Citation Nr: 21039923 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-26 677 DATE: July 1, 2021 REMANDED Entitlement to an initial compensable rating prior to September 20, 2011, in excess of 10 percent from September 20, 2011, and in excess of 30 percent from January 25, 2020, for service-connected mycosis fungoides is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to June 1969. A July 2013 rating decision granted service connection for mycosis fungoides and assigned a noncompensable rating, effective July 17, 2012. The Veteran filed a June 2014 notice of disagreement regarding the rating assigned. An April 2016 rating decision assigned an earlier effective date for the grant of service connection for mycosis fungoides, effective November 25, 1981. A noncompensable rating was assigned from November 25, 1981, and a 10 percent evaluation was assigned, effective April 9, 2013. In October 2018, the Board remanded the appeal to the RO for additional development. In a June 2020 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) assigned a noncompensable disability rating prior to September 20, 2011, a disability rating of 10 percent effective September 20, 2011, and a disability rating of 30 percent effective January 25, 2020. The appeal has been returned to the Board for further consideration. Entitlement to an initial compensable rating prior to September 20, 2011, in excess of 10 percent from September 20, 2011, and in excess of 30 percent from January 25, 2020, for service-connected mycosis fungoides Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Appellant's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran asserts that his service-connected mycosis fungoides is worse than reflected by his currently assigned disability rating. Specifically, the Veteran asserts that his skin was damaged during radiation treatment, resulting in disfiguration of the skin. See June 2016 Statement from Veteran. The Veteran describes this disfiguration as the loss of approximately 50 percent of facial hair, thinning of head hair, balding behind the ears, and no hair on most of the body. Id. The Veteran also asserts the loss of approximately 85 percent of sweat glands and oil glands which caused him to suffer heat stroke requiring emergency room visits twice in July 1982. Id. The Veteran states that he must avoid areas without air conditioning. Id. Regarding the progression of his mycosis fungoides since 1982, the Veteran asserts that lesions appeared on his body throughout the 1990's, and that he eventually sought treatment in 2002. Id. The Veteran states that he received ultraviolet B (UVB) therapy at that time. Id. The Veteran states that he is currently receiving UVB treatment for life. Id. The Veteran asserts that the residuals of UVB therapy include chronic sensation of sunburn (which is worse after treatment and accompanied by lethargy); inability to exercise; difficulty bathing, swimming, eating hot foods/drinks, wearing jewelry, wearing glasses/hearing aids; bleeding easily due to thinning of the epidermal layer; daily use of ointment which bleeds through dress shirts; limited areas of perspiration, with perspiration accumulating at the neck and groin which impacts work in business environment and requires him to change underwear several times a day; athletes foot and bleeding requiring daily treatment and requires plastic bags to be worn under socks; and requirement that he sleep separately from his wife due to needing a cooler environment. Id. The Veteran also asserts that beginning in the summer of 2015, he began experiencing mild to medium loss of bladder control when he becomes overheated. The Veteran asserts that he has a decreased life expectancy due to increased risk of heat stroke and cancer, a compromised immune system, and a sedentary lifestyle required due to the loss of sweat glands. The Veteran's mycosis fungoides is rated as a skin disability under 38 C.F.R. § 4.118, Diagnostic Code (DC) 7818 from November 25, 1981, and under DC 7822 from January 25, 2020. The Veteran's representative asserts that the currently assigned disability ratings do not contemplate the severity of the Veteran's disability. Based on the asserted progression of the Veteran's mycosis fungoides since his original diagnosis in November 1981, the Veteran's representative contends that the Veteran's disability has been rated under an incorrect diagnostic code. The Veteran's representative asserts that mycosis fungoides is a type of non-Hodgkins lymphoma. See August 2020 Appellant's Brief. As mycosis fungoides and non-Hodgkins lymphoma were not recognized in the 1981 rating schedule, the Veteran's representative contends that the Veteran's mycosis fungoides should have been rated by analogy to Hodgkin's disease under 38 C.F.R. § 4.117, DC 7709. As such, the Veteran's representative contends that the Veteran should have been assigned a 100 percent rating from the start of radiation treatment in January 1982 until one year after the March 1982 cessation of treatment, and that the Veteran should thereafter have been rated on the residuals of his condition. As the Veteran was not provided an examination at the one year mark, the representative assets that the Veteran's condition should be rated from March 1983 on the residuals of loss of facial hair; loss of sweat glands and the resulting heat stroke; severe limits of exposure to hot environments; and dietary limitations. Specifically, the representative asserts that the Veteran's loss of sweat glands should have been rated as analogous to 38 C.F.R. § 4.118, DC 7832 for hyperhydrosis. The representative also asserts that as non-Hodgkin's lymphoma was added to the Diagnostic Code in 1994, the Veteran's condition should have been rated under DC 7715 and that the Veteran was entitled to a 100 percent rating during the active disease and treatment phases in 1981 and 2002. As the Veteran has not been provided with a VA examination which fully addresses his statements regarding the severity of his symptoms since 1981, a remand is necessary. Further, the RO should consider in the first instance whether evaluation of the Veteran's disability under 38 C.F.R. § 38 C.F.R. § 4.117, to include DC 7709 and DC 7715, or under DC 7832 is appropriate at any point during the period on appeal. The Board notes that the most recent VA treatment records associated with the Veteran's file are from June 2020. Any additional VA treatment records should be obtained on remand. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from June 2020 to the Present. Associate the records with the claims file. 2. After the development above is completed, schedule the Veteran for a VA examination with a dermatologist to determine the severity of the service-connected mycosis fungoides. The entire claims file, to include this Remand, must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The relevant Disability Benefits Questionnaire(s) must be utilized. The examiner should provide a retrospective opinion which addresses whether each of the symptoms claimed by the Veteran, as listed below, is at least as likely as not related to the Veteran's mycosis fungoides or a residual of treatment for mycosis fungoides. Specifically, the examiner should address the following: (a.) Is it at least as likely as not that the Veteran's claimed loss of approximately 50 percent of facial hair, thinning of head hair, balding behind the ears, and no hair on most of the body is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (b.) Is it at least as likely as not that the Veteran's claimed loss of 85 percent of sweat glands and oil glands, resulting in an inability to regulate his body temperature and two 1982 heat strokes, is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (c.) Is it at least as likely as not that the Veteran's claimed chronic sensation of sunburn is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (d.) Is it at least as likely as not that the Veteran's claimed inability to exercise is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (e.) Is it at least as likely as not that the Veteran's claimed difficulty bathing and swimming is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (f.) Is it at least as likely as not that the Veteran's claimed difficulty eating hot foods and drinks is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (g.) Is it at least as likely as not that the Veteran's claimed difficulty wearing jewelry, glasses, and hearing aids is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (h.) Is it at least as likely as not that the Veteran's claimed bleeding easily due to thinning of the epidermal layer is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (i.) Is it at least as likely as not that the Veteran's claimed inability to regulate his body temperature is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (j.) Is it at least as likely as not that the Veteran's claimed athletes foot is related to or caused by his mycosis fungoides or treatment for mycosis fungoides? (k.) Is it at least as likely as not that the Veteran's claimed bladder problems are related to or caused by his mycosis fungoides or treatment for mycosis fungoides? For any symptoms which are related to the Veteran's condition or treatment thereof, the examiner must provide a retrospective opinion which estimates the severity of these symptoms from November 25, 1981. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to mere speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. In light of the Veteran's contentions that he underwent treatment for mycosis fungoides in 1981-1982 and 2002 and that he has continuously experienced residuals of radiation treatment since 1982, the RO should adjudicate in the first instance the propriety of evaluating the Veteran's mycosis fungoides under DC 7709, 7715, or other Diagnostic Codes as appropriate based on the findings of the VA examiner, to include the propriety of a temporary total evaluation for the claimed periods of treatment, and an analogous rating under DC 7832 for loss of sweat glands. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Bynum, 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.