BVA9501414 DOCKET NO. 92-11 974 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an increased rating for psoriasis, currently evaluated as 50 percent disabling. 2. Entitlement to a total compensation rating by reason of individual unemployability. REPRESENTATION Appellant represented by: Alabama Department of Veterans Affairs ATTORNEY FOR THE BOARD Robert E. P. Jones, Associate Counsel INTRODUCTION The veteran served on active duty from September 1964 to October 1966. This matter came before the Board of Veterans' Appeals (Board) on appeal from an October 1991 rating decision by the Montgomery, Alabama, Regional Office (RO). The veteran's claims were remanded by the Board in February 1993 so that the RO could determine whether the veteran's strokes, hypertension, or nervous disorder were secondary to the veteran's service-connected psoriasis. In a July 1994 rating decision the RO granted service connection for a nervous disorder and denied service connection for strokes and hypertension. The veteran was notified of this decision and did not submit a notice of disagreement concerning those issues. CONTENTIONS OF APPELLANT ON APPEAL The veteran asserts that he is totally debilitated due to his service-connected psoriasis, which he avers warrants a rating greater than 50 percent. He maintains that it constantly bothers him and that he will not go out when it is flared up. The veteran also contends that he is entitled to a total rating due to individual unemployability. He asserts that his psoriasis and nervous disorder prevent him from performing any substantive employment. 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 preponderance of the evidence is against an increased rating for psoriasis and that it supports a total rating for compensation purposes based on individual unemployability FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran has psoriasis in isolated locations over 15 percent of his body. He has occasional aggravated attacks of psoriasis involving much greater areas of his body. 3. The veteran's service-connected disabilities, which include psoriasis and organic anxiety syndrome, preclude the veteran from engaging in gainful employment. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 50 percent for psoriasis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.118, Code 7816 (1993). 2. The criteria for a total compensation rating based on individual unemployability have been met. 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS We note that we have found that the veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented claims which are plausible. We are also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a) I. The veteran seeks an increased rating for psoriasis. The veteran's service medical records reveal that the veteran was treated for psoriasis in 1965 and 1966. He received a Veterans Administration (now Department of Veterans Affairs) (VA) examination in March 1967. The veteran was noted to have moderately severe psoriasis covering many parts of his body. The veteran was granted service connection and a 30 percent disability evaluation for psoriasis in a May 1967 rating action. The veteran's claims file contains an August 1986 statement from David A. McLain, M.D. Dr. McLain stated that the veteran had psoriasis and psoriatic arthritis. On VA examination in August 1986, the examiner noted psoriasis and noted that a diagnosis of psoriatic arthritis had been made by a private physician. The VA examiner did not make any findings of his own concerning psoriatic arthritis. On VA examination in June 1987 the veteran was noted to have psoriasis lesions over 20 to 30 percent of his body. The examiner had x-rays of the left knee, right elbow, right hand and right ankle taken to determine if the veteran had psoriatic arthritis. The x-rays did not reveal psoriatic arthritis. The veteran's disability evaluation for psoriasis was increased to 50 percent in a September 1987 rating action. The veteran was received treatment for psoriasis as well as for a possible cerebral vascular accident at a VA hospital in September 1991. He was treated with ultraviolet beam radiation and local aggressive skin care. In January 1992, Sidney P. Smith, III, M.D., reported that the veteran had psoriasis of 90% of his body area and received outpatient light treatment for this condition. The veteran was afforded a VA dermatological examination in March 1992. He gave a 25 year history of psoriasis. He stated that the severity of his skin condition fluctuated. It never resolved and sometimes it covered his entire body. He reported that the psoriasis was so severe that he had to undergo wet wrap therapy one to three times a week. The veteran complained of occasional psoriasis in his ears resulting in ear aches. He complained of marked itching especially in the winter when it was most severe. On examination there were numerous well demarcated, erythematous plaques with seborrheic scales on the veteran's post auricular areas of his scalp, on his left upper arms to his elbows, on his right arm throughout, as well as some guttate foci on his chest. There was approximately 35 percent body involvement. The diagnosis was psoriasis, plaque type. The veteran received another VA dermatological examination in December 1993. He reported that he was using steroid creams once or twice a day to the psoriasis plaques, that he was using tar shampoo to the scalp, and that he was bathing in coal tar solution diluted into water. He also used petroleum jelly three times a day. Examination showed multiple thin, red plaques with silver scale in isolated locations on his elbows, hips and inner thighs involving 15 percent of his body surface. There was also a mild amount on his scalp. The diagnosis included psoriasis, relatively well controlled. The veteran's psoriasis disorder is currently rated at the maximum rating available under the rating schedule for psoriasis. 38 C.F.R. § 4.118, Code 7816. A higher rating is only available on an extraschedular basis. The Board finds that in this case the disability picture is not so exceptional or unusual so as to warrant an evaluation on an extraschedular basis. It has not been shown that the veteran's psoriasis in and of itself has resulted in frequent hospitalization or marked interference with employment. 38 C.F.R. § 3.321(b)(1) (1993). The evidence is not so evenly balanced that there is doubt as to any material issue. 38 U.S.C.A. § 5107. II. The veteran also seeks entitlement to a total rating based on individual unemployability. He currently has a 50 percent disability evaluation for a cardiovascular disability and a 30 percent disability evaluation for organic anxiety syndrome as secondary to his psoriasis disability. The veteran received a VA psychiatric examination in November 1993. The veteran's wife reported that when the veteran's psoriasis became worse the veteran would refuse to leave the house and would not allow people to visit him. She reported that the veteran became very agitated during his bouts of psoriasis. On examination the veteran was fully alert and oriented in all spheres. He was able to perform simple mental calculations without difficulty. He denied specific suicidal thoughts but admitted to having thoughts of being better off dead whenever the psoriasis was active. The VA examiner reported that the veteran experienced recurrent attacks of anxiety which appeared to be directly related to the severity of his psoriatic lesions. During active bouts of psoriasis the veteran exhibited social phobia, motor tension, restlessness, increased fatigue, trembling, shortness of breath, palpitations, sweating, dry mouth, dizziness, nausea, trouble swallowing, feeling keyed up, difficulty concentrating, irritability and sleep disturbance. The diagnoses included organic anxiety syndrome. The veteran was granted service connection and a 30 percent disability evaluation for an organic nervous disorder in a July 1994 rating action. A total compensation rating based on individual unemployability may be granted where the schedular rating is less than total and the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that there is at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.340, 4.16. The veteran has two service-connected disabilities, one evaluated as 50% disabling, which combine to produce a 70 percent rating. As the veteran satisfies the percentage requirements for a total compensation rating based on individual unemployability, the question becomes whether his service-connected conditions actually keep him from working, bearing in mind his individual educational and occupational background. The veteran's claims file reveals that the veteran has at most 10 years of formal education and that he worked as a laborer. The evidence reveals that the veteran needs to spend large amounts of time attending to his skin condition. He has seasonal flare-ups with his condition which results in great discomfort and restricts his activities. Furthermore the veteran's service-connected psychiatric condition prevents the veteran from associating with other people when he has flare ups. The veteran's extensive skin condition and treatment for that condition interferes with the possibility of both manual or sedentary employment. Even if the veteran's service-connected disabilities did not prevent the veteran from engaging in sedentary employment, he does not have the education or occupational background for such a position. The Board recognizes that the veteran has several serious nonservice-connected disabilities, to include the residuals of a cerebral vascular accident. However, the Board finds that the veteran is prevented from virtually all forms of gainful work for which he is qualified solely on account of his service-connected disabilities. Accordingly, the Board finds that the criteria have been satisfied and that a total compensation rating based on individual unemployability is warranted. All doubt has been decided in favor of the veteran. 38 U.S.C.A. § 5107. ORDER An increased rating in excess of 50 percent for psoriasis is denied. A total rating for compensation purposes based on individual unemployability is granted, subject to the law and regulations governing the payment of monetary benefits. WAYNE M. BRAEUER 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.