PSEUDOFOLLICULITIS BARBAE

C. CRAWFORD · 2025 · Case ID: A25106515

MIXED

Summary

The veteran, who served in the U.S. Navy from September 1999 to September 2006, appeals a July 2024 rating decision. The veteran sought an initial compensable rating for pseudofolliculitis barbae (PFB) and service connection for a low back strain and sleep apnea. The Board granted an initial 10 percent rating for PFB, finding that the veteran's symptoms of rash, itching, and bleeding with shaving more closely approximated the criteria for a 10 percent rating under Diagnostic Code 7804 for painful or unstable scars, resolving doubt in the veteran's favor. The Board found that a higher rating was not warranted as the evidence did not indicate three or more painful or unstable scars, nor did it meet the criteria for higher ratings under the General Rating Formula for the Skin or for disfigurement. The Board also noted that while the PFB impacted his ability to shave, it did not significantly impact his current employment as a bridge-tender. The claims for service connection for a low back strain and sleep apnea were remanded. The Board found a duty to assist error in the low back claim, as the VA examiner did not address the veteran's contention of repetitive heavy lifting in service, and a private opinion lacked sufficient rationale. For sleep apnea, the VA examiner only addressed toxic risk exposure, not the veteran's claims related to shift work and standby watches. A private opinion was also deemed insufficient due to lack of rationale. The case was remanded for new VA opinions addressing the etiology of both the low back condition and sleep apnea in relation to service.

Rationale

PFB symptoms approximated criteria for 10% rating under DC 7804; Resolving doubt in veteran's favor; Higher rating not warranted due to limited number of scars/area affected

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7804

Docket No.

250624-557847

Full Decision Text

Citation Nr: A25106515
Decision Date: 12/10/25 Archive Date: 12/10/25

DOCKET NO. 250624-557847
DATE: December 10, 2025

ORDER

Entitlement to an initial rating of 10 percent, but no higher, for pseudofolliculitis barbae is granted.

REMANDED

Entitlement to service connection for a lower back strain (low back disability) is remanded.

Entitlement to service connection for sleep apnea is remanded.

FINDING OF FACT

Resolving all reasonable doubt in favor of the Veteran, his pseudofolliculitis barbae manifests in a rash with bleeding and itching which more nearly approximates a painful or unstable scar.

CONCLUSION OF LAW

The criteria for an initial 10 percent rating, but no higher, for pseudofolliculitis barbae have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.118, Diagnostic Codes 7813, 7804.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Navy from September 1999 to September 2006.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2024 AMA rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the July 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 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.

However, because the Board is remanding the claims of service connection for sleep apnea and a low back strain, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Entitlement to an initial compensable rating for pseudofolliculitis barbae.

The Veteran contends that his pseudofolliculitis barbae (PFB) should be rated 20 percent disabling. For the reasons that follow, and resolving all reasonable doubt in favor of the Veteran, the Board finds that a 10 percent rating, but no higher, is warranted for the entire appeal period.

Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.

illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

The Veteran's skin disability is rated noncompensable pursuant to DC 7813.

The General Rating Formula for the Skin is used to rate under DC 7813.

Under this formula, a noncompensable 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.

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.

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.

A 60 percent rating 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. Or rate 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. 38 C.F.R. § 4.118, General Rating for the Skin for DCs 7806, 7809, 7813-7816, 7820-7822, and 7824.

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).

As relevant here, under DC 7800, a 10 percent rating is warranted with one characteristic of disfigurement (outlined below); a 30 percent rating requires visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or two or three characteristics of disfigurement; a 50 percent rating is warranted for disfigurement with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or four or five characteristics of disfigurement. An 80 percent rating is warranted for visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or six or more characteristics of disfigurement. 38 C.F.R. § 4.118.

Note (1) to Code 7800 lists the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or
, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or four or five characteristics of disfigurement. An 80 percent rating is warranted for visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or six or more characteristics of disfigurement. 38 C.F.R. § 4.118.

Note (1) to Code 7800 lists the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id.

Note (3) to Code 7800 instructs that, when evaluating under these criteria, unretouched color photographs be taken into consideration.

Note (5) to Code 7800 explains characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.

DC 7804 pertains to unstable or painful scars. A 10 percent evaluation is assigned for one or two scars that are unstable or painful. A 20 percent evaluation is assigned for three or four scars that are unstable or painful. A 30 percent evaluation is assigned for five or more scars that are unstable or painful. Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2): If one or more scars are both unstable and painful, 10 percent is added to the evaluation that is based on the total number of unstable or painful scars. Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable.

After a review of the evidence, and resolving all reasonable doubt in favor of the Veteran, the Board finds that a 10 percent rating is warranted for the Veteran's PFB pursuant to DC 7804. In this regard, the Veteran reported at a private June 2025 evaluation that he experienced a rash, itching, and bleeding with shaving. The Board finds such symptomatology akin to a painful or unstable scar. Thus, the Board finds that the Veteran's symptoms more nearly approximate the criteria for a 10 percent rating under DC 7804.

However, the Board finds that an even higher rating under DC 7804 is not warranted. In this regard, the Veteran has described experiencing a singular rash, and given the total area affected by the Veteran's PFB, the Board finds that the evidence does not indicate that the Veteran's symptoms more nearly approximate three or more painful or unstable scars.

Further, a rating higher than 10 percent is not warranted under the General Rating Formula for the Skin. There is no evidence of record indicating that 20 to 40 percent of the Veteran's body, or 20 to 40 percent of exposed areas are affected by his skin condition. See May 2024 VA fee-based examination. Further, the evidence also does not show that the Veteran has required systemic therapy (including oral antibiotics or use of retinoids) at any time during the appeal. Id. Rather, the evidence of record shows that he only has received topical treatment for his skin condition during the relevant appeal period. Id.

The Board acknowledges that the Veteran has reported that his PFB impacted his ability to work certain jobs due to the inability to shave. See May 2024 VA fee-based examination. However, the evidence reflects that such has not significantly impacted his ability to work as he is currently employed as a bridge-tender, and the Veteran has not indicated that his PFB impacts his current employment. See July 2025 Mental Disorders Disability Benefits Questionnaire. Furthermore, the Board finds that the Veteran's 10 percent rating contemplates any functional impairment or impairment in earning capacity due to the Veteran's PFB.

The Board also has considered whether any other DCs related to disabilities of the skin would provide for a higher disability evaluation, to include DC 7800 (disfigurement of the head, face, or neck). However, the evidence does not reflect that the Veteran's PFB would warrant a higher rating under a different DC. See 38 C.F.R.
ability to work as he is currently employed as a bridge-tender, and the Veteran has not indicated that his PFB impacts his current employment. See July 2025 Mental Disorders Disability Benefits Questionnaire. Furthermore, the Board finds that the Veteran's 10 percent rating contemplates any functional impairment or impairment in earning capacity due to the Veteran's PFB.

In conclusion, resolving all reasonable doubt in favor of the Veteran, the Board finds his PFB more nearly approximates the criteria for a 10 percent rating under DC 7804 for the entire appeal period. Accordingly, the claim for an increased rating is granted.

REASONS FOR REMAND

1. Entitlement to service connection for a low back disability.

The Veteran contends that his current low back condition is related to his active service. The Board finds that a remand is warranted to correct a pre-decisional duty to assist error.

The Veteran underwent a VA fee-based examination in May 2024 at which time an etiology opinion was provided. The examiner opined that it was less likely than not that the Veteran's back condition was related to his active service. While the examiner considered the Veteran's in-service reports of back pain, it does not appear that he considered or addressed the Veteran's contention that his back condition is related to repeated heavy lifting in service. See April 2024 Fully Developed Claim, VA 21-526EZ (claim). Accordingly, the Board finds that a new or addendum opinion should have been obtained.

The Board acknowledges that the Veteran submitted an opinion from Dr. M.T. in August 2025 who opined that it is at least as likely as not that the Veteran's back condition is directly and causally related to his active service. However, the opinion is conclusory with no rationale provided. To the extent that Dr. M.T. opined that the Veteran's back pain had onset in service and has persisted since, she did not reconcile such finding with the multiple service treatment records (STRs) after 1999 showing that the Veteran denied experiencing back pain. Thus, the Board finds that the opinion is insufficient to grant the claim at this time.

For RO consideration, in the August 2025 private evaluation, the Veteran reported treatment with a civilian provider.

2. Entitlement to service connection for sleep apnea.

The Veteran contends that his sleep apnea is related to his active service. A remand is necessary to correct a pre-decisional duty to assist error.

The Veteran contends that his sleep apnea is related to performing back to back watches that required him to be on standby for 24 hour flight operations while at sea and performing alternating watching standing shifts. See April 2024 claim. While an opinion was obtained in May 2024, the examiner only addressed whether the Veteran's sleep apnea was related to his toxic risk exposure activities (TERA) and did not address whether it was related to the Veteran's shift work in service. Thus, a remand is necessary to obtain such etiology opinion.

The Board again acknowledges that the Veteran submitted a positive private opinion from Dr. M.T. in August 2025. However, the opinion is conclusory without explanation as to why the Veteran's sleep apnea is related to the symptoms the Veteran reports experiencing in service. Therefore, the Board finds the opinion is insufficient to grant the claim at this time.

The matters are REMANDED for the following action:

1. Obtain a VA medical opinion regarding the etiology of the Veteran's low back condition from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand.

The examiner must opine whether it is at least as likely as not that the Veteran's low back condition had its onset in, or is otherwise related to, active service, to include the complaints of exercise-induced back pain in 1999 and/or repetitive lifting of heavy objects in service.

A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran's lay statements.

2. Obtain a VA medical opinion regarding the etiology of the Veteran's sleep apnea from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must
the entire claims file and a copy of this Remand.

A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran's lay statements.

The examiner must opine whether it is at least as likely as not that the Veteran's sleep apnea had its onset in, or is otherwise related to, active service, to include the Veteran's reports of experiencing snoring and cessation of breathing in service, performing back-to-back 24 hour standby watches, and/or performing alternating watching standing shifts.

A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran's lay statements.

C. CRAWFORD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Mortimer, 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.

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