Citation Nr: 1237981 Decision Date: 11/06/12 Archive Date: 11/16/12 DOCKET NO. 09-06 912 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to an initial disability rating in excess of 10 percent for service-connected scar, residuals of a wound to the left forearm. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD S. M. Kreitlow INTRODUCTION The Veteran had active service from October 1980 to February 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In September 2010, the Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge. A copy of the transcript of this hearing has been associated with the claims file. In October 2010, the Board remanded the Veteran's claim for further development. After conducting the requested development, a Supplemental Statement of the Case was issued in October 2011, and the Veteran's claim was returned to the Board for final adjudication. Upon review, the Board finds that the prior remand has been substantially complied with; therefore, the Board may proceed forward with adjudicating the Veteran's claim. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). FINDINGS OF FACT 1. The Veteran's service-connected scar, residuals from a wound to his left forearm, is productive of no worse than tenderness on examination. No other residual resulting from the in-service wound to his left forearm has been shown. 2. The scar, residuals from a wound to the Veteran's left forearm, does not represent an exceptional disability picture. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent for scar, residuals of a wound to the left forearm, are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A and 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, and 4.118, Diagnostic Code 7804 (2008). 2. The criteria for awarding a separate evaluation for residuals of a wound to the left forearm are not met. 38 U.S.C.A. §§ 1155 (West 2002 & Supp. 2011); 38 C.F.R. §§ 4.73, 4.124a (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Notice and Assistance Requirements 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107 and 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) describe VA's duties to notify and assist claimants in substantiating a claim for VA benefits. Upon receipt of a complete or substantially complete application for a service-connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and notify the claimant and his or her representative, if any, of what information and evidence not already provided, if any, is necessary to substantiate, or will assist in substantiating, each of the five elements of the claim including notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Sufficient notice must inform the claimant (1) of any information and evidence not of record that is necessary to substantiate the claim; (2) of the information and evidence that VA will seek to provide; and (3) of the information and evidence that the claimant is expected to provide. Notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. 38 C.F.R. § 3.159(b)(1); Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). For a claim seeking increased compensation for an already service-connected disability, 38 U.S.C.A. § 5103(a) requires, at a minimum, that VA notify the claimant that he/she must provide, or ask VA to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment in order to substantiate the claim. Vazquez-Flores, 22 Vet. App. 37 (2008). VA must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation. Id. It is noted that, on September 4, 2009, the Federal Circuit vacated and remanded Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), and Schultz v. Peake, No. 03-1235, 2008 WL 2129773, at 5 (Vet. App. Mar. 7, 2008). Specifically, the Federal Circuit concluded that "the notice described in 38 U.S.C. § 5103(a) need not be veteran specific." In addition, the Federal Circuit determined that "while a veteran's 'daily life' evidence might in some cases lead to evidence of impairment in earning capacity, the statutory scheme does not require such evidence for proper claim adjudication." Thus, the Federal Circuit held, "insofar as the notice described by the Veterans Court in Vazquez-Flores requires the VA to notify a veteran of alternative diagnostic codes or potential 'daily life' evidence, we vacate the judgments." In this case, notice was sent to the Veteran in February 2008, prior to the initial adjudication of his claim for service connection. The Veteran's claim was originally one for service connection for residuals of the in-service wound to the left forearm, which was granted in the September 2008 rating decision and evaluated as 10 percent disabling effective January 14, 2008 (the date the Veteran's initial claim for service connection was filed). Thereafter, the Veteran disagreed with the 10 percent evaluation of this now service-connected disability. Because the Veteran's claim was initially one for service connection, which has been granted, the Board finds that VA's obligation to notify him was met as the claim for service connection was obviously substantiated. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Therefore, any deficiency in notice relating to the Veteran's appeal for an increased rating is not prejudicial to him. With respect to VA's duty to assist, VA is only required to make reasonable efforts to obtain relevant records that the Veteran has adequately identified to VA. 38 U.S.C.A. § 5103A(b)(1). All efforts have been made to obtain relevant, identified and available evidence. The duty to assist includes providing the Veteran a thorough and contemporaneous examination. Green v. Derwinski, 1 Vet. App. 121 (1991). The Veteran was afforded VA examinations in August 2008 and November 2010. Significantly, the Board observes that the Veteran does not report that the condition has worsened since he was last examined, and thus a remand is not required solely due to the passage of time. Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007); VAOPGCPREC 11-95 (1995), 60 Fed. Reg. 43186 (1995). Thus, the Board finds that VA has satisfied its duties to inform and assist the Veteran. Additional efforts to assist or notify him would serve no useful purpose. Therefore, he will not be prejudiced as a result of the Board proceeding to the merits of his claim. II. Analysis Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities. Id. Evaluation of a service-connected disorder requires a review of the veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1 and 4.2. It is also necessary to evaluate the disability from the point of view of the veteran working or seeking work, 38 C.F.R. § 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the veteran's favor, 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's claim for a higher evaluation is an original claim that was placed in appellate status by his disagreement with the initial rating award. In these circumstances, separate ratings may be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). In the September 2008 rating decision on appeal, the RO granted service connection for scar, residuals of a wound to the left forearm, and evaluated this disability as 10 percent disabling for a painful scar under Diagnostic Code 7804. The Board notes that the Diagnostic Codes applicable to scars were revised in October 2008. These revisions, however, apply only to claims that were filed on or after the effective date of October 23, 2008, or when the Veteran has specifically requested reconsideration of his claim under these revised criteria. As the Veteran's claim was filed before October 2008 and he has not requested reconsideration under the revised criteria effective October 23, 2008, evaluation of his residual scar under these revised criteria is not warranted. Consequently, the Board will evaluate the Veteran's service-connected disability under the rating criteria in effect at the time he submitted his claim (i.e., the 2008 regulations). Scars, other than on the head, face, or neck, that are deep or that cause limited motion warrant a 10 percent rating if the area or areas exceed 6 square inches (39 sq. cm). A deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801. When these requirements are not shown, a zero percent rating is assigned. 38 C.F.R. § 4.31. Scars, other than on the head, face, or neck, that are superficial and that do not cause limited motion warrant a 10 percent rating for area or areas of 144 square inches (929 sq. cm.) or greater. Scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, will be separately rated. A superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802. A 10 percent rating may be assigned for scars which are superficial and unstable. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7803. A 10 percent rating may be assigned for scars which are superficial and painful on examination. 38 C.F.R. § 4.118, Diagnostic Code 7804. Scars may also be rated on the basis of limitation of function of the affected part. 38 C.F.R. § 4.118, Diagnostic Code 7805. At the VA examination in August 2008, the Veteran reported that, while in service, he had a laceration wound on his left forearm as a result of being attacked by another soldier with a knife. He reported he was taken to the hospital where sutures were placed and the arm was placed in a sling. He related that the wound healed without any complications. He reported that he has had pain and occasional numbness in the left arm ever since this laceration wound. He denied swelling and redness. He complained of tenderness to palpation in the scar area occasionally. He reported that his scar condition was affecting his activities of daily living because he had difficulty with repetitive use of his left arm. He complained of weakness and pain on his left arm with repetitive use. Physical examination of the left arm demonstrated there was a 6 cm long by 0.2 cm wide white hypopigmented scar on the left forearm. The scar was tender to deep palpation; however, there was no redness, swelling, drainage, inflammation, edema, erythema, or keloid formation. There was no adherence to underlying tissue. The texture of the skin was normal. The scar was stable. There was no elevation or depression of the surface contour. The scar was superficial. There was no induration or inflexibility of the skin in the area of the scar. There was no limitation of functioning. The assessment was scar on the left forearm status post laceration injury. In November 2010, the Veteran underwent a VA peripheral nerves examination. The Veteran gave essentially the same history of injury, except he reported that he fell and hurt his left wrist during the incident. He again reported tenderness of the scar on palpation but denied redness, swelling, lesion, drainage or burning pain. With regard to the scar, he reported no functional limitation secondary to the scar and no skin breakdown. He also denied any inflammation or edema secondary to the scar. Physical examination noted a 6-cm long and 0.2-cm wide, hypopigmented well-healed scar. The scar was tender to palpation. There was no redness, swelling, drainage, adherence to underlying tissue, abnormal texture of the skin, elevation or depression of the surface contour, instability, inflammation, edema, erythema, keloid formation, or induration or inflexibility of the skin. The scar was stable and superficial. There was no limitation. There was no evidence of tissue loss. The assessment was the same as at the previous examination. Consequently, in evaluating the Veteran's scar residuals of the wound to his right forearm, the Board finds that the preponderance of the evidence is against finding that a disability rating is excess of 10 percent is warranted. The medical evidence demonstrates that the Veteran's scar is productive of tenderness on palpation. The scar is noted to only measure 6-cm by 0.2-cm (i.e., an area of 30 square centimeters). It is also noted to be well-healed, superficial, stable, and not to limit functioning of the affected body part. Hence, a higher or separate disability rating is not warranted under Diagnostic Codes 7801, 7802, 7803 or 7805. The Board notes, however, that the record reflects that the Veteran has reported that he has numbness in the third, fourth and fifth fingers of his left hand as well as pain and numbness around the laceration. He has also reported having loss of fine finger movement (including being unable to play his guitar as well as he used to) and cramping/spasms/contracture of the fingers and/or hand on repetitive use that causes him to not be able to hold things and to drop things. Consequently, in October 2010, the Board remanded the Veteran's claim for additional development and consideration of whether the Veteran has residuals from the laceration wound to the left forearm other than a scar. After additional development, the denial of the Veteran's claim was continued in an October 2011 Supplemental Statement of the Case. In this regard, the evidence of record shows that the first medical evidence showing complaints of numbness of the third, fourth and fifth fingers is a VA Primary Care note from April 2008. This treatment note indicates the Veteran reported that he received a cut in his upper forearm in service and that his fingers had been numb since then. Also at that time, he reported dropping things out of his hands from time to time. The assessment was "ulnar neuropathy left arm will get NCV for confirmation." On neurology consultation in May 2008, the Veteran complained of numbness over the dorsum of the middle three fingers of his left hand following trauma to the dorsum of his left forearm in 1982. He also complained of weakness of the left hand. Brief examination showed a giveaway weakness of the left wrist extensors. Nerve conduction velocity (NCV) testing and electromyogram (EMG) of the left arm demonstrated normal bilateral median and ulnar motor conduction studies and F wave latencies and normal bilateral median, ulnar and radial sensory conduction studies. A needle EMG examination of the selected muscles did not show any evidence of denervation or of cervical radiculopathy or radial nerve neuropathy. The physician commented that it appears that the Veteran's injury in the left forearm was not deep enough to affect the radial nerve. At the VA examination in August 2008, the Veteran reported having pain and occasional numbness in the left arm ever since the laceration wound and difficulty with repetitive use of the left arm. He complained of weakness and dropping things with repetitive use of his hand. He also reported numbness of the left little finger, ring finger, and middle finger off and on. The examiner noted that the Veteran was diagnosed with ulnar neuropathy of the left arm by his primary care physician and had an EMG done on May 27, 2008, which reported normal bilateral median and ulnar motor conduction studies and normal bilateral median, ulnar and radial sensory conduction studies. Despite the Veteran's reports of weakness and numbness in the left upper extremity, however, the examiner only noted that neurological examination showed the Veteran had normal reflexes of the left arm. There was no additional testing (such as for muscle strength or sensory loss) conducted to determine whether the Veteran had any additional disability involving the muscles or nerves of the forearm and/or hand. As previously discussed, the Board remanded the Veteran's claim in October 2010 for additional development to include a VA examination to determine whether the Veteran had any muscle or neurological residuals as a result of the wound to the left forearm. He underwent a VA peripheral nerves examination in November 2010. At that time, he reported a history of constant tingling in the third, fourth and fifth fingers of the left hand for several years. He denied any burning pain. He reported he has difficulty playing the violin and guitar, typing, and jumping rope secondary to the numbness in the left hand. He also reported that the three fingers of his left hand often go into spasm when he is playing guitar or with prolonged use of his left hand. He denied any pain or limited range of motion of the joints of the left hand. He also denied any pain or weakness to the muscles of the left forearm. He reported no pain, redness, tenderness, swelling, stiffness or limited range of motion of the left wrist, left elbow, left shoulder or left hand joints. He reported functional limitation secondary to the numbness in the last three fingers of the left hand. He related that the numbness is usually worsened by cold weather or cold water but gets better with hot water or warm weather. He was not taking any medications or undergoing any other treatment for his complaints. Physical examination demonstrated there was no loss of muscle function secondary to the scar. There was also no evidence of muscle herniation. There was no change in muscle strength. There was no evidence of bone or joint damage; nor was there evidence of tendon damage. There was no anatomical defect of the wrist or hand. There was no swelling, heat, instability, weakness, tenderness or redness. Range of motion of the left hand, wrist, elbow and shoulder joints was within normal limits. There was no pain with range of motion. Motor strength was 5/5 throughout the left upper extremity. There was no change in function with repetition. Sensory was noted to be decreased on the third, fourth and fifth fingers of the left hand. Dexterity was normal. No atrophy was noted. X-rays of the wrist and hand were normal. EMG of the left hand showed mild left carpal tunnel syndrome. The examiner, therefore, diagnosed the Veteran to have mild left carpal tunnel syndrome. In commenting, the examiner stated that there is no functional limitation noted secondary to the scar on the left forearm. She noted that the EMG examination conducted in 2008 states that the injury in the left forearm was not deep enough to affect the radial nerve. She further stated there is no disability noted secondary to the scar condition. The Veteran's X-ray of the left wrist and left hand are normal with no evidence of fracture, or degenerative changes. The Veteran's symptoms are consistent with mild left carpal tunnel syndrome, which she opined is not related to the laceration wound in service or secondary to the scar. Although the Board acknowledges that Veteran's lay statements as to the onset of the numbness and tingling in his fingers and forearm, he has not provided any medical opinion other than his own that these symptoms are the result of the laceration wound to the left forearm he incurred in service. The Board notes that the Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge (such as experiencing symptoms during or after service). Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Further, under certain circumstances, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The presence of either a muscle or neurological disorder as a result of the laceration wound to the left forearm, however, is a determination "medical in nature" and not capable of lay observation. A layperson is generally not deemed competent to opine on a matter that requires medical knowledge, such as the question of whether a chronic disability is currently present or a determination of etiology. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Therefore, the Board finds that the Veteran's lay opinion that his current symptoms involving the left hand and fingers was caused by the laceration wound incurred in service is not probative. Rather, the more probative and persuasive evidence is the medical evidence, especially the November 2010 VA examiner's opinion, that fails to relate the Veteran's complaints of symptoms to the laceration wound to the left forearm in service. Although the Veteran has related he has had these symptoms since the injury in service, the first medical treatment for such complaints was not until April 2008. And although the primary care physician thought he might have ulnar neuropathy, that diagnosis was ruled out by the normal diagnostic testing (EMG and NCV studies) conducted in May 2008 by Neurology. Rather, the first evidence of any neurological deficit involving the Veteran's left upper extremity is the November 2010 VA examination, which diagnosed mild left carpal tunnel syndrome by EMG study, which the examiner specifically opined was neither related to the laceration wound of the forearm incurred in service nor secondary to the service-connected scar. Furthermore, the neurologist who did the consult in May 2008 stated that it appears the injury to the forearm was not deep enough to affect the radial nerve. Consequently, the Board finds that the preponderance of the evidence is against finding that the Veteran has any neurological residuals as a result of the in-service laceration wound to the left forearm. Furthermore, there is no evidence that the Veteran has any muscle residuals. Although the May 2008 Neurology consultation note indicates there was giveaway weakness of the left wrist extensors, no muscle weakness was found on examination in November 2010. There is no other medical evidence to support the Veteran has a muscle injury to the right forearm as a result of the laceration wound. The scar itself is superficial. It is not adherent to the underlying tissue. There is no finding of atrophy or loss of function of the muscles in the left forearm. Essentially, the medical evidence fails to demonstrate a diagnosis of any muscle injury as a result of the in-service laceration wound to the left forearm. As previously discussed, although the Veteran is competent to state that he experiences weakness in the left forearm or hand, he is not competent to provide an opinion that such weakness is the result of the laceration wound to the left forearm incurred in service. Thus, his opinion relating the two is not probative to establish that he has a muscle injury as the result of the in-service laceration wound to the left forearm. Consequently, the Board finds that the preponderance of the evidence is against finding that the Veteran has any muscle injury residuals as a result of the in-service laceration to the left forearm. Finally, the Board must consider whether the evidence warrants referral of the Veteran's claim for consideration of an extraschedular disability rating under 38 C.F.R. § 3.321(b). It is generally provided that the rating schedule will represent, as far as can practicably be determined, the average impairment in earning capacity in civil occupations resulting from a service-connected disability. 38 C.F.R. § 3.321(a). In the exceptional case, however, to accord justice, where the schedular evaluations are found to be inadequate, the Secretary is authorized to approve, on the basis of the criteria set forth in 38 C.F.R. § 3.321(b)(1), an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. 38 C.F.R. § 3.321(b). The Veteran's entire history is reviewed when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1995). Loss of industrial capacity is the principal factor in assigning schedular disability ratings. See 38 C.F.R. §§ 3.321(a), 4.1. Indeed, 38 C.F.R. § 4.1 specifically states: "[g]enerally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability." Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992) & Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). The Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that disability are inadequate. In other words, whether the disability picture presented in the record is adequately contemplated by the rating schedule. In doing so, there must be a comparison between the level of severity and the symptomatology of the claimant's disability with the established criteria provided in the rating schedule for this disability. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. In the present case, the evidence demonstrates that the only residual the Veteran has as a result of the in-service laceration wound to the left forearm is a scar and that this scar is tender to palpation. The rating schedule clearly provides for such a disability with a 10 percent disability rating under Diagnostic Code 7804. There is no medical evidence to demonstrate that the Veteran has any other symptoms relating to his scar residuals of the laceration wound to the left forearm that are not contemplated by the rating schedule. In fact, he specifically denied having any other residuals at both VA examinations in 2008 and 2010. Furthermore, the Board acknowledges the Veteran's reported history of having numbness and tingling in his forearm and fingers of his left hand since the injury in service. The medical evidence, however, fails to support a finding that any neurological deficit he currently has (diagnosed as mild left carpal tunnel syndrome as of November 2010) is related to the in-service laceration wound to the left forearm. Nor does the medical evidence support a finding that his complaints of weakness are related to this injury as well. Essentially, the medical evidence does not support the Veteran's complaints, and the Board finds this medical evidence to be more probative and persuasive than the Veteran's reported history. Consequently, the Board finds the evidence fails to demonstrate that the Veteran's disability picture is so exceptional as to render the VA rating schedule inadequate to rate his service-connected scar, residuals of a wound to the left forearm. Thus, the preponderance of the evidence is against finding that referral for consideration of an extraschedular rating under 38 C.F.R. § 3.321(b) is warranted. For the foregoing reasons, the Board finds that the preponderance of the evidence is against the Veteran's claim for a higher disability rating for the service-connected scar residuals of a wound to his left forearm. The preponderance of the evidence being against the claim, the benefit of the doubt doctrine is not for application. Consequently, the Veteran's claim must be denied. Finally, the Board notes that the claims folder contains no competent and credible evidence (including any assertions from the Veteran) that he is unemployable as a result of this service-connected disability. Thus, the question of entitlement to a total disability rating based on individual unemployability due to this service-connected disability has not been raised by the record, and no further discussion of this matter is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). ORDER Entitlement to an initial disability rating in excess of 10 percent for the service-connected scar, residuals of a wound to the left forearm, is denied. ____________________________________________ THERESA M. CATINO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs