Citation Nr: 22010213 Decision Date: 02/22/22 Archive Date: 02/22/22 DOCKET NO. 17-28 100 DATE: February 22, 2022 REMANDED Entitlement to a compensable disability rating for nummular dermatitis/eczema prior to March 8, 2021, is remanded. Entitlement to a disability rating for nummular dermatitis/eczema for the period beginning March 8, 2021, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 2008 to July 2012, including service in Iraq. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO), which denied a compensable rating for service-connected nummular dermatitis/eczema. This appeal was most recently before the Board in August 2021, at which time it was remanded for additional consideration. While further delay is regrettable, the Board finds that remand is required, as additional evidence is necessary in order to accurately assess the severity of the Veteran's skin disability during the appeal period. During the appeal period, VA revised the definition of "systemic therapy" found in Diagnostic Code (DC) 7806. 38 C.F.R. § 4.118. Effective August 13, 2018, "systemic therapy" is defined as treatment administered through any route other than the skin. The Board may apply the prior version of DC 7806 to appeals pending on or before the effective date of the revised criteria (as is the case here) if the prior version is more favorable to the Veteran. 38 C.F.R. § 4.118. In this regard, the outcome of this case turns on whether the Veteran's medications prescribed and used since the inception of the appeal period can be classified as either systemic therapy or topical therapy. Johnson v. Shulkin, 862 F. 3d 1351, 1356 (Fed. Cir. 2017); Burton v. Wilkie, 30 Vet. App. 286, 291 (2018). The August 2021 Board remand listed the medications the Veteran used during the appeal period and requested the examiner to address whether each medication affected the body as a whole in treating the Veteran's skin condition. The remand directives also instructed the examiner to discuss whether the prescribed topical creams and antihistamines were/are "like" a corticosteroid or other immunosuppressive drugs. Upon remand, at the September 2021 examination, the examiner found that the Veteran's prescription for Ceterizine was an oral medication that was not considered a steroid or immunosuppressive drug. He also opined that the Veteran's current topical medications did not affect the whole body but rather only affected the areas to which they were applied. Notably, the examiner acknowledged that he limited his analysis to the medications the Veteran is currently taking and did not address the medications the Veteran was prescribed in the past. Thus, this opinion does not address all of the Board's remand directives and a remand is required in order to address all the medications the Veteran has been prescribed and used since the inception of the appeal period. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following actions: 1. Obtain a VA medical opinion regarding the Veteran's nummular dermatitis/eczema. The examiner should review the entire claims file, and indicate on the examination report that such review took place. The examiner is asked to identify any medications (topical, oral, or otherwise) used to treat the Veteran's nummular dermatis/eczema since the inception of the appeal period (the date of the current claim of June 26, 2015). For each prescribed topical cream, the examiner should determine whether the treatment is of a sufficient scale to affect the body as a whole. Some examples include a topical medication administered on a large enough scale or a topical medication that works by circulating through the bloodstream rather than by direct contact with the skin. For any systemic medication, which includes topical medications that affect the body as a whole and medications administered other than topically, the examiner should determine whether the treatment is "like" a corticosteroid or immunosuppressive drug. The examiner should indicate how long and how frequent each treatment has been required. A complete rationale must be provided for any opinion(s) expressed. The need for an in-person examination is left to the discretion of the examiner. (Continued on the next page) 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. S. M. Watkins Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Orie, 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.