BVA9501215 DOCKET NO. 91-47 886 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. An increased disability rating for generalized atopic dermatitis, currently evaluated as 30 percent disabling. 2. Service connection for an acquired psychiatric disorder, claimed as secondary to service-connected skin disorder. 3. Service connection for memory loss. 4. Service connection for degenerative joint disease, also claimed as bilateral chondromalacia patella. 5. Service connection for acne vulgaris. 6. Service connection for hyperglycemia. 7. Whether new and material evidence sufficient to reopen a claim for service connection for hypothalamic-pituitary-adrenal suppression has been submitted. 8. A total rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Barry F. Bohan, Counsel INTRODUCTION The appellant served on active duty in the United States Air Force from October 1979 to July 1986. The appellant was granted service connection for generalized atopic dermatitis, steroid dependent, by the Department of Veterans Affairs Regional Office in Roanoke, Virginia (VARO) in November 1986. A 30 percent disability rating was assigned. Service connection was denied for hypothalamic-pituitary-adrenal suppression. The appellant was informed of that decision in a letter dated January 1987. he did not appeal that decision. The appellant filed a claim for service connection for a variety of disorders, including hypothalamic-pituitary-adrenal suppression, in April 1990. He subsequently requested an increased disability rating for his service-connected skin disorder. In a July 1990 decision, VARO denied the appellant's claim as to all issues. This appeal followed. In February 1992, a personal hearing, at which the appellant testified, was conducted before a former member of the Board at the offices of the Board in Washington, D.C. In May 1992, this case was remanded by the presiding Board member and the undersigned Board member so that additional development of the evidence could be accomplished. That was accomplished, and in April 1994, VARO issued a Supplemental Statement of the Case which continued to deny the appelant's claim as to all issues. The case was thereupon returned to the Board, where it was received in October 1994. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in substance, that his service-connected skin disorder has increased in severity and that a higher disability rating should be assigned. He further contends that he has a psychiatric disorder which was caused by the service- connected skin disorder. Additionally, he contends that the other disorders for which he seeks service connection are related to his military service, specifically to steroids prescribed for his skin condition. Implicit in the appellant's presentation is the contention that new and material evidence which is sufficient to reopen his claim for hypothalamic-pituitary-adrenal has been submitted. The appellant finally contends that he is unable to work because of the various disorders, physical and psychiatric, which he believes are due to his military service. 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 files. 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 An increased disability rating for generalized atopic dermatitis, to 50 percent, is granted. Service connection for acne vulgaris is granted. Service connection for an acquired psychiatric disorder secondary to service-connected generalized atopic dermatitis is granted. Service connection for memory loss, degenerative joint disease and hyperglycemia is denied. New and material evidence sufficient to reopen a claim for service connection for hypothalamic-pituitary-adrenal suppression not having been submitted, service connection remains denied. A total rating based on individual unemployability due to service- connected disabilities is granted. FINDINGS OF FACT 1. During service, the appellant experienced a severe skin condition, diagnosed as steroid dependent atopic dermatitis. 2. The appellant's service-connected generalized atopic dermatitis is currently manifested by itching and scaling on the appellant's scalp, face, trunk arms, legs and feet. 3. The appellant has a psychiatric disorder, diagnosed as dysthymia, which is deemed by his medical providers to be related to his service-connected skin disorder. 4. The appellant does not currently have memory loss. 5. The appellant does not currently have degenerative joint disease. 6. Acne vulgaris was present during military service. 7. The appellant currently has acne vulgaris. 8. The appellant does not currently have hyperglycemia. 9. In a November 1986 decision, the appellant was denied service connection for hypothalamic-pituitary-adrenal suppression. 10. Evidence submitted by the appellant since the November 1986 decision is not new and material and does not serve to reopen the appellant's claim for service connection for hypothalamic- pituitary-adrenal suppression. 11. The appellant is not currently employed due to service- connected disabilities. CONCLUSIONS OF LAW 1. The appellant's service-connected generalized atopic dermatitis is no more than 50 percent disabling according to the schedular criteria. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.20, 4.118, Diagnostic Code 7806 (1993). 2. The appellant's dysthymia is proximately due to or is the result of his service-connected generalized atopic dermatitis. 38 C.F.R. § 3.310 (1993). 3. Memory loss was not incurred in and was not aggravated by military service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 303 (1993). 4. Degenerative joint disease was not incurred in and not was aggravated by military service, and may not be so presumed. 38 U.S.C.A. §§ 1101, 1111, 1112, 1131, 1137 (West 1991); 38 C.F.R. § 303 (1993). 5. Acne vulgaris was incurred in or was aggravated by military service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 303 (1993). 6. Hyperglycemia was not incurred in and was not aggravated by military service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 303 (1993). 7. The November 1986 decision which denied service connection for hypothalamic-pituitary-adrenal suppression is final. Evidence submitted since the November 1986 decision is not new and material and the appellant's claim is not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a), 20.302, 20.1103 (1993). 8. The appellant's service-connected disabilities preclude him from securing or following a substantially gainful occupation. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16(a), and Part 4 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is seeking an increased disability rating for his service-connected skin disorder, as well as service connection for a number of claimed disorders. As will be discussed below, the Board has also inferred the issue of a total rating based on individual unemployability due to service-connected disabilities. Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). Furthermore, we believe that this case has been adequately developed for appellate purposes by VARO and that we may therefore proceed to a disposition on the merits without the necessity of a remand for further records. In the interest of clarity, the Board will first discuss the appellant's pertinent medical history. 38 C.F.R. § 4.1 (1993); Peyton v. Derwinski, 1 Vet.App. 282 (1991). Each of the issues presented on this appeal will then be discussed. Medical history In July 1980, while in service, the appellant was treated for a skin rash, which persisted and worsened. Atopic dermatitis was first diagnosed in October 1981. In December 1981, a history of the same disorder pre-puberty was noted. The appellant continued to experience severe atopic dermatitis. After topical medications and ultraviolet light treatment failed to control the disorder, high dosages of steroids were prescribed, which resulted in chronic, daily systemic steroid therapy. On several occasions during service, the appellant sought treatment at mental hygiene clinics due to personal and marital difficulties. In April 1984, the appellant sought treatment for hives, which were considered to be related to tension and anxiety without any physical cause. The psychologist stated: "Very strong possibility of etiologic factors which could account for [the appellant's] dermatitis." The appellant was placed in a stress reduction program. Service medical records dated July through October 1984 indicate that the appellant received counseling from a psychologist due to stress caused by an unhappy marital situation. The appellant's hives were considered to be a psychophysiologic reaction. The psychologist stated, in August 1984, that "marital prob[lems] and other prob[lems] 'get under his skin'". The appellant's steroid dependent atopic dermatitis continued to worsen. Liver function testing in March 1986 was abnormal. An April 1986 report of a United States Air Force Medical Board concluded with diagnoses of (1) severe, steroid dependent atopic dermatitis; (2) mild elevated liver function tests secondary to Troleandomycin; and (3) hypothalamic pituitary-adrenal suppression secondary to chronic systemic steroid use. A May 1986 Physical Evaluation Board found the appellant to be physically unfit for service due to severe atopic dermatitis, steroid dependent. Other diagnoses were mild elevated liver function tests and hypothalamic-pituitary-adrenal suppression. Separation from the Air Force was recommended. In July 1986, the appellant was placed on the Temporary Disability Retirement List (TDRL) due to disability caused by skin disease. A VA physical examination of the appellant was completed in September 1986. Skin rash over the entire body was noted. The appellant's face was described as slightly puffy. No pathology of the musculoskeletal system identified. Diagnoses included generalized atopic dermatitis, steroid dependent; hypothalamic- pituitary-adrenal suppression secondary to steroids, by history; and hepatitis, resolved without residuals. The appellant complained of right knee pain in February 1988. "on and off for one year". The examiner's impression was right chondromalacia patella. In July 1988, the appellant underwent a physical examination at a United States Navy facility. The appellant's skin condition had not stabilized. Liver function tests were normal. Serum glucose was slightly elevated, which was thought to be an effect of steroid use. An Air Force Physical Evaluation Board reviewed these findings and concluded that the appellant was unfit for service due to a diagnosis of steroid dependent eczematous dermatitis. Other diagnoses included history of elevated liver function, now normal; hypothalamic pituitary-adrenal suppression secondary to chronic systemic steroid use; chondromalacia patella, right, "TDRL incurred" and mild hyperglycemia. In December 1988, another Air Force Physical Evaluation Board gave diagnoses similar to above, with the exception of chondromalacia patella, right, "incurred on TDRL but secondary to medication/steroid usage." In a letter dated October 1988, the appellant's VA endocrinologist stated that continued heavy use of steroids to treat his atopic dermatitis could lead to a variety of complications, including "possibly altered mental function." The appellant was admitted to a VA psychiatric hospital in August 1989 after threatening suicide in the admissions area of another VA facility because of itching and hives. On admission, the appellant claimed to have intellectual impairment caused by prolonged use of steroids. He reported free basing and snorting cocaine and drinking 3-4 beers daily. An X-ray of the right knee was negative. Discharge diagnoses were organic mood syndrome, cocaine and alcohol abuse, personality disorder, and atopic dermatitis. In February 1990, the appellant was admitted to a VA psychiatric facility after expressing suicidal ideation related to physical discomfort caused by the skin condition. He reported a history of alcohol and cocaine abuse. Diagnoses were dysthymia; alcohol and cocaine dependence, in remission; personality disorder; and chronic purities secondary to eczema. The report of hospitalization concluded by characterizing the appellant as "Permanently disabled. Severe itching appears to be debilitating him severely with psychological repercussions." A VA physical examination of the appellant was completed in May 1990. Patches of scaly skin were identified over the his scalp, face, trunk and extremities. The appellant was also examined by a VA psychiatrist. The appellant stated that he felt like jumping off a building in order to stop his itching. During the interview, he was itchy, fidgety and was preoccupied with his skin condition. His memory for recent and remote events was not impaired. The diagnosis was organic affective disorder. A VA Social and Industrial Survey was completed in May 1990. The appellant reported working as an aircraft technician during military service. However, he was cross-trained as an electrician because exposure to aircraft fuels and chemicals exacerbated his skin condition. After he left military service, he worked as an electrician and as a waiter and attended college for two semesters. At the time of the survey, he was unemployed and was not attending college. The appellant stated that he experienced memory loss as a side effect of prolonged steroid use. He described constant itching, resulting in scratching until his skin bled. The appellant was divorced and had little social life because he avoided others due to his skin disorder. In September 1990, the appellant's VA psychologist stated that "due to [the appellant's] affective response to severe rash, I have recommended an intensive course of individual psychotherapy." The appellant was admitted to a VA hospital. On admission, he was described as being unemployed and reportedly had last worked in February 1988. A history of alcohol abuse and cocaine addiction was noted. An October 1990 progress note contained the statement: "The unremitting progression of his skin condition has taken a severe toll on his mental health." A VA examination of the appellant was completed in November 1990. The appellant complained of skin problems, psychiatric symptoms, and joint pain. A neuropsychiatric consultation resulted in diagnoses of organic mood disorder by history and polysubstance abuse by history. The appellant ascribed all of his problems to his skin disorder. The appellant's cognition was described by the examiner as being intact. Also of record is a December 1990 report of the appellant's VA psychologist, which stated that the appellant had "anxiety and depression secondary to a chronic dermatological condition." The appellant continued to be treated for dermatitis. Generalized anxiety disorder was diagnosed in October 1991. In June 1992, an examiner stated that there was a neurodermatitis component to the appellant's skin disorder. In March 1992, he complained of aching joints. VA psychological testing of the appellant was completed in January 1993. The appellant's medical and social history was available to the examiner. It was noted that the appellant had been hospitalized on several occasions due to physical and emotional distress related to his skin condition. The appellant was described as "alert, oriented and cognitively clear". The examiner stated that the appellant suffered from a chronic, low- grade depression which worsened in response to environmental pressures. His skin disorder similarly became exacerbated in response to increases in stress. "Thus, his disturbed psychological state and his service-connected physiological disorder (atopic dermatitis) appear to be indirectly but undoubtedly linked." The appellant's skin disorder was evaluated in December 1992. Subjective complaints included severe itching and burning, stinging and pain. The symptoms were reportedly made worse by stress. On physical examination, patches with lichenification were noted in the appellant's scalp, face, trunk (chest, upper back and abdomen), arms, legs and feet. Another VA examination of the appellant was completed in February 1994. Minimal residual rounding of his face was noted. No significant bone or muscle impairment was noted. Urinary steroid production was normal, "suggesting that he is no longer adrenally suppressed." The diagnosis was "no adrenal suppression currently." 1. An increased disability rating for generalized atopic dermatitis, currently evaluated as 30 percent disabling. In evaluating the appellant's request for an increased rating, the Board considers the medical evidence of record. The medical findings are compared to the criteria in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (1991). In so doing, it is our responsibility to weigh the evidence before us. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). In evaluating service-connected disabilities, the Board looks to functional impairment. We attempt to determine the extent to which a service-connected disability adversely affects the ability of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.2, 4.10 (1993). Atopic dermatitis is rated by analogy to eczema. 38 C.F.R. § 4.20 (1993). The schedular criteria call for a 30 percent disability rating for eczema with constant exudation or itching, extensive lesions, or marked disfigurement. A 50 percent disability rating is called for in cases involving ulceration or extensive exfoliation or crusting and systemic or nervous manifestations, or if the skin disorder is exceptionally repugnant. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.118, Diagnostic Code 7806 (1993). The medical evidence, described above, documents a lengthy history of an unrelenting and intractable skin disorder which involves virtually the appellant's entire body. This disorder is manifested by itching and scaling on the appellant's scalp, face, trunk arms, legs and feet. In the opinion of the Board, based on the evidence of record there is no question that the appellant's service-connected skin disorder has caused "systemic or nervous manifestations", particularly with respect to the physiological consequences of prolonged steroid treatments. Accordingly, a 50 percent disability rating is granted. Although the Board has given some thought to an award of an extraschedular rating for the skin disorder under 38 C.F.R. § 3.321 (1993), it is believed that a grant of service connection for a psychiatric disorder and the grant of a total rating based on individual unemployability due to service-connected disabilities is a more appropriate course of action under the circumstances presented in this case. 2. Service connection for an acquired psychiatric disorder, claimed as secondary to service-connected skin disorder. The appellant is also seeking service connection for an acquired psychiatric disorder, which he contends was caused by his service-connected skin disorder. Under the pertinent VA regulation, service connection for a disability may be granted if such disability is found to be proximately due to or is the result of a service-connected disability. 38 C.F.R. § 3.310 (1993). It is obvious from the lengthy medical history narrated above that the interrelationship between the appellant's service- connected skin disorder and his psychiatric symptomatology is complex and is not fully understood. In fact, there are some medical opinions of record which ascribe the appellant's skin problems to his psychiatric problem, rather than the reverse. In any event, it is quite clear that the two disorders, one physical and the other psychiatric, are very closely related. The Board believes that there is sufficient evidence of record, for example the December 1990 report of the appellant's VA psychologist, which stated that the appellant had "anxiety and depression secondary to a chronic dermatological condition", to grant service connection for dysthymic disorder secondary to the service-connected generalized atopic dermatitis. 3. Service connection for memory loss. Under pertinent law and VA regulations, service connection may be granted if symptomatology of a disease resulting in memory loss appeared during service. 38 U.S.C.A. §§ 1131 (West 1991). In the alternative, service connection may be granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred as a result of service. 38 C.F.R. § 3.303(d) (1993). As noted above the appellant complained of memory loss during an August 1989 VA hospitalization and repeated his complaint during the May 1990 VA Social and Industrial Survey. However, there has never been a finding of organic cognitive deficit. On the contrary, VA examiners in May 1990, November 1990 and January 1993 commented that the appellant was cognitively clear and demonstrated no signs of memory loss. Service connection cannot be granted for a disability which cannot be demonstrated to exist. Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Accordingly, service connection for memory loss is denied. 4. Service connection for degenerative joint disease, also claimed as bilateral chondromalacia patella. The appellant is seeking service connection for degenerative joint disease. Under pertinent law and VA regulations, service connection may be granted if symptomatology attributable to chronic disorders such as arthritis appeared during service or to a compensable degree within one year thereafter. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). In the alternative, service connection may be granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred as a result of service. 38 C.F.R. § 3.303(d) (1993). Service medical records reveal that in May 1985, the appellant complained of tenderness, swelling and limited range of motion of his left knee after falling. The diagnosis was contusion of the left knee. No further treatment was required. As indicated in the medical history described above, the appellant first reported problems with his knees in 1988, over one year after he was discharged from service. During the February 1994 VA physical examination, the appellant complained of joint and muscle weakness. X-rays failed to disclose any evidence of degenerative joint disease and "did not show the effects of steroids." Based on the appellant's entire medical history, the Board has concluded that service connection should not be granted for degenerative joint disease. Although the appellant has complained on occasion of joint pain, degenerative joint disease has never been diagnosed. Service connection cannot be granted for a disability which cannot be demonstrated to exist. Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Accordingly, service connection is denied. 5. Service connection for acne vulgaris. In March 1980 and in August 1980, the appellant was seen for acne at the jaw line and on his neck. He was allowed to grow a short beard. Residual cystic acne was noted in December 1980. During the VA dermatology examination in December 1992, a history of acne vulgaris and steroid acne was noted. Acne was not identified on physical examination of the appellant. In a follow up report in April 1993, the dermatologist stated that acne vulgaris can be exacerbated by systemic steroids and that the etiology of acne is unknown. During the February 1994 VA examination, acne was identified on the appellant's face, chest and buttocks. The Board believes that, under the circumstances, service connection should be granted for acne vulgaris. The appellant had acne during service, and he had acne during the February 1994 VA examination. There is some medical evidence on the record which indicates that acne vulgaris can be exacerbated by steroid use. Thus, it is possible that acne which existed during service was made worse by the prolonged steroid treatments. 6. Service connection for hyperglycemia. As noted above, elevated blood sugar was identified during laboratory testing in 1988. During the February 1994 VA physical examination, the appellant reported a history of diabetes mellitus. No diagnosis was made, however. A careful review of the appellant's recent medical history fails to disclose any further reference to elevated blood sugar, hyperglycemia or diabetes. In the absence of a diagnosed disease entity, service connection may not be granted. Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). 7. Whether new and material evidence sufficient to reopen a claim for service connection for hypothalamic-pituitary-adrenal suppression has been submitted. As was indicated in the Introduction, the appellant's claim for service connection for hypothalamic-pituitary-adrenal suppression was denied in a November 1986 rating decision. He was duly notified of that decision by letter in January 1987 but he did not file a substantive appeal within one year. The decision of the Regional Office is considered to be final. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 3.104(a), 20.302, 20.1103 (1993). Under pertinent law and regulations, as interpreted by the United States Court of Veterans Appeals, the Board may reopen and review a claim which has been previously denied if new and material evidence is submitted by or on behalf of the appellant. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1993); and Manio v. Derwinski, 1 Vet.App. 140 (1991). "New" evidence means evidence which is not merely cumulative or redundant. Colvin v. Derwinski, 1 Vet.App. 171 (1991). "Material" evidence is evidence which is relevant and probative of the issue at hand and which, furthermore, leads to a reasonable possibility that the new evidence, when viewed in the context of all of the evidence of record, would change the outcome of the case. Smith v. Derwinski, 1 Vet.App. 178 (1991). Evidence which was considered by the Regional Office in November 1986 consisted of reports of the 1986 service medical board findings, which indicated that the appellant had hypothalamic- pituitary-adrenal suppression secondary to chronic steroid use, and the report of the September 1986 VA physical examination, which did not find hypothalamic-pituitary-adrenal suppression. The rating decision denied service connection because of the lack of clinical findings on the most recent medical examination. Evidence submitted after the November 1986 rating decision consisted chiefly of the report of the VA physical examination in February 1994, which resulted in a diagnosis of no adrenal suppression, based on laboratory testing. The Board concludes that the evidence which was submitted after November 1986 is not new and material because it does not lead to a reasonable possibility that the outcome of the case would be change. Indeed, the additional medical evidence merely confirms the findings of the September 1986 VA examination upon which the rating board relied in denying the appellant's claim. Service connection for hypothalamic-pituitary-adrenal suppression remains denied. 8. A total rating based on individual unemployability due to service-connected disabilities. As reported above, the appellant has repeatedly stated that he is unable to work. He attributes his unemployment to his service- connected skin disorder and related psychiatric problem. VA is obligated to consider all issues reasonably inferred from the evidence of record, even if such issues are not directly raised by the appellant. Douglas v. Derwinski, 2 Vet.App. 435, 438-440 (1992), and cases cited therein. Therefore, the issue of a total rating based on individual unemployability will be addressed in this decision. Before moving on to a review of the evidence, the Board must determine whether this case should be remanded to VARO for further development and adjudication. The basis for such determination is whether the appellant would be prejudiced by the lack of such development and adjudication at the Regional Office level. Bernard v. Brown, 4 Vet.App. 384, 394 (1993). A review of the history of this case is found in the Introduction. It is clear that the appellant has been afforded ample opportunity to present argument to VARO and to the Board. Of great significance, in our opinion, is the fact that the appellant has had the opportunity to present his case at a personal hearings before a member of the Board. It is believed that a review of the evidence and a decision on the merits will not prejudice the claimant or violate VA's statutory duty to assist, based on the history of this case. 38 U.S.C.A. § 5107(a) (West 1991); O.G.C. Prec. 6-92 (March 6, 1992). A total disability compensation rating may be assigned in a case in which the schedular rating is less than 100 percent, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16(a) and Part 4 (1993). In addition to the service-connected skin and psychiatric disorders and acne vulgaris discussed above, the appellant is service-connected for hemorrhoids. A noncompensable disability rating is currently in effect for hemorrhoids. The evidence of record has been discussed at length above. The appellant has worked as a waiter and as an electrician since being discharged from military service, but was unable to remain unemployed for long periods of time. He has explained his inability to hold a job as being due to his skin condition and resultant depression. He evidently last worked in approximately 1990. He also attempted to attend college, without much success. Also of record is a December 1990 opinion of a Social Security Administration Administrative Law Judge which awarded the appellant disability benefits. In substance, the decision was based on findings that the appellant's dermatitis and associated depression rendered him unable to engage in most types of work on a sustained basis. The Board is not free to ignore this evidence. Murincsak v. Derwinski, 2 Vet.App. 363, 372 (1992). The Board believes that the appellant's service-connected disabilities preclude him from securing or retaining gainful employment. It is noted that the report of hospitalization in February 1990 concluded by characterizing the appellant as "permanently disabled" because of the skin disorder and attendant psychiatric symptomatology. Moreover, the appellant's medical history, which includes reports of psychiatric hospitalizations, as well as the May 1990 VA Social and Industrial Survey, portrays him as an individual who is tormented physically and emotionally and is consequently unable to work. A total rating based on individual unemployability due to service-connected disorders is therefore granted. ORDER An increased disability rating for generalized atopic dermatitis, to 50 percent, is granted, subject to controlling regulations applicable to the payment of monetary benefits. Service connection for an acquired psychiatric disorder is granted. Service connection for memory loss is denied. Service connection for degenerative joint disease is denied. Service connection for acne vulgaris is granted. Service connection for hyperglycemia is denied. New and material evidence sufficient to reopen a claim for service connection for hypothalamic-pituitary-adrenal suppression not having been submitted, the benefit sought on appeal remains denied.. A total rating based on individual unemployability due to service-connected disabilities is granted. KENNETH R. ANDREWS, JR. 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.