Citation Nr: 18144735 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-35 215A DATE: October 25, 2018 ORDER 1. Entitlement to a compensable rating for the left cheek scar is denied for the entire period on appeal. 2. Entitlement to a compensable rating for atopic eczema is denied for the entire period on appeal. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s left cheek scar has been manifested by a superficial, nonlinear scar, which measured one centimeter without resulting pain, skin breakdown, underlying tissue damage, inflammation, edema, keloid formation, disfigurement, or limitation of motion or function. 2. For the entire period on appeal, the Veteran’s eczema has not covered more than five percent of his body and has not been characterized by whole body treatment amounting to systemic therapy. The Veteran’s skin has had no disfigurement, tissue loss, inflexibility, hypopigmentation, hyperpigmentation, or limitation of motion. CONCLUSIONS OF LAW 1. The criteria for a compensable disability rating for the left cheek scar have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.21, 4.118, Diagnostic Code (DC) 7802. 2. The criteria for entitlement to a compensable rating for atopic eczema have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.21, 4.118, DC 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from June 1980 until July 1983. This matter comes before the Board of Veterans’ Appeals (Board) from a November 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. The Veteran filed a notice of disagreement in February 2016 and was provided with a statement of the case in April 2016. The Veteran was issued a Form 8 in November 2016 and notified that his appeal had been certified to the Board of Veteran’s Appeals. Increased Rating Increased Ratings – Generally The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is prohibited. 38 C.F.R. § 4.14. Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). With respect to the Veteran’s increased rating claim on appeal, the Board has considered the relevant temporal period, including one year prior to his increased rating claim, as well as whether any additional staged rating periods are warranted. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107. When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). If the preponderance of the evidence weighs against the claim, it must be denied. Id. 1. Entitlement to a compensable rating for the left cheek scar The Veteran claims that he should be in receipt of a compensable rating for the scar on his left cheek, which scar is currently rated as zero percent disabling under DC 7802. 38 C.F.R. § 4.118, DC 7802. DC 7802 provides that scars, other than on the head, face, or neck, that are superficial and nonlinear, and cover an area of at least 144 square inches (929 sq. cm.) warrant a compensable evaluation. Id. A superficial scar is one not associated with underlying soft tissue damage. Id. At a January 2013 decision review officer (DRO) hearing, the Veteran testified that his scar is more sensitive than the other skin on his face and that he notices it when he shaves. At a September 2015 VA examination, the examiner noted the Veteran’s scar: a one-centimeter, superficial, linear, flat scar on the left cheek, which was not painful on palpation, and which was well healed. There was no skin breakdown, underlying tissue damage, inflammation, edema, keloid formation, disfigurement, or limitation of motion or function. Initially, the Board notes that the Veteran’s relevant scar does not cover a surface area of 144 square inches or greater; therefore, a compensable rating is not available under DC 7802. Id. Nevertheless, the Board has also considered the additional rating criteria for scars set forth in 38 C.F.R. § 4.118, DCs 7800, 7801, 7804, and 7805. However, as explained below, these additional diagnostic codes do not warrant compensable disability ratings for the Veteran’s service-connected scar for any period on appeal. First, DC 7800 contemplates scars of the head, face, or neck. 38 C.F.R. § 4.118, DC 7800. DC 7800 provides that a scar must demonstrate one characteristic of disfigurement in order to warrant a compensable evaluation. Because the scar does not leave the Veteran disfigured in this case, DC 7800 does not provide a basis for a higher rating. DC 7801 provides that scars other than on the head, face, or neck that are deep, nonlinear, and cover an area of at least 6 square inches (39 square (sq.) centimeters (cm.)) warrant a compensable evaluation. Id., DC 7801. A deep scar is one associated with underlying soft tissue damage. Id. Here, the VA examination of record documents that the Veteran’s scar is linear and superficial; therefore, DC 7801 does not provide a basis for a higher rating. DC 7804 contemplates scars that are unstable or painful. DC 7804. Again, the objective VA examination of record documents that the Veteran’s scar is neither unstable or painful, and the Veteran has not asserted otherwise; therefore, DC 7804 does not provide a basis for the Veteran to receive a higher rating. The Board is aware that the Veteran has stated that the scar is sensitive and feels differently, but this is not indicative of a scar that is unstable or painful, and the Board does not find that sensitivity is equivalent to an unstable or painful scar. Finally, DC 7805 provides that other scars (including linear scars), not otherwise rated under DCs 7800-7804, in addition to the other effects of scars which are otherwise rated under DCs 7800-7804, are also to be rated based on any disabling effects not provided for by DCs 7800-7804. 38 C.F.R. § 4.118, DC 7805. This includes, where applicable, diagnostic codes pertaining to limitation of function. Id. As discussed above, the March 2010 VA examiner found no resulting limitation of function or functional impact as a result of the Veteran’s service-connected scar; therefore, DC 7805 is likewise inapplicable to the Veteran’s claims. In conclusion, the Board finds that the preponderance of evidence weighs against the Veteran’s claim of entitlement to a compensable disability rating for the left cheek scar for the entire period on appeal. As such, there is no reasonable doubt to be resolved, and the claim for increase is denied. See 38 U.S.C. § 5107(b). 2. Entitlement to a compensable rating for atopic eczema Disability evaluations are determined by comparing the Veteran’s current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155. Under DC 7806, a rating of 0 percent for dermatitis or eczema is warranted if less than five percent of the entire body is affected or if less than five percent of exposed areas of the body are affected, and if no more than topical therapy was required during the past 12-month period. 38 C.F.R. § 4.118, DC 7806. A rating of 10 percent is warranted for eczema if at least five percent, but less than 20 percent, of the entire body is affected, or if at least five percent, but less than 20 percent, of exposed areas are affected, or if intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past 12-month period. Id. A rating of 30 percent is warranted if 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or if systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past 12-month period. Id. A rating of 60 percent is warranted if more than 40 percent of the entire body or more than 40 percent of exposed areas are affected, or if constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past 12-month period. Id. DC 7806 also advises, if applicable, to rate disfigurement of the head, face, or neck (DC 7800), and scars (DC’s 7801, 7802, 7803, 7804, or 7805) depending upon the predominant disability. Id. At a January 2013 decision review officer (DRO) hearing, the Veteran testified that his eczema is worse during the summertime, and that he has taken medication for this condition in the past. In September 2015, the Veteran was afforded an in-person VA examination. The examiner remarked that an examination of the Veteran’s arms revealed no rash or evidence of eczema at that time, and that the Veteran had not been treated with oral or topical medications in the past 12 months for any skin condition. The examiner noted that the Veteran did not have any of the specific skin conditions listed on the examination, including eczema. During the entire period on appeal, the Veteran’s eczema has not covered more than five percent of his body and has not required whole body treatment amounting to systemic therapy. The Veteran’s skin had no disfigurement, tissue loss, inflexibility, hypopigmentation, hyperpigmentation, or limitation of motion. As the Veteran is not currently taking any prescribed medication for this condition, a discussion of systemic and topical therapies is not warranted. Given these facts, the Board finds that a compensable rating is not warranted under DC 7806 for atopic eczema during the period on appeal, as the Veteran’s eczema does not cover more than five percent of his body and the Veteran has not undergone systemic treatment during the appeal period. There is no reasonable doubt to resolve, and the claim for increase is denied. See 38 U.S.C. § 5107(b). A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Caruso, Associate Counsel