Citation Nr: 18143956 Decision Date: 10/23/18 Archive Date: 10/22/18 DOCKET NO. 16-20 184 DATE: October 23, 2018 ORDER Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a right thigh disability is denied. Entitlement to service connection for sarcoidosis is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for a hypertension is denied. Entitlement to service connection for a high cholesterol is denied. Entitlement to an initial disability rating of 30 percent for facial scars is granted. REMANDED The issues of service connection for peripheral neuropathy of the bilateral lower extremities are remanded. FINDINGS OF FACT 1. A left shoulder disability was not manifested in active service, and the current left shoulder symptoms and disability are not related to disease or injury or other event in active service. 2. A right thigh disability was not manifested in active service, and the current right thigh symptoms and disability are not related to disease or injury or other event in active service. 3. Sarcoidosis was not manifested in active service, was first manifested many years after service separation, and is not related to disease or injury or other event in active service including the treatment for upper respiratory infections in active service. 4. Diabetes mellitus was not manifested in active service, was first manifested many years after service separation, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. 5. Hypertension was not manifested in active service, was first manifested many years after service separation, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. 6. High cholesterol or hypercholesterolemia is not a disability for VA purposes. 7. The service-connected facial scars are manifested by a left upper eyelid scar that is 2.6 centimeters by .4 centimeters, a scar on the right cheek that is 4 centimeters by 3 centimeters with depressed surface contour, and a scar of the left cheek that is 3.5 centimeters by 4 centimeters with depressed surface contour, and there are no objective findings of any other characteristics of disfigurement; the scars are not painful and do not result in visible or palpable tissue loss, gross distortion, asymmetry, or functional limitation. CONCLUSIONS OF LAW 1. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). 2. The criteria for service connection for a right thigh disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). 3. The criteria for service connection for sarcoidosis have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 4. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 5. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 6. The criteria for service connection for hypercholesteremia or high cholesterol are not met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2018). 7. The criteria for a 30 percent initial disability rating for facial scars have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800, 7804 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1978 to August 1981 and he served with the National Guard from March 1983 to July 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in January 2013 and April 2015 of the Department of Veterans Affairs (VA) Regional Office (RO) in Little Rock, Arkansas. In June 2018, the Veteran submitted a waiver of agency of original jurisdiction (AOJ) consideration of new evidence pursuant to 38 C.F.R. § 20.1304 (2018). In August 2018, the Veteran withdrew his request for a hearing before the Board. 1. Service Connection Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection requires competent evidence showing, (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Where a veteran served ninety days or more of active service, and certain chronic diseases, to include sarcoidosis, diabetes mellitus, and cardiovascular disease, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). 38 C.F.R. § 3.303 (b) applies to the “chronic diseases” under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Under 38 C.F.R. § 3.310 (a), service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury. That regulation permits service connection not only for disability caused by service-connected disability, but for the degree of disability resulting from aggravation to a nonservice-connected disability by a service-connected disability. See 38 C.F.R. § 3.310 (2017); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Pursuant to § 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. at 448. Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. 2. Entitlement to service connection for left shoulder and right thigh disabilities is denied. The Veteran asserts that he has current left shoulder and right thigh disabilities due to service. He asserts that he was treated for left shoulder and right thigh disabilities in active service and the in-service injuries led to the current disabilities. At the January 2013 VA examination, the Veteran stated that in 1978 while loading military equipment in an overhead storage bin, some of the equipment fell on his left shoulder. He stated that he was treated at the local aid station. He indicated that x-ray of his shoulder was taken but he was never told what the results were. The Veteran stated that he was also given some pain medications and he denied going back for any treatment of his left shoulder while he was on active duty. The March 2015 VA examination report indicates that the Veteran reported sustaining a thigh contusion in the military approximately 35 years ago. He reported that he now had intermittent crampy thigh pain in the right leg, and it bothered him mostly when he drove for long periods of time. He has not sought treatment for the right thigh from a physician. Service enlistment exam dated in July 1978 indicates that examination of the upper and lower extremities was normal. An August 1979 service treatment record indicates that the Veteran sought medical treatment for a left arm problem that he had for five months. Examination revealed no edema, crepitus, or point tenderness. There was full range of motion. The assessment was tendonitis. He was told to apply heat to the area and take aspirin for 24 hours, and to perform shoulder exercises. In July 1981, the Veteran sought treatment for right thigh pain at an emergency room. The Veteran stated that he had the pain for two days. He stated that he was hit by another person’s knee. The diagnosis was contusion. He was told to apply heat to the area, take aspirin, and use an ace wrap. There is no separation exam of record. The Veteran separated from active service in August 1981. The Veteran entered the National Guard in March 1983. A March 1983 enlistment examination report indicates that the Veteran did not have any complaints pertinent to the left shoulder or right thigh. Physical examination of the upper and lower extremities was normal. The Veteran separated from the National Guard in July 1989. There is no National Guard separation exam of record. The Board finds that the weight of the competent and credible evidence establishes that the Veteran does not have current left shoulder and right thigh disabilities. The Board finds that the weight of the competent and credible evidence establishes that the current left shoulder and right thigh symptoms are not related to injury or other event in active service. The Veteran first reported having right thigh symptoms when he filed his claim for compensation for the right thigh disability in May 2014, and he first sought medical treatment for left shoulder pain in July 2009, over two decades after service separation. This lengthy period of time without complaints or treatment, while not dispositive, is a factor that weighs against the finding that the claimed disabilities have existed since service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a lengthy period without medical complaints about a condition can be considered as a factor in resolving a claim). VA treatment records show that a July 2009 x-ray exam of the left shoulder was normal and the assessment was left shoulder pain. The VA treatment record notes that the Veteran reported having a post-service injury a few days before he sought medical care. The Veteran was afforded a VA examination of the left shoulder in January 2013. He reported having a left shoulder injury in service. As noted above, the Veteran reported that in 1978 while loading military equipment in an overhead storage bin, some of the equipment fell down on his left shoulder. The Veteran reported having pain and tightness with lifting an overhead use. He complained of muscle tightness in left trapezius into his neck area which, the VA examiner noted, was most likely due to cervical spine pathology and muscle spasms. Examination of the left shoulder revealed less movement than normal and pain on movement. X-ray examination of the left shoulder did not reveal arthritis. The VA examiner noted that after review of the Veteran’s claims file, there’s no medical documentation of any treatment for left shoulder pain/injury while he was on active duty. The VA examiner stated that the Veteran’s main complaint today is pain and muscle tightness in trapezius muscle area into his neck. The VA examiner noted that the Veteran had a cervical spine x-ray in dated July 2009 at VA which showed “straightening of the normal lordotic curvature on the lateral view which may be related to muscle spasm” and “Minimal degenerative changes at C5-6.” The VA examiner noted that x-rays of left shoulder on exam was within normal limits. The VA examiner opined that the Veteran’s complaint of pain and muscle tightness in left trapezius muscle and neck are more consistent with muscle spasms due to his cervical spine pathology as noted in previous x-rays in July 2009. The VA examiner stated that considering these finding it was less likely than not (less than 50 percent probability) that the shoulder contusion this Veteran sustained in 1978 is what is causing the current complaints of pain and muscle spasms. The VA examiner stated that it was not feasible to express this with any degree of medical certainty. The Board finds that the VA examiner’s notation that the Veteran’s claims file does not show any medical documentation of any treatment for left shoulder pain/injury while he was on active duty is accurate; the service treatment records do not document complaints of pain or an injury but document a “left shoulder problem” and an assessment of tendonitis. It is clear from the VA examination report that the VA examiner considered the Veteran’s report of the left shoulder injury and symptoms in active service and post service when formulating the medical opinion. The Veteran was afforded a VA examination of the right thigh in March 2015. The Veteran reported sustaining a thigh contusion in the military approximately 35 years ago. He reported that now, he had intermittent crampy thigh pain in the right leg and stated that it bothers him mostly when he is driving for long periods of time. The Veteran has not sought treatment for the right thigh from a physician. The VA examiner stated that the Veteran had occasional crampy thigh pain, that mostly only bothers him when he drives for an extended period of time, and there was no evidence of history on exam or on imaging of any orthopedic dysfunction/impairment of hip, thigh, or knee. The VA examiner opined that there was no reason that an isolated thigh contusion sustained over 35 years ago would have any correlation to current symptoms. The Board finds that the VA medical opinions are probative because the VA examiners reviewed the Veteran’s claims file and medical history, considered the Veteran’s lay statements, and provided a rationale for the opinion. The VA medical opinions state that the claims file was available and reviewed. The Board finds that the opinions are based upon sufficient facts and data and that these opinions are probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The weight of the competent and credible evidence establishes that the current right thigh and left shoulder symptoms and claimed disabilities are not related to any documented event or incident or injury of active service. There is no indication of an association between the claimed right thigh and left shoulder disabilities and any documented event or incident or injury of active service. The Board acknowledges that the Veteran is competent to report his symptoms and observations during the appeal period, and the Board finds these reports are credible. The Veteran has also related his claimed left shoulder and right thigh disabilities to active service. Although lay persons are competent to describe observable symptoms and provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, an opinion as to the etiology and onset of an orthopedic disability falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Some medical issues require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology. Neither the Veteran nor his representative has produced a medical opinion or identified medical evidence that establishes a medical nexus between the claimed disability and active service. There is no competent evidence that indicates an association between the disorders and any documented event or injury of active service. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for a right thigh or left shoulder disability. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for sarcoidosis, diabetes mellitus, and hypertension is denied. The Veteran contends that sarcoidosis first manifested in active service. He asserts that he was treated for sarcoidosis in service. The Veteran also asserts that he has diabetes mellitus and hypertension secondary to the sarcoidosis. He contends that he has diabetes secondary to taking prednisone for the sarcoidosis and he then developed hypertension secondary to the diabetes mellitus. See the February 2013 notice of disagreement and the August 2015 statement. In the February 2013 notice of disagreement, the Veteran stated that he was treated for respiratory symptoms in active service in November 1979 and he had dizziness, fever, weakness, and cough like the flu. He stated that he had the same thing in August 1980 and he still had respiratory symptoms. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has current diagnoses of sarcoidosis, diabetes mellitus, and hypertension, the preponderance of the evidence weighs against finding that these disabilities began during service or are otherwise related to an in-service injury, event, or disease or are caused or aggravated by a service-connected disability. The Board finds the weight of the competent and credible evidence shows that the current sarcoidosis first manifested decades after active service and is not related to disease or injury or other event in active service. Service enlistment exam dated in July 1978 indicates that examination of the lungs and chest was normal. Chest x-ray exam was normal. A November 1979 service treatment record indicates that the Veteran sought medical treatment for dizziness and weakness in the limbs. The physician noted that the Veteran may have had flu viral symptoms. The assessment was possible upper respiratory infection. An August 1980 service treatment record indicates that the Veteran had complaints of scratchy throat, hoarseness, dry cough and nasal discharge for 5 days. The assessment was upper respiratory assessment. A December 1980 service treatment record notes that the veteran had a viral flu syndrome with complaints of weakness and congestion. There is no separation exam of record. The Veteran separated from active service in August 1981. The Veteran entered the National Guard in March 1983. A March 1983 enlistment examination report indicates that the Veteran did not have any complaints pertinent to the lungs or respiratory system. Physical examination of the lungs and chest was normal. Chest x-ray exam was negative. The Veteran separated from the National Guard in July 1989. There is no National Guard separation exam of record. The first evidence of sarcoidosis was in 2005. February 2005 VA treatment records that show that a mass was detected in the right upper lobe. A CT scan of the chest was ordered to differentiate between carcinoma versus lymphoma versus sarcoidosis. It is not clear whether a CT scan was performed in 2005. An April 2009 CT scan report indicates that the findings were most consistent with sarcoidosis. See also the January 2013 VA examination report which indicates that the VA examiner concluded that sarcoidosis was manifest in 2005. The Board notes that a lengthy time interval between service and the earliest post service clinical documentation of the disability is of itself a factor for consideration against a finding that the disability is related to service. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). There is no competent evidence of record showing a diagnosis of sarcoidosis compensable to 10 percent within one year from service separation. Thus, presumptive service connection pursuant to C.F.R. § 3.307(a) is not warranted. The Board also finds that the weight of the competent and credible evidence shows that the Veteran did not experience chronic and continuous symptoms of sarcoidosis in active service or since service separation. As discussed in detail below, the more probative evidence shows that the current sarcoidosis did not manifest in service and is not related to the injury or symptoms in active service. Thus, continuity of symptoms is not shown. Presumptive service connection under the provisions of 38 C.F.R. § 3.303 (b) is not warranted. The Board finds the weight of the competent and credible evidence shows that the current sarcoidosis is not related to injury or event in active service. The Veteran was afforded a VA examination in January 2013. The VA examiner opined that the sarcoidosis was less likely than not (less than 50 percent probability) incurred in or caused by illness that occurred in August 1980. The VA examiner stated that the Veteran’s service treatment records contain a medical clinic visit in August 1980 for a “scratchy throat, nasal drainage, and dry cough” for 5 days. The VA examiner stated that the diagnosis was a self-limited, upper respiratory viral infection and the Veteran was treated symptomatically with warm saline gargles and dimetapp. The VA examiner indicated that the problem resolved. The VA examiner stated that in December 1980, the Veteran presented with a sore throat and runny nose for 2 days. He was treated with Entex LA and saline gargles again. The VA examiner stated that these were both self-limited viral infections. The VA examiner stated that the sarcoidosis is a multisystem granulomatous disorder of unknown etiology that affects individuals worldwide and is characterized pathologically by the presence of noncaseating granulomas in involved organs. The VA examiner noted that it typically affects young adults, and initially presents with bilateral hilar adenopathy or pulmonary reticular opacities. The VA examiner cited to Up-to-Date. The Board finds that the VA medical opinion is probative because the VA examiner reviewed the Veteran’s claims file and medical history, considered the Veteran’s lay statements, and provided a rationale for the opinion. The VA examiner specifically considered the treatment in active service and cited to the medical research regarding sarcoidosis. The Board finds that the opinions are based upon sufficient facts and data and that these opinions are probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The weight of the competent and credible evidence establishes that the current sarcoidosis is not related to any documented event or incident or injury of active service, and this disorder first manifested many years after active service. There is no indication of an association between the sarcoidosis and any documented event or incident or injury of active service. The Board acknowledges that the Veteran is competent to report his symptoms and observations during the appeal period, and the Board finds these reports are credible. The Veteran has also related the sarcoidosis to active service and he stated that the symptoms began in active service and have continued since then. Although lay persons are competent to describe observable symptoms and provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, as to the specific issue in this case, an opinion as to the etiology and onset of sarcoidosis falls outside the realm of common knowledge of a lay person. Jandreau; supra. Some medical issues require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology. Neither the Veteran nor his representative has produced a medical opinion or identified medical evidence that establishes a medical nexus between the sarcoidosis and active service. There is no competent evidence that indicates an association between the sarcoidosis and any documented event or injury of active service. Further, as noted above, the VA examiner concluded that the sarcoidosis was not manifested in active service and the current sarcoidosis is not related to the respiratory symptoms in service. As such, the medical findings and opinion of the VA examiner warrant greater probative weight than the Veteran’s lay contentions. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for sarcoidosis. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran contends that he has diabetes and hypertension as a result of sarcoidosis and the prednisone he takes for that disease. However, as service connection for sarcoidosis is being denied by this decision, service connection for hypertension and diabetes mellitus on a secondary basis to sarcoidosis must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the Board should deny the claim on the ground of lack of legal merit). As to service connection on a direct basis for hypertension and diabetes mellitus, the Board finds that the weight of the competent and credible evidence establishes that the diabetes mellitus and hypertension first manifested decades after service and are not related to active service. VA treatment records dated in February 2012 indicate that the Veteran was on medications for hypertension. A January 2013 VA treatment record shows a prior medical history of hypertension and diabetes mellitus. An April 2013 VA treatment record indicates that the diabetes mellitus appeared to be prednisone induced and the Veteran had borderline hypertension. The Veteran has not contended, and the medical evidence does not reflect, that the Veteran had hypertension or diabetes mellitus related to service. There is no evidence of diabetes mellitus or hypertension in active service. The weight of the competent and credible evidence establishes that the diabetes mellitus and hypertension first manifested decades after service. With respect to negative evidence, the fact that there were no records of any complaints, treatment, or diagnosis of diabetes mellitus or hypertension for many years after service separation weighs against the claim. See Maxson, 230 F.3d at 1333. The Board also finds that the Veteran did not experience continuous symptoms of diabetes mellitus or hypertension in active service or since service separation until the diseases were diagnosed in about 2012 or 2013. Thus, presumptive service connection under the provisions of 38 C.F.R. § 3.303 (b) and § 3.307(a) is not warranted. Moreover, there is no indication of an association between the diabetes mellitus and hypertension and any documented event or incident of service. A VA medical opinion and examination were not provided to address the theory that the Veteran’s the diabetes mellitus and hypertension are related to active service or a service-connected disability. The Federal Circuit Court of Appeals (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A (d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon v. Nicholson, 20 Vet. App.79, 81 (2006). As discussed, there is no probative evidence of an in-service symptoms or diagnosis. The Veteran does not identify an in-service injury or event that led to the claimed disorders. There is no lay or medical evidence of the disabilities in active service. There is no indication of an association between the disabilities and injury, event, or disease in active service or a service-connected disability. The record in this case is negative for any indication, other than the Veteran’s own general assertions, that the disabilities are associated to service or a service-connected disability. As noted above, the Veteran, as a layperson, is not competent to provide a medical opinion as to the etiology of a disease. There is sufficient competent medical evidence on file for VA to make a decision on this claim. As such, VA’s duty to provide an examination is not triggered. In light of the above, the Board finds that the preponderance of the evidence is against a finding that the diabetes mellitus or hypertension is related to active service or are due to or aggravated by a service-connected disability. As the preponderance of the evidence is against the Veteran’s claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert; supra. The claims are denied. 4. Entitlement to service connection for high cholesterol is denied. The Veteran maintains that he has high cholesterol secondary to the treatment for sarcoidosis. However, as service connection for sarcoidosis is being denied by this decision, service connection for high cholesterol on a secondary basis to sarcoidosis must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Further, the Veteran does not meet the preliminary requirement for service connection, namely showing of a current “disability.” By way of reference, “hyperlipidemia” is defined as “a general term for elevated concentrations of any or all of the lipids in the plasma, such as...hypercholesterolemia, and so on.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 903 (31st Ed. 2007). In turn, “hypercholesterolemia” is defined as “excessive cholesterol in the blood.” Id., at 899. In other words, hypercholesterolemia (i.e., an elevated or high cholesterol level) is merely a laboratory finding, not a ratable disability for VA compensation purposes. The term “disability,” as used for VA purposes, refers to impairment of earning capacity and Congress specifically limits entitlement to service connection for diseases or injuries that have resulted in a disability. See 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439, 448. Simply stated, this is a test result, not a disability. In this case, there is no evidence showing that the Veteran’s hypercholesterolemia or high cholesterol has resulted in a disability. See Brammer, 3 Vet. App. 223; Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists). The Court has held that where the law is dispositive of the claim, the claim should be denied because of lack of entitlement under the law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Therefore, as there is no basis in the law to grant the Veteran’s appeal, the claim for service connection for high cholesterol or hypercholesterolemia must be denied. Under the circumstances, the Veteran has not met the regulatory requirements to establish service connection for high cholesterol and service connection must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. Here, however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert; supra. 5. Entitlement to an initial 30 percent disability rating for facial scars is granted. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two evaluations (ratings) shall be applied, the higher rating 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. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. While a veteran’s entire history is reviewed when assigning a disability rating, where service connection has already been established and an increase in the rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). In determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). VA should interpret 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. Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. By way of history, a January 2013 rating decision granted service connection for scars of the head, face, and neck claimed as pseudofolliculitis barbae scar and left eye laceration. A 10 percent rating was assigned under Diagnostic Code 7800, burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. 38 C.F.R. § 4.118. The Board has carefully reviewed the evidence of record and finds that the evidence more closely approximates the assignment of a 30 percent disability evaluation and no higher for the service-connected facial scars. On July 13, 2018, VA issued a final rule amending its regulations on skin disabilities. The effective date of this final rule is August 13, 2018. For this final rule, VA’s intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592-32601 (July 13, 2018). The Board notes that the new regulations did not amend the provisions of Diagnostic Codes 7800 and 7804 which are the pertinent diagnostic codes in this appeal. See 38 C.F.R. § 4.118. The Board notes that the provisions of Diagnostic Code 7805 were not substantively changed. Id. Diagnostic Code 7800, applicable to burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck, provides the following ratings: 10 percent: With one characteristic of disfigurement. 30 percent: 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. 50 percent: 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. 80 percent: 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. 38 C.F.R. § 4.118, Diagnostic Code 7800. The eight characteristics of disfigurement are as follows: (1) Scar 5 or more inches (13 or more cm) in length; (2) Scar at least one quarter inch (0.6 cm) wide at its widest part; (3) Surface contour of scar elevated or depressed on palpation; (4) Scar adherent to underlying tissue; (5) Skin hypo or hyperpigmented in an area exceeding six square inches (39 sq. cm.); (6) Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm); (7) Underlying soft tissue missing in an area exceeding six square inches (39 sq. cm); and (8) Skin indurated and inflexible in an area exceeding six square inches (39 sq. cm). Id., Note 1. The January 2013 VA examination report indicates that the Veteran has three scars on his face. The first scar is a left upper eyelid scar that is 2.6 centimeters by .4 centimeters. The second scar or area of disfigurement is on the right cheek and is caused by pseudofolliculitis and acne. The area is 4 centimeters by 3 centimeters. The VA examiner indicated that the second scar is triangular so the area of the scar is one half of 12 centimeters which is 6 square centimeters. The third scar or area of disfigurement is on the left cheek and is caused by pseudofolliculitis and acne. The area is 3.5 centimeters by 4 centimeters. The VA examiner indicated that the third scar is triangular so the area of the scar is one half of 14 centimeters which is 7 square centimeters. The second and third scars had a surface contour that was depressed on palpation. The second and third scars had hyperpigmentation and abnormal texture that was irregular and depressed. The VA examiner indicated that the area of the hyperpigmentation and abnormal texture of the scars was 13 square centimeters. There are no objective findings of facial scars manifested by an area of hyperpigmentation and abnormal texture exceeding 39 square centimeters. The objective findings show that the area of the hyperpigmentation and abnormal texture of the scars was 13 square centimeters. There are no objective findings of a facial scar that was 13 or more centimeters in length, adherent to underlying tissue, with missing underlying soft tissue in an area exceeding 39 square centimeters, or with skin indurated and inflexible in an area exceeding 39 square centimeters. The scars are not painful and do not result in visible or palpable tissue loss, gross distortion, asymmetry, or functional limitation. The Board finds that the evidence supports the assignment of a 30 percent disability evaluation and no higher for the service-connected facial scars. The service-connected facial scars meet two characteristics of disfigurement. The service-connected facial scars are manifested by two scars that are at least.6 centimeters wide at the widest part and two scars manifested by surface contour that was depressed on palpation. See the January 2013 VA examination report. Thus, a 30 percent rating is warranted under Diagnostic Code 7800 based upon the findings of two characteristics of disfigurement for the entire period of the appeal. A disability rating in excess of 30 percent is not warranted for the facial scars under Diagnostic Code 7800. There are no objective findings of more than two characteristics of disfigurement. Thus, the Board finds that the preponderance of the evidence weighs against the claim for a disability rating in excess of 30 percent for the facial scars under Diagnostic Code 7800. Diagnostic Codes 7801 and 7802 do not apply because those Diagnostic Codes apply to scarring affecting parts of the body other than the face. A higher or separate rating under Diagnostic Code 7804, scars, unstable or painful, is not warranted because the service-connected facial scars are not shown to be painful or unstable on examination. A higher or separate rating under Diagnostic Code 7805 is not warranted. Diagnostic Code 7805 provides that other scars and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802 and 7804, any disabling effects not considered in a rating provided under diagnostic codes 7800-04 may be evaluated under an appropriate diagnostic code. See 38 C.F.R. § 4.118, Diagnostic Code 7805 (in effect before and after August 13, 2018). The weight of the competent and credible evidence shows that the facial scars do not cause any other disabling effects. The January 2013 VA examination report indicates that the facial scars do not cause or result in a limitation of function. Thus, the Board finds that the evidence supports the assignment of a 30 percent disability evaluation and no higher for the service-connected facial scars. The claim for a higher initial rating is granted to that extent. In a March 2013 statement, the veteran asserts that he has a loss of vision in the left eye due to the left eye laceration I active service. The Board notes that the Veteran was afforded a VA vision exam in March 2016. The March 2016 VA eye examination report indicates that no visual impairment was noted on exam. Thus, a separate rating for left eye vision loss, in addition to the rating assigned under Diagnostic Code 7800, is not warranted. REASONS FOR REMAND A June 2017 rating decision denied service connection for peripheral neuropathy of both lower extremities. In July 2017, the Veteran filed a notice of disagreement for the issues of service connection for peripheral neuropathy. The requisite statement of the case has not been issued in response. The Board is required to remand, rather than refer, this matter. Manlincon v. West, 12 Vet. App. 238 (1999). The matter is REMANDED for the following action: Issue the Veteran a statement of the case with regard to the issues of service connection for peripheral neuropathy of the bilateral lower extremities. If the benefit sought cannot be granted, the Veteran should be informed of his appellate rights and of the actions necessary to perfect an appeal on this issue. Thereafter, the issues should be returned to the Board only if an adequate and timely substantive appeal is filed. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel