Citation Nr: 18145781 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-33 333A DATE: October 30, 2018 ORDER Entitlement to an effective date of October 7, 2009 for the grant of a 10 percent disability rating for surgical scar, ganglion cyst removal, left wrist, is granted. REMANDED Entitlement to a compensable rating for left wrist ganglion cyst residuals is remanded. FINDING OF FACT It is factually ascertainable that the Veteran’s left wrist residual scar was painful throughout the appeal period. CONCLUSION OF LAW The criteria for an effective date of October 7, 2009 for the grant of a 10 percent disability rating for surgical scar, ganglion cyst removal left wrist have been met. 38 U.S.C. §§ 1155, 5101, 5103A, 5107, 5110 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400, 4.118, Diagnostic Code 7804 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The statutory guidelines for the determination of an effective date of an award are set forth in 38 U.S.C. § 5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is the latter. 38 C.F.R. § 3.400. In cases involving an increased disability rating, if an increase in disability occurred within one year prior to the claim, the increase is effective as of the date the increase was “factually ascertainable.” If the increase occurred more than one year prior to the claim, the increase is effective the date of claim. If the increase occurred after the date of claim, the effective date is the date of increase. 38 U.S.C. § 5110(b)(2); Harper v. Brown, 10 Vet. App. 125 (1997); 38 C.F.R. § 3.400(o); VAOPGCPREC 12-98 (1998). Scars are rated under 38 C.F.R. § 4.118, schedule of ratings for disorders of the skin, under Diagnostic Codes 7801-7805. Diagnostic Code 7804 pertains to unstable or painful scars. In relevant part, a 10 percent evaluation is assigned for one or two scars that are unstable or painful. In a June 2015 rating decision, the Agency of Original Jurisdiction granted a 10 percent disability rating for surgical scar, ganglion cyst removal left wrist (previously rated as status post ganglion cyst and residual scar left wrist), effective June 17, 2015. The Veteran contends the effective date for the increase should be the date of his original claim, as the disability is part of his original claim. See July 2016 VA Form 9; September 2015 notice of disagreement. Upon VA examination in June 2010, the VA examiner stated the Veteran’s left wrist scar was not tender. A June 2015 VA examiner noted the Veteran’s report that his left wrist scar is painful. The Veteran is competent to report the symptoms he experiences, including pain. The Veteran has indicated that his left wrist scar has been painful throughout the appeal period. See November 2011 Veteran statement; September 2011 notice of disagreement. Accordingly, the Board will afford the Veteran the benefit of the reasonable doubt, and finds it was factually ascertainable that the Veteran’s left wrist scar was painful throughout the appeal period. Accordingly, the Board finds that entitlement to a 10 percent disability rating for surgical scar, ganglion cyst removal left wrist under Diagnostic Code 7804 is warranted since the Veteran’s date of claim, October 7, 2009. 38 C.F.R. § 3.400(o). REASONS FOR REMAND The Veteran reported to the June 2015 VA examiner that his private primary care physician has prescribed ibuprofen for his left wrist pain. Treatment records from Patel, Ramanan and Associates associated with the claims file date only up to 2010. A remand is required to allow VA to obtain authorization and request the updated treatmend records. Treatment records from MedStar Orthopaedic Institute dated in July 2015 and June 2016 indicate the Veteran’s left wrist disability has increased in severity since the Veteran was last examined by VA in June 2015, as they indicate objective pain in the left wrist, as well as ligament instability. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his left wrist disability. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for relevant records from Dr. P. and/or Patel, Ramanan and Associates from February 2010 to the present. Make two requests for the authorized records from the provider, unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left wrist disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the left wrist disability alone and discuss the effect of the Veteran’s left wrist disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner should specifically address the indications of instability with laxity of the wrist ligaments and tenderness over the scapholunate interval in the July 2015 and June 2016 MedStar Orthopaedic Institute notes. The examiner should also address the Veteran’s reports of experiencing pain when putting any kind of pressure, strain, or weight on his left wrist, loss of motion due to pain including upon repetition, and impaired strength. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Delhauer, Counsel