BVA9504780 DOCKET NO. 91-52 094 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to an increased evaluation for a tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD William J. Jefferson, III Counsel INTRODUCTION The veteran had active service from August 1967 to June 1970. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Muskogee, Oklahoma, Regional Office (RO). A rating decision dated in October 1990 granted service connection for tinea infection of the groin and feet, evaluated as 10 percent disabling. The veteran disagreed with the determination and filed a timely substantive appeal. The case was remanded in May 1992 to obtain additional clinical information, and for the RO to address the issue of service connection for a skin disorder(s) for parts of the veteran's body other than his feet and groin on a secondary and direct basis. A rating decision dated in September 1992 confirmed the 10 percent evaluation for a skin disorder of the feet and groin. The rating decision also indicated that the veteran's skin disorder was not related to his service connected tinea infection of the feet. In February 1994 the Board remanded the case, determining that the issue of service connection for a skin disorder of areas of the veteran's body other than his groin and feet was, inextricably intertwined with the issue of an increased evaluation of tinea infection. The case was remanded for additional clinical information. A rating decision dated in September 1994 determined that tinea infection of the chest, abdomen, back, right arm, and right leg was related to the infections of the groin and feet, and those areas were service connected. The veteran's disability evaluation was continued at 10 percent. CONTENTIONS OF APPELLANT ON APPEAL The veteran argues that he has a skin disorder that involves many areas of his body, which is constant and extensive. He maintains that his skin disorder more nearly approximates at least a 30 percent disability evaluation, and an increased evaluation is warranted. 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 preponderance of the evidence is in favor of the veteran's claim for an increased evaluation for a tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg. FINDING OF FACT The tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg is considered extensive, in the abdominal fold and groin; but it is not productive of ulceration or extensive exfoliation or crusting, and systematic or nervous manifestations, nor is it exceptionally repugnant. CONCLUSION OF LAW A 30 percent disability evaluation for tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 4.7, Part 4 Code 7806 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION We find that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is we find that he has presented a claim which is not implausible. We are also satisfied that all relevant facts have been properly developed. 38 U.S.C.A. § 5107(a). The RO has assigned a 10 percent disability evaluation for tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg analogously under the provisions of Diagnostic Code 7806 of the VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4, eczema. Service medical records show that the veteran received treatment for a tinea infection of the feet. A VA medical examination in July 1990 showed that the veteran had tinea infection involving the crural areas of both groins and the feet, including the intertriginous areas and plantar surfaces of both feet, including the nails of the feet. It was reported in November and December 1990 that a rash involved an enlarged area of the upper right back, left buttock and left medial thigh. VA clinical records show that through May 1992, the veteran continued to receive treatment for a rash, primarily on the back. A VA medical examination was performed in August 1992. The veteran complained of itching and a rash which lasted from 2 to 3 months. It was indicated that the rash began on the trunk and spread to the groin and other areas. It was reported that the rash was crescent shaped and 10 centimeters wide extending from the right iliac crest, across the periumbilical and back to the right clavicle area. There was a small patch on the back and disseminate area at the waist line. Possible nervous manifestations were reported. A December 1992 VA clinical entry reported that the veteran mainly had eczematous patches on the trunk. Atopic dermatitis, and tinea cruris and pedis were diagnosed. Itching on the back in the axillae, with some eruption on the arms was reported in July 1993. At an April 1994 VA medical examination, the veteran complained of rash, itching and burning, often relieved with Mycelex antifungal medication. The examination revealed a skin rash distributed in both soles, intertriginous areas, axillary regions, groin area, and thighs. Macular rash, scaly, with desquamation was reported. The diagnoses were: Tinea cruris "jock itch"; tinea pedis "athletes foot"; tinea corporis. A VA medical examination was conducted in June 1994. It was indicated that the veteran had a rash on his chest, abdomen, back, right arm, right leg, and groin which lasted three months, resolved, and recurred. He used Cortisone and petroleum jelly. Objectively it was reported that there was a 5.5 centimeter by 48 centimeter band of hyperpigmented skin in the suprapubic area under his large abdominal fold and in the groin. It was reported that he had extensive increased pigmented, weeping, and thickened tissue. The description was hyperpigmented, thick, weeping skin disorder. The distribution of the skin disorder was reported of the abdomen, suprapubic, groin, peroneal, soles of the feet and between the toes. There was no nervous manifestation. The diagnostic opinion reported dermatological involvement of the abdomen, groin and feet, with episodic exacerbations elsewhere on the back, leg, and abdomen (not evident). It was indicated the rashes were related. Analysis The Board has reviewed the entire evidentiary data of record and concludes that the preponderance of the evidence is in favor of the veteran's claim for an increased evaluation for a tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg. In the case at bar, the record shows that the veteran has a long history of skin infections which was initially in the feet and has spread, affecting other body areas. The skin fungus disorder is episodic and seems to be only somewhat controlled with topical medications, before it resurfaces in another area. In the recent past VA out-patient clinical records indicate that the veteran's main skin problems were on his back, which seemingly resolved. However, the most recent VA medical examination in June 1994, shows that the veteran had an exacerbation in the suprapubic region, including the abdominal fold and groin, measured as 5.5 centimeters by 48 centimeters. Such a measurement seems substantial in terms of its area. Furthermore, the VA examiner specifically described the veteran's suprapubic fold and groin dermatological involvement as extensive, increased pigmented, weeping, thickened tissue. It is important to note that Diagnostic Code 7806, eczema, for which the veteran's skin disability has been analogously evaluated, essentially indicates that extensive lesions are sufficient for a 30 percent disability evaluation. Here it has been shown that he has extensive skin problems in the abdomen, groin, suprapubic area, peroneal area and the soles of the feet and between the toes. The clinical findings and the VA physician's description of the veteran's skin problem as extensive warrant assignment of a 30 percent evaluation. The Board notes that while the veteran's skin problem should be considered extensive, the record, including the clinical data, does not show that it is productive of ulceration or extensive exfoliation or crusting, and systematic or nervous manifestations, nor is it exceptionally repugnant. A rating in excess of 30 percent is not demonstrated. Therefore, with respect to the foregoing, the Board is of the opinion that the preponderance of the evidence is in favor of the veteran's claim, and a 30 percent disability evaluation for a tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg is warranted. ORDER A 30 percent disability evaluation for a tinea (fungal) infection involving the feet, groin, chest, abdomen, back, right arm, and right leg is granted, subject to the laws and regulations regarding the award of monetary benefits. SAMUEL W. WARNER 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.