PSEUDOFOLLICULITIS BARBAE

Summary

The Veteran, who served in the United States Marine Corps from July 1985 to September 1993, appeals for an increased rating for his service-connected pseudofolliculitis barbae (PFB). The Board of Veterans' Appeals (Board) reviewed the case following a previous remand for a new VA examination. The Veteran sought a higher rating for PFB, which was previously rated as noncompensable (0 percent). The Board considered both pre- and post-August 13, 2018, rating criteria for skin conditions under Diagnostic Code 7806. The Veteran's PFB was described as affecting less than 5 percent of the body or exposed areas, with no scarring or disfigurement noted in multiple VA examinations. Post-service treatment records indicated the Veteran used Doxycycline, an oral antibiotic, in 3-month periods for his PFB, exceeding six weeks but not constantly within a 12-month period. The Board found Doxycycline to be systemic and analogous to corticosteroids or immunosuppressive drugs due to its anti-inflammatory purpose. Applying the pre-amendment criteria, the Board determined that the Veteran's treatment regimen warranted a 30 percent rating. Service connection for PFB is granted at 30 percent.

Rationale

Board found Doxycycline to be systemic and analogous to corticosteroids/immunosuppressive drugs.; Treatment with Doxycycline exceeded six weeks but was not constant.; No scarring or disfigurement noted.

Full Decision Text

Citation Nr: 26004809
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 16-56 439
DATE: April 21, 2026

ORDER

A 30 percent rating for pseudofolliculitis barbae (PFB) is granted; subject to the laws and regulations governing the payment of monetary benefits.

FINDING OF FACT

For the period on appeal, the Veteran's PFB required systemic therapy for a total duration of more than six weeks, but not constantly, during a twelve-month period.

CONCLUSION OF LAW

The criteria for a 30 percent disability rating for PFB are met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.118, Diagnostic Code 7806.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Marine Corps from July 1985 to September 1993.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) and was most recently remanded by the Board in July 2024.

The Board's July 2024 remand directed the RO to afford the Veteran a new VA examination to assess the current severity of his service-connected PFB.  The Board finds that there has been substantial compliance with its July 2024 remand directives, and it will proceed with adjudication of the issue on appeal.  Stegall v. West, 11?Vet. App.?268 (1998).

Increased Rating

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 caused by a given disability.  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 ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  However, if different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned.  Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999).

Entitlement to a compensable rating for PFB

The Veteran seeks a higher rating for his service-connected PFB, which is currently rated as noncompensable (0 percent) under Diagnostic Code 7806.  38 C.F.R. § 4.118, Schedule of ratings skin.

VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whichever criteria is more favorable to the veteran will be applied.  The Board may not apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise.  Kuzma v. Principi, 341 F. 3d 1327 (Fed. Cir. 2003).  However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

Prior to August 13, 2018, under Diagnostic Code 7806, a noncompensable (0 percent) rating is assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and no more than topical therapy required during the past 12 months.  38 C.F.R. § 4.118.  A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period.  Id.  A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to
 percent of the entire body or less than 5 percent of exposed areas affected, and no more than topical therapy required during the past 12 months.  38 C.F.R. § 4.118.  A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period.  Id.  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.  Id.  A 60 percent rating, the maximum schedular rating available, is assigned for 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.  Id.  Under the former rating criteria for Diagnostic Code 7806, the skin disability may also be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability.  Id.

For claims filed prior to August 13, 2018, the Court held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran's skin condition; and (2) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug."  Burton v. Wilkie, 30 Vet. App. 286 (2018).  Only the second question need be addressed if the treatment is clearly systemic.  Id.

Effective August 13, 2018, VA regulations explicitly state that 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.  38 C.F.R. § 4.118(a).

Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Code 7806.  See 38 C.F.R. § 4.118.  Under this formula, a noncompensable (0 percent) rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected.  Id.  A 10 percent rating is assigned for at least one of the following: 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.  Id.  A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 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.  Id. A 60 percent rating, the maximum schedular rating available, is assigned for at least one of the following: 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.  Id.  Under the revised General Rating Formula for the Skin for Diagnostic Code 7806, the skin disability may
 but not constantly, over the past 12-month period.  Id. A 60 percent rating, the maximum schedular rating available, is assigned for at least one of the following: 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.  Id.  Under the revised General Rating Formula for the Skin for Diagnostic Code 7806, the skin disability may also be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability.  Id.

Turning to the evidence of record, during the August 2014 VA examination, the examiner noted that the Veteran's PFB affected less than 5 percent of the total body area and less than 5 percent of exposed area.  No scaring or disfigurement was found.

During the May 2015 VA examination, the Veteran's PFB was not present upon examination.

During the May 2022 VA examination, the Veteran indicated that he was treating his PFB with Doxycyline.  The examiner indicated that the Veteran's PFB affected less than 5 percent of the total body area and less than 5 percent of exposed area.  No scaring or disfigurement was found.

At the September 2024 VA examination, the examiner found that the Veteran's PFB affected less than 5 percent of total body area and less than 5 percent of exposed area.  No scaring or disfigurement was found.

Post-service VA treatment records reflect that, throughout the period on appeal, the Veteran has been prescribed Doxycycline in 3 month periods to treat his PFB.  In any given year, the periods of treatment were greater than 6 weeks but not on a constant or near-constant basis.  The Veteran's treatment primarily consisted of 3-month periods, resulting in his PFB clearing up, and then treatment would resume again when his PFB flared-up.

Upon review of the relevant evidence, the Board finds that a 30 percent rating for the Veteran's service-connected PFB is warranted.  For this rating, the evidence must demonstrate that the Veteran's PFB affected 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas, or that systemic therapy such as corticosteroids or other immunosuppressive drugs were required to treat his PFB for a total duration of six weeks or more, but not constantly during a twelve-month period.  Here, the record reflects that the Veteran has been prescribed Doxycyline to treat his PFB.  For a 30 percent rating to be warranted under the pre-amendment regulations for Diagnostic Code 7806, the Board must determine (1) whether a topical treatment affects the body as a whole in treating a veteran's skin condition; and (2) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug."  

In this case, the Board notes that Doxycyline is not a corticosteroid or other immunosuppressive drug.  However, it is an oral antibiotic used to treat a range of infections and inflammation, such as PFB.  The Board finds that this medication is systemic in nature because it treats the Veteran's body as a whole in treating his PFB through use of this oral antibiotic.  See Dorland's Illustrated Medical Dictionary, 1888 (31st ed. 2007) (defining systemic as "pertaining to or affecting the body as a whole").  Next, the Board finds that Doxycycline is "like" a corticosteroid or other immunosuppressive drug in that its goal is to reduce inflammation in the body, which the Veteran experiences with his PFB.  As such, because the Veteran's prescribed Doxycycline is systemic in nature, and is used in 3-month periods to treat infection and inflammation of PFB, a 30 percent rating is warranted.  See Warren v. McDonald, 28 Vet. App. 194 (2016).  

The Board has also considered whether any other diagnostic codes related to disabilities of the skin would provide for a higher disability evaluation.  However, the evidence does not reflect any scaring or disfigurement due to the Veteran's PFB.  As such, a higher rating under a different diagnostic code is not warranted.