Citation Nr: 22018502 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 13-28 143A DATE: March 29, 2022 REMANDED Entitlement to an initial disability rating in excess of 10 percent for tinea pedis is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2006 to November 2006. He also served in the U.S. Navy Reserves from November 1987 to April 2008 with several periods of active duty for training (ACDUTRA), including in June 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board initially denied, in relevant part, entitlement to an increased initial rating for tinea pedis in August 2017. The Veteran appealed this determination to the United States Court of Appeals for Veterans Claims (Court). The Court vacated the Board's denial of this issue pursuant to an August 2020 Joint Motion for Remand (JMR). In March 2021, the Board again denied entitlement to an increased rating for tinea pedis. The Veteran once again appealed this decision to the Court. In December 2021, the Court vacated the Board's denial pursuant to another JMR. 1. Entitlement to an initial disability rating in excess of 10 percent for tinea pedis is remanded. The Veteran seeks an initial rating in excess of 10 percent for tinea pedis. The Veteran's skin condition is listed as rated pursuant to 38 C.F.R. § 4.118, Diagnostic Code (DC) 7813-7803. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. The rating criteria for skin disabilities were revised effective August 13, 2018. Prior to August 13, 2018, DC 7813 referred to dermatophytosis (ringworm: Of body, tinea corporis; of head, tinea capitis; of feet, tinea pedis; of beard area, tinea barbae; of nails, tinea unguium (onychomycosis); of inguinal area (jock itch), tinea cruris; tinea versicolor), and it was rated based upon disfigurement of the head, face, or neck (DC 7800), scars (DCs 7801-7805), or dermatitis (DC 7806), depending on the predominant disability. The Veteran's rating documents reflect assignment of a rating under DC 7803, unstable scarring. Unfortunately, DC 7803 had been removed from the rating schedule effective October 23, 2008, and the effective date for service connection for the Veteran's tinea pedis in this case was July 16, 2009. Based upon the initial rating decision, as well as the Statement of the Case, it appears that the Regional Office instead rated this condition as analogous to DC 7806 for dermatitis. Under the new rating criteria in effect on August 13, 2018, disabilities rated under Diagnostic Code 7813 are to be evaluated under the General Rating Formula for the Skin. 38 C.F.R. § 4.118. In the December 2021 JMR, the parties agreed that the Board's factual analysis was inadequate as it did not sufficiently address the issue of systemic therapy. It noted that in Burton, the Court held that a topical corticosteroid could be considered either a systemic therapy or topical therapy based on the factual circumstances of each case. Burton v. Wilkie, 30 Vet. App. 286, 291-292 (2018). The Board's most recent denial inappropriately focused on the portion of skin covered by the topical treatment when discussing the issue of systemic therapy. On review, the Board finds that remand is required to obtain a new examination to address this deficiency. The Veteran's most recent VA examination occurred in November 2017. His tinea pedis was described as causing thick nails, peeling skin, and itchiness of the skin. VA treatment records reflect topical treatment with Triamcinolone. However, the examiner did not identify the topical medications used or discuss how they operate. Thus, the Board cannot determine whether the Veteran's topical medications constituted systemic therapy. Accordingly, remand is warranted to obtain a new examination to assess the severity of his condition, to include the nature of his topical treatment. The matters are REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). All attempts to contact the Veteran should be documented in the record. 2. Schedule a new examination to assess the severity of the Veteran's tinea pedis. The examiner must review the entire claims file, to include a copy of this REMAND, in conjunction with authoring the opinion. If the Veteran declines a new examination, or fails to report, an addendum opinion must be obtained. (a.) The examiner is asked to provide a thorough assessment of the disability pursuant to the relevant rating criteria. (b.) The examiner is asked to identify any topical treatments the Veteran used to treat his skin condition since July 2009. (c.) For each identified topical treatment, the examiner is asked to describe how each operates, and whether any constitute systemic therapy. The term "systemic therapy" describes a treatment that operates by affecting the entire body in its treatment of the condition at issue. Burton, 30 Vet. App. at 291-292. It is not limited to corticosteroids or other immunosuppressive drugs, and topical treatment may qualify as systemic therapy depending on how it operates. Id. For example, a topical treatment would affect the body as a whole if it circulates through the bloodstream. Hannah Fisher Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.