Here’s a little primer to acquaint Veterans with one of the diseases associated with both Agent Orange and HCV. I have it and from what I gather, several of you that I have helped do too. PCT stands for Porphyria Cutanea Tarda.

The following BVA rating is important for what it illustrates in various ratings codes and why they can be separately rated without being classified as pyramiding. Pyramiding, to those unfamiliar with the term, is VA’s habit of looking at anything you file for and denying it if it duplicates (in their eyes) any rating you already have. Thus you can see the unique difference of having PCT scars on your head, face and neck versus the scarring damage on your arms or legs.

The Veteran has argued that his skin disability affects his face, and consideration for facial scarring is warranted. Under Diagnostic Code 7800, disfigurement of the head, face, or neck with one characteristic of disfigurement warrants a 10 percent evaluation. Disfigurement of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement warrants a 30 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Code 7800 (2008).

I have extensive hypopigmentation, also referred to as Vitiligo. Some know it as Michael Jackson disease. It’s all the white areas that occur in former scarred areas. Few know that PCT also makes the skin very fragile and susceptible to mechanical trauma. Simply smacking  a hand against a sharp board will open it up like a knife slice. The scars are often permanent as we get older. I look like Frankenstein I’ve cut myself so frequently. VA examiners can’t seem to “see” it during a C&P exam.

When I finally received my rating for it in 2008, they gave me 10% for scarring. I complained and said my monthly phlebotomies entitled me to 40% for it as described in Diagnostic Code 7704 (http://www.law.cornell.edu/cfr/text/38/4.117).  VA begrudgingly agreed, gave me the 40% and promptly withdrew the 10% for scarring. This is now in contention as a Clear and Unmistakable Error claim. Any time VA assays to take away one of your ratings, they have to have about 2 or 3 C&Ps to make sure they aren’t jumping the gun and doing something illegal. I didn’t get even one. This isn’t pyramiding. You can have a rating for the scarring and one for the phlebotomies as well. This is akin to having peripheral neuropathy secondary to DM2 secondary to HCV. VA usually takes these away and waits to see if you file a Notice of Disagreement. After five years of appeals, they give it back (if you’re still alive, of course).

While this decision is not precedential, it gives you valuable cites that are. Keep it close at hand when filing PCT claims. Make sure you don’t let VA roll you on this. Remember, if you believe everything the VA bozos tell you, you might want to start putting your teeth under your pillow when they fall out. You could be rich beyond your wildest dreams. I’ve been told the Tooth Fairy is far more munificent the bigger your teeth are anyway.