Citation Nr: 0004027 Decision Date: 02/16/00 Archive Date: 02/23/00 DOCKET NO. 96-26 071 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES Entitlement to an increased rating for post-cerebral concussion with anxiety reaction, headaches, and tinnitus, currently evaluated as 30 percent disabling. Entitlement to an increased rating for tinea versicolor and tinea pedis, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Marisa Kim, Associate Counsel INTRODUCTION The veteran had active military service from October 1968 to March 1970. The matters before the Board of Veterans' Appeals (Board) are on appeal from the November 1994, July 1995, and May 1999 rating decisions from the New Orleans, Louisiana, Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this case in September 1997 for comprehensive VA neurological, psychological, psychiatric, and dermatology examinations. This matter is now before the Board for final appellate review. FINDINGS OF FACT 1. The medical evidence shows appropriate affect, normal speech, fair judgment and insight, and no evidence of panic attacks. 2. The veteran successfully worked for 16 years after his head injury, and he maintains a close relationship with his wife and ties with his children. 3. The veteran does not experience prostrating and prolonged headaches productive of severe economic adaptability. 4. The medical evidence shows pruritus resolved with treatment, mild scaling, and no exudate, extensive lesions, or marked disfigurement. CONCLUSIONS OF LAW 1. The criteria are not met for an increased rating for post cerebral concussion with chronic anxiety reaction, headaches, and tinnitus, currently 30 percent disabling. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.10, 4.20, 38 C.F.R. § 4.124a, Diagnostic Codes 8045 and 8100 (1999); 38 C.F.R. § 4.130, Diagnostic Codes 9304, 9400, and 9413 (1999) (effective November 7, 1996); 38 C.F.R. § 4.132, Diagnostic Codes 9304, 9400, and 9413 (effective prior to November 7, 1996). 2. The criteria are not met for an increased rating for tinea versicolor and tinea pedis, currently 10 percent disabling. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.10, 4.20, 4.118, Diagnostic Codes 7804 and 7806 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The claim of entitlement to an increased rating for post-cerebral concussion with anxiety reaction, headaches, and tinnitus, currently evaluated as 30 percent disabling. Factual Background The veteran underwent a VA neurological examination in August 1970. The veteran was ambulatory and unaccompanied. He reported that he was engaged in combat in Vietnam when he was blown into the air and sustained a cerebral concussion during a mortar rocket attack. Afterwards, he became extremely nervous and experienced headaches. Physical examination revealed that the cranial nerve 5 revealed a slight increase in jaw jerk and no other abnormality. The other cranial nerves were within normal limits. Motor function was pretty good. Reflexes were 2 or 3 + overall equal, bilaterally. Cerebellar testing was entirely within normal limits in the upper and lower extremities. Sensory examination revealed no loss of sensation over all 4 extremities in the trunk and face. The impression was a cerebral concussion, by history, with psychogenic moderately severe headaches and chronic anxiety reaction. The veteran underwent a VA neurological disorders examination in August 1994. He reported having headaches in 1970s when he was posted in Vietnam. The headaches last for 45 minutes to 1 hour and occur 2-3 per week. At times, the pain was so severe, pounding in character, that he had to lie down and rest. There was no associated symptomatology of nausea, vomiting, photophobia, double vision, or paresthesias during the headaches. Physical examination revealed that the veteran's mental status, cranial nerves, including fundi, were within normal limits. There was no motor weakness, no atrophy of muscles, and stance and gait were normal. The impression was headache of muscle contraction type that was aggravated by anxiety and tension. The veteran also underwent a mental disorders examination in August 1994. The veteran reported poor sleep, fair appetite, good concentration and good energy. He stated that he was a loner and did not like to relate to people. He reported that he had difficulty with his anger but was able to control it. He reported that he had lost interest in his hobbies. He was able to have a close relationship with his wife but felt detached from other people. Physical examination revealed that the veteran's speech was of normal rate, tone, and volume, and his affect was full range and appropriate. His thought process was goal-directed with no looseness of association or flight of ideas. He had no suicidal ideation, no homicidal ideation, and no auditory or visual hallucinations. He was alert and oriented times 3. He remembered 3 of 3 objects in 5 minutes. He performed serial 3s times 5. His judgment and insight were fair. The Axis III diagnosis was post-cerebral concussion with chronic anxiety reaction and headaches. The October 1994 treatment report stated that the veteran had muscle contraction type headaches aggravated by anxiety. The veteran's April 1995 appeal alleged that he experienced headaches 3-4 times weekly for hours and that he had blurred vision, ringing of the ears and dizziness. The veteran provided sworn testimony at a regional office hearing in April 1995. He went to the mental hygiene clinic every 3 months. As a result of the concussion, he experienced anxiety and difficulty sleeping. He had headaches 3-4 times per week, sometimes for 2 hours or longer. He had a terrible pain on the top of his head and blurred vision. Transcript (April 1995), page 2. He had to lay quietly in the dark to get relief. He experienced ringing in his ears during the headaches. Transcript (April 1995), page 5. His last job was in March 1993, and he was not working now. Transcript (April 1995), page 6. The veteran was married and had 3 children. The children were older and stayed out of his way. When he was working, some people got on his nerves. Transcript (April 1995), page 7. The veteran was still going to the mental hygiene clinic. Transcript (April 1995), page 8. In April 1996, the veteran reported headaches related to increased stress. The veteran also reported headaches to VA examiners in April 1995, July 1995, September 1995, November 1995, December 1995, February 1996, May 1996, July 1996, September 1996, November 1996, January 1997, and July 1997. The August 1997 treatment note stated that the veteran had chronic tension headaches and anxiety. The October 1997 x-ray revealed no evidence of fracture or dislocation. The impression was that there was a calcification in the fax cerebri; otherwise, the skull series was normal. The veteran underwent a VA brain and spinal cord examination in November 1997. Since the head injury in Vietnam, he had headaches 2-3 times per week that lasted 1-2 hours. He reported that the headaches started in both temples, radiated to the back, and required him to lie down in a quiet place. He had photophobia, phonophobia, blurred vision, and ringing in the ears. Neurological examination revealed that the cranial nerves were all within normal limits. The diagnosis was headache most probably related to the trauma and some element of vascular type headache, and a back problem with radiculopathy. The veteran underwent a VA psychological disability examination in November 1997. The veteran reported that he last worked in January 1997 for 2 months but that he had to discontinue due to back problems. He performed well at his previous job as a courier because he did not have to associate with people. The veteran reported that some people bothered him and that he liked being alone most of the time. He reported an anxiety reaction because he always looked forward and back to see who was watching him. He complained of bad headaches 2-3 times per week. The veteran arrived on time for his appointment and was casually dressed with adequate hygiene. He was fully oriented. His spontaneous speech was normal. There was no evidence of cognitive deficits. His headaches were exacerbated when he became anxious. He reported occasional nightmare, and in the past, had even grabbed his wife and started choking her in response to a nightmare. He was less interested in activities since his return from Vietnam, and he described feelings of emotional detachment, even from his mother. He reported sleep disturbances and frequent irritability. In accordance with the Board remand, the psychologist delineated symptoms according to the organic brain syndrome and posttraumatic stress disorder (PTSD). The psychologist opined that most likely related to the organic brain syndrome were headaches, irritability, social withdrawal, and cognitive dysfunction. Most likely related to PTSD were re-experiencing symptoms, avoidance symptoms, emotional detachment, arousal symptoms, and some exacerbation of concussion symptoms. Although irritability was probably directly attributable to the concussion, it was likely that PTSD was exacerbating the irritability, headaches, and social withdrawal. The veteran had concentration difficulties although it was difficult to determine if this was a function of the head injury or of PTSD. Test results suggested little intellectual decline related to the head injury. His concentration was adequate on simple tasks but mildly impaired on tasks requiring more extensive mental manipulation. He had significant difficulty with mental flexibility. Naming and spoken language functions were within normal limits. Fine motor speed was impaired for the right, dominant hand. Psychological testing revealed generalized distress with both depressive and anxious components. The diagnostic impression of Axis I was mild to moderate chronic PTSD, cognitive disorder not otherwise specified, related to post concussive syndrome, and personality change due to head injury. The diagnostic impression of Axis III was a history of traumatic brain injury with concussion. The psychologist opined that the current global assessment function (GAF) of 60 was based on the veteran's moderate social problems due to his explosive temper but that he continued in a marriage with reasonable relationships with his wife and children. Although he was not working, this work dysfunction was mostly a result of his back injury, and his job choices had been restricted due to his social withdrawal and difficulties interacting with others. The cognitive disorder and personality changes due to the head injury were equivalent to the old organic brain syndrome diagnosis. The psychologist could not determine completely the relative degree to which PTSD versus personality change due to head injury contributed to the veteran's occupational and social impairment. The psychologist opined that it was likely that the cognitive impairment contributed little to his occupational and social dysfunction because the veteran was distressed from combat before the head injury. However, his head injury seemed to be the major turning point in the symptom expression of irritability and social withdrawal. The psychologist opined that PTSD was likely to further exacerbate the irritability, social withdrawal, and headaches. The veteran underwent a psychiatric disability examination in November 1997. The examiner stated that he reviewed the neurological and psychological examination reports and the veteran's claims file. The psychiatrist did not see any residual of the veteran's organic brain syndrome secondary to his concussion from a psychiatric standpoint. The psychiatrist noted that the neurologist felt that headaches might be posttraumatic or vascular in origin. The psychiatrist opined that the psychologist would be more equipped to pick up any cognitive disorder that he had been unable to find in the psychiatric mental status examination. Criteria Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Schedule). 38 C.F.R. Part 4 (1999). The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Regulations require the evaluation of the complete medical history of the veteran's condition. 38 C.F.R. §§ 4.1, 4.2 (1999). The Rating Schedule also provides that when evaluating the mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission shall be considered and the evaluation shall be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. The evaluation also must consider the extent of social impairment, but shall not be assigned solely on the basis of social impairment. When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition. See 38 C.F.R. § 4.126 (1999). Organic disease of the central nervous system are evaluated under the criteria of 38 C.F.R. § 4.124, the schedule of ratings for neurological conditions and convulsive disorders. With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves. Brain disease due to trauma is evaluated under the criteria of Diagnostic Code 8045. Purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code (e.g., 8045-8207). Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304. This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma. 38 C.F.R. § 4.124a, Diagnostic Code 8045 (1999). In turn, dementia due to head trauma is evaluated under the criteria of Diagnostic Code 9304. Dementia, generalized anxiety disorder and anxiety disorder, not otherwise specified, are evaluated under the criteria of the General Rating Formula for Mental Disorders. Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name, is entitled to a 100 percent evaluation. Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships, is entitled to a 70 percent evaluation. Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships, is entitled to a 50 percent evaluation. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events), is entitled to a 30 percent evaluation. 38 C.F.R. § 4.130 (1999). New evaluation criteria for anxiety disorders became effective November 7, 1996. Where a law or regulation changes after a claim is filed or reopened, but before the administrative or judicial appeal process has been concluded, the version more favorable to the appellant applies unless Congress provided otherwise or permitted the Secretary to do otherwise and the Secretary does so. Karnas v. Derwinski, 1 Vet. App. 308 (1991). Therefore, anxiety disorders must be evaluated under the criteria, old or new, which are determined to be more beneficial to the veteran. Prior to November 1996, governing regulation provided that the severity of a psychiatric disability would be measured by actual symptomatology, as it affects social and industrial adaptability. Evaluators were specifically instructed not to "underevaluate the emotionally sick veteran with a good work record, nor [to] overevaluate his or her condition on the basis of a poor work record not supported by the psychiatric disability picture." 38 C.F.R. § 4.130 (1996). Under the old criteria, a 30 percent evaluation was warranted for definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency, and reliability levels as to produce definite industrial impairment. A 50 percent evaluation was warranted if an ability to establish or maintain effective or favorable relationships with people is considerably impaired, and by reason of psychoneurotic symptoms, the reliability, flexibility, and efficiency levels are so reduced as to result in considerable industrial impairment. A 70 percent evaluation was warranted if an ability to establish and maintain effective or favorable relationships with people is severely impaired, and the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 100 evaluation was warranted if the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, and there are totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such a fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior, and the veteran is demonstrably unable to maintain or retain employment. 38 C.F.R. § 4.132 (1996). In applying this standard, the VA interprets "definite" to mean "distinct, unambiguous, and moderately large in degree." VAOPGCPREC 9- 93 (Nov. 9, 1993). Headaches will be evaluated under the criteria for migraine headaches, an analogous disease. See 38 C.F.R. § 4.20 (1999). Migraine headaches are evaluated under the criteria of 38 C.F.R. § 4.124a, Diagnostic Code 8100. A 50 percent evaluation is warranted for migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 30 percent evaluation is warranted for migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months. A 10 percent evaluation is warranted for migraine headaches with characteristic prostrating attacks averaging one in 2 months over last several months. 38 C.F.R. § 4.124a, Diagnostic Code 8100 (1999). When 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). Analysis As a preliminary matter, the Board will adjudicate a decision based upon the current evidence because the veteran did not answer the RO's July 1995 letter that asked whether he wanted a Board hearing in Washington, D.C. or a Travel Board hearing at the regional office. In any event, the veteran received a regional office hearing in April 1995. The claim for an increased rating is well grounded because the veteran's June 1994 statement asserted that his service- connected disabilities have increased in severity. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78 (1990). A veteran's assertion that the disability has worsened serves to render the claim well grounded. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The veteran's disability has been diagnosed as both a physical condition and as a mental disorder. Therefore, the Board will rate the disability under the diagnostic code that represents the more disabling aspect of the veteran's condition. See 38 C.F.R. § 4.126. With respect to the veteran's physical condition, the veteran has already received an evaluation in excess of the 10 percent rating available under Diagnostic Code 8045 for purely subjective complaints of headaches and insomnia without a diagnosis of multi-infarct dementia. In addition, an increased rating is not warranted for headaches under the criteria of Diagnostic Code 8100. Although the veteran experiences headaches 2-3 times per week for 1-2 hours at a time, he did not provide evidence of prostrating and prolonged headaches productive of severe economic adaptability. Rather, the veteran worked for 16 years after his head injury, and the November 1997 examiner and the veteran attributed most of his current work dysfunction to a back injury. With respect to a mental disorder, the current 30 percent rating continues to be warranted under the criteria of Diagnostic Codes 9304, 9400, and 9413. A 50 percent rating is not warranted under the new criteria that went into effect in November 1996. In support of an increased rating, the veteran is only able to work if left alone, and the November 1997 examiner noted mild impairment of concentration and significant difficulty with mental flexibility. Against an increased rating, the veteran reported that he worked well as a courier. His affect was appropriate and of full range in August 1994. His speech was of normal rate, tone, and volume in August 1994, and his spontaneous speech was normal in November 1997. There was no evidence of panic attacks. There was no evidence of cognitive deficits in November 1997. His judgment and insight were fair in August 1994. His thought process was goal-directed with no looseness of association or flight of ideas in August 1994. Although he is detached from his mother, he maintains a close relationship with his wife and ties with his children, and prior to his back injury, the veteran worked successfully for 16 years. A 50 percent rating is also not warranted under the old criteria in effect prior to November 1996. With respect to an ability to establish and maintain effective and favorable relationships with people, the veteran is irritable and wants to be alone. Nonetheless, he has maintained a close relationship with his wife and ties with his children. Although he experiences significant difficulty with mental flexibility, the veteran has not experienced considerable industrial impairment because he worked successfully for 16 years. The November 1997 examiner opined that cognitive impairment contributed little to occupational and social dysfunction because the veteran was distressed from combat before the head injury. In any event, the November 1997 examiner and the veteran attributed his current industrial impairment to his back injury. Accordingly, the veteran's disability picture more nearly approximates the criteria for a 30 percent rating. It should also be noted that service connection is also in effect for post-traumatic stress disorder with anxiety reaction, which is currently assigned a separate 10 percent evaluation. Finally, extraschedular considerations do not apply in this case because exceptional circumstances have not been claimed or demonstrated. See Smallwood v. Brown, 10 Vet. App. 93, 97-98 (1997); 38 C.F.R. § 3.321(b)(1999). The claim of entitlement to an increased rating for tinea pedis and tinea versicolor, currently 10 percent disabling Factual Background The veteran underwent a VA dermatology examination in August 1970. He reported that, in Vietnam in 1969, he developed itching, scaling rash on both of his feet. He also noticed some scaling and itching rash on his neck and upper shoulders. Physical examination revealed slightly yellow hypopigmented scaly macula lesions of 1-2 centimeters (cm) diameter on the posterior aspect of the neck, upper part of the back, and deltoid areas. On the plantar aspect of both feet, there was a minimal amount of scaliness on the ball and heel areas and in both fourth web spaces. The diagnosis was tinea versicolor of the back and deltoid areas and tinea pedis, bilaterally. In October 1992, the veteran underwent a single shave biopsy of the skin of his left dorsal forearm. The epidermis showed a raised, pigmented lesion measuring 9 millimeters (mm) at the greatest dimension. The diagnosis was seborrheic keratosis. The veteran underwent a VA general examination in August 1994. Physical examination revealed pigmented spots on the frontal area with scars secondary to acne on the upper back, a chronic skin rash in the groin area, and tinea pedis maceration of the skin between the toes. The veteran's April 1995 appeal alleged that he had a chronic rash on his feet, chest, groin, back, and forehead. He alleged that medication did not help. The veteran provided sworn testimony at a regional office hearing in April 1995. The veteran requested a special dermatology examination. Transcript (April 1995), page 2. He had a chronic skin problem between his toes, in the groin area, and on his chest, back, and forehead. Transcript (April 1995), page 3. The veteran underwent a VA skin diseases examination in October 1997. The veteran reported darkening of his face for 10 years. It started as small red and scaly patches and occasionally involved his back and chest. The veteran complained that his face burned in hot weather and occasionally scaled and got darker in sunlight. He also complained of itching on his flanks. Physical examination revealed glabella, dorsal nose, lateral cheeks with non-scaly hyper-pigmented patches, bilateral flanks with xerotic changes, and a few slightly eczematous small patches. Potassium hydroxide scraping of the face was negative. The diagnoses were melasma and nummular eczema. The examiner opined that these diagnoses were likely not related to his service connection. The veteran underwent a VA skin disease examination in July 1998. The veteran reported a 30-year history of bilateral facial, forehead, and brown pruritus. Recently, his pruritus resolved with treatment. In addition, the veteran complained that he had jock itch in addition to bilateral foot dermatitis. Physical examination revealed that the face was significant for areas of confluent hyper-pigmentation across the forehead and bilateral face including the chin. There were no areas of erythema, vesicles bulla or scale appreciated. The chest, shoulders, back, buttocks, and groin were without lesions. The veteran had hyper-pigmented patches bilaterally in the inguinal areas intertriginous. The veteran had maceration of the bilateral toe webs without significant scaling. The veteran had deep-seated vesicles located on the bilateral feet primarily lateral aspects and insteps in addition to air insercinate areas hyperkeratosis. The toenails appeared normal. Potassium hydroxide testing of the bilateral feet was positive for fungus. The assessments included tinea pedis, hyper-pigmentation of the face, probable tinea corporis with hyper-pigmented intertrigo. The veteran underwent a VA skin diseases examination in November 1998. The veteran reported a 30-year history of bilateral facial, forehead, and brow pruritus. Physical examination revealed that the veteran had tinea pedis and maceration between the toes bilaterally. There was some mild scaling that was pruritic. There was no exudate. There was no evidence of tinea versicolor on today's examination. It appeared that the veteran had a long history of seborrheic dermatitis on his forehead, globular region, and nasal labial folds. There was hyperpigmentation of those areas but some mild erythema and scaling in the nasal labial folds. The examiner opined that that hyperpigmentation was from the seborrheic dermatitis. The veteran stated that this had also been a problem since the 1970s. It was on the veteran's forehead and cheeks and was not of normal skin color. Hyperpigmentation was in the inguinal area bilaterally. The examiner was not sure if the veteran had tinea corporis in the past because there was no evidence of tinea corporis in the inguinal region in the previous charts. The examiner opined that the veteran had tinea pedis since the 1970s and that it was possibly related to Vietnam. The January 1999 outpatient note stated that the veteran had hyperpigmentation of the glabella and both cheeks, minimal maceration between the toes, no appreciable scaling of the face or scalp, and an 8 mm subcutaneous nontender nodule on the lower left helix with no overlying epidermal change. Criteria Tinea versicolor and tinea pedis are not listed in the rating schedule. Therefore, tinea versicolor and tinea pedis will be evaluated under the criteria of tinea barbae, an analogous disease. When a disability not specifically provided for in the rating schedule is encountered, it will be rated under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. See 38 C.F.R. § 4.20 (1999). In turn, tinea barbae is evaluated under the criteria of Diagnostic Code 7806. 38 C.F.R. § 4.118, Diagnostic Code 7804 (1999). Eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or exceptionally repugnant eczema, is entitled to a 50 percent evaluation. Eczema with exudation or itching constant, extensive lesions, or marked disfigurement is entitled to a 30 percent evaluation. Eczema with exfoliation, exudation or itching, if involving an exposed surface or extensive area is entitled to a 10 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Code 7806 (1999). Analysis The Board will adjudicate a decision based upon the current evidence because the veteran did not answer the RO's July 1995 letter that asked whether he wanted a Board hearing in Washington, D.C. or a Travel Board hearing at the regional office. In any event, the veteran received a regional office hearing in April 1995. The claim for an increased rating is well grounded because the veteran's June 1994 statement asserted that his service- connected disabilities have increased in severity. See 38 U.S.C.A. § 5107(a); Proscelle v. Derwinski, 2 Vet. App. 629 (1992). A 10 percent rating continues to be warranted for tinea pedis and tinea versicolor. In July 1998, the examiner noted that pruritus, or itching, had resolved with treatment. In November 1998, although the veteran had itchy tinea pedis and maceration between the toes bilaterally, scaling was mild, and there was no exudate. Moreover, in November 1998, there was no evidence of tinea versicolor. In January 1999, the examiner noted that maceration was minimal between the toes, and there was no appreciable scaling of the face or scalp. A 30 percent rating is not warranted because the evidence does not show constant exudation or itching, extensive lesions, or marked disfigurement. Accordingly, the veteran's disability picture more nearly approximates the criteria for a 10 percent rating. Finally, extraschedular considerations do not apply in this case because exceptional circumstances have not been claimed or demonstrated. See Smallwood v. Brown, 10 Vet. App. 93, 97-98 (1997); 38 C.F.R. § 3.321(b)(1999). ORDER The claim of entitlement to an increased rating for post cerebral concussion with chronic anxiety reaction, headaches, and tinnitus, currently 30 percent disabling, is denied. The claim of entitlement to an increased rating for tinea pedis and tinea versicolor, currently 10 percent disabling, is denied. V. L. Jordan Member, Board of Veterans' Appeals