DERMATOPHYTOSIS (RINGWORM)

Summary

The Veteran served from December 2002 to July 2008, with additional active duty periods in 2011 and from 2016 to 2017. The Veteran appealed a July 17, 2023, decision concerning his service-connected pseudofolliculitis barbae (PFB) and cervical spine disability. The appeal focused on whether the Veteran was entitled to an initial compensable rating for PFB prior to March 6, 2023, and an increased rating for his cervical spine disability prior to April 26, 2023. For PFB, the Board denied the claim, finding that the evidence prior to March 6, 2023, did not meet the criteria for a compensable rating, as the Veteran's condition and treatment did not warrant a higher rating than the non-compensable one assigned initially. The Board noted that while the Veteran received a 60 percent rating effective March 6, 2023, the evidence prior to that date did not support such a rating. The Board also addressed the Veteran's dissatisfaction with a January 2022 VA Skin Diseases DBQ, finding it adequate despite the Veteran's concerns. The cervical spine claim was remanded due to a duty to assist error, as the VA examinations did not adequately address the ameliorative effects of the Veteran's medications on his range of motion, necessitating a retrospective opinion.

Rationale

Evidence prior to March 6, 2023, did not meet criteria for compensable rating.; Treatment prior to March 6, 2023, did not involve systemic therapy required for higher rating.; PFB evaluated under DC 7813, General Rating Formula for the Skin.

Full Decision Text

Citation Nr: A26040393
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251104-603973
DATE: April 29, 2026

ORDER

An initial compensable rating prior to March 6, 2023, for service-connected pseudofolliculitis barbae (PFB) is denied. 

REMANDED

Entitlement to an initial rating in excess of 10 percent prior to April 26, 2023, for service-connected cervical spine disability is remanded. 

FINDING OF FACT

Prior to March 6, 2023, the Veteran's service-connected PFB was not manifested by characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period.

CONCLUSION OF LAW

The criteria for an initial compensable rating  prior to March 6, 2023,  for service-connected PFB are not met.  38 U.S.C. §1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, DC 7813.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from December 2002 to July 2008 and from November 2016 to November 2017 with periods of active duty service from June 2011 to July 2011 and from July 2011 to February 2013. 

In July 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a July 17, 2023, decision. On November 4, 2024, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior July 17, 2023, decision. 

In the November 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 17, 2023, AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran, or representative, 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, which was subsequently subject to higher-level review 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 cervical spine claim, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

Other than addressed below, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

The Board has recharacterized the issues on appeal to more accurately reflect that this appeal involves the Veteran's disagreement with the initial rating prior to the assignment of a higher 60 percent rating, which has been continuously pursued.  

Evaluations

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the
 raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

The Board has recharacterized the issues on appeal to more accurately reflect that this appeal involves the Veteran's disagreement with the initial rating prior to the assignment of a higher 60 percent rating, which has been continuously pursued.  

Evaluations

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran.  38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999).

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim.  Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 369 (2009).  When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed.  Hart, 21 Vet. App. at 509.

Entitlement to an initial compensable rating prior to March 6, 2023, for service-connected PFB. 

An April 2022 rating decision granted the Veteran's claim for service connection for PFB and assigned a noncompensable rating effective March 25, 2021. See Rating Decision-Narrative (April 2022). The Veteran pursued a higher initial rating by filing timely AMA review options. Ultimately, a July 2023 rating decision granted a 60 percent rating for PFB from March 6, 2023. See Rating Decision (November 2024) (noting that this claim for an increased rating was inappropriately established from the date VA received an intent to file that is associated with another claim). 

This appeal arises from the Veteran's disagreement with that decision denying him a compensable rating prior to March 6, 2023
 rating decision granted the Veteran's claim for service connection for PFB and assigned a noncompensable rating effective March 25, 2021. See Rating Decision-Narrative (April 2022). The Veteran pursued a higher initial rating by filing timely AMA review options. Ultimately, a July 2023 rating decision granted a 60 percent rating for PFB from March 6, 2023. See Rating Decision (November 2024) (noting that this claim for an increased rating was inappropriately established from the date VA received an intent to file that is associated with another claim). 

This appeal arises from the Veteran's disagreement with that decision denying him a compensable rating prior to March 6, 2023, for PFB-he seeks the 60 percent rating for that period. See VA Form 10182 Notice of Disagreement (November 2025). The relevant rating review period begins on March 25, 2021-the date of the grant of service connection-and ends on March 6, 2023, the date of the award of the 60 percent rating. See 38 C.F.R. §3.2500. The Boards has considered all evidence submitted during an authorized evidentiary window as explained above .

The Board concludes that the criteria for assignment of an initial compensable rating prior to March 6, 2023for service-connected PFB are not met. 38 U.S.C. §1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, DC 7813.

The Veteran's PFB has been evaluated under DC 7813, which is evaluated pursuant to the General Rating Formula for the Skin. 38 C.F.R. § 4.118 (the General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824). 

The General Rating Formula for the Skin provides that 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, psoralen with long-wave ultraviolet-A light (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 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, PUVA, or other immunosuppressive drugs required over the past 12-month period. Finally, the disability is to be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating Formula for the Skin.

The Board finds that, prior to March 6, 2023, the Veteran's service-connected PFB was not manifested by characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period.

A January 2022 VA Skin Diseases DBQ reflects that the Veteran's PFB was manifested
, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating Formula for the Skin.

The Board finds that, prior to March 6, 2023, the Veteran's service-connected PFB was not manifested by characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period.

A January 2022 VA Skin Diseases DBQ reflects that the Veteran's PFB was manifested by acne and bumps over the face, which affected less than 5 percent of his total body and exposed areas; and that the Veteran was not treated with medication within the past 12 months for any skin condition. Further, it was noted that there were no benign or malignant neoplasms or metastases related to the condition, no scarring or disfigurement of the head, face, or neck, and that the Veteran's PFB does not impact his ability to work. 

VA treatment record, dated April 2022, reflects that the Veteran was referred to dermatology for follow up treatment for PFB and he reports he has tried topical and oral treatment. See CAPRI at 16 (June 2022). A June 23, 2022, VA dermatology consult reflects that the Veteran was prescribed daily retinoid treatment. See CAPRI at 34 (The Veteran was instructed to restart tretinoin nightly to treat his PFB). Physical examination reveals many erythematous papules throughout his beard line. See CAPRI at 33 and 34 (September 2022). 

An  April 2023 VA Skin Diseases DBQ reflects that the Veteran's PFB is manifested by multiple scattered and raised, solid papules with some visible ingrown hairs and surrounding erythema that is tender to palpation on the cheeks, chin, neck and anterior neck. PFB was noted as treated with Tretinoin, a retinoid medication, in the past 12 months for a duration described as "Constant/near-constant." PFB was noted to affect: (1) 5% to less than 20% of total body area; and (2) greater than 40% of exposed areas.. 

Here, prior to March 6, 2023, the more persuasive evidence of record does not show that the Veteran's PFB covered an area of his body what warranted a higher compensable rating; or that his treatment was of the type that met the criteria for a higher rating. His treatment prior to March 6, 2023, is not shown to have involved intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required. Therefore, the criteria for an initial compensable rating under prior to March 6, 2023, are not more nearly met. See 38 C.F.R. § 4.118, General Rating Formula for the Skin. Indeed, it is not factually ascertainable that the Veteran met the criteria for a compensable rating, to include a 60 percent rating, prior to March 6, 2023. 

Accordingly, the claim is denied. As the evidence of record persuasively weighs against the claims, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Lastly, the Veteran has expressed concern and dissatisfaction with his VA-provided Skin Disease DBQ of January 2022. Indeed, all those who come before the Department of Veterans Affairs should be treated with dignity and respect. The Veteran asserts that the examiner did not ask the Veteran to remove his COVID-19 mask, did not inquire about flare ups of his skin condition, and did not review photographs provided by the Veteran. However, a review of the January 2022 Skin Diseases DBQ reflects a full description of the disability along with all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.  The clinical findings shows a review of the Veteran's e-folder, history as provided by the Veteran concerning symptom onset, details of onset, condition since onset, and current symptoms and treatment. The DBQ further shows that the clinician obtained medical information through physical examination. It is regretful that the Veteran feels that the examination did not comport to his expectations. However, to be clear,
 not ask the Veteran to remove his COVID-19 mask, did not inquire about flare ups of his skin condition, and did not review photographs provided by the Veteran. However, a review of the January 2022 Skin Diseases DBQ reflects a full description of the disability along with all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.  The clinical findings shows a review of the Veteran's e-folder, history as provided by the Veteran concerning symptom onset, details of onset, condition since onset, and current symptoms and treatment. The DBQ further shows that the clinician obtained medical information through physical examination. It is regretful that the Veteran feels that the examination did not comport to his expectations. However, to be clear, the clinician is consulted in a medical capacity for their clinical expertise relating to the claimed condition and this clinician's examination notes do not reflect any legal determinations regarding the Veteran's disability claim. Therefore, the Board finds no reasonable basis to set aside the examination findings to include remanding pursuant to 38 C.F.R. § 20.802 for a new examination.

The Veteran is further reminded that he may file a Supplemental Claim using the instructions provided with this decision for consideration of new and relevant evidence.  

REASONS FOR REMAND

In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand.

Entitlement to rating in excess of 10 percent prior to April 26, 2023, for service-connected cervical spine disability is remanded

An April 2022 rating decision granted service connection for cervical spine disability and assigned a 10 percent rating effective March 25, 2021, under 38 C.F.R. § 4.71a, DC 5237. See Rating Decision (April 2022). In March 2023, the Veteran filed a supplemental claim requesting readjudication of the initial assigned rating; a July 2023 rating decision granted a 20 percent rating from June 9, 2022, for cervical spine disability. See VA Form 20-0995 (March 2023); Rating Decision (July 2023). The Veteran then filed in July 2024 an HLR request as to the denial of a 20 percent rating earlier than assigned, asserting that it should have been assigned from the date of his intent to file, March 25, 2021. See VA Form 0-0996 (July 2024). A November 2024 HLR rating decision granted a 20 percent rating from April 26, 2023, and denied a 20 percent or higher rating prior thereto. The appeal arises from the Veteran's disagreement with the rating assigned prior to April 26, 2023. See VA Form 10182 (November 2025).

The issue of entitlement to a rating in excess of 10 percent prior to April 26, 2023, for service-connected cervical spine disability is remanded to correct a duty to assist error that occurred prior to the decision on appeal. 

VA's duty to assist claimants in the development of their claim includes obtaining an examination and/or opinion when necessary to decide the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Further, once an examination or opinion is obtained, VA must ensure that it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that it is adequate).

Here, the January 2022 and June 2022Neck (Cervical Spine) Conditions DBQs are inadequate for rating purposes because they do not reflect that the clinician discounted the ameliorative effects of medication when evaluating the Veteran's range of motion (ROM) findings. These reports show reflect that the Veteran uses over-the-counter (OTC) medications regularly to treat symptoms associated with his cervical spine disability. See C&P Exam at 5 (February 2022) (Veteran reports taking OTC pain medication during flare ups two times a month lasting 1 to 2 hours to the whole day); C&P Exam at 4 (June 2022) (Veteran reports taking OTC pain medication during flare ups one to two times a week that are moderate and last one to two hours); C&P Exam at 3 (May 2023) (Veteran reports he only takes OTC medications that do not help; however, then reports taking OTC medication to alleviate flare ups that occur daily). 

Under Jones v. Shinseki, 23 Vet. App. 382, 389 (201
 cervical spine disability. See C&P Exam at 5 (February 2022) (Veteran reports taking OTC pain medication during flare ups two times a month lasting 1 to 2 hours to the whole day); C&P Exam at 4 (June 2022) (Veteran reports taking OTC pain medication during flare ups one to two times a week that are moderate and last one to two hours); C&P Exam at 3 (May 2023) (Veteran reports he only takes OTC medications that do not help; however, then reports taking OTC medication to alleviate flare ups that occur daily). 

Under Jones v. Shinseki, 23 Vet. App. 382, 389 (2010), VA must discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use. Id. More recently, the Court in Ingram v. Collins, 38 Vet. App. 130 (2025), held that Jones applies to the evaluation of musculoskeletal conditions. Thus, the AOJ had a duty to obtain retrospective findings that fully satisfy the requirements of Sharp and Jones/Ingram prior to issuing the rating decision on appeal. See Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Chotta v. Peake, 22 Vet. App. 80, 85-86 (2008) (discussing situations when it may be necessary to obtain a "retrospective" medical opinion to determine the date of onset or severity of a condition in years past); Vigil v. Peake, 22 Vet. App. 63 (2008) (holding that the duty to assist may include development of medical evidence through a retrospective medical evaluation where there is a lack of medical evidence for the time period being rated). 

Therefore, remand is necessary to correct the duty to assist errors on the part of the originating agency in satisfying its duties under 38 U.S.C. § 5103A, which occurred prior to the rating decision on appeal. See 38 C.F.R. § 20.802.

The matters are REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician to determine the severity of the Veteran's service-connected cervical spine disability to supplement the January 2022 and  June 2022Neck Conditions DBQs.

If it is not possible to provide a specific measurement without speculation, the clinician 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 clinician (does not have the knowledge or training).

In rendering the below, the clinician should estimate the effective ROM for the disability and present the results of ROM tests in a written report which complies with 38 C.F.R. § 4.59 by recording separate sets of the ROM test results for both active and passive motion, and in weightbearing and non-weightbearing.

Provide an addendum retrospective opinion for the Veteran's service-connected cervical spine disability to supplement the January 2022 and June 2022 that: 

(a.) Estimates the amount in degrees of ROM lost due to pain to both weightbearing and non-weight bearing positions, and on both active and passive motion based on the evidence of record and the Veteran's statements and without considering the ameliorative effects of his medications. 

(b.) Estimates the amount in degrees of ROM due to flare-ups experienced by the Veteran based on the evidence of record and the Veteran's statements and without considering the ameliorative effects of his medications.  

 

C.A. SKOW

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Kenney, K.A.

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.