SKIN CONDITIONS

Summary

The veteran, who served from April 1994 to April 1997, appeals the reduction of his disability rating for acne keloidalis nuchae (ACN) from 30 percent to 10 percent, effective April 1, 2025. The Board reviewed the case based on the Direct Review docket, considering only evidence of record at the time of the agency of original jurisdiction's decision. Service connection for ACN was initially granted at 30 percent in July 2022, based on a VA examination finding lesions covering 20 to 40 percent of exposed areas and treatment with steroids for over six weeks annually, along with work limitations. The reduction was based on a July 2024 VA examination, which described current symptoms as "bumps in the head," affecting less than 5 percent of the body, with less than six weeks of corticosteroid treatment and no work limitations. However, the Board found this examination internally inconsistent and not thorough. Specifically, the examiner did not address whether the disability improvement reflected an improvement in the veteran's ability to function under ordinary conditions, and the conclusion that the condition worsened but no longer impacted work was contradictory. The Board determined that the reduction was improper due to the failure to properly apply 38 C.F.R. § 3.344, which requires evidence of actual improvement in functioning. Consequently, the Board granted the restoration of the 30 percent rating.

Rationale

Reduction of rating from 30% to 10% was improper.; July 2024 VA exam was internally inconsistent and not thorough.; Failure to demonstrate actual improvement in functioning.; Restoration of 30% rating granted.

Full Decision Text

Citation Nr: A26031774
Decision Date: 04/07/26	Archive Date: 04/07/26

DOCKET NO. 251229-618628
DATE: April 7, 2026

ORDER

The reduction of the 30 percent rating for service-connected acne keloidalis nuchae (ACN) to 10 percent effective April 1, 2025, was not proper, and restoration of the 30 percent rating is granted.

FINDING OF FACT

The reduction in the disability rating for the Veteran's service-connected ACN from 30 percent to 10 percent was not based on improvement in the Veteran's ability to function under the ordinary conditions of life and work.

CONCLUSION OF LAW

The reduction in the disability rating for ACN from 30 percent to 10 percent effective April 1, 2025, was not proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105(e)(i), 3.344, 4.1, 4.2, 4.3, 4.118, Diagnostic Code 7820.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from April 1994 to April 1997. This matter comes ot the Board on appeal from a January 2025 rating decision. In the December 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in this decision.  See 38 C.F.R. § 20.300.

The reduction of the 30 percent rating for service-connected ACN to 10 percent effective April 1, 2025, was not proper, and restoration of the 30 percent rating is granted.

VA disability ratings are based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. See 38 U.S.C. § 1155. In no event shall a veteran's disability rating be reduced unless an improvement in the veteran's service-connected disability is shown to have occurred. See id. When a veteran's disability rating is reduced without compliance with applicable VA regulations, the erroneous reduction is void ab initio and must be vacated resulting in restoration of the prior rating. See Schafrath v. Derwinski, 1 Vet. App. 589, 595-96 (1991).

Where a reduction in an evaluation of a service-connected disability or employability status is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance must be prepared setting forth all material facts and reasons. See 38 C.F.R. § 3.105(e). VA regulations further require that (1) the veteran be notified at his latest address of record of the contemplated action and furnished detailed reasons therefor; (2) the veteran be given sixty days for the presentation of additional evidence to support the continuation of compensation payments at their present level; and (3) if additional evidence is not received within that period, the final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. See id.

In this case, the Board finds that the procedural requirements of 38 C.F.R. § 3.105 are met. An August 2024 rating decision proposed to reduce the rating for ACN. Then, the January 2025 rating decision on appeal decreased the rating of the Veteran's ACN from 30 to 10 percent effective April 1, 2025. 

By way of history, service connection for ACN was granted in a July 2022 rating decision and evaluated under Diagnostic Code 7820, with a 30 percent rating assigned for characteristic lesions involving 20 to 40 percent of exposed areas affected, as found during a May 2022 VA examination. 38 C.F.R. § 4.118.

Prior to reducing a veteran's disability rating, VA is required to consider the entire history of the veteran's disability, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10. Such review requires VA to ascertain, based upon a review of the entire
 of history, service connection for ACN was granted in a July 2022 rating decision and evaluated under Diagnostic Code 7820, with a 30 percent rating assigned for characteristic lesions involving 20 to 40 percent of exposed areas affected, as found during a May 2022 VA examination. 38 C.F.R. § 4.118.

Prior to reducing a veteran's disability rating, VA is required to consider the entire history of the veteran's disability, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10. Such review requires VA to ascertain, based upon a review of the entire record, whether the evidence of record reflects an actual change in the Veteran's disability, and whether the examination reports reflecting such change are based upon a thorough examination. See Faust v. West, 13 Vet. App. 342, 349-50 (2000). Thus, in any rating reduction appeal, not only must it be determined that an improvement in a disability has actually occurred, but also that such improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. See Brown v. Brown, 5 Vet. App. 413, 420-21 (1993).

In addressing whether improvement is shown, the last examination on which the disability rating at issue was assigned or continued generally serves as the point of comparison. See Hohol v. Derwinski, 2 Vet. App. 169, 172-73 (1992). However, if the disability rating was continued in order to see if improvement was in fact shown, the comparison point may also include prior examinations. See Collier v. Derwinski, 2 Vet. App. 247, 250 (1992). A rating reduction generally must have been supported by the evidence of record at the time of the reduction, but pertinent post-reduction evidence favorable to restoring the rating must also be considered. See Dofflemyer v. Derwinski, 2 Vet. App. 277, 281 (1992).

The requirements for reduction of ratings in effect for five years or more are subject to additional protection and may only be reduced upon evidence that establishes with reasonable certainty that any material improvement in the physical or mental condition will be "maintained under the ordinary conditions of life," as shown by full and complete examinations. See 38 C.F.R. § 3.344(a), (b). Disability ratings which are likely to improve or have been continued at the same level for fewer than five years do not qualify for the protections of 38 C.F.R. § 3.344(a) and (b); instead, such ratings are subject to re-examination that may potentially disclose mental or physical improvement, which if shown, will warrant a reduction in rating. See 38 C.F.R. § 3.344 (c).

In this case, the rating at issue had been in effect for fewer than five years, and therefore, the 30 percent rating is not subject to the heightened protections of 38 C.F.R. § 3.344(a) and (b). See Brown, 5 Vet. App. at 418-19. Nevertheless, no rating reduction may be implemented unless the evidence of record persuasively weighs in favor of a finding that not only has an improvement in the disability level actually occurred, but also that such improvement actually reflects an improvement in the ability of the veteran to function under the ordinary conditions of life and work. See id. at 420-21.

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. See 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). 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. See 38 C.F.R. § 4.7.

The Veteran's ACN is rated under the General Rating Formula for the Skin. 38 C.F.R. § 4.118. Under that formula, a
3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. See 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). 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. See 38 C.F.R. § 4.7.

The Veteran's ACN is rated under the General Rating Formula for the Skin. 38 C.F.R. § 4.118. Under that 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 for 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. Id.

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. Id.

As noted above, the Veteran's 30 percent rating was based on the findings of a May 2022 VA examiner. The examiner found lesions covering 20 to 40 percent of exposed areas and treatment with steroids for greater than 6 weeks of the year. The examiner also indicated limitations to the Veteran's ability to work, noting limitations on submerging the skin in fluid, no direct sunlight, no close haircuts, and no shaving. The Veteran reported he still got lesions on his scalp constantly and had gone to see doctors who gave him oral medications and steroid injections. He reported that some lesions never go away and some go away and return within a month.

The Veteran subsequently attended a July 2024 VA examination, which is the basis for the reduction at issue. The examiner described the current symptoms as "bumps in the head," without elaboration. The examiner found that the Veteran's ACN impacted less than 5 percent of the Veteran's total body and exposed areas. The examiner noted continued use of corticosteroid injections, but for less than 6 weeks of the year. The examiner noted the use of topical shampoo to treat bumps in the head. The examiner found no limitations on work. However, the examiner also stated the Veteran's ACN had worsened.

The January 2025 rating decision on appeal relied solely on the July 2024 examination report to reduce the Veteran's rating. However, that examination was not thorough and was internally inconsistent. The July 2024 examiner did not address whether there was an actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. The examiner did not indicate whether they were considering the Veteran's skin condition at a time when the Veteran's lesions were at their worst (as described during the 2022 examination), and their conclusions that the condition had worsened but was no longer affecting the Veteran's ability to work were internally inconsistent. 

The failure to properly apply the provisions of 38 C.F.R. § 3.344 renders void ab initio the reduction for the Veteran's service-connected ACN from 30 percent to
 to reduce the Veteran's rating. However, that examination was not thorough and was internally inconsistent. The July 2024 examiner did not address whether there was an actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. The examiner did not indicate whether they were considering the Veteran's skin condition at a time when the Veteran's lesions were at their worst (as described during the 2022 examination), and their conclusions that the condition had worsened but was no longer affecting the Veteran's ability to work were internally inconsistent. 

The failure to properly apply the provisions of 38 C.F.R. § 3.344 renders void ab initio the reduction for the Veteran's service-connected ACN from 30 percent to 10 percent. Accordingly, the previously assigned 30 percent disability rating must be restored effective April 1, 2025.

 

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Baker, 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.