PSORIASIS

Summary

The veteran, who served in the United States Army across multiple periods from October 1981 to October 1985, March 1992 to September 1992, and October 1992 to December 2009, appeals a January 2026 rating decision. The veteran sought a higher rating for service-connected psoriasis, and the Board granted an initial 60 percent rating, finding the criteria met based on the need for daily topical corticosteroid treatment. The Board found the November 2023 VA examination inadequate for psoriasis as it incorrectly stated the veteran had not used medication within the past 12 months, contradicting private treatment records. The Board resolved reasonable doubt in the veteran's favor for the psoriasis claim. The veteran also appealed the evaluation of degenerative joint disease in the left and right feet, and thoracic spine degenerative disc disease, all currently rated at 10 percent. These claims were remanded due to inadequacies in the November 2023 VA examination. For the foot conditions, the examiner provided inconsistent ratings for pain and affected areas, making it impossible to determine the severity. For the spine condition, the examiner failed to elicit and report on the severity, frequency, duration, or functional loss during flare-ups or with repeated use, as required by law. Remands are for obtaining adequate medical opinions addressing these deficiencies.

Rationale

Private treatment records show daily topical corticosteroid use.; November 2023 VA examination was inadequate due to incorrect factual premise.; Resolving reasonable doubt in veteran's favor, 60% rating warranted.

Full Decision Text

Citation Nr: A26038419
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 260114-623976
DATE: April 24, 2026

ORDER

A 60 percent rating for psoriasis is granted.

REMANDED

Evaluation of degenerative joint disease, left foot, which is currently 10 percent disabling, is remanded.

Evaluation of right foot degenerative joint disease with calcaneal spur, which is currently 10 percent disabling, is remanded.

Evaluation of thoracic spine degenerative disc disease, which is currently 10 percent disabling, is remanded.

FINDING OF FACT

The Veteran's service-connected psoriasis required constant or near-constant systemic therapy including corticosteroids over the past 12-month period.

CONCLUSION OF LAW

The criteria for entitlement to an initial 60 percent disability rating for psoriasis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7816.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from October 1981 to October 1985, from March 1992 to September 1992 and from October 1992 to December 2009.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In January 2026 the Veteran submitted a VA Form 10182, notice of disagreement, requesting direct review by a Veterans Law Judge. Therefore, the Board will consider only the evidence of record at the time of the rating decision on appeal. 38 C.F.R. § 20.301.

Evaluation of psoriasis

The Veteran is seeking a higher rating for his service-connected psoriasis.  

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Individual disabilities are assigned separate diagnostic codes. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations should 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. See 38 C.F.R. § 4.7.

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

The Veteran's psoriasis is rated under 38 C.F.R. § 4.118, Diagnostic Code 7816.

Under 38 C.F.R. § 4.118, DC 7816, psoriasis is to be rated under the General Rating Formula for the Skin. A 30 percent rating is warranted if the skin disability meets 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; 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 is warranted if the skin disability meets one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas; or constant or near-constant 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 or more, but not constantly, over the past 
 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 is warranted if the skin disability meets one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas; or constant or near-constant 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 or more, but not constantly, over the past 12-month period. Id.

Turning to the evidence of record, privatemedical records show that between July 2023 and April 2024 the Veteran was prescribed a topical corticosteroid medication to be applied daily for his psoriasis.

During a November 2023 VA medical examination the Veteran reported using a topical corticosteroid daily for his psoriasis. The Board notes that the VA examiner marked that the Veteran had not been treated with medication for his skin condition within the past 12 months on examination report. The Board finds the November 2023 examination to be inadequate as it is based on an incorrect factual premise. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (indicating a medical opinion based on incorrect factual premise is not probative). Private treatment records clearly indicate that the Veteran was being treated with medication for his skin disorder.

Considering this, the Board finds that the Veteran's overall disability picture more closely approximated the criteria associated with a 60 percent rating under Diagnostic Code 7816. The record shows that during the appeal period on review, the Veteran was treated with topical corticosteroid medication to be applied daily.

Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that, the maximum 60 percent rating is warranted under DC 7816. 38 U.S.C. § 5107(b); See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Evaluation of degenerative joint disease, left foot

2. Evaluation of right foot degenerative joint disease with calcaneal spur

The Veteran is seeking a higher rating for his service-connected bilateral foot disorder.

The Veteran was given a VA examination in November 2023. The Board finds the November 2023 VA examination is inadequate as it is internally inconsistent. When asked to indicate the severity of pain and the side affected the examiner marked "not affected" and "right" foot, "mild" and "right" foot, "moderate" and "left" foot, "moderately severe" and "right" foot, and "severe" and "right" foot. The Board is unable to determine the severity of the Veteran's bilateral foot disorder based off of these answers. 

Once VA obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). A remand based on this pre-decisional duty-to-assist error is warranted to obtain an adequate VA medical opinion. 38 C.F.R. § 20.802(a).

3. Evaluation of thoracic spine degenerative disc disease

The Veteran is seeking a higher rating for his service-connected thoracis spine disorder.

During a November 2023 VA examination the Veteran reported daily back pain usually while asleep. He experienced difficulty bending, climbing, and walking for extended periods. He denied experiencing flareup but further reported his symptoms are relieved with rest. The examiner measured both active and passive range of motion but did not provide estimated range of motion for repeated use over time or with flareups. 

By law, a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. 

The Board finds that the current November 2023 VA examination report is inadequate because it did not conform with the requirements of Sharp v. Shulkin. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). A remand based on this pre-decisional duty-to-assist error is warranted to obtain an adequate VA medical opinion. 38 C.F.R. § 20.802(a).

The matters are
 be given. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. 

The Board finds that the current November 2023 VA examination report is inadequate because it did not conform with the requirements of Sharp v. Shulkin. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). A remand based on this pre-decisional duty-to-assist error is warranted to obtain an adequate VA medical opinion. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with a VA physician of appropriate expertise (i.e., orthopedist) to evaluate the current severity of his bilateral foot condition. The claims file, including a copy of this REMAND, must be made available to the examiner and it should be reviewed in its entirety. A detailed history of symptoms should be procured from the Veteran. All pertinent diagnostic tests and studies should be conducted, and all findings reported in detail.

Thereafter the examiner is asked to:

(a) Identify and describe all symptoms and manifestations attributable to the disabilities. All necessary diagnostic testing and evaluation should be performed, including range of motion testing in both passive and weight-bearing situations. If pain is identified during passive or non-weight-bearing range of motion, the examiner should estimate the degree at which pain begins.

(b) The examiner should attempt to elicit information from the Veteran regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. Based on the information provided, the examiner must provide an estimate of any additional degrees of limitation of range of motion caused by functional loss during a flare-up of symptoms and/or repeated use over time.

It should be noted that VA's Clinicians Guide specifically advises examiners to try to procure information necessary to render an opinion regarding flare-ups from Veterans.

(c) The examiner should discuss the impact of the Veteran's disabilities on occupational functioning and activities of daily living.

If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

2. Schedule the Veteran for a VA examination with a VA physician of appropriate expertise (i.e., orthopedist) to evaluate the current severity of his spine condition. The claims file, including a copy of this REMAND, must be made available to the examiner and it should be reviewed in its entirety. A detailed history of symptoms should be procured from the Veteran. All pertinent diagnostic tests and studies should be conducted, and all findings reported in detail.

Thereafter the examiner is asked to:

(a) Identify and describe all symptoms and manifestations attributable to the disabilities. All necessary diagnostic testing and evaluation should be performed, including range of motion testing in both passive and weight-bearing situations. If pain is identified during passive or non-weight-bearing range of motion, the examiner should estimate the degree at which pain begins.

(b) The examiner should attempt to elicit information from the Veteran regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. Based on the information provided, the examiner must provide an estimate of any additional degrees of limitation of range of motion caused by functional loss during a flare-up of symptoms and/or repeated use over time.

It should be noted that VA's Clinicians Guide specifically advises examiners to try to procure information necessary to render an opinion regarding flare-ups from Veterans.

(c) The examiner should discuss the impact of the Veteran's disabilities on occupational functioning and activities of daily living.

If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

 

 

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jarvis, Krystal L.

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.