Citation Nr: 18143766 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 16-27 883 DATE: October 22, 2018 ORDER Entitlement to an increased (compensable) rating for service-connected residuals of excision of a cyst on the scalp is denied. FINDING OF FACT Throughout the rating period on appeal, the Veteran's residuals of excision of a cyst on the scalp has not resulted in any characteristics of disfigurement, exceeded a surface area of six square inches (39 sq. cm.), been unstable or painful, or resulted in any limitation of function. CONCLUSION OF LAW The criteria for an increased compensable rating for residuals of a cyst excision on the scalp have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.14, 4.118, Diagnostic Codes 7800-7806 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1977 to March 1995. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) decision dated in March 2016 that denied an increase in a noncompensable rating for service-connected residuals of excision of a cyst on the scalp. 1. Increased rating for residuals of excision of a cyst on the scalp The Veteran contends that his service-connected residuals of excision of a scalp cyst are more disabling than currently evaluated. He has not identified any symptoms from this disability. Service connection was originally established for this scalp scar in a November 1995 rating decision. The Veteran filed the instant claim for an increased rating in October 2015. Throughout the rating period on appeal, the AOJ has rated this disability as noncompensable under Diagnostic Code 7800, pertaining to scars of the head, face or neck. 38 C.F.R. § 4.118. The rating criteria used to evaluate scars is found at 38 C.F.R. § 4.118, Diagnostic Codes 7800 through 7805. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. (1991). In general, the degree of impairment resulting from a disability is a factual determination and the Board’s primary focus in such cases is upon the current severity of the disability. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994); Solomon v. Brown, 6 Vet. App. 396, 402 (1994). However, staged ratings are appropriate in any initial rating/increased-rating claim in which distinct time periods with different ratable symptoms can be identified. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes that some of the criteria for rating skin disorders were revised effective August 13, 2018. 83 Fed. Reg. 32,592 (July 13, 2018). Diagnostic Code 7800 was not revised. Scars, burn scars, and disfigurement of the head, face, or neck are rated under Diagnostic Code 7800. 38 C.F.R. § 4.118. A 10 percent evaluation is warranted for disfigurement of the head, face, or neck with one characteristic of disfigurement. A 30 percent evaluation is warranted for disfigurement 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. Id. A 50 percent evaluation is warranted for disfigurement with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or with four or five characteristics of disfigurement. Id. The highest evaluation of 80 percent is warranted for disfigurement with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or with six or more characteristics of disfigurement. Id. The eight characteristics of disfigurement, for purposes of evaluation under § 4.118 are: (1) scar 5 or more inches (13 or more centimeters (cm.)) in length; (2) scar at least one-quarter inch (0.6 cm.) wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding 6 square inches (39 sq. cm.); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square inches (39 sq. cm.); (7) underlying soft tissue missing in an area exceeding 6 square inches (39 sq. cm.); and (8) skin indurated and inflexible in an area exceeding 6 square inches (39 sq. cm.). Id. at Note (1). Note (4) provides that ratings under Diagnostic Code 7800 should separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply § 4.25 to combine the evaluation(s) with the evaluation assigned), and Note (5) provides that the characteristic(s) of disfigurement may be caused by one scar or by multiple scars and that the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation. Historically, service treatment records show that the Veteran underwent incision and drainage of a cyst on the scalp at the top of his head. On VA examination in June 1995, the examiner noted a scar in the posterior scalp area from removal of a benign cyst. Medical records dated during the pendency of the appeal are negative for any treatment or evaluation of the service-connected scalp scar. Records reflect that in August 2015, the Veteran underwent removal of a lipoma of the parietal scalp and a cyst of the occipital scalp. The Veteran has not identified any symptoms or reported any treatment of his service-connected scalp scar. On VA examination in March 2016, the examiner diagnosed a scalp scar, residual of cyst excision. The Veteran reported that he had an area of his scalp “lanced” during service, and that it was closed over now. The examiner noted that the Veteran had two other small masses removed in August 2015, one on a different part of the scalp, and one on the posterior neck, and opined that these masses were not the same as, or a progression of, the service-connected condition. On examination, the service-connected scar was located on the crown/vertex (posterior top) of the scalp. The scar was intact, non-tender, pliable, superficial linear, and barely visible. There was no palpable residual cyst, sinus tract, or any evidence of drainage (current or recent). The length and width (at widest part) of the scar/disfigurement was 1.3 by 0.2 centimeters. The scar was not painful or unstable, and was not from a burn. There was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue. There was no abnormal pigmentation or texture, and no gross distortion or asymmetry of facial features or visible or palpable tissue loss. The scar did not result in limitation of function, and there were no other pertinent physical findings associated with the scar. The examiner opined that the scar did not impact the Veteran's ability to work. The examiner stated that the Veteran's scars from August 2015 surgeries were not the same as, or a progression of, his service-connected condition. The most comprehensive and probative findings regarding the severity of the Veteran’s service-connected scalp scar are contained within the March 2016 VA scars examination. Most notably, the VA examiner documented that the scar did not result in any of the 8 characteristics of disfigurement, measured 1.3 by 0.2 centimeters at its maximum, was not painful or unstable, and did not result in other disabling effects. The Veteran’s residuals of excision of a cyst on the scalp has not resulted in any characteristics of disfigurement, or exceeded a surface area of six square inches (39 sq. cm.). For the above reasons, and upon review of the record, the Board finds that symptoms consistent with an increased compensable rating are not shown at any point during the period under review. The preponderance of the competent and credible evidence of record does not support the assignment of a compensable rating for the service-connected scalp scar, residual of cyst excision under Diagnostic Code 7800. The Board has also considered whether the Veteran is entitled to an increased rating under any other applicable diagnostic codes. Diagnostic Codes 7801 and 7802 are inapplicable, as these codes pertain to scars on other parts of the body and the Veteran’s scalp scar is located on his head. 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802. An increased rating is not warranted under Diagnostic Code 7804 as the Veteran’s scar has not been shown to be unstable or painful. Finally, a compensable rating is not warranted under Diagnostic Code 7805 because there is no competent and credible evidence the scalp scar causes any limitation of function or has any other disabling effects. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2018), and as revised August 13, 2018. For the reasons set forth above, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim and that an increased compensable rating for the service-connected residuals of cyst excision on the scalp is not warranted throughout the rating period on appeal. The Veteran has not raised any other issues with respect to the increased rating claim, nor have any other assertions been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Although the Veteran's representative has asserted that the case should be remanded for another VA examination of the service-connected scalp scar, since the last examination was performed over two years ago, he has not identified any inadequacies in the examination. The Board finds that another examination is not required. With respect to a claim for an increased rating, only if the record is inadequate or there is suggestion the current rating may be incorrect is there then a need for a more contemporaneous examination. 38 C.F.R. § 3.327 (a). Here, the most recent VA compensation examination for the scalp scar was conducted in March 2016. The mere passage of time since does not, in and of itself, necessitate another examination. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007). A medical opinion is adequate when it is based upon consideration of the appellant’s prior medical history and examinations and also describes the disability in sufficient detail so that the Board’s “evaluation of the claimed disability will be a fully informed one.” Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board finds that the March 2016 VA examination report is sufficiently detailed with recorded history, impact on employment and daily life, and clinical findings. The examination was conducted by a competent medical professional. In addition, it is not shown that the examination was in any way incorrectly conducted or that the VA examiner failed to address the clinical significance of the Veteran’s symptoms. Further, the VA examination report addressed the applicable rating criteria. In this regard, the reports of record contain sufficiently specific clinical findings and informed discussion of the pertinent history and features of the service-connected scalp scar to provide probative medical evidence for rating purposes. Based on the foregoing, the Board finds that, in the circumstances of this case, any additional development as to this issue would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant are to be avoided). The Board finds that the most recent VA examination is adequate as it provides the information needed to properly rate this disability. 38 C.F.R. §§ 3.327 (a), 4.2. The Board finds that another examination is not needed since there is sufficient evidence, already on file, to fairly decide this claim. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. L. Wasser, Counsel