Citation Nr: 21028394 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-36 566 DATE: May 11, 2021 ORDER For the period prior to October 23, 2020, an evaluation of 10 percent, but no higher, for tinea pedis, tinea manus, and tinea cruris is granted. For the period beginning October 23, 2020, an evaluation in excess of 10 percent for tinea pedis, tinea manus, and tinea cruris is denied. FINDINGS OF FACT 1. Prior to October 23, 2020, there is evidence of record that the Veteran's skin conditions, which include tinea pedis, tinea cruris, and tinea manus involved at least 5 percent but less than 20 percent of his entire body surface area. 2. The Veteran has had no treatments or procedures other than topical medications in the past 12 months for any skin condition. The Veteran's current skin conditions, which include tinea pedis, tinea cruris, and tinea manus involve between 5 and 20 percent of the Veteran's total body area. CONCLUSIONS OF LAW 1. The criteria for an evaluation of 10 percent prior to October 23, 2020 for tinea pedis, tinea manus, and tinea cruris have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7813. 2. The criteria for a rating in excess of 10 percent for tinea pedis, tinea manus, and tinea cruris from October 23, 2020, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7813. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 2000 to May 2003 and from April 2005 to August 2006. This matter comes before the Board of Veterans Appeals (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified at a video conference hearing in Waco, Texas before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. In November 2019, the Board remanded the Veteran's claim for additional development. The claim has since been returned to the Board for further appellate action. The Board is satisfied there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Increased ratings for tinea pedis, tinea manus, and tinea cruris Prior to August 13, 2018, Diagnostic Code 7806 provided that where there is less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12-month period a noncompensable evaluation is warranted. When 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 immunosuppressive drugs required for a total duration of less than six-weeks during the past 12-month period, a 10 percent rating is assigned. Where there is 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period, a 30 percent rating is assigned. Where there is more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period, a 60 percent rating is assigned. 38 C.F.R. § 4.118, Diagnostic Code 7806. The Federal Circuit addressed the meaning of "systemic" and "topical" for rating skin disabilities under the regulatory criteria prior to August 31, 2018. See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). For these purposes, systemic therapy means treatment pertaining to or affecting the body as a whole, whereas topical therapy means treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. Id. at 1355. The Federal Circuit acknowledged that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, but the Court emphasized that this possibility does not mean that all applications of topical corticosteroids amount to systemic therapy. Id. Rather, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the facts of each case. Id. at 1356. Effective August 31, 2018, VA regulations explicitly state that for the purposes of the skin disability ratings, "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). Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Code 7806. Under this formula, a maximum 60 percent rating under this formula requires at least one of the following: (1) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (2) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. A 30 percent rating requires at least one of the following: (1) characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (2) systemic therapy such as those listed under the 60 percent criteria required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 10 percent rating requires at least one of the following: (1) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (2) at least 5 percent, but less than 20 percent, of exposed areas affected; or (3) intermittent systemic therapy such as those listed under the 60 percent criteria required for a total duration of less than 6 weeks over the past 12-month period. A noncompensable (0 percent) rating is assigned where there is no more than topical therapy required over the past 12-month period and at least one of the following: (1) characteristic lesions involving less than 5 percent of the entire body affected; or (2) characteristic lesions involving less than 5 percent of exposed areas affected. Amended rating criteria, if favorable to the claim, can be applied only for periods from and after the effective date of the regulatory change. However, a claimant does get the benefit of having both the old regulation and the new regulation considered for the period after the change was made. VAOPGCPREC 3 00 (2000), 65 Fed. Reg. 33422 (2000). An increase in benefits cannot be awarded earlier than the effective date of the change in law pursuant to which the award is made. 38 U.S.C. § 5110(g); 65 Fed. Reg. 33422 (2000). 1. An evaluation in excess of 0 percent but not greater than 10 percent prior to October 23, 2020 for tinea pedis, manus, cruris The Veteran contends that he is entitled to a compensable rating prior to October 23, 2020 for skin conditions that include tinea pedis, tinea manus, and tinea cruris. The Veteran was service connected for dermatophytosis at a 0 percent rating from the day after leaving military service in August 2006. In the meantime, the Veteran has had three VA skin examinations in September 2006, June 2014, and most recently in October 2020. The Veteran underwent two VA skin examinations prior to the one on October 23, 2020. The next most recent examination was in June 2014. At the 2014 exam the Veteran was diagnosed with tinea pedis, tinea cruris, and tinea manus, but on the date of this examination, the last two conditions were asymptomatic. The examiner noted that tinea pedis was chronic with objective findings during this examination. When asked about changes in his skin conditions since his last VA examination in September 2006, the Veteran said, There has not been any change. They offered me some type of ointment, but it never went away and it's still there. The hands and the groin area don't inflame as much. It's more on my heels and the small of my feet. During the summer months is when it gets in my groin area because it's hot. At the time of this exam, the Veteran was applying prescription strength anti-fungal cream (does not recall name of cream), which he reported applying to his bilateral feet every night. The Veteran stated he only applies the cream to bilateral groin area as needed. The Veteran has been seeing a non-VA primary care provider since 2006 every 6 months to a year, whom he reported had been managing his skin condition. Veteran stated he has never sought evaluation/treatment through the VA for tinea pedis, manus, or cruris. At the time of the 2014 exam the Veteran was employed by the VA since July 2013, where he worked in Engineering and Patient Transport. The Veteran claimed tinea pedis, manus, and cruris did not impact his ability to work. The examiner also noted that the Veteran's skin conditions did not cause scarring or disfigurement of the Veteran's head, face or neck. The Veteran has been treating his tinea pedis constantly or near constantly with topical medications in the past 12 months. The Veteran has been treating his tinea cruris with Prescription Strength Antifungal Medication (Does not recall the name of medication), less than 6 weeks in the past 12 months. Less than 5 percent of the Veteran's total body area was affected by skin infections, and none of his exposed skin was affected by infection at the time of the 2014 VA examination. Review of non-VA Treatment records in VBMS show evaluation and treatment for tinea cruris in 2009. The first VA skin examination took place in September 2006. At this examination the Veteran noted the onset of rashes on his hands and feet and also in the inguinal folds bilaterally. He stated that it had been intermittent on his hands and fairly constant and progressive in the inguinal folds and on his feet. He was not treating the infections with anything. He did use Lamisil cream for approximately a month twice a day within the previous year, but this caused drying of the skin and bleeding. Physical examination in 2006 reported less than 5 percent of the Veteran's exposed skin surface area affected and less than 10 percent of his entire body surface area affected. The examiner noted there were no scars or disfigurement, and no acne or chloracne. Also, at the March 2019 Board hearing the Veteran stated that he believed his skin disorders affected more than 5 percent of his total body surface. Having reviewed the Veteran's 2014 and 2006 VA examinations and 2019 hearing testimony, the Board finds that a compensable rating is warranted for the appeal period prior to October 23, 2020. Namely at the 2006 examination, it was observed that less that 10 percent of the Veteran's entire body surface area was affected (not less than 5 percent). DC 7806 both old and new grant a 10 percent rating when at least 5 percent but not more than 20 percent of the entire body surface is affected. Because of this September 2006 VA examination finding and 2019 hearing testimony, and resolving all doubt in the Veteran's favor, the Veteran's condition more nearly approximates the criteria for a compensable rating. The record fails to show the Veteran's skin condition impacted 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more. The 2014 VA examination documented constant to near constant use of topical medications; however, this does not affect the body as a whole so as to be considered systemic. To the extent the Veteran used topical creams, these were topical medications applied to very specific areas and used as needed. As such, it was not administered on a large enough scale such that it affected the body as a whole and it is not like a corticosteroid or other immunosuppressive drug. As such, the Veteran's service-connected skin conditions rating is compensable, and the Veteran's claim for a compensable rating of 10 percent, but not higher, prior to October 23, 2020 is granted. 2. An evaluation in excess of 10 percent from October 23, 2020 for tinea pedis, tinea manus, and tinea cruris The Veteran contends that he is entitled to a disability rating in excess of 10 percent from October 23, 2020 for skin conditions that include tinea pedis, tinea manus, and tinea cruris. In this case, the Board finds that a rating in excess of 10 percent for the period from October 23, 2020 is not warranted, under the old or the new rating criteria. The October 2020 VA skin exam had the following results. The Veteran was diagnosed with tinea pedis, tinea cruris, and tinea manus the day of the exam. The Veteran said the skin problems began in 2005 with blisters and dryness in his hands, redness and itching to his groin area, as well as rash, scaly and itching feet. The Veteran's records show he was treated with clotrimazole, a topical cream, less than 6 weeks. During this exam it was established that the Veteran had no other treatments or procedures other than topical medications in the past 12 months for any skin condition. The Veteran has dermatophytosis that covers less than 5 percent of his exposed skin area and between 5 and 20 percent of his total body area. The Veteran does not have a benign or malignant neoplasm or metastases related to any of the diagnoses. None of the Veteran's skin conditions cause scarring or disfigurement of the head, face or neck. The Veteran does not have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any skin conditions diagnosed, and the Veteran's skin conditions do not impact his ability to work. Applying the rating criteria to these findings, the Board finds the Veteran, due to dermatophytosis affecting between 5 and 20 percent of his total body area is entitled to a 10 percent rating but no more, from the date of this latest exam, on October 23, 2020. The record does not demonstrate characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected nor does it reflect systemic therapy. As such, there is no evidence of record, not in the latest VA skin examination or the service treatment notes since October 23, 2020, that would warrant a higher rating than 10 percent for the Veteran's service-connected skin conditions at any time during the period pertinent to this appeal. See Francisco, 7 Vet. App. 55; Hart, 21 Vet. App. 505. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Black, 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.