasses any psychiatric disability found/shown, however diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). While VA examinations have not been conducted in conjunction with the claims of service connection for headaches and hyperhidrosis, because there is no evidence that such diseases may be related to the Veteran’s qualifying for VA benefits service, the low threshold standard for determining when a VA examination is necessary is not met. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 1. Entitlement to service connection for urinary incontinence (claimed as bladder disorder) to include as secondary to CWCL, is denied. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013) (only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the disease or injury in service. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 providing a presumption of service connection for certain diseases based on exposure to contaminants in the water supply at Camp Lejeune. Essentially, as amended, 38 C.F.R. §§ 3.307 and 3.309 establish a presumption of service connection for veterans who served at Camp Lejeune for no less than 30 days (consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987, and have a diagnosis of any of the following eight diseases, even though there is no record of such disease during service: kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. §§ 3.307(a), 3.309(f). Such listed diseases shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307(a)(7)(ii). The Veteran contends that he has been treated for a urinary incontinence that resulted from his exposure to contaminated water at Camp Lejeune. His service personnel records confirm that he was stationed at Camp Lejeune at various times (including 17 weeks for training beginning October 1978) (thereby easily meeting the 30-day service at Camp Lejeune requirement and establishing his exposure to CWCL). On April 2014 VA urinary tract examination, the examiner opined that it was less likely than not that the Veteran’s urinary incontinence was due to his service, to include exposure to contaminated water at Camp Lejeune. He explained that there was nothing in medical literature indicating that urinary incontinence is secondary to water contamination at Camp Lejeune. A March 2015 VA treatment record notes that the Veteran asserted that he had experienced stress urinary incontinence for several years. A March 2018 VA notes that the Veteran’s urinary incontinence responded better to Oxybutynin. On November 2019 VA urinary tract examination, the examiner opined that the Veteran’s urinary incontinence was less likely than not related to his service, to include exposure to contaminated water at Camp Lejeune. She explained that the Veteran’s service treatment records (STRs) do not show any evidence of recurrent signs, symptoms, diagnosis, treatments, nor a chronic disability pattern to support a diagnosis of urinary incontinence during his military service or within a year after his separation from military service. The examiner noted that the medical (urology) literature did not support a direct etiologic relation between the currently claimed urinary incontinence and the exposures that the Veteran might have been exposed to while on active duty at Camp Lejeune. She opined that the Veteran’s urinary incontinence was at least as likely as not secondary to his benign prostate hypertrophy (BPH). She explained that in 2015 the Veteran underwent an evaluation and physical by a VA urologist, and that provider’s assessment was that his lower urinary tract symptoms were more likely related to BPH. In support of that assessment, the 2019 examiner noted that on current physical examination, a mildly enlarged prostate was shown despite daily use of Doxazosin. Although the examiner identified a likely etiology for the Veteran’s urinary incontinence, she also opined that his urinary incontinence was less likely than not caused or aggravated by a service-connected disability or other issues such as a kidney disorder or hyperhidrosis (and the Board notes that service connection is denied for each in this decision). She explained that there was no evidence of a kidney disease on the current examination, and a review of the medical literature indicated that tinnitus and dermatitis, and the claimed hearing loss, hyperhidrosis, headache, depression and anxiety are not etiologic, contributory or aggravating factors for the development or aggravation of BPH and/or urinary incontinence, essentially because they are different disease entities with different pathophysiological processes and are not etiologically related. It is not in dispute that the Veteran now has urinary incontinence. As noted above, his exposure to CWCL has been conceded, and not in dispute. The critical question remaining is whether there is competent evidence of a nexus between his service, to include exposure to contaminated drinking water therein, and his urinary incontinence. Inasmuch as urinary incontinence is not listed among the 8 diseases for which presumptive service connection based on exposure to contaminated water at Camp Lejeune is warranted, service connection for such disease/disorder based on such exposure may not be presumed. 38 C.F.R. §§ 3.307(a), 3.309(f). The Veteran’s STRs are silent for complaints, findings, treatment, or diagnosis of urinary incontinence and/or a bladder disorder. The first postservice notation of urinary incontinence is in a September 2010 VA treatment record (that references a possible diagnosis of urinary incontinence in May 2010). Accordingly, service connection for urinary incontinence on the basis that such disability became manifest in service and persisted is not warranted. What remains for consideration is whether the Veteran’s urinary incontinence is otherwise shown to be etiologically related to his service or caused or aggravated by a service-connected disability. Although laypersons are competent to provide opinions on some medical questions, see Kahana, 24 Vet. App. at 428, whether urinary incontinence may (in the absence of onset in service/continuity since) be related to service that ended more than 35 years earlier or be secondary to a service-connected disability is a medical question outside the scope of common knowledge. It requires medical expertise. Jandreau, 492 F.3d at 1372. Although the April 2014 VA opinion is inadequate because it did not identify the likely etiology for the claimed urinary incontinence (and did not address whether the incontinence may be secondary to one of the other disabilities for which service connection is sought in this appeal), the November 2019 VA examiner’s opinions are probative evidence against the Veteran’s claim and the Board finds them persuasive. The examiner reviewed the record, considered the Veteran’s lay statements, and supported the opinions with rationale that cites to supporting factual data and medical literature. She explained that the urinary incontinence was more likely due to the Veteran’s non-service-related BPH and noted that on current physical examination, a mildly enlarged prostate was shown despite daily use of Doxazosin. Although a more likely etiology was identified, the examiner also explained that a review of the medical literature indicated that tinnitus and dermatitis, and the claimed hearing loss, hyperhidrosis, headache, depression and anxiety were not shown to be etiologic, contributory or aggravating factors for the development or aggravation of BPH and/or urinary incontinence, essentially because they are different disease entities with different pathophysiological processes and are not etiologically related. The provider is a medical professional with subject matter expertise. Because there is no probative evidence to the contrary, the opinion is persuasive. The Veteran is a layperson and has not presented any probative medical evidence in support of his theory that his urinary incontinence is related to his exposure to CWCL or was caused or aggravated by a service-connected disability (or other non-service-connected disorder on remand). Consequently, his own opinion in these matters is not probative evidence in the matter. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claim of service connection for a urinary incontinence. The benefit-of-the-doubt standard of proof does not apply; the appeal seeking service connection for urinary incontinence must be denied. 2., 3. Entitlement to service connection for hyperhidrosis and a headache disorder is denied. The Veteran contends that he has a headache disorder and hyperhidrosis due to his military service. He has been noted to have headaches and episodes of hyperhidrosis (excessive sweating). To establish service connection for such disabilities, there must still be evidence of a related disease or injury in service and competent evidence linking the current headaches and hyperhidrosis with service (disease or injury therein). The Veteran’s STRs are silent for any complaints of, treatment for, or diagnosis of a headache disability or hyperhidrosis. On January 1981 medical examination, the Veteran’s head, neurological system, and nervous system were normal on clinical evaluation. A March 2017 VA treatment record notes that the Veteran reported excessive sweating when he engaged in light work. A March 2018 VA treatment record notes treatment for hyperhidrosis and that the Veteran experienced a “tension type” headache which responded well to Tramadol. To the extent that that the Veteran may be seeking to establish a nexus between his headaches and hyperhidrosis and his service by his own opinion, the etiology of a headache and/or hyperhidrosis disability, to include whether it may be related to remote service is a medical question. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Veteran is a layperson, does not profess to have any medical expertise, and has not submitted a medical opinion which includes rationale or treatise evidence in support of his claim (i.e. that his headache disorder and hyperhidrosis are related to his service). Accordingly, his own opinion is not probative evidence in the matter. In fact, the record includes no competent evidence that the claimed hyperhidrosis and headaches may be etiologically related to the Veteran’s service. Considering the foregoing, the Board finds that the preponderance of the probative evidence is against a finding that the Veteran’s headaches and hyperhidrosis are etiologically related to his service/a disease or injury therein. Accordingly, service connection for headaches and hyperhidrosis must be denied. 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 Veteran’s claim, that doctrine has no applicability in the matter. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). 4. Entitlement to service connection for a kidney disorder is denied. The Veteran’s STRs contain no mention of complaints, diagnosis or treatment pertaining to a kidney disorder. On April 2014 VA kidney examination, a kidney disorder was not diagnosed. The Veteran reported that he was exposed to SWCL and that many years later he began to experience urinary incontinence. He denied a history of a kidney disorder. On examination, renal dysfunction, urolithiasis, kidney infection, and tumors or neoplasms were not shown. On November 2019 VA kidney examination, a kidney disorder was not diagnosed. The examiner noted that there was no evidence of any kidney disease or disability on the current examination (including interview of the Veteran and records review), and that the available records showed normal kidney function, normal creatinine, and normal glomerular filtration rate (GFR). There was no evidence of renal failure or insufficiency. VA treatment records do not show a diagnosis of a kidney disability and no other kidney treatment is listed in the Veteran’s treatment records other than the VA examinations listed above. The Veteran has not submitted treatment records showing he has a diagnosis of a current kidney disability or a medical opinion relating any alleged kidney disability to his service. The threshold requirement for substantiating a claim of service connection (whether direct or secondary) is that there must be competent evidence of the disability for which service connection is sought. Here, there is no competent evidence that the Veteran has, or at any time during the pendency of the instant claim has had, a kidney disability. No medical provider has diagnosed such a disability. While the Veteran may be competent to observe that he has urinary issues on occasion, whether or not he has a diagnosis of a kidney disability is a medical question; he is a layperson and lacks the expertise to provide a competent opinion in the matter. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). He does not cite to supporting clinical data, medical opinion, or treatise evidence, and his opinion in the matter has no probative value. As there is no competent evidence that the Veteran has, or has had, a kidney disability, he has not presented a valid claim of service connection for such disability. See 38 U.S.C. § 1110, 1131; see also Brammer v. Derwinski, 3 Vet. App. 223 (1992). The preponderance of the evidence is against the claim. Accordingly, the appeal in the matter must be denied. 5. Entitlement to a rating in excess of 10 percent for tinnitus is denied. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Pertinent general policy considerations include: interpreting examination reports in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). After careful consideration of the evidence, any reasonable doubt remaining, including regarding degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When the appeal is from the initial rating assigned with a grant of service connection, the severity of the disability during the entire period from the grant of service connection to the present is to be considered. “Staged” ratings may be assigned for distinct periods when different levels of impairment are shown. Fenderson v. West, 12 Vet. App. 119 (1999). Recurrent tinnitus is evaluated under Code 6260, which provides for a maximum rating of 10 percent. Code 6260, which was revised effective June 13, 2003 to clarify existing VA practice, also provides that only a single 10 percent evaluation is assigned for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Code 6260, Note 2. In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the United States Court of Appeals for the Federal Circuit (Federal Circuit) affirmed VA’s longstanding interpretation of Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral. Citing United States Supreme Court precedent, the Federal Circuit explained that an agency’s interpretation of its own regulations was entitled to substantial deference by the courts as long as that interpretation was not plainly erroneous or inconsistent with the regulations. Smith, 451 F.3d at 1350-51. Finding that there was a lack of evidence in the record suggesting that VA’s interpretation of Code 6260 was plainly erroneous or inconsistent with the regulations, the Federal Circuit concluded that VA’s interpretation of a single 10 percent rating being the maximum available for tinnitus was reasonable. On April 2014 VA examination, the Veteran reported that his tinnitus was bothersome and interfered with his ability to sleep and rest. A March 2018 VA treatment record notes that Veteran reported ongoing tinnitus. The Veteran’s tinnitus has been assigned the maximum schedular rating available for tinnitus under 38 C.F.R. § 4.87, Code 6260, and a higher schedular rating or separate 10 percent ratings for tinnitus of each ear are not warranted. The Board has considered whether referral of the claim for consideration of an extraschedular rating is warranted. See 38 C.F.R. § 3.321(b)(1); see Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a Veteran is entitled to an extraschedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is, thus, found inadequate, the Board must determine whether the disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” Third, if the rating schedule is inadequate to evaluate a Veteran’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, the case must be referred to [the Director of the Compensation Service] to determine whether an extraschedular rating is warranted. The Board finds that the first prong of the Thun analysis is not satisfied. The Veteran’s tinnitus is not shown (or alleged) to have manifestations or to cause impairment not encompassed by the schedular criteria. His reports of ringing in the ears are the basis for the 10 percent rating for tinnitus. He has not identified factors warranting referral for extraschedular consideration, such as marked interference with employment. Furthermore, there is nothing exceptional or unusual about his tinnitus. See Long v. Wilkie, No. 16-1537 (Vet. App. December 30, 2020). Therefore, the schedular criteria are not inadequate, and referral for extraschedular consideration is not necessary. REASONS FOR REMAND 6. Entitlement to service connection for bilateral hearing loss. A May 2014 rating decision denied service connection for bilateral hearing loss because audiological examination did not show a right ear hearing loss (as defined in 38 C.F.R. § 3.385), and although left ear hearing loss was shown, the April 2014 examiner opined that it was less likely than not that the left ear hearing loss was related to service. She explained that the Veteran’s STRs do not show any complaints of hearing loss, VA treatment records do not show complaints of hearing loss immediately after service, and that it was well established in the medical literature that exposure to high levels of noise causes either immediate hearing loss, such as in cases of noise/acoustic trauma, or progressive hearing deficits during prolonged periods of exposure during military service, but “retroactive hearing effect is not expected 33 years after being exposed to military noise.” Under governing caselaw, however, the absence of a hearing loss in service is not fatal to a claim of service connection for hearing loss (see Hensley v. Brown, 5 Vet. App. 155, 159 (1993)). Furthermore, an alternate [considered to be] more likely etiology for the Veteran’s bilateral hearing loss was not identified. Also, a March 2018 VA audiogram showed right ear puretone thresholds of 30 decibels at 2000, 3000, and 4000 Hz, suggesting the Veteran now has right ear hearing loss disability as defined in 38 C.F.R. § 3.385. Therefore, the opinion is inadequate for rating purposes, and remand for an examination to obtain a fully adequate medical advisory opinion is necessary. 7. Entitlement to service connection for a variously diagnosed psychiatric disability, to include anxiety and depression. Service connection for a psychiatric disability to include anxiety and depression, has been denied because the Veteran’s STRs do not show treatment for a psychiatric disability during service, and he has not provided a private opinion relating a psychiatric disability to service. However, Social Security Administration (SSA) records received in November 2019 note that the Veteran reported that he developed severe depressive symptoms due to concerns over his physical conditions and pain. He has established service-connection for dermatitis and tinnitus. Also, although the Veteran was not afforded a formal psychiatric evaluation during service, he was reduced in rank in court martial proceedings, in part, for saying vulgar things to a superior officer and throwing a can of rations at another Marine. He has not been afforded an examination in conjunction with his claim of service connection for a psychiatric disability. Under these circumstances, the low threshold standard for determining when VA must provide an examination to assess the nature and likely etiology of the claimed disability is met. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 8. Entitlement to a compensable rating for dermatitis. The Veteran was last examined to assess the severity of his dermatitis in April 2014. Generally, the mere passage of time, without evidence of worsening, is not a sufficient basis for a new examination. Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007). Here, however, a review of the record of VA treatment since 2014 found suggestion that the Veteran’s skin disability has not remained static. On April 2014 VA skin examination, the total body area and total exposed area affected by dermatitis were noted by the examiner to be “none.” However, a March 2018 VA treatment record notes that the Veteran reported diffuse plaque-like dark lesions over his arms and legs for the last 5-10 years, a current rash on his groin, and toenail fungus. The assessment was tinea unguium, tinea cruris, xerosis, and seborrheic keratosis. Since the record suggests that the Veteran’s dermatitis has spread (i.e. increased in severity), an examination to determine the current severity of the dermatitis is necessary. It also appears that the Veteran receives ongoing VA treatment for hearing loss, psychiatric disability, and skin disabilities. The most recent records of such treatment in the file are from May 2020. Updated (to the present) treatment records may contain pertinent information, are constructively of record, and must be sought. The matters are REMANDED for the following: 1. Secure for the record complete updated records of all VA evaluations and treatment the Veteran has received for hearing loss and psychiatric and skin disabilities since May 2020. 2. When the development requested above is completed arrange for an audiological evaluation of the Veteran to ascertain the likely etiology of his bilateral hearing loss disability. The Veteran's record must be reviewed by the examiner in conjunction with the examination. The examiner should: (a) Identify the likely etiology of the Veteran’s hearing loss disability. Specifically, is it at least as likely as not (i.e., a 50% or better probability) that it is related to his service (to include as due to his acknowledged exposure to noise therein)? (b) If the hearing loss is determined to not be related to the Veteran’s service, identify the etiology for the hearing loss that is considered to be more likely (and explain why that is so). Include rationale with all opinions. 3. Arrange for the Veteran to be examined by an appropriate psychiatrist or psychologist to determine the nature and likely etiology of his claimed psychiatric disability (ies). Upon examination and interview of the Veteran and review of his medical history (to include any additional records received pursuant to the above development), the examiner should: (a) Identify (by diagnosis) each psychiatric disability entity found (or shown by the record). (b) Identify the likely etiology for each psychiatric disability entity diagnosed (specifically including depression and anxiety). Is it at least as likely as not that such disability is related directly to the Veteran’s service/events therein, or was caused or aggravated (the opinion must include aggravation) by a service-connected disability? (c) If a diagnosed psychiatric disability is determined to be unrelated to the Veteran’s service, and to not have been caused or aggravated by a service-connected disability, identify (to the extent possible) the etiology considered more likely. The examiner must include rationale with all opinions. 4. Also arrange for a dermatological examination of the Veteran to assess the current severity of his service-connected dermatitis. The Veteran’s record (to include this remand, and post service treatment records) must be reviewed by the examiner in conjunction with the examination. In addition to reporting clinical findings, the examiner should elicit from the Veteran a detailed description of the nature, frequency, durations, and all affected areas of involvement (and their extent) during periods of exacerbation. Upon review of the record and interview and examination of the Veteran, the examiner should: (a) Assess the current severity of the Veteran’s dermatitis. [The examiner must be provided a copy of the criteria for rating skin disabilities, including Code 7806 (which references the General Rating Formula for the Skin), and the findings noted should include all information needed to rate under all applicable criteria.] All clinical findings should be described in detail. Specifically note the percentages of the entire body and exposed areas affected by the dermatitis (including during periods exacerbation, considering the Veteran’s reports, and commenting whether they are consistent with the clinical picture presented by the record) and the nature, frequency, and duration of any systemic therapy provided. Identify any related scarring, indicating whether it is painful, unstable, or causes functional limitations (describing any in detail). The examiner must explain the rationale for all opinions. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Bayles, 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.