Citation Nr: 21041567 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 16-51 847 DATE: July 9, 2021 ORDER Entitlement to a rating higher than 10 percent for early compartment regional pain syndrome (previously rated as right knee condition) is denied. Entitlement to a compensable rating for tension headaches is denied. Entitlement to a rating higher than 10 percent for seborrheic dermatitis is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's right knee early compartment regional pain syndrome manifested as painful motion and flexion that was limited to, at worst, 115 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 2. Throughout the period on appeal, the Veteran's tension headaches were characterized as prostrating attacks less than once every two months. 3. Throughout the period on appeal, the Veteran's seborrheic dermatitis affected more than five percent of the entire body and less than twenty percent of exposed areas and has not involved treatment from corticosteroids or other immunosuppressive drugs approximating systemic therapy. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 10 percent for early compartment regional pain syndrome is denied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.59, 4.71a, Diagnostic Codes 5260. 2. The criteria for a compensable rating for tension headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.124a, Diagnostic Code 8100. 3. The criteria for entitlement for a rating higher than 10 percent for seborrheic dermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Code 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in active duty in the U.S. Marine Corps from September 1983 to April 1991. These matters come before the Board of Veterans' Appeals (Board) from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In a July 2020 decision, the Board remanded this matter to the RO for further development. More specifically, the Board directed the RO to review additional evidence submitted by the Veteran. In September 2020, the RO issued a Supplemental Statement of the Case again denying increased ratings for the Veteran's claimed disabilities. The matters now return to the Board. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 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 appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). 1. Entitlement to a rating higher than 10 percent for early compartment regional pain syndrome. The Veteran generally contends that he should have a higher rating for his right knee early compartment regional pain syndrome, which he believes is worse than contemplated by the currently assigned rating. See December 2020 Appellate Brief. The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). The Veteran's right knee disability is currently rated under Diagnostic Code 5260. The amendments did not impact that Diagnostic Code and the evidence does not demonstrate impairment of the tibia/fibula, recurrent subluxation/instability, or patellar instability. The Veteran's right knee disability has been rated a 10 percent disabling effective December 7, 2011 under 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5260, flexion of the knee limited to 15 degrees warrants a 30 percent rating; flexion limited to 30 degrees warrants a 20 percent rating; flexion limited to 45 degrees warrants a 10 percent rating; and flexion limited to 60 degrees warrants a zero percent (noncompensable) rating. 38 C.F.R. § 4.71a Separate ratings can be assigned for the other knee disabilities (Diagnostic Codes 5257, 5258, 5259, and 5261) when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology. See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). Under Diagnostic Code 5257, recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The new rating criteria address incomplete ligament tears causing instability and unrepaired or failed repair of complete ligament tear. Under Diagnostic Code 5258, when the knee disability affects the meniscus, a 20 percent rating is warranted when there is dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Under Diagnostic Code 5258, a 10 percent rating is warranted when there has been removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). In this case the evidence does not reflect, and the Veteran does not allege, that he has tibia or fibula impairment, genu recurvatum, or ankylosis of either knee. As such, those diagnostic codes are not for application. In August 2013, the Veteran was afforded a VA examination for his knee. At that time, the examiner noted a diagnosis of patella fracture and medial meniscus tear of the right knee. He reported flare-ups of daily right knee pain which limited his ability to run, stoop and squat. His right knee flexion was up to 140 degrees and extension was zero degrees. There was no objective evidence of painful motion. After repetitive use testing the Veteran's flexion had flexion to 135 degrees and extension was zero degrees. Pain and fatigability significantly limited functional ability during flare-ups, or when the joint was used repeatedly over a period of time. There was no joint instability, no patellar subluxation or dislocation, and no shin splits. There was no pain on palpation. The examiner noted a meniscus semilunar cartilage condition with frequent episodes of joint pain and a prior meniscectomy was reported, which resulted with a scar. There was no medial tibial stress syndrome, no stress fractures, no chronic exertional compartment syndrome or any other tibial and/or fibular impairment. The Veteran did not use an assistive device. In August 2016, the Veteran was afforded another VA examination. At that time, the examiner noted a diagnosis of early compartment regional pain syndrome. The Veteran did not report any flare-ups. His right knee flexion was up to 140 degrees and extension was zero degrees. There was no objective evidence of painful motion. After repetitive use testing there was no additional functional loss. The examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit the Veteran's functional ability with repeated use over a period of time. There was no joint instability, no patellar subluxation or dislocation, no shin splits. There was no pain on palpation, no meniscus semilunar cartilage condition, no ankylosis and no stress fractures. There was chronic exertional compartment syndrome which resulted in cramping in the right knee. The Veteran did not use an assistive device. In August 2017, the Veteran was afforded another VA examination. The Veteran reported flare-ups of daily right knee pain which limited his ability to flex freely, stoop and squat. He had flexion to 115 degrees and extension was zero degrees. There was painful motion on flexion and evidence of pain on weight-bearing, as well as, evidence of localized tenderness or pain. After repetitive use testing there was no additional functional loss. The Veteran was not examined immediately after repetitive use over time so functional ability due to pain, weakness, fatigability, or incoordination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss. However, the examiner noted that the Veteran's right knee was stiff, and he shifted his weight and knees while sitting. His knee gave out periodically. There was no joint instability, no patellar subluxation or dislocation, no shin splits, no ankylosis. The muscle strength testing for flexion was 4/5 and extension was 5/5. There was no medial tibial stress syndrome, no stress fractures or any other tibial and/or fibular impairment. The Veteran did not use an assistive device. With regards to right knee early compartment regional pain syndrome, the record reflects that a 10 percent rating is warranted throughout the period on appeal under Diagnostic Code 5260. An August 2013 VA examination demonstrated flexion to 135 degrees following repetitive use testing and an August 2016 VA examination demonstrated flexion was up to 140 degrees with no reported flare-ups, as well as, an August 2017 VA examination demonstrated flexion was up to 115 degrees with pain. The Board finds that a rating higher than 10 percent is not warranted. There is no evidence that the Veteran experienced worse than 45 degrees of flexion during this period on appeal. On VA examination in August 2017, the Veteran endorsed flare-ups that impacted his ability to flex freely, stoop and squat. This would not more nearly approximate flexion being limited to 39 degrees. Therefore, Board finds that such factors do not result in functional loss more nearly approximating flexion limited to 30 degrees in the knee. See DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. The Board has considered whether the Veteran is entitled to a separate rating for limitation of extension. Under Diagnostic Code 5261, a 10 percent rating is warranted for limitation of extension of the leg to 10 degrees; a noncompensable rating is warranted for extension limited to five degrees. The evidence shows, however, that the Veteran had full left knee extension during the appeal period, even in consideration of additional functional loss due to symptoms such as pain, swelling, weakness, fatigue, or incoordination or a result of repetitive motion and/or flare-ups. Therefore, a separate rating for limitation of extension is not warranted. The Board has also considered whether the Veteran is entitled to any additional separate rating for his right knee early compartment regional pain syndrome. While the August 2013 VA examination reflects that the Veteran underwent a meniscectomy for his right knee resulting in residual symptoms, the record does not reflect in the August 2016 and August 2017 VA examinations that the Veteran has current residual symptoms. See 38 C.F.R. § 4.71a, Diagnostic Code 5259. Further, the clinical evidence does not establish, and the Veteran has not alleged, ankylosis, impairment of the tibia or fibula, or genu recurvatum. Therefore, Diagnostic Codes 5256, 5258, 5262, and 5263 are not for application. The Board acknowledges the Veteran's belief that his right knee disability is more severe than the current rating reflects. Although the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his right knee disability. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The Board has considered whether a staged rating under Hart, supra, are warranted. However, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning further staged ratings is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Finally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability (TDIU) has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The August 2016 examiner stated that the Veteran's disability does not have an impact on occupational tasks and the August 2017 examiner noted that the Veteran's disability impacted him standing for a prolonged period, running, constantly walking, lifting and shifting his weight while sitting. However, the Veteran has not alleged, and the record does not suggest, that he is not able to obtain or maintain employment due to his right knee disability. Indeed, VA treatment records from May 2017 indicate that the Veteran was working outdoors as a correctional officer. As such, a claim for TDIU under Rice is not raised. Therefore, the preponderance of the evidence is against a higher or separate rating for the Veteran's right knee disability. Thus, the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to a compensable rating for tension headaches. The Veteran generally asserts that he is entitled to a higher rating for his tension headaches because his symptoms are more severe than contemplated by the currently assigned rating. Specifically, the Veteran's representative argues that the Veteran reported experiencing headaches 2-3 times a week and that although he has prostrating attacks less than once every two months, the term "prostrating" is not define in the code which would determine the type and frequency of headaches to determine a higher rating. See December 2016 Statement of Representative and February 2020 Appellate Brief. The Veteran's tension headaches are rated as noncompensable under 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under Diagnostic Code 8100, a noncompensable rating is warranted for less frequent attacks than as follows. A 10 percent rating is warranted where the disorder manifests with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months. A maximum 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Governing case law and regulations have not defined "prostrating." For reference, the Board notes that "prostration" is defined as "extreme exhaustion or powerlessness." See Dorland's Illustrated Medical Dictionary 1531 (32d. Ed. 2012). The use of the conjunctive "and" in a statutory provision means that all of the conditions listed in the provision must be met. Melson v. Derwinski, 1 Vet. App. 334 (1991); Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for a higher rating to be assigned). Here, each of the criteria listed in the 10 percent rating must be met in order to warrant a 10 percent rating. Tatum v. Shinseki, 23 Vet. App. 152 (2009). The Veteran was afforded a VA examination for his headaches in August 2013. At that time, he reported headaches that occurred two to three times a week, in the front of his head. He also reported that his pain lasted less than a day and he was sensitive to light and sound during the pain. He took Motrin and Tylenol to relieve his pain. No other symptoms were reported, such as vomiting and diarrhea. The Veteran reported that he had characteristic prostrating attacks of non-migraine pain that occurred more frequently than once a month. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms found. The examiner noted that the Veteran's headaches did not impact his ability to work. The Veteran was afforded another VA examination in August 2016. At that time, he reported experiencing pulsating or throbbing headaches. However, denied experiencing nausea, vomiting, sensitivity to light or sound and the duration of pain was less than a day. The Veteran took Tylenol to alleviate his pain. The Veteran reported experiencing characteristic prostrating attacks of non-migraine pain that were less than once every two months. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms found. The examiner noted that the Veteran's headaches hindered his concentration during the pain. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported headache symptoms that are worse than those noted in the various VA examination reports of record. After having considered all of the evidence of record, including the Veteran's lay statements, the Board finds that a compensable rating for the Veteran's tension headaches is not warranted. Under the rating criteria, a 10 percent rating is warranted when there are characteristic prostrating attacks averaging one in two months over the last several months. Here, there is no evidence that the Veteran experienced headaches to such a degree. Specifically, at his August 2016 VA examination, the Veteran was shown to have characteristic prostrating attacks less than once every two months without light and sound sensitivity, which is an improvement from his August 2013 findings of prostrating headaches more frequently than once a month with light and sound sensitivity. In making its determination in this case, the Board acknowledges the Veteran's belief that his headache symptoms are more severe than the current rating reflects. Although the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran's reports regarding the severity of his disability. The Board also considered whether an inferred claim for a total disability based upon individual unemployability (TDIU) has been raised pursuant to Rice. The August 2013 examiner stated that the Veteran's condition did not affect his occupational tasks and the August 2016 examiner noted that the Veteran could not concentrate during his headaches. However, as noted above, the evidence of record suggests the Veteran is still working. He has not alleged, and the record does not suggest, that he is not able to obtain or maintain employment due to his tension headaches as he experiences them less than once every two months. As such, a claim for TDIU under Rice is not raised. The Board has considered whether a further staged rating under Hart, supra, is warranted. However, the Board finds that his symptomatology has improved throughout each period on appeal. Therefore, assigning a further staged rating is not warranted. Further, neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra. Accordingly, the Board finds that the preponderance of the evidence is against the claim. Thus, entitlement to a compensable rating for headaches must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to a rating higher than 10 percent for seborrheic dermatitis is denied. The Veteran generally asserts that he is entitled to a higher rating for his seborrheic dermatitis because his symptoms are more severe than contemplated by the currently assigned rating. Specifically, the Veteran's representative argues that the Veteran's skin disability is not limited to just his nose and scalp, but also his face, ears, and other parts of his body. See December 2016 Statement of Accredited Representative. The Veteran's seborrheic dermatitis has been assigned a 10 percent rating under Diagnostic Code 7806. Under Diagnostic Code 7806, a noncompensable rating is assigned for less than five percent of the entire body or less than five percent of exposed areas affected, and; no more than topical therapy is required during the past 12-month period. A 10 percent rating contemplates at least five percent, but less than 20 percent, of the entire body, or at least five percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immuno-suppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is assigned for 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 60 percent rating contemplates 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. 38 C.F.R. § 4.118, Diagnostic Code 7806. The Federal Circuit Court has held that 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, and that nothing in Diagnostic Code 7806 displaces the accepted understandings of systemic therapy and topical therapy to permit a topical therapy that affects "only the area to which it is applied" to count as a systemic therapy under the Code. However, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case and does not automatically mean systemic therapy because Diagnostic Code 7806 distinguishes between systemic and topical therapy. Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). On August 13, 2018, the VA adopted new regulations for skin disorders. Under the new regulations 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. 83 Fed. Reg. 32,592 (July 13, 2018). The new regulations create a bright-line definition of topical and systemic treatment therapies. Prior to this change, the regulations did not define topical or systemic treatment and the determination of whether a Veteran received topical or systemic treatment was based on the factual circumstances of each case. Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017). As the Veteran filed a claim for service connection prior to August 13, 2018 and his appeal for an increased rating was pending on August 13, 2018, the Board must consider both the new and old regulations and apply the most favorable. The Federal Circuit also held 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, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Burton v. Wilkie, 30 Vet. App. 286 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects. The Veteran was afforded a VA examination for his skin in August 2013. At that time, he reported that he has had a marked rash affecting his face, neck, chest, and arms since active service. He denied scarring or disfigurement of the head, face, or neck and no benign or malignant skin neoplasms were found. The Veteran reported taking topical ointments six weeks or more but not constantly in the form of topical steroids and using Selsun shampoo for his scalp. The examiner noted that the skin disability impacted greater than five percent but less than 20 percent of exposed areas and impacted greater than five percent but less than 20 percent of the total body area. The Veteran was afforded another VA examination for his skin in August 2016. He reported that his skin condition started in the nasal area, and radiated to his scalp, elbows, knees, chest, and groin area. He denied scarring or disfigurement of the head, face, or neck and no benign or malignant skin neoplasms were found. The Veteran reported taking systemic corticosteroids or other immunosuppressive medications in the form of Selsun shampoo for his scalp with for less than six weeks in the past 12 months. There were no other treatments reported. The Veteran also reported having on and off debilitating episodes that involved flaky skin resulting in it being puffy, scaly, and warm, four or more times in the 12 months prior, which occurred despite ongoing immunosuppressive therapy. Further, the Veteran reported that he had had non-debilitating episodes of urticaria and primary cutaneous vasculitis, in the prior 12 months. A review of the Veteran's clinical records does not show that the Veteran has complained of symptoms not reflected in the above-mentioned examination reports. As noted above, the Veteran currently in receipt of a 10 percent rating for seborrheic dermatitis under 38 C.F.R. § 4.118, Diagnostic Code 7806. The Board agrees that this is the appropriate diagnostic code, as there is no noted disfigurement of the head, face, neck, and no scarring. As noted above, in order to receive a higher 30 percent rating, the evidence must show that the seborrheic dermatitis covered 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. 38 C.F.R. § 4.118, Diagnostic Code 7806. The Board must thus consider two questions, in any order, when determining whether topical treatment for a skin disorder constitutes "systemic therapy such as corticosteroids or other immunosuppressive drugs" under the pre-August 13, 2018 version of Diagnostic Code 7806: a) Whether the topical treatment operates by affecting the body as a whole in treating a Veteran's skin condition; and b) Whether the given treatment is "like" a corticosteroid or other immunosuppressive drug. Only the second question needs to be considered if the treatment is clearly systemic. In August 2013, the Veteran reported using topical corticosteroids six weeks or more but not constantly in the form of topical steroids and Selsun shampoo for his scalp for more than six weeks over the past 12 months and in August 2016 the Veteran only reported using Selsun shampoo to treat his seborrheic dermatitis on his scalp for less than six weeks over the past 12 months. The evidence shows that these topical medications pertain only to a particular surface area, which is mostly his scalp, and there is no evidence that these medications affected other areas outside of the locations to which they were applied. Moreover, there is no evidence that the Veteran's seborrheic dermatitis affected more than twenty percent of his entire body or exposed areas. In this regard, the August 2013 VA examiner noted that it affected five to twenty percent of his body and the August 2016 VA examination found that it also impacted five to twenty percent of the Veteran's total body area. Accordingly, a rating higher than 10 percent under Diagnostic Code 7806 is not warranted at any time during the appeal period. 38 C.F.R. § 4.118. The Board has also considered higher ratings under Diagnostic Codes 7825 and 7826 for chronic urticaria and primary cutaneous vasculitis, respectively. During the August 2016 examination, the Veteran reported having non-debilitating episodes of urticaria and primary cutaneous vasculitis, occurring four or more times in the past 12 months. Under Diagnostic Code 7825, a 30 percent rating, the next higher rating level, is warranted for second line treatment (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone) for control. Under Diagnostic Code 7826, a 30 percent rating, the next higher rating level, is warranted for recurrent documented vasculitic episodes occurring four or more times over the past 12-month period; and requiring intermittent systemic immunosuppressive therapy for control. Here, the Veteran did not report using corticosteroids, only topical treatment for his scalp and although he reported recurring episodes of four or more times over the past 12-month period for primary cutaneous, he did not report having systemic immunosuppressive therapy. Therefore, a higher rating under Diagnostic Codes 7825 and 7826 are not warranted. In reaching its conclusions, the Board acknowledges the Veteran's belief that his seborrheic dermatitis symptoms are more severe than the current rating reflects. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. Although the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert, 21 Vet. App. 456. The Board finds the medical evidence in which professionals with medical expertise examined the Veteran's toenails and feet, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own reports regarding the severity of such conditions. The Board has considered whether a staged rating under Hart v. Mansfield, supra is warranted, however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating is not warranted. Further, neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra. Accordingly, the Board finds that a rating higher than 10 percent for seborrheic dermatitis is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. MARTHA R. LUBOCH Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Adeyemi, B. 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.