BVA9502483 DOCKET NO. 93-06 608 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to an increased rating for psoriasis currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant INTRODUCTION This matter comes before the Board of Veterans (Board) on appeal from rating determinations by the St. Petersburg, Florida Regional Office (RO) of the Department of Veterans Affairs (VA). The veterans military service extended from March 1973 to December 1973. In January 1992 the RO granted service connection for psoriatic arthritis and assigned a 20 percent rating for that disorder. The veteran appealed for a higher rating. In October 1992 the RO raised the rating for psoriatic arthritis to 40 percent effective June 19, 1991. The veteran and his representative thereafter indicated by statements as to what the veteran was appealing, that they were no longer seeking a higher rating for psoriatic arthritis. The separate 30 percent rating for psoriasis, which has been in effect since 1983, is the subject of the current appeal. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the psoriasis has been reported to be marked and extensive, that he considers it disfiguring, that it causes cracking of the skin and flaking and that it is repugnant. 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(s). 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 in favor of the claim seeking an increased rating for psoriasis. FINDINGS OF FACT 1. The service-connected psoriasis is currently manifested by marked skin lesions on the hands, elbows, knees, and lower legs, the nails of the hands and feet and the abdomen. 2. The manifestations of the service-connected psoriasis are productive of extensive exfoliation and exceptional repugnance. CONCLUSION OF LAW A 50 percent rating is warranted for psoriasis. 38 U.S.C.A. §§ 5107(a), 1155 (West 1991); 38 C.F.R. § 3.321(b), Part 4, Codes 7816, 7806 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Many of the VA outpatient treatment records in the claims folder dated from 1990 to 1992 discuss manifestations of psoriatic arthritis, for which a separate rating is in effect, and is not in issue at this time. As far as the skin lesions themselves are concerned, they were described in 1990 records as involving the bridge of the nose, ears, elbows, knees and ankles. There was no weeping or ulcers. Between June and September 1991 skin lesions involved the upper and lower extremities, trunk and face. The physicians were resorting to various medications including Methotrexate in an attempt to control the disease. VA outpatient treatment records further reveal that in January 1992 marked psoriasis was noted over the hands, elbows, knees and lower legs. Most of the nails of the hands and feet were involved. In May 1992 the lesions were described as extensive and as involving all extremities and the anterior abdomen. All the nails were involved as well. Comment was made that there was no real remission with Methotrexate and that Indocin and Prednisone were being added as medications. The veterans testimony at the August 1992 RO hearing as to the severity of the psoriasis was compatible with the clinical findings noted in the VA outpatient treatment records. The testimony is considered credible and of significant probative value. He stated that some people considered the psoriasis to be repugnant and that when he swims at a hotel pool, he goes there at night (indicating self consciousness about other people viewing the condition). To warrant a 50 percent rating for psoriasis there must be ulceration, or extensive exfoliation, or crusting and systemic or nervous manifestations, or exceptional repugnance. 38 C.F.R. Part 4, Diagnostic Codes 7816, 7806 (1993). In this case the clinical findings and hearing testimony are clear. There is extensive exfoliation and exceptional repugnance, either of which would justify a 50 percent rating. Such a rating is in order here. We have also considered the question of an extraschedular rating for psoriasis in excess of 50 percent. However, the disability picture as it relates to psoriasis is not so exceptional or unusual to warrant a higher evaluation on an extraschedular basis. It does not cause marked interference with employability or necessitate frequent periods of hospitalization. The veteran's work involves construction, carpentry and painting and the psoriatic arthritis produces considerable difficulty in this type of work. As noted above, that disorder is the subject of a separate 40 percent rating. The requirements for an extraschedular rating above 50 percent for psoriasis are not met. 38 C.F.R. § 3.321(b) (1993). (CONTINUED ON NEXT PAGE) ORDER An increased rating for psoriasis is granted to the extent indicated above subject to laws and regulations governing the payment of monetary awards. BRUCE E. HYMAN Member, Board of Veterans' Appeals 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.