10-29 918
10-29 918
| Board of Vet. App. | Apr 28, 2017Background
- Veteran served Aug 1984–Jun 1987 and appealed VA RO decisions: (1) continued 10% rating for discoid lupus erythematosus (DLE) and (2) denial to reopen service connection for an acquired psychiatric disorder.
- Board previously remanded in May 2016 for records and VA exam; remand compliance is addressed for the DLE claim and found adequate for adjudication. The psychiatric-connection claim is remanded again for a new opinion.
- Medical record (2007–2016) shows biopsy-confirmed DLE with largely inactive lesions since 2008, limited hyper-/hypopigmented macules and minimal facial redness on sun exposure; clinicians repeatedly found no systemic lupus erythematosus (SLE).
- Episodes of thrombocytopenia/TTP and MRSA skin infections occurred (2010, 2016), but VA rheumatologists and examiners generally concluded these are not attributable to DLE; one private physician speculated a possible link but gave ambiguous opinion.
- Multiple VA exams (May 2008, Sept 2009, June 2016) found DLE affected <5% total/ exposed body area, no disfiguring scars meeting Diagnostic Code 7800 thresholds, and no requirement for chronic systemic immunosuppressive therapy tied to DLE.
- Board found no basis for an extraschedular rating or TDIU; denied rating above 10% for DLE and remanded the psychiatric service-connection claim for a new VA psychiatric opinion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Entitlement to >10% rating for DLE | Veteran argued severity/systemic episodes (thrombocytopenia/TTP) and treatment justify higher/derivative rating | VA argued DLE involvement is limited (<5% area), lacks required disfigurement features, and systemic episodes are not shown to be caused by DLE or to require chronic systemic therapy | Denied — preponderance shows DLE limited to minimal facial/ear lesions <5%; no disfiguring characteristics or systemic therapy for 6+ weeks tied to DLE, so 10% remains correct |
| Service connection for acquired psychiatric disorder | Veteran sought reopening/service connection (claimed psychiatric disability related to service) | VA previously denied; Board remanded for inadequate prior examiner opinions | Remanded — AOJ to obtain a new VA psychiatric opinion (in-person if needed) addressing diagnosis and nexus to service; readjudicate after opinion |
Key Cases Cited
- Stegall v. West, 11 Vet. App. 268 (Board remand orders must be complied with)
- Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must ensure examinations are adequate)
- Gilbert v. Derwinski, 1 Vet. App. 49 (1990) (preponderance of evidence standard)
- Thun v. Peake, 22 Vet. App. 111 (2008) (extraschedular referral framework)
- Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007) (no indication of missing relevant evidence)