DERMATOPHYTOSIS (RINGWORM)

THOMAS ENGLISH · 2024 · Case ID: A24085594

DENIED

Summary

The Veteran, an Army Veteran who served from August 2006 to January 2008, appeals the denial of an increased disability rating for his service-connected pseudofolliculitis barbae. The Veteran sought a rating higher than the current 10 percent, which is assigned under Diagnostic Code 7813 of the Schedule for Rating Disabilities. The Board reviewed the February 2023 VA examination, which noted the condition affected 5-19 percent of the Veteran's total body area and exposed areas, and that no systemic therapy was required in the past 12 months. Post-service treatment records indicated mild papules treated with prescription lotion. The Board found that this evidence did not meet the criteria for a higher rating, specifically the 30 percent or 60 percent levels, which require more extensive body/exposed area involvement or constant systemic therapy. The Board also considered the Veteran's argument regarding scheduling examinations during flare-ups, finding the February 2023 examination adequate as the Veteran reported active symptoms at that time. The Board concluded that the evidence did not warrant a higher rating and that the benefit-of-the-doubt doctrine was not applicable as the evidence was persuasively against the claim. Service connection for pseudofolliculitis barbae remains at 10 percent.

Rationale

2023 VA examination noted condition affects 5-19% of body/exposed areas.; No systemic therapy required in past 12 months.; Evidence does not meet criteria for 30% or 60% rating levels.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7813

Docket No.

230412-338308

Full Decision Text

Citation Nr: A24085594
Decision Date: 12/20/24 Archive Date: 12/20/24

DOCKET NO. 230412-338308
DATE: December 20, 2024

ORDER

An initial disability rating higher than 10 percent for pseudofolliculitis barbae is denied.

FINDING OF FACT

Throughout the period on appeal, the Veteran's pseudofolliculitis barbae affects between 5 to 19 percent of the entire body, with between 5 to 19 percent of the exposed areas affected, but it is not treated with systemic therapy.

CONCLUSION OF LAW

The criteria for an initial disability rating higher than 10 percent for pseudofolliculitis barbae ar not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7813.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from August 2006 to January 2008. The rating decision on appeal was issued in March 2023 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In his April 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the March 2023 decision on appeal. 38 C.F.R. § 20.301.

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 an initial disability rating higher than 10 percent for pseudofolliculitis barbae

The Veteran seeks a higher initial disability rating for his service-connected pseudofolliculitis barbae, which is currently rated as 10 percent disabling under Diagnostic Code 7813. 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.

Diagnostic Code 7813 instructs to evaluate a skin disability under the General Rating Formula for the Skin. See 38 C.F.R. § 4.118. Under this formula, 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
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. The General Rating Formula for the Skin also allows for a skin disability to be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. Id.

Turning to the evidence of record, during the February 2023 VA examination, the Veteran indicated that his pseudofolliculitis barbae affects his head, chin, and neck, and that his symptoms of itching and irritation are not relieved by dermatologist prescriptions. The examiner noted that the Veteran's pseudofolliculitis barbae was not treated with any medication in the past 12 months, to include systemic treatment. Further, the examiner noted that the Veteran's pseudofolliculitis barbae affects between 5 to 19 percent of his total body area and between 5 to 19 percent of the total exposed area. No scarring or disfigurement was found.

Post-service treatment records reflect that the Veteran's pseudofolliculitis barbae affects his beard area and that papules that are mild in nature are treated with prescription lotion.

Upon review of the relevant evidence, the Board determines that an initial disability rating higher than 10 percent for the Veteran's service-connected pseudofolliculitis barbae is not warranted. Here, the 2023 VA examination and post-service treatment records do not reflect that the Veteran's pseudofolliculitis barbae more nearly approximates characteristic lesions involving at least 20 to 39 percent of the entire body affected or at least 20 to 39 percent of exposed areas affected, nor do they show that the Veteran's pseudofolliculitis barbae requires systemic therapy. Here, the 2023 VA examiner noted that the Veteran's pseudofolliculitis barbae affects between 5 to 19 percent of the total exposed area and between 5 to 19 percent of total body area. Moreover, the Veteran indicated that he did not treat his pseudofolliculitis barbae with either oral or topical medication that is systemic in nature. Therefore, the currently assigned 10 percent initial disability rating for pseudofolliculitis barbae is appropriate under Diagnostic Code 7813, and a higher rating is not warranted.

The Board acknowledges the Veteran's argument in his Appellate Brief concerning scheduling a VA examination during an active stage of a skin infection. In Ardison v. Brown, 6 Vet. App. 405 (1994), and Bowers v. Brown, 2 Vet. App. 675, 676 (1992), the Court held that whenever possible, examinations of skin disorders should be made when most disabling (e.g., during flare-ups). Here, the Board finds the February 2023 VA examination to be adequate, as the Veteran indicated during the examination that his pseudofolliculitis barbae symptoms (itching and irritation) were active at the time of the examination, and the examiner considered this evidence when finding that his pseudofolliculitis barbae affects between 5 to 19 percent of total exposed area and between 5 to 19 percent of total body exposed. Therefore, a remand is not necessary, as there is no duty-to-assist error.

The Board has considered whether any other diagnostic codes related to disabilities of the skin would provide for a higher disability evaluation. However, the relevant evidence does not reflect that the Veteran's pseudofolliculitis barbae would warrant a higher rating under a different diagnostic
Veteran indicated during the examination that his pseudofolliculitis barbae symptoms (itching and irritation) were active at the time of the examination, and the examiner considered this evidence when finding that his pseudofolliculitis barbae affects between 5 to 19 percent of total exposed area and between 5 to 19 percent of total body exposed. Therefore, a remand is not necessary, as there is no duty-to-assist error.

The Board is sympathetic to the Veteran's position that his pseudofolliculitis barbae is more severe than as reflected by the currently assigned disability rating. However, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. The Veteran is competent to describe his observable symptomatology. Layno v. Brown, 6 Vet. App. 465 (1994). However, in this case, the competent medical evidence offering specific specialized determinations relevant to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms of the Veteran's pseudofolliculitis barbae.

In conclusion, the Veteran's claim for an initial disability rating higher than 10 percent for pseudofolliculitis barbae is denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990), Lynch v. McDonough, 21 F.4th 776 (2021).

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Houle, Denise

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.

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