Citation Nr: A24047445 Decision Date: 08/16/24 Archive Date: 08/16/24 DOCKET NO. 210728-175609 DATE: August 16, 2024 ORDER Entitlement to a compensable rating for onychomycosis is denied. FINDING OF FACT The Veteran's onychomycosis (hereinafter "skin condition") has affected less than 5 percent of his total body area and requires no more than topical therapy. CONCLUSION OF LAW The criteria for entitlement to a compensable rating for onychomycosis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Codes 7820 and 7806. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from March 1988 to March 1992. This matter comes before the Board of Veterans' Appeals (Board) from a July 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), the Agency of Original Jurisdiction (AOJ), which continued the noncompensable (zero percent) rating for the service-connected skin disability. In July 2021, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal, in which he elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2021 decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another rating decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental claim are included with this decision. Skin Condition The Veteran's skin condition is currently rated as noncompensable (a 0 percent rating) under Diagnostic Codes 7820-7806. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. While the veteran's entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Hyphenated Diagnostic Codes are used when a rating under one code requires use of an additional Diagnostic Codes to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Where a particular disability is not listed, it may be rated by analogy to a closely related disease by not only the functions affected, but also where the anatomical location and symptomatology are closely analogous. 38 C.F.R. §§ 4.20, 4.27; cf. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) ("[W]hen a condition is specifically listed in the Schedule, it may not be rated by analogy"). In this regard, the RO has evaluated the Veteran's skin disability as analogous to dermatitis or eczema pursuant to 38 C.F.R. § 4.118, DC 7806. Diagnostic Code 7806 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin." Diagnostic Code 7806 continues to apply to dermatitis or eczema but is rated under the general rating formula for the skin. Under the general rating formula, a 10 percent rating is warranted where at least one of the following is present: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is warranted where at least one of the following is present: characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. In June 2021, the Veteran attended a VA examination. The examiner noted the Veteran's onychomycosis diagnosis and that he had tried treating it with topical creams in the past but was currently not treating the condition. Specifically, the examiner found the Veteran was not treating the condition with any systemic or other, non-topical medications. The examiner found that less than 5 percent of the Veteran's total body area and less than 5 percent of his exposed body area was affected by his skin condition, specifically noting the condition affected all of the Veteran's toenails. The Veteran had no benign or malignant neoplasms or metastases related to his skin condition, no scarring, and no pertinent findings related to his skin condition. The Veteran's VA treatment records do not document any reports or treatment for pertinent symptoms. After reviewing the record, the Board concludes that the lay and clinical evidence reflects that the Veteran's onychomycosis covers less than 5 percent of his total body area, less than 5 percent of the exposed body area, and has not required more than topical treatment in the past 12 months. Thus, a compensable, 10 percent rating is not warranted for the skin disability. In reaching this conclusion, the Board acknowledges the Veteran's belief that his skin condition is more severe than the current disability evaluation reflects. He has reported that his skin condition affects all of his toes, that his nails grow curled and inward, and that he experiences anxiety and embarrassment, especially regarding wearing sandals. He further reported that his nails are hard to clip down and that his wife complains about issues with his feet. In this regard, the Board must consider the entire evidence of record when analyzing the criteria set forth in the ratings schedule. Although the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, for the reasons discussed above, the Board finds that his symptomatology does not meet the criteria for a higher disability rating. The Board has also considered whether a compensable evaluation is warranted under any other diagnostic codes. However, there are no findings of disfigurement of the head, face, or neck, as the disability only affects his feet/toes. Thus, Diagnostic Code 7800 is not applicable. In addition, there is no evidence of any scars, so Diagnostic Codes 7801 to 7805 are also not applicable. For these reasons, the Board concludes that the Veteran is not entitled to a compensable disability rating for his service-connected skin condition. The Board concludes that the evidence substantially weighs against the claim, and it is denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Black 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.