BVA9504236 DOCKET NO. 93-09 337 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to an increased evaluation for a skin disorder, evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD James A. Frost, Associate Counsel INTRODUCTION The veteran served on active duty from September 1982 to June 1991. This appeal arises from a rating decision in July 1991 by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his skin disability is more severe than is reflected by the currently assigned evaluation. He states that his skin is sensitive to the sun and that it becomes uncomfortable in hot or cold weather. He asserts that he left active service and resigned from a job as a prison guard to avoid sun exposure. 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 the veteran's claim. FINDINGS OF FACT 1. A skin disorder is primarily manifested by patches of fine papular scaly dermatitis involving the face, neck, feet and trunk, without ulceration, extensive exfoliation or crusting or systemic or nervous manifestations; it does not cause exceptionally repugnant disfigurement. 2. The veteran's skin disorder has not markedly interfered with employment. CONCLUSION OF LAW The schedular and extraschedular criteria for an evaluation in excess of 30 percent for a skin disorder are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.20, 4.118 and Code 7806 ( 1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board notes that the veteran's claim is "well- grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed. No further assistance with the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). Service medical records disclose that, in 1983 and 1984, the veteran was treated for acne vulgaris on the face and chest. In 1987 he was seen for a facial rash, diagnosed as acne. In May 1990 he presented at a dermatology clinic with acne and small keratotic plaques on his palms and soles. On treatment with Minocin he developed edema of the face and urticaria, which resolved with discontinuation of the medication. In September 1990 he developed scaly plaques on the chin and cheek; the palm and sole lesions persisted. Differential diagnoses included sarcoid, seborrheic dermatitis and eczema, which did not respond to other medications. A biopsy performed in December 1990 was consistent with seborrheic dermatitis. The veteran's skin disease did not respond to Nizoral. In January 1991 two punch biopsies were consistent with folliculitis. A repeat biopsy was consistent with seborrheic dermatitis, with more follicular involvement, and was not inconsistent with pityriasis rubra pilaris. In February 1991 the eczematous, scaly plaques had spread to the trunk and also involved the scalp, causing alopecia. Differential diagnoses included pityriasis rubra pilaris and seborrheic dermatitis. In March 1991 the veteran was admitted to a service department hospital with a nine-month history of alopecia and dry, flaking red plaques which had spread from his face to his chest, back, arms, legs and perineum. On examination multiple angular polycyclic plaques were scattered over the patient's scalp, face, chest, back, suprapubic region, legs and feet; alopecia was noted in the center of the plaques. A laboratory study was consistent with chronic inflammation. Punch biopsies were consistent with pityriasis rubra pilaris. The diagnosis was papular squamous disorder, likely an atypical presentation of pityriasis rubra pilaris. The atypicality was due to associated alopecia and pityriasis rubra pilaris plaques. In May 1991 a service department dermatologist reported that the veteran had developed an unusual cutaneous, papulosquamous eruption during the previous year. Extensive evaluation with laboratory studies, skin biopsies and radiographic studies was not diagnostic. Eruption was a cosmetic problem, not physically limiting. The veteran would require ongoing medical treatment for an indefinite period of time, which might require temporary physical limitations. In a letter to VA dated in January 1992, the veteran stated that military and civilian dermatologists have been unable to make a definitive diagnosis of his skin disease. The skin condition primarily affected his face and head, but had spread to other areas of his body; it was "disfiguring." He stated that his skin disorder was sun sensitive. The reason he did not reenlist in 1991 was that the only assignment available to him would have been in Hawaii and involved sun exposure. At a VA dermatological examination in August 1992, the veteran complained that his skin disease involved continuous, itchy eruptions. He had a history of examination by numerous dermatologists without a specific diagnosis. Treatment had included topical and systemic medications, to which the disorder responded only partially; the side effects of the medications forced their discontinuation. On examination, the veteran had patches of fine papular scaly dermatitis involving the neck, face, feet and trunk. With reference to the diagnosis, the examiner stated that he had entertained a diagnosis of pityriasis rubra pilaris but thought that the conclusion had to be that the veteran had a mystery disease which resembled pityriasis rubra pilaris to some extent. With the substantive appeal, received at the RO in February 1993, the veteran submitted color photographs of his face, chest and back which, the Board finds, show a noticeable skin abnormality but do not present an exceptionally repugnant appearance. The veteran stated that the epidermis of the affected areas has disappeared and the exposed layers of skin were unprotected from heat or cold. Direct sunlight made the affected areas feel like they were "on fire." He also stated that he was working the night shift at his first postservice job but might have to change to the day shift. As he spent time outside in his work, his sun- sensitive skin might cause a problem if he was transferred to the day shift. The veteran later submitted a copy of the United States Bureau of Prisons personnel action, which stated that, in June 1993, he resigned from a position as a correctional officer at a Federal prison in Texas, "due to a medical condition that requires I avoid outside activities because of my sun-sensitive skin." Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. The veteran's skin disorder, for which a definitive diagnosis has not been made, is rated as analogous to eczema. Diagnostic Code 7806 provides that a 30 percent evaluation is warranted for eczema with constant exudation or itching, extensive lesions or marked disfigurement. A 50 percent evaluation requires ulceration or extensive exfoliation or crusting and systemic or nervous manifestations or exceptionally repugnant disfigurement. While the veteran may have some exfoliation of the scaly dermatitis on areas of his skin, his disability does not meet the other requirements for a 50 percent schedular rating. Specifically, there is no evidence of record that he experiences ulceration or crusting of the skin. His condition is not systemic, nor is it characterized by nervous manifestations. As noted above, the Board has reviewed the color photographs of the veteran which he submitted and finds as a fact that his skin disorder does not produce exceptionally repugnant disfigurement. An increased schedular evaluation is thus not in order. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.20, 4.118 and Code 7806. This case does not present an exceptional or unusual disability picture, with such related factors as frequent hospitalizations or marked interference with employment, so as to render impractical regular schedular standards. In this connection, the Board finds that there is no showing that the veteran's alleged inability to work in the sun is productive of marked interference with indoor employment opportunities. An extraschedular evaluation is thus not in order. 38 C.F.R. § 3.321(b)(1). ORDER An increased evaluation for a skin disorder is denied. ALBERT D. TUTERA 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.