BVA9508213 DOCKET NO. 92-53 746 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to a disability evaluation in excess of 10 percent for skin disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD James L. March, Associate Counsel INTRODUCTION The veteran had active service from June 1955 to June 1958. This appeal comes to the Board of Veterans' Appeals (Board) from an October 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In December 1992, the Board remanded the case for further development. The veteran argues that a higher disability rating should have been in effect back to 1986; however, the Board denied an increased rating in a January 1991 decision, which was not appealed to the United States Court of Veterans Appeals (Court). CONTENTIONS The veteran contends that his skin disability should be rated higher than 10 percent disabling. He alleges that all five fingers of the right hand are involved, and that the disability is manifested by scaling and itching. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence is at least in equipoise and thus supports a 30 percent rating for the veteran's service-connected skin disability. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. The skin disability is manifested by tinea between the third and fourth interphalangeal web spaces, with mild maceration, and yellowish toenails and right fingernails. 3. No unusual or exceptional disability factors have been presented. CONCLUSION OF LAW The criteria for a 30 percent for skin disability have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.10, 4.118, Diagnostic Codes 7806, 7813 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim for an increased rating for skin disability is plausible and capable of substantiation, and thus well grounded within the meaning of 38 U.S.C.A. § 5107(a). When a veteran submits a well- grounded claim, VA must assist him in developing facts pertinent to the claim. 38 U.S.C.A. § 5107(a). The Board is satisfied that all available relevant evidence has been obtained regarding the claim, and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). Specifically, the Board notes that the veteran has not identified any pertinent treatment records which he believes should be obtained to support his claim. In accordance with 38 C.F.R. §§ 4.1, 4.2, and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's skin disability over the sacrum. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. The Board is of the opinion that this case presents no evidentiary considerations, except as noted below, which would warrant an exposition of the remote clinical histories and findings pertaining to the disability at issue. In July 1959, the RO granted service connection for dermatophytosis of the right hand, fingernails, buttocks, lower abdomen and crural regions. A 10 percent disability evaluation was assigned under the provisions of Diagnostic Code 7813 of VA's Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. That code requires that the veteran's skin disability be rated by analogy to eczema under Code 7806. In October 1970, the RO increased the disability rating to 30 percent effective from July 1970. In October 1989, the rating was decreased to 10 percent disabling, which the Board confirmed in a January 1991 decision. Evidence submitted since the Board's January 1991 decision includes VA outpatient treatment records, a VA examination report, private medical records, and the veteran's hearing testimony. Private medical records dated from November 1987 to February 1992 primarily are concerned with maladies other than the veteran's skin disability. However, in November 1987, the veteran complained of itching, cracking and a piling up of his nails, and onychomycosis was diagnosed. In March 1991, it was reported that his skin was generally clear, but that he did have evidence of tinea. The diagnoses included tinea corporis of the nail beds and intertriginous areas. VA outpatient records dated from November 1989 to November 1993 show treatment for dermatophytosis and onychomycosis of the fingers, toes and groin area, and for scaling tinea pedis. The veteran complained of pain and itching, especially of the right thumb. At times, his hands were observed cracking and scaling. Medical treatment consisted of creams to keep the hands moist. The VA examination conducted in January 1993, revealed tinea between the third and fourth interphalangeal web spaces, with mild maceration. The toenails and right fingernails had yellowish discoloration. The assessment was onychodystrophy, probably mycotic, tinea pedis with id reaction and intertrigo with tinea cruris. In April 1993, a hearing was held at the RO. The veteran testified that his skin disorder had affected all of the fingers of the right hand. He stated that the hand exhibited scaling, which inhibited his work performance. He also complained of scaling between the toes and on the soles of the feet. He indicated that he had a fungus infection of the nails of the big toes and the right hand. He stated that the skin on the right hand was embarrassing. A second hearing was held in January 1994. The veteran alleged that when his disability was rated at 30 percent, only two fingers were involved. He indicated that now all five fingers were involved, and that therefore the disability should be rated higher than 10 percent. He reported that the condition of the right hand interfered with his work. Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (1994). The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10. As indicated above, the veteran's service- connected disability has been rated as 10 percent disabling under Diagnostic Code 7806. That Code provides that a 10 percent evaluation is warranted for eczema with exfoliation, exudation or itching and involvement of an exposed surface or extensive area. A 30 percent evaluation requires constant exudation or itching, extensive lesions, or marked disfigurement. A 50 percent evaluation requires ulceration or extensive exfoliation or crusting and systemic or nervous manifestations or exceptionally repugnant disfigurement. The veteran's service-connected disability currently is manifested by tinea between the third and fourth interphalangeal web spaces, with mild maceration and yellowish toenails and right fingernails. The current diagnoses are onychodystrophy, probably mycotic, tinea pedis with id reaction, and intertrigo with tinea cruris, and the outpatient treatment records show that the veteran has complained of pain and itching. Regulations require that where there is a question as to which of two evaluations is to 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. In light of the apparent chronicity of the itching and scaling, and resolving all reasonable doubt in the veteran's favor, the Board is disposed to grant a 30 percent rating but finds no justification for any higher evaluation. There is no evidence of ulceration, extensive exfoliation or crusting, and no evidence of systemic or nervous manifestations or repugnant disfigurement. The Board has given due consideration to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). Moreover, the Board finds that the evidence discussed above does not suggest that the veteran's service-connected disability presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards and warrant the assignment of an extraschedular evaluation pursuant to the provisions of 38 C.F.R. § 3.321(b)(1). The disability in question has not recently required frequent hospitalization, nor has it caused marked interference with employment. ORDER Entitlement to a 30 percent rating for skin disability is granted, subject to the applicable criteria governing the payment of monetary benefits. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.