Citation Nr: 21027792 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-38 649 DATE: May 6, 2021 ORDER Entitlement to an initial disability rating of 60 percent, but no higher, for tinea versicolor is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, the evidence is at least in equipoise that his tinea versicolor affects more than 40 percent of his body for the entire period on appeal. CONCLUSION OF LAW The criteria for a 60 percent disability rating for tenia versicolor are met. 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.21, 4.104, Diagnostic Code (DC) 7806. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 2003 to September 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a June 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in October 2018. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes the Veteran's representative asserted in the July 2020 Post-Remand Brief that the RO did not comply with the remand orders because they did not make two requests for any authorized records from all identified healthcare providers. However on July 9, 2019, VA sent the Veteran Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs so they could obtain treatment records on the Veteran's behalf. The Veteran failed to return the releases; thus, VA was unable to make any requests for healthcare records. The Board is cognizant of the ruling of the United States Court of Appeals for Veterans Claims (Court) in Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the Court held that a claim for a total rating based on individual unemployability (TDIU) due to service-connected disability, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the Veteran has not argued, and the record does not otherwise reflect, that the disability at issue renders him unemployable. Accordingly, the Board concludes that a claim for TDIU has not been raised. Increased Rating Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). Tinea versicolor The Veteran is service connected for tinea versicolor which is rated under 38 C.F.R. § 4.118, Diagnostic Code 7806 for dermatitis or eczema. His skin disability is rated as 10 percent disabling prior to September 15, 2016 and as 30 percent disabling thereafter. In the June 2018 Appellant's Brief the Veteran's representative asserted more than 40 percent of the Veteran's entire body or more than 40 percent of exposed areas were affected, or; he required constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Under Diagnostic Code 7806, a 10 percent rating is warranted if 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 affected or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six week during the past 12-month period. A 30 percent rating requires that 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas be affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A maximum rating of 60 percent is warranted when the skin disability covers an area of more than 40 percent of the entire body or when more than 40 percent of exposed areas is affected, or; when constant or near constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past 12-month period. 38 C.F.R. § 4.1118, Diagnostic Code 7806. Systemic treatment must consist of corticosteroids or other immunosuppressive drugs. Corticosteroids are anti-inflammatory drugs that are synthetic derivatives of the natural steroid, cortisol, which is produced by the adrenal glands. They are called "systemic" steroids if taken by mouth or given by injection as opposed to topical corticosteroids, which are applied directly to the skin. For purposes of Diagnostic Code 7806, the use of topical corticosteroids does not mean systemic treatment although in some cases a topical corticosteroid could conceivably be administered on a large enough scale to affect the body as a whole. See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). Additionally, eczema can be alternatively rated as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801-7805). 38 C.F.R. § 4.118, Diagnostic Code 7806. In the instant case, the Board notes that none of the evidence of record indicates that the Veteran's skin disability affects his head, face, or neck. As such, consideration of the rating criteria based on disfigurement of the head, face, or neck (Diagnostic Code 7800) is not warranted. Additionally, none of the medical evidence indicates that the Veteran has scars from his skin disability, such that consideration of diagnostic codes for scars (Diagnostic Codes 7801-7805) is also not warranted. As such, the Veteran's skin disability is appropriate considered under the criteria of Diagnostic Code 7806 for dermatitis or eczema. A June 2013 VA dermatology treatment note stated the Veteran has tinea versicolor affecting 60 percent of his body surface area and 18 percent of his exposed areas. The Veteran has received near-constant therapy with antifungals over one year and systemic antifungals intermittently for a few weeks. The Veteran underwent a VA skin examination in connection with his skin disability in June 2013, which confirmed the tinea versicolor diagnosis. During this examination, the examiner noted the condition covered less than 20 percent of the Veteran's entire body and less than five percent in the exposed area. The Veteran's tinea versicolor was not treated with oral or topical medication in the last 12 months. The Veteran's condition did not cause scarring or disfigurement of the head, face, or neck. The skin disability did not impact the Veteran's ability to work. A September 2016 VA dermatology note stated the Veteran has moderate to severe tinea versicolor (it is normal for the condition to wax and wane), with 40 percent of body surface involvement based upon the physical examination and review of patient photographs and charts. The Veteran's most recent VA examination for his tinea versicolor took place in September 2016. During this examination, the VA examiner reported that the Veteran's tinea versicolor covered approximately 20 to 40 percent of the Veteran's total body area, none of which was an exposed area. The Veteran had received no oral or topical treatment during the past 12-month period. The Veteran's condition did not cause scarring or disfigurement of the head, face, or neck. The skin disability did not impact the Veteran's ability to work. The Board finds after resolving any reasonable doubt in the Veteran's favor, an initial disability rating of 60 percent is warranted for the Veteran's skin disability. While the VA examinations may have shown slightly less severe symptoms, the June 2013 and September 2016 VA dermatology consultations show the Veteran's skin disability exceeded or approximated the criteria for a 60 percent disability rating, the maximum available under the applicable diagnostic code. (Continued on the next page) (Continued on the next page) J. TUNIS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. St. Laurent, 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.