Citation Nr: 21032035 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 16-48 929 DATE: May 25, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for eczema is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1993 to September 2013. He received the Bronze Star Medal, Meritorious Service Medal, Afghanistan Campaign Medal with Two Campaign Stars, and the Iraq Campaign Medal with Campaign Star, among other decorations. The Board sincerely thanks the Veteran for his many years of honorable service to the United States. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). After reviewing the record, the Board finds that this matter must be remanded for a VA examination and medical opinion addressing contentions that the use of topical corticosteroids constituted a "systemic therapy" under applicable regulations during the rating period. See 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806 (2017). The Veteran's eczema is rated under the general rating formula for skin disorders at 38 C.F.R. § 4.118, DC 7806. The general rating formula assigns ratings from non-compensable to 60 percent based on factors including the total and exposed areas affected by the disorder, and whether a treatment was "systemic" or "topical". The term "systemic therapy" does not automatically include topical steroids, and the Board must make a case-specific factual determination. Johnson v. Shulkin, 862 F.3d 1351, 1355 (Fed. Cir. 2017). The Board observes that the Veteran cited Johnson v. McDonald, 27 Vet. App. 497 (2016) for the proposition that systemic therapy automatically includes the use of topical corticosteroids, but notes that the holding in that case was subsequently reversed by the Federal Circuit in 2017. Applicable regulations for rating skin disorders have changed for claims pending on August 13, 2018. See 83 Fed. Reg. 32,592 (July 13, 2018). The new regulations should be followed if they are more favorable to the Veteran. However, the new regulations set bright line rules for what constitutes a "topical" versus a "systemic" treatment, and define a "systemic" treatment as "therapy administered through any route (orally, injection, suppository, intranasally) other than the skin." As such, the Board will apply the old criteria as it is potentially more favorable to the Veteran. The Veteran contends that his use of the topical corticosteroid betamethasone dipropionate constituted a "systemic therapy" under applicable regulations. See VA Form 9, October 2016. He asserted that he must use the medication constantly to keep his eczema under control, and that if he discontinues the use of the steroid, the symptoms spread throughout the rest of his body. He submitted photographs showing skin symptoms on various body areas in 2014. Therefore, the Veteran has apparently asserted that the topical medication he applies to the affected areas prevents the disorder from spreading to the rest of his body, thus acting as a "systemic therapy" under applicable regulations. The VA examination reports have not explicitly discussed whether the Veteran's use of topical corticosteroids may be considered a "systemic therapy". As such, the Board is left in doubt as to whether the use of topical corticosteroids constituted a "systemic therapy" in this case, and a medical opinion is necessary to address this contention. See Burton v. Wilkie, 30 Vet. App. 286 (2018) (holding that the Board must determine whether a topical treatment operates by affecting the body as a whole in treating a veteran's skin condition, which may require a medical opinion); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (holding that the Board may not substitute its own judgment for that of a medical expert on a matter requiring medical knowledge). The matters are REMANDED for the following actions: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorder on appeal. 2. Schedule the Veteran for a VA examination to determine the current severity of his eczema disorder. The examiner should describe the disorder in detail and report all signs and symptoms necessary for evaluating it under the relevant criteria. In addition, the examiner is asked to review the Veteran's medications for eczema since 2013. For each medication identified, including betamethasone dipropionate, the examiner is asked to: (1) Note the duration of the treatment (if possible); and (2) Offer an opinion as to whether the medication can be classified as a "systemic" therapy A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: The VA examination reports in 2013, 2015, and 2017, documenting use of topical corticosteroids, including betamethasone dipropionate The Veteran's lay contentions that his topical medications act as a systemic therapy by keeping his eczema in check and preventing it from spreading to the rest of his body VA Form 9 received in October 2016 VA treatment records, including a primary care note in February 2017, in which the Veteran denied any present rashes, sores, lesions, erythematous areas, jaundice, skin discolorations, and the physician diagnosed a history of eczema controlled on current medication regimen Photographs submitted by the Veteran in 2014, purportedly showing symptoms of his eczema disorder on various areas of his body Private medical records submitted by the Veteran, including reports of treatment for eczema in September and October 2014 ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Reed, 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.