11-21 383, 11-21 383

Veteran served Jan 1964–Dec 1965 and was service-connected for tinea pedis effective Nov 5, 2010, at a 0% rating.
Medical records show chronic, recurrent tinea pedis with itching, scaling, fissuring and treatment with multiple topical agents (ketoconazole, econazole, spectazole, urea) and references to oral antifungals (Lamisil, fluconazole).
RO rated the condition under DC 7806 (dermatitis) at 0% based on <5% body involvement and reliance on topical therapy.
Court of Appeals for Veterans Claims (CAVC) decisions (Johnson, Warren) previously treated some topical corticosteroid or other therapies as potentially constituting "systemic therapy" for DC 7806 purposes; the Federal Circuit reversed that view in Johnson v. Shulkin, holding "systemic" means body-wide effect and topical treatments are not per se systemic.
A November 2016 VA file-review by a dermatologist concluded no systemic therapies like steroids/immunosuppressants were used for tinea pedis but failed to address earlier VA evidence of oral Lamisil and gave no supporting rationale.
The Board found the November 2016 opinion inadequate, ordered another VA examination to determine current severity and to identify and evaluate all treatments from Nov 5, 2010 onward (including whether any are "systemic" and, if so, whether they are "like or similar to corticosteroids or other immunosuppressive drugs"), and remanded the claim for further development.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the veteran's treatments (topical and oral antifungals) during the appeal period qualify as "systemic therapy" under DC 7806	Johnson (CAVC) reasoning: certain topical corticosteroids or other therapies can qualify as "systemic"; examiner must evaluate whether treatments are systemic or akin to corticosteroids/immunosuppressants	Federal Circuit (Johnson v. Shulkin): "systemic" means body-wide effect; topical treatments are not automatically systemic; factual inquiry required	Board remanded for a new VA exam to identify treatments since Nov 5, 2010 and opine whether any constitute systemic therapy and whether they are like or similar to corticosteroids/immunosuppressants
Adequacy of November 2016 VA medical opinion that found no systemic therapy for tinea pedis	Veteran evidence/earlier VA exams show oral Lamisil and near-constant oral medication use; examiner should account for record and veteran statements	2016 examiner concluded no medications similar to systemic steroids were prescribed but did not reconcile or adequately explain conflicts with prior records	Board found the opinion inadequate (based on inaccurate factual premise and lack of rationale) and ordered a new, detailed exam and rationale

Johnson v. McDonald, 27 Vet. App. 497 (CAVC) (held topical corticosteroids may be considered "systemic therapy" for DC 7806 purposes)
Warren v. McDonald, 28 Vet. App. 194 (CAVC) (held compensable systemic treatments include therapies "like or similar to corticosteroids or other immunosuppressive drugs")
Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017) (reversed CAVC: "systemic therapy" requires body-wide effect; topical therapies are not per se systemic)