Citation Nr: 0001273 Decision Date: 01/14/00 Archive Date: 01/27/00 DOCKET NO. 98-04 687 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to an increased evaluation for psoriasis, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD W. Mulligan, Associate Counsel INTRODUCTION The veteran served on active duty from April 1967 through November 1968. This matter comes before the Board of Veterans' Appeals (hereinafter "the Board") on appeal from an October 1997 rating decision of the Department of Veterans' Affairs (hereinafter "VA") Regional Office in Detroit, Michigan (hereinafter "RO"), in which the RO continued the 30 percent evaluation assigned the veteran's psoriasis. The Board notes that the veteran, in a VA Form 9 (Appeal to Board of Veterans' Appeals) received in March 1998, requested a hearing at the RO before the traveling section of the Board. However, in a form received in April 1998, he withdrew his request and asked that his appeal be forwarded to the Board as soon as possible. The Board further notes that the veteran's representative, in a December 1999 Informal Hearing Presentation, appears to be raising additional claims for review. First, on the veteran's behalf, he contends that a notation made in a July 1998 VA examination report should be considered an informal claim for service connection for tinea pedis pursuant to 38 C.F.R. §§ 3.155, 3.157. Second, he claims that due to the veteran's use of topical medication for his service-connected skin disability, the veteran is eligible for a clothing allowance pursuant to 38 C.F.R. § 3.810(a)(2). These raised issues are not now before the Board and are referred to the RO for initial consideration. FINDINGS OF FACT 1. The VA has obtained and fully developed all relevant evidence necessary for the equitable disposition of the veteran's claim. 2. The veteran's psoriasis is characterized by lesions over his body and constant itching, without ulceration, extensive exfoliation or crusting, on examination. On recent examination the disorder was described as mildly disfiguring and that approximately 3 percent of the veteran's body was affected. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for the veteran's psoriasis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.118, Diagnostic Codes 7806, 7816 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The veteran's service medical records contain an April 1967 induction examination report showing no skin abnormalities. In September 1967 the veteran was seen for complaints of rash. The examiner noted raised scaling and isolated tan- colored lesions on the veteran's trunk and legs. The veteran's November 1968 separation examination report notes the veteran's skin as normal. In October 1972, Harold K. Poff, D.O., treated the veteran for a fungus infection of the scalp and legs. In February 1973, the veteran was seen again by Dr. Poff for an eruption of the skin located on the upper arm and the scalp. In October 1979, the veteran was seen by Dr. Poff's associate, Dr. Crist, who noted that the fungal infection was still present. VA outpatient treatment records indicate that the veteran was seen in November 1979 for complaints of a rash on his legs, arms, and chest. The veteran reported that the rash had been present since 1968, mostly on his legs, and was itchy. The examiner noted scaly plaques on the chest and legs, and diagnosed probable psoriasis, rule out fungus infection. In December 1979, the veteran filed a claim for compensation for a fungus infection. In February 1980, a VA examiner noted coin-sized silvery, scaly medallions on the veteran's legs, thighs, and trunk and diagnosed mild psoriasis. In May 1980, the RO granted the veteran service connection and assigned him a 10 percent rating for psoriasis, effective from December 1979. In a March 1981 rating decision, following VA examination, the RO denied the veteran's request for an increased rating. The veteran was seen at a VA dermatology clinic on four occasions in 1993. During these visits, examining physicians found pruritic eruptions, multiple erythematous plaques with active borders, and scaly rashes. In VA outpatient treatment records dated March 1996 and April 1996, examining physicians noted the presence of erythematous plaques with scaling on the groin, trunk, thighs, buttocks, and arms. During an April 1996 VA examination, the examiner noted erythematous scaling plaques of the scalp bilaterally above the ear, annular erythematous scaling plaques on both axillae along with discrete foci satellite lesions, and discrete, one-to-five millimeter erythematous plaques on the torso. He indicated that the lesions were discrete with central scaling and erythematous borders. The examiner noted similar, larger lesions on the upper thigh and in the groin area, and a smaller lesion on the chin. He wrote that the veteran reported the lesions itched and burned and caused pain and discomfort when walking and engaging in ordinary activities. The examiner diagnosed nummular eczema. In a June 1996 rating decision, following VA examination, the RO increased the rating assigned the veteran's psoriasis to 30 percent. The veteran underwent a VA examination in April 1997, during which the examiner noted generalized eruptions over the right ear lobe, entire back, lower extremities, and scrotum. The eruptions were described as papular macular eruptions with fine scaling and sharply marginated lesions. The lesions, which were noted to be scattered and discreet, were also described as pink-red in color, of round or oval shape, and varying between 0.5 and 1 cm. The examiner identified the most distinctive characteristic of the lesions as that they were covered with white fine scaling. The veteran continued to receive outpatient treatment for his skin disability in 1996 and 1997. Twice in May 1997, an examining physician noted that the veteran had scattered, circular lesions on his back, legs and buttocks. In a statement dated June 1998, the veteran indicated that he worked through the pain of his psoriasis, kept his pain to himself while at work, and occasionally played ball with his children. In July 1998, the veteran underwent a VA examination. The examiner recorded the veteran's report of intractable itching. The examiner noted that approximately 3 percent of the veteran's body was covered with guttate scaly papules with a thick scale, most evident on the dorsal hand. A lesion on the head of the penis was noted. The examiner wrote that the eruption was scattered otherwise mostly on the trunk. Marked involvement of the gluteal cleft, with a fissure in the middle was noted. The presence of toenail dystrophy of both fifth toenails was noted, with friable scale between the fourth and fifth toes. The examiner wrote that "Associated systemic and nervous manifestations this veteran complains of constant itch." The examiner diagnosed psoriasiform dermatitis, consistent with either psoriasis or nummular eczema, guttate in nature. The examiner noted that the veteran's disorder was "mildly disfiguring, but not horribly so." The examiner was unable to appreciate any major malodor associated with any of the veteran's problems. As part of the VA examination, a series of photographs (color slides) of the veteran's psoriasis were taken and associated with the record. Legal Analysis The veteran contends that the rating assigned his psoriasis does not adequately reflect the severity of his skin symptomatology, and that a 50 percent rating should be assigned. The preliminary question before the Board, however, is whether the veteran has submitted a well-grounded claim, and if so, whether VA has properly assisted him in the development of his claim. A mere allegation that a service- connected disability has become more severe is sufficient to establish a well-grounded claim for an increased rating. Caffrey v. Brown, 6 Vet.App. 337, 381 (1994); Proscelle v. Derwinski, 2 Vet.App. 629, 632 (1992). As the veteran has claimed that his skin disability has worsened, the Board finds that the veteran has presented a claim that is well grounded. The Board also finds that all relevant facts have been properly developed, and that all available evidence necessary for an equitable disposition of this appeal has been obtained. Therefore, no further assistance to the veteran is required. Disability evaluations are determined by evaluating the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Ratings Disabilities (rating schedule). 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.10 (1999). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to service connection 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). This is so despite the fact that a given disability must be viewed in relation to its history. See 38 C.F.R. § 4.1; see also Schafrath v. Derwinski, 1 Vet.App. 589, 594 (1991). The veteran's psoriasis is currently evaluated as 30 percent disabling under Diagnostic Code (DC) 7816-7806. Under 38 C.F.R. § 4.119, it is indicated that DC 7816, which governs ratings for psoriasis, is to be rated as for eczema, dependent upon location, extent, and repugnant or otherwise disabling character of manifestations. DC 7806, which governs ratings for eczema, provides that a 30 percent rating is warranted for eczema (or in this case, psoriasis) with exudation or itching constant, extensive lesions, or marked disfigurement. A 50 percent evaluation requires psoriasis with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant. The veteran and his representative assert that he is entitled to an increased rating for his service connected skin disorder. The veteran's representative has also contended that the severity of the disorder more closely aligns to the criteria described for a 50 percent rating. In that regard, the July 1998 VA examiner observed "Associated systemic and nervous manifestations this veteran complains of constant itch." The Board considers this statement evidence that the veteran's psoriasis causes systemic or nervous manifestations. However, the other rating criteria to support an increased rating have not been demonstrated. Every examining physician and examiner on record described the veteran's psoriasis as scaly lesions. None indicated that the veteran's psoriasis caused ulceration, extensive exfoliation, or crusting. Indeed, during the July 1998 examination, it was reported that the disorder affected 3 percent of his body. Further, none indicated that the veteran's disorder is exceptionally repugnant. In fact, the July 1998, VA examiner wrote that the veteran's psoriasis "is mildly disfiguring, but not horribly so." Photographic evidence from the examination was provided and is on record. Thus, consistent with the aforementioned criteria, the evidence does not show that an increased rating of 50 percent is warranted. The evidence shows that the veteran's psoriasis is characterized by intractable, or constant, itching lesions that are spread over many areas of his body, including his scalp, fact, torso, back, groin, and legs; however, the objective manifestations shown on examination to support an increased 50 percent rating, as discussed above, have not been shown to be present. We have carefully considered the assertions advanced on the veteran's behalf, but find that the disability picture more nearly approximates the criteria for a 30 percent rating under 38 C.F.R. § 4.119, DC 7806. Accordingly, the Board concludes that a preponderance of the evidence is against the veteran's claim for an increased rating. ORDER A rating in excess of 30 percent for psoriasis is denied. STEVEN L. COHN Member, Board of Veterans' Appeals