Citation Nr: 1318526 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 06-18 865 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, depression, and anxiety disorder. 2. Entitlement to a disability rating higher than 20 percent for sensory loss affecting the left hand. 3. Entitlement to an increased disability rating for postoperative left wrist scars, evaluated as noncompensably disabling prior to November 18, 2011, and as 10 percent disabling thereafter. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL The Veteran ATTORNEY FOR THE BOARD C. Fleming, Counsel INTRODUCTION The Veteran had active military service from March 1963 to March 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2004 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia, and an August 2006 rating decision by the RO in Nashville, Tennessee. In the March 2004 rating decision, the Atlanta RO denied the Veteran's claims for increased ratings. In the August 2006 rating decision, the Nashville RO denied the Veteran's claim for service connection for what it identified as posttraumatic stress disorder (PTSD). During the pendency of the Veteran's appeal, the RO awarded an increased evaluation for the service-connected sensory loss of the left hand to 20 percent, and for the service-connected left wrist scars to 10 percent. The Board remanded the case, most recently in October 2012, for further notification, evidentiary development, and adjudication. The Board instructed the agency of original jurisdiction (AOJ) to provide VCAA-compliant notice, obtain treatment records, provide the Veteran with a psychological examination, and then re-adjudicate the claims. The AOJ provided the requisite notice via an October 2012 letter, obtained the identified VA treatment records, and scheduled the Veteran for a VA examination, which was conducted in December 2012. The Veteran was then provided supplemental statements of the case (SSOCs), most recently in March 2013, in which the RO again denied the Veteran's claims. Thus, there has been compliance with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). The Board notes that the United States Court of Appeals for Veterans Claims (Court) has recently has held that, although an appellant's claim identified only a single diagnosed disorder, it cannot be a claim limited only to that diagnosis, but must rather be considered a claim for any disability that may reasonably be encompassed by several factors-including the claimant's description of the claim, the symptoms the claimant describes, and the information the claimant submits or that VA obtains in support of the claim. The Court reasoned that the appellant did not file a claim to receive benefits only for a particular diagnosis, but for the affliction (symptoms) his condition, however described, causes him. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Here, although the Veteran filed his claim seeking service connection for PTSD specifically, the Board notes that the Veteran has been diagnosed with multiple acquired psychiatric disorders, including depression and an anxiety disorder. The Board thus finds that, pursuant to Clemons, supra, the Veteran's service connection claim is more accurately classified as one for any acquired psychiatric disorder, to include depression and anxiety disorder. See Clemons, 23 Vet. App. 1 (2009). In July 2012, the Veteran testified during a hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. FINDINGS OF FACT 1. Any acquired psychiatric disorder is not related to the Veteran's military service or an event of service origin. 2. The Veteran's sensory loss affecting the left hand has been evidenced by no more than moderate symptoms such as subjective complaints of pain, numbness, and tingling, and objective findings of neuroma. 3. For the entirety of the claim period, the Veteran's postoperative left wrist scars have been shown to measure a total of no more than 1.7 square centimeters in area; there is one scar that is painful; the scars are not deep or unstable; and they do not cause any disabling effects or limitation of function. CONCLUSIONS OF LAW 1. The Veteran does not have an acquired psychiatric disorder that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 2. The criteria for a rating higher than 20 percent for sensory loss affecting the left hand have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.124a, Diagnostic Code 8515 (2012). 3. The criteria for a rating of 10 percent for postoperative left wrist scars were met for the period prior to November 18, 2011. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2012); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2008). 4. The criteria for a rating higher than 10 percent for postoperative left wrist scars have not been met since November 18, 2011. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2012); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist At the outset, the Board notes the enactment of the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), in November 2000. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, and 5107 (West 2002 & Supp. 2012). To implement the provisions of the law, VA promulgated regulations codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify the claimant of what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). In this case, the Board finds that all notification and development action needed to arrive at a decision has been accomplished. In this respect, through September 2003, May 2004, January 2006, August 2006, and October 2012 notice letters, the Veteran received notice of the information and evidence needed to substantiate his claims. Thereafter, the Veteran was afforded the opportunity to respond. Hence, the Board finds that the Veteran has been afforded ample opportunity to submit information and/or evidence needed to substantiate his claims. The Board also finds that the September 2003, May 2004, January 2006, August 2006, and October 2012 notice letters satisfy the statutory and regulatory requirement that VA notify a claimant what evidence, if any, will be obtained by the claimant and which evidence, if any, will be retrieved by VA. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). In the letters, the RO also notified the Veteran that VA was required to make reasonable efforts to obtain medical records, employment records, or records from other Federal agencies. The RO also requested that the Veteran identify any medical providers from whom he wanted the RO to obtain and consider evidence. Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. See Pelegrini v. Principi, 18 Vet. App. 112, 121 (2004). See also Notice and Assistance Requirements and Technical Correction, 73 Fed. Reg. 23,353 (Apr. 30, 2008) (codified at 38 C.F.R. § 3.159) (removing the prior requirement that VA specifically ask the claimant to provide any pertinent evidence in his possession). These requirements were met by the aforementioned September 2003, May 2004, January 2006, August 2006, and October 2012 letters. Further, the Veteran was provided notice regarding an award of an effective date and rating criteria in the August 2006 and October 2012 letters. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Nothing about the evidence or any response to the RO's notification suggests that the case must be re-adjudicated ab initio to satisfy the requirements of the VCAA. The Board also points out that there is no indication that any additional action is needed to comply with the duty to assist in connection with the claims on appeal. The Veteran's service treatment records, as well as records of his post-service treatment with private and VA treatment providers, have been associated with the claims file. Records of the Veteran's award of Social Security Administration (SSA) benefits have also been associated with the claims file. The Veteran also underwent VA examination in January 2004, November 2011, and December 2012, reports of which are of record. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the Board finds that the VA examinations obtained in this case are adequate, as they are predicated on full physical and psychological examination as well as consideration of the medical records in the claims file and the Veteran's reported history. The examinations consider all of the pertinent evidence of record, to include statements given by the Veteran at the time of the examinations, and provide a complete rationale for the opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the claims on appeal has been met. 38 C.F.R. § 3.159(c)(4). Additionally, the Veteran and his representative have both submitted written argument, and the Veteran testified before the undersigned Veterans Law Judge at a hearing in July 2012. Otherwise, neither the Veteran nor his representative has alleged that there are any outstanding records probative of the claims on appeal that need to be obtained. Under these circumstances, the Board finds that VA has complied with all duties to notify and assist required under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159. II. Analysis A. Service Connection Claim Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires: (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease; and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). Further, it is not enough that an injury or disease occurred in service; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection for PTSD requires: (1) a medical diagnosis of PTSD utilizing the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 138 (1997). Certain chronic diseases, including psychoses, may be presumed to have been incurred during service if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307(a)(3); 3.309(a) (2012). Regarding diagnosis of the Veteran's mental disabilities, the Board first acknowledges that the Veteran's service treatment records are silent as to any psychological complaints; he replied "No" when asked if he suffered from nightmares, depression or excessive worry, or any other psychiatric troubles at his January 1966 separation examination and was noted to be "normal" psychiatrically. Records are silent as to any complaints of or treatment for psychological difficulty while the Veteran was serving on active duty. Post-service medical records reflect that the Veteran was first seen for psychological complaints in January 1990, at which time he was diagnosed with depression secondary to a motor vehicle accident he sustained in 1989. Later private treatment records from 1990 to 1997 reflect a consistent diagnosis of depression, but no etiological opinions were offered in conjunction with any of these diagnoses. At a June 1990 SSA evaluation, the Veteran was diagnosed with dysthymia and generalized anxiety disorder. The examiner opined that "some of these effects may be due to ... being disabled." In addition, the Veteran was also assessed with "posttraumatic stress syndrome" in November 1990, but no etiological opinion was offered. Post-service VA treatment records reflect that the Veteran has sought VA treatment since at least 2004; a PTSD screen in December 2004 was positive. He has been assigned a diagnosis of anxiety disorder as well as a rule-out diagnosis of PTSD, which was first assigned in August 2004. However, in July 2004 the Veteran reported that he experienced no symptoms associated with his reported stressor. Similarly, in February 2006 the Veteran reported that he had a "31-month vacation when in military," due to the traveling he did throughout Europe during service. No symptoms associated with any in-service stressor were reported. The Veteran was first assigned a diagnosis of PTSD by his VA treatment providers in June 2005, although no etiological opinion was provided at that time. In addition, at a November 2005 treatment visit, the treatment provider assigned a diagnosis of PTSD but identified no related stressors. Later treatment records from June and August 2006 reflect only that the Veteran carried a PTSD diagnosis "by history"; treatment providers at that time diagnosed him instead with depressive disorder. The Veteran was diagnosed with anxiety disorder in June 2008. At that time, the treatment provider noted that the Veteran reported an in-service stressor and opined that a PTSD diagnosis "could be entertained." However, no such diagnosis was assigned. The Veteran underwent VA examination in December 2012, pursuant to the Board's October 2012 remand. Report of that examination reflects that the VA examiner reviewed the Veteran's claims file and conducted a thorough psychiatric examination. The examiner exhaustively reviewed the Veteran's claims file and treatment history. He noted that no mental health problems were documented in service but acknowledged that the Veteran reported having witnessed an incident in which two soldiers were run over and killed while on active duty. The examiner concluded that the Veteran did not meet even minimal criteria for a diagnosis of PTSD, despite the historical diagnosis of PTSD assigned by the Veteran's VA treatment providers. In so finding, the examiner noted that testing revealed scores that were "not at all consistent with" a diagnosis of PTSD. The examiner instead assigned a diagnosis of anxiety disorder and opined that the disability is not etiologically linked to the Veteran's time on active duty. In so finding, the examiner noted that the Veteran displayed no psychiatric symptoms in service and indeed was not treated for or diagnosed with any psychiatric disorder until his 1989 motor vehicle accident. Thus, the examiner concluded that the disorder is less likely than not related to service. The Veteran has also submitted statements to VA in support of his service connection claim and has testified before the undersigned Veterans Law Judge. To that end, the Veteran stated at his July 2012 hearing before the undersigned Veterans Law Judge that he experienced a stressor in service when he witnessed two fellow soldiers get run over and killed. Similarly, the Veteran described the same stressor at a June 2005 hearing before a Decision Review Officer, at which time he stated at that time that he had experienced depression and nightmares since service. The Veteran has also submitted buddy statements from a fellow soldier who testified to having witnessed the accident. Upon consideration of the above evidence, the Board finds that the preponderance of the evidence is against the Veteran's claim of service connection for an acquired psychiatric disorder. The Board concedes that VA examination confirms that the Veteran currently suffers from anxiety disorder. The Board concludes, however, that the greater weight of the evidence is against the claim. As an initial matter, the Board notes that the evidence establishes that the Veteran does not experience PTSD. In that connection, the Board first notes that the Veteran contends that he was exposed to an in-service stressor, in the form of witnessing a fatal accident, that led to PTSD. This stressor has been verified by a fellow soldier, who submitted a statement attesting to having witnessed the incident. However, the Board notes that in order for the Veteran's claim of service connection for PTSD to be granted, the record would have to contain a clear diagnosis of PTSD. As discussed above, the December 2012 VA examiner considered the Veteran's contentions and results of psychological testing as well as the available medical evidence-including his positive PTSD screen in December 2004 and subsequent diagnoses of PTSD-in specifically concluding that it was less likely than not that the Veteran experiences PTSD. In so concluding, the examiner specifically noted that results from the Veteran's psychiatric testing did not support his contentions and that his symptoms were more likely explained by a different diagnosis of anxiety disorder. The examiner offered a clear explanation for his opinion, relying on the Veteran's medical history and his medical expertise, as well as current medical knowledge, in concluding that the Veteran does not in fact have PTSD. Regarding the Veteran's claim for service connection for an acquired psychiatric disorder other than PTSD, the Board notes that the Veteran's service treatment records are completely silent as to complaints of or treatment for psychiatric complaints. His January 1966 separation medical examination revealed findings of no psychiatric abnormalities. Further, the December 2012 VA examiner found no link between any current disability and military service. Furthermore, the Board finds persuasive the absence of probative medical evidence to support a finding of a nexus between the Veteran's service and his current anxiety disorder. In that connection, the Board notes that the medical opinion submitted by the December 2012 VA examiner specifically addressed the question but did not attribute the Veteran's current anxiety disorder to active duty. In so finding, the examiner explicitly considered the positive PTSD screen and the diagnoses of PTSD assigned to the Veteran in 2005 and 2006. The VA examiner also relied on the record and articulated why the record, especially the absence of documented problems until well after military service, caused him to arrive at the conclusions he did. The Board therefore gives significant weight to this opinion. The December 2012 VA examiner provided a report that considered the Veteran's history, set out his findings in detail, and contained clearly articulated reasons for his conclusions. Thus, the Board relies upon this opinion in making its determination. As discussed above, the December 2012 VA examination specifically addressed causation, clearly indicating that the Veteran's current anxiety disorder is not likely related to his time in service. Additionally, the examiner offered a clear and well-reasoned explanation for his opinion that the evidence contained in the Veteran's claims file, including his own statements to the VA medical examiner and to other VA personnel, supported a conclusion that the current anxiety disorder is not likely related to service, relying on the examination report and his medical expertise as well as medical knowledge in concluding that any such etiological link was doubtful. The Board acknowledges that the Veteran has contended, at his June 2005 hearing before a Decision Review Officer (DRO) at the RO, that he first experienced psychiatric symptoms of nightmares and depression in service. In this regard, the Board notes that in order for the Veteran's claim of service connection for an acquired psychiatric disorder to be granted, the record would have to contain competent and credible evidence linking his current disability to his military service. As discussed above, the VA examiner considered the Veteran's contentions as well as the available medical evidence in specifically concluding that it is less likely than not that any current psychiatric disorder is etiologically linked to service. The examiner offered a clear explanation for his opinion, relying on the Veteran's medical history and his medical expertise, as well as current medical knowledge, in concluding that any connection between the Veteran's currently diagnosed anxiety disorder and service was doubtful. As noted above, in this instance, the Veteran's report of continuity of symptomatology of psychiatric symptoms is not supported by the other evidence, particularly the opinion of the VA examiner, who examined the Veteran, considered his contentions, and nevertheless concluded that the Veteran's version of events was not the most likely explanation. Moreover, the Veteran was noted in his January 1966 separation report of medical examination to have a normal psychiatric system. Tellingly, at that time, the Veteran himself responded "No" on his separation report of medical history when he was asked if he was experiencing any psychological problems. Consequently, based on the Veteran's own contemporaneous report of his psychological state, as well as his later private treatment records indicating that he first developed symptoms of an acquired psychiatric disorder more than twenty years after separation from service following an unrelated motor vehicle accident, it cannot be concluded that he had symptoms of an acquired psychiatric disorder that began in service and have continued without interruption to the present. This evidence contradicts the Veteran's version of events regarding the continuity of symptomatology of an acquired psychiatric disorder. Further, the VA examiner considered the Veteran's contentions and yet clearly concluded that the Veteran's anxiety disorder was less likely than not related to service. Consequently, the Board finds that, to the extent that the Veteran has asserted that he developed an acquired psychiatric disorder while on active duty that has continued to the present, that assertion is not credible. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for an acquired psychiatric disorder. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C.A § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). B. Claims for Increase The Veteran contends that his service-connected sensory loss affecting the left hand is more disabling than reflected by the 20 disability rating currently assigned. The Veteran also contends that his service-connected postoperative left wrist scars are more disabling than the noncompensable disability rating assigned prior to November 18, 2011, and the 10 percent assigned thereafter. Disability evaluations are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2012). The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The United States Court of Appeals for Veterans Claims (Court) has also found that staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where a service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2008). . When evaluating musculoskeletal disabilities, VA must consider granting a higher rating in cases in which the Veteran experiences functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination (to include during flare-ups or with repeated use). See 38 C.F.R. §§ 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Relevant evidence of record consists of VA and private treatment records, as well as VA examinations conducted in January 2004 and November 2011. Report of the January 2004 VA examination reflects that the Veteran complained of left wrist pain, numbness, and limitation of motion, as well as decreased grip strength and decreased sensation with tenderness to palpation in his fifth finger and the ulnar side of his wrist. Physical examination revealed one tender scar measuring 1 square centimeter as well as three non-tender scars measuring a total of 0.7 square centimeters. Range-of-motion testing found the Veteran to have dorsiflexion of the left wrist to 40 degrees, palmar flexion to 40 degrees, radial deviation to 10 degrees, and ulnar deviation to 20 degrees. Palmar abduction of the left thumb was limited to 45 degrees; otherwise, range of motion of the left hand and fingers was normal. The Veteran again underwent VA examination on November 18, 2011. Report of examination of the Veteran's peripheral nerves reflects that the Veteran complained of constant, severe left upper extremity pain, as well as mild paresthesia and numbness. The Veteran complained that he was unable to drive a truck secondary to the constant pain in his left hand. Physical examination found the Veteran to have normal strength, deep tendon reflexes, and sensation in the upper left extremity, and no nerve was noted to be affected. He was diagnosed with neuroma. Report of the examination of the Veteran's scars found him to have one painful scar and three non-painful scars, with a total area of 1.5 square centimeters. All scars were noted to be superficial, with no instability. Records of the Veteran's private and VA treatment records reflect that he has been seen on an ongoing basis for complaints of pain in his left wrist and hand. A private treatment visit dated in May 2004 reflects a diagnosis of left ulnar neuritis. Similarly, the Veteran's VA treatment providers diagnosed him with neuropathy of the left arm in August 2004. He was noted to complain of "significant" pain in his left arm and wrist in December 2005, and was again seen for left arm and wrist pain on multiple occasions in 2006. Similarly, VA treatment records reflect that the Veteran's scars was noted to be tender to the touch at a January 2008 treatment visit. At that time, he complained of pain in his left wrist and forearm; tenderness to palpation of the left wrist forearm, as well as some decreased sensation, was noted on evaluation. He was again seen in November 2012 for complaints of chronic left arm pain for which he had been prescribed medication. The Veteran has also contended on multiple occasions, including at his July 2012 hearing before the undersigned Veterans Law Judge, that his left wrist scars are painful and tender, causing him to be unable to wear a watch on his left wrist or buttoned cuffs of long-sleeved shirts. At the July 2012 hearing, the Veteran specified that he had multiple scars but that only one was painful. He further testified that he had trouble lifting and carrying heavy objects and was limited in his ability to drive. The Veteran's sensory loss affecting the left hand has been evaluated under Diagnostic Code 8515, paralysis of the median nerve. 38 C.F.R. § 4.124a (2012). Under that Diagnostic Code, ratings are applied based on whether the disabled extremity is the major or minor extremity. Here, the record shows that the Veteran is right handed; therefore, evaluation of the Veteran's sensory loss affecting the left hand will be evaluated utilizing the ratings applicable to the minor extremity. Under Diagnostic Code 8515, a 20 percent rating is for application when there is moderate disability of the minor extremity, and a 40 percent rating is for application when there is severe disability of the minor extremity. A 60 percent rating is for application when there is complete paralysis of the minor extremity. Id. Applying the above-noted rating criteria to the medical evidence of record, the Board finds that the Veteran's sensory loss affecting the left hand more nearly approximates the criteria required for the presently assigned 20 percent rating, and that a higher rating is not warranted at any time during the appeal period. As noted, the Veteran's VA examiners and treatment providers have diagnosed the Veteran with both neuropathy and neuroma of the left wrist. Examination in January 2004 revealed pain, numbness, decreased grip strength and decreased sensation with tenderness to palpation in his fifth finger and the ulnar side of his left wrist. Similarly, although the Veteran complained of severe constant pain, as well as mild paresthesia and numbness, the November 2011 VA examiner found no decreased sensation to the left upper extremity and concluded that there was no nerve involvement. These findings have been replicated by the Veteran's VA treatment providers, who have noted the Veteran's complaints of pain, numbness, and sensitivity in his left upper extremity. Further, the November 2011 VA examiner specifically found no nerve involvement in the Veteran's left upper extremity. Thus, the Board finds that the medical evidence demonstrates no more than a moderate disability of the left wrist and hand. Here, as discussed below, the Veteran experiences no compensable functional loss of the left wrist or hand as a result of his symptoms, and although he has complained that his left wrist disorder limits his ability to carry heavy objects and drive for any length of time, no VA examiner has found such objective symptomatology or categorized the disorder as "severe." Consequently, the Board finds that the Veteran's symptoms are best characterized as no more than moderate, warranting no more than the 20 percent disability rating currently assigned under Diagnostic Code 8515. Turning to the Veteran's left wrist scars, the Board notes that his postoperative scars of the left wrist have been evaluated as noncompensably disabling prior to November 18, 2011, and as 10 percent disabling thereafter, under Diagnostic Code 7804 for painful scars. 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2012); 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805 (2008). The Board notes as an initial matter that the criteria for rating scars under Diagnostic Codes 7800 through 7805 were changed in September 2008. 73 Fed. Reg. 54,708-12 (Sept. 23, 2008) (effective from October 23, 2008). In this case, the RO initially applied the prior Diagnostic Codes in rating the Veteran's scars but has also applied the revised Diagnostic Codes in evaluating the scars in its December 2011 rating decision. Thus, the Board will evaluate the Veteran's scars under both the old and the new criteria. Under the Diagnostic Codes governing scars prior to September 2008, Diagnostic Code 7801 allowed for a 10 percent rating, or higher, for scars, other than on the head, face, or neck, that are deep or that cause limited motion, which are an area exceeding 6 square inches (39 sq. cm.) or greater. A note following the criteria defined a deep scar as one associated with underlying soft tissue damage. Diagnostic Code 7802 provided for a maximum 10 percent rating for scars, other than on the head, face, or neck, that are superficial and that do not cause limited motion with an area of 144 square inches (929 sq. cm.) or greater. Under prior Diagnostic Code 7803, a maximum 10 percent rating was warranted for unstable superficial scars. A note following the criteria defines an unstable scar as one where, for any reason, there is frequent loss of covering of skin over the scar. Diagnostic Code 7804 provided for a maximum 10 percent rating for superficial scars that are painful on examination. According to a note following the Diagnostic Code, a superficial scar is one not associated with underlying soft tissue damage. Under prior Diagnostic Code 7805, scars are to be rated on the basis of limitation of function of the affected part. 38 C.F.R. § 4.118. Pursuant to the version of Diagnostic Code 7804 in effect from September 2008, one or two scars that are unstable or painful warrant a 10 percent rating. 38 C.F.R. § 4.118, DC 7804 (2012). Three or four scars that are unstable or painful warrant a 20 percent rating. Id. Five or more scars that are unstable or painful warrant a 30 percent rating. Id. In this case, the Board notes that the Veteran was found at both his January 2004 and November 2011 VA examinations to have one tender scar, and three non-tender scars, on the left wrist. Thus, a 10 percent rating is warranted under both prior and current Diagnostic Code 7804, governing painful scars. This is so for the entirety of the claim period. The Board does not find, however, that a rating higher than 10 percent is warranted for the Veteran's postoperative left wrist scars at any time during the claim period. In this connection, the Board notes that the scars have been found to measure no more than 1.7 square centimeters in total and to be otherwise asymptomatic, with no underlying soft tissue damage or instability noted in any of the scars. Thus, separate ratings are not warranted under prior Diagnostic Codes 7801, 7802, or 7803. Similarly, current Diagnostic Code 7801 evaluates scars not of the head, face, or neck, that are deep and nonlinear. In this case, the VA examination shows that, although one scar is nonlinear, all of the scars are superficial. No underlying soft tissue damage has been shown, and no medical professional has opined that the scars are deep. Thus, a rating under Diagnostic Code 7801 is not warranted. As the total surface are of the Veteran's left wrist scars is no more than 1.7 square centimeters, a separate rating under current Diagnostic Code 7802 is not warranted. See 38 C.F.R. § 4.118, Diagnostic Code 7800, 7801, 7802 (2012). Furthermore, limitation of motion of the wrist is evaluated under Diagnostic Code 5215, which assigns a maximum 10 percent rating for limitation of dorsiflexion to less than 15 degrees, or limitation of palmar flexion in line with forearm. 38 C.F.R. § 4.71a (2012). (The standardized range of motion for the wrist is plantar flexion to 80 degrees, dorsiflexion to 70 degrees, ulnar deviation to 40 degrees, and radial deviation to 20 degrees. 38 C.F.R. § 4.71, Plate I (2012).) In this case, the Board has considered ratings under both prior and current Diagnostic Code 7805, which govern limitation of the part affected. However, in this case, the Veteran's left wrist range of motion is not limited to dorsiflexion of 15 degrees or with palmar flexion limited in line with the forearm to warrant a 10 percent rating under Diagnostic Code 5215. The Board acknowledges that the Veteran experiences some limitation of motion of the left wrist, as evidenced on his VA examinations. However, even if the limitation is attributed solely to the service-connected sensory loss affecting the left hand or to the postoperative left wrist scars, the limitation does not rise to the level of a compensable rating. To that end, the Board notes that the Veteran's dorsiflexion and palmar flexion have been limited to, at worst, 40 degrees, which does not rise to the level of a compensable limitation of motion under Diagnostic Code 5215. Thus, evaluating the Veteran's disability under the limitation of the part affected does not warrant a compensable disability rating under either prior or current Diagnostic Code 7805, 38 C.F.R. § 4.118. The Board has considered the Veteran's and his representative's contentions with regard to his claim for a higher ratings for his service-connected disabilities. While the Board does not doubt the sincerity of the Veteran's belief that his disabilities are more severely disabling than reflected in the current ratings, as a lay person without the appropriate medical training or expertise, he simply is not competent to provide a probative opinion on a medical matter, such as the severity of a current disability as evaluated in the context of the rating criteria. See Bostain v. West, 11 Vet. App. 124, 127 (1998). The statements from the Veteran clearly articulate the symptoms and troubles he experiences; however, even with consideration of those problems, ratings higher than those already assigned are not warranted under the relevant criteria. The above determination is based on consideration of the applicable provisions of VA's rating schedule. The Board also finds that at no time have the disabilities under consideration been shown to be so exceptional or unusual as to warrant consideration of a higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1). Here, there is an absence of evidence of marked interference with employment (i.e., beyond that contemplated in the assigned evaluation), frequent periods of hospitalization, or evidence that the Veteran's service-connected disorders have otherwise rendered impractical the application of the regular schedular standards. In that connection, the Board acknowledges that the Veteran is not employed but notes that his inability to work has been attributed to non-service-connected neck and back disorders. Thus, the criteria for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Furthermore, it bears emphasis that the schedule is intended to compensate for average impairments in earning capacity resulting from service-connected disability in civil occupations. 38 U.S.C.A. § 1155. Generally, the degrees of disability specified in the rating schedule 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. 38 C.F.R. § 4.1 (2012). Thus, based on the record before it, the Board does not find that the medical evidence demonstrates any unusual disability with respect to the claims that is not contemplated by the rating schedule. The symptoms the Veteran experiences are all specifically contemplated by the rating schedule. Thun v. Peake, 22 Vet. App. 111 (2008). As a result, the Board concludes that a remand to the RO for referral of the rating issue to the VA Central Office for consideration of extra-schedular evaluation is not warranted. ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to a rating higher than 20 percent for sensory loss of the left hand is denied. Entitlement to a disability rating of 10 percent for postoperative left wrist scars for the period prior to November 18, 2011, is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to a disability rating higher than 10 percent for postoperative left wrist scars is denied. _______________________________ MARK F. HALSEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs