Citation Nr: 18146417 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 14-40 311 DATE: October 31, 2018 ORDER Entitlement to an initial compensable disability rating for a scar on the left hand is denied. REMANDED Entitlement to service connection for a left shoulder disorder is remanded. Entitlement to service connection for a left hand disorder is remanded. FINDING OF FACT The Veteran’s scar on the left hand is linear and has not been manifested by symptoms of pain, instability, functional impairment, or a total area of 929 square centimeters (144 square inches) or greater. CONCLUSION OF LAW The criteria for an initial compensable disability rating for a scar on the left hand have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. § 4.118, Diagnostic Codes 7800-7805 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1973 to April 1977. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). 1. Entitlement to a compensable rating for a scar on the left hand. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2018). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2018). Consideration of the whole recorded history is necessary so that a rating may accurately compensate the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). Here, the Veteran seeks an initial compensable rating for his service-connected scar on his left hand that is currently rated under Diagnostic Code 7805. After a review of the evidence of record, the Board finds that the Veteran does not meet the criteria for a compensable disability rating. Scars are rated under 38 C.F.R. § 4.118, the schedule of ratings for disorders of the skin, under Diagnostic Codes 7800-7805. Diagnostic Code 7800 provides the rating criteria for burn scars of the head, face or neck. Diagnostic Code 7801 provides the rating criteria for burn scars or scars due to other causes, not of the head, face, or neck, which are deep and nonlinear. Diagnostic Code 7802 provides the rating criteria for burn scars or scars due to other causes, not of the head, face, or neck, which are superficial and nonlinear; with a 10 percent rating warranted for a total area of 144 square inches or greater. Diagnostic Code 7804 pertains to unstable or painful scars. Diagnostic Code 7805 pertains to other scars (including linear scars), and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. It also directs the adjudicator to evaluate any disabling effects not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate diagnostic code. An April 2013 VA examination for scars shows the Veteran was diagnosed with a scar on his left hand which the examiner described as a very faint scar at the base of his left index finger (palmar surface). The examiner noted in the written report that the Veteran complained of a gradual onset of left hand pain 5 years ago with decreased grip because of pain and reported that he had been diagnosed with arthritis of the hand. Upon examination, the examiner noted the Veteran had a very faint scar on his left hand measuring 2.5 cm in length that was not painful, unstable, superficial, or deep; and, no limitation in function of the scar was noted. The examiner also noted in his written report that April 2013 X-rays of the left hand showed all bones and joints were intact; the bony mineralization and soft tissues were normal; and the impression was a normal left hand. An April 2017 VA examination for scars shows the Veteran was diagnosed with a scar on his left hand that was measured to be 2.5 cm in length and was observed to be not painful, unstable, non-linear, or deep; and, no limitation in function of the scar was noted. The evidence of record, in particular the two VA examinations noted above, shows the Veteran’s left hand scar is not a burn scar of the head, face or neck. Thus, Diagnostic Code 7800 is not applicable. The scar is not deep and nonlinear; thus, Diagnostic Code 7801 is not applicable. The scar is not superficial and nonlinear or covering a total area of 144 square inches or greater; thus, Diagnostic Code 7802 is not applicable. Finally, the scar is not unstable or painful; thus, Diagnostic Code 7804 is not applicable. Accordingly, the Board finds that the evidence does not establish that the Veteran meets the criteria for a compensable disability rating under Diagnostic Codes 7800, 7801, 7802, or 7804, and an increased rating is therefore not warranted under those diagnostic codes. In addition, the evidence does not show the Veteran’s scar on his left hand has any disabling effects that are not considered under Diagnostic Codes 7800-7804 that are to be considered under another appropriate Diagnostic Code. As there are no symptoms of the Veteran’s left hand scar to support a higher rating under Diagnostic Codes 7800 through 7805, the Board concludes that an initial compensable rating for the left hand scar is not warranted, and the claim is denied. REASONS FOR REMAND The Board finds that additional development is warranted before a decision may be rendered on the Veteran’s claims for service connection for a left shoulder disorder and a left hand disorder. 1. Entitlement to service connection for a left shoulder disorder is remanded. The Veteran contends that he injured his left shoulder in service, when he fell on ice, breaking his fall with his left hand and shoulder. A VA examination of the Veteran’s left shoulder was conducted in April 2017. The examiner opined that the Veteran’s arthritis in his left shoulder is “most likely related to his many years of working as a carpenter and less likely as not due to his laceration to the left hand in active duty.” The Board finds this opinion to be inadequate, as the issue presented is not whether the Veteran’s left shoulder disorder is due to his left-hand laceration, but whether the left shoulder disorder is due to a fall in service. 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). 2. Entitlement to service connection for a left hand disorder is remanded. The Veteran contends that he injured his left hand in service, when he fell on ice, breaking his fall with his left hand and shoulder. A VA examination of the Veteran’s left hand was conducted in April 2017. The examiner noted in the written report the Veteran had a hand laceration while in active duty in the 1970s; that he since worked as a carpenter for over 20 years using a hammer and other tools, mostly with his left hand because he is left-handed; and, that the Veteran now has arthritis in the left hand. The examiner then opined that the Veteran’s arthritis in his left hand is most likely related to his many years of working as a carpenter and less likely than not due to his laceration of the left hand during active duty. In response to the April 2017 VA examination report, the Veteran submitted a lay statement, received by the VA in March 2018, in which he stated that he did not work as a carpenter for 20 years as reported by the examiner. The Veteran provided a short summary of his work history, including dates and his various job titles, including work as a carpenter only from 1996–2003. In addition, the Veteran stated that while working as a carpenter he seldom used a hammer and mostly used screw guns during projects. Upon consideration of the April 2017 VA examiner’s report, and the Veteran’s response thereto, the Board finds the April 2017 VA examiner’s opinion to be inadequate, as it appears to have been based, at least in part, on an inaccurate premise that the Veteran worked for 20 years as a carpenter after separation from service. 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). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion, or a VA examination if necessary, from an appropriate medical professional to determine the current nature and etiology of the Veteran’s left shoulder disorder. The examiner must thoroughly review the claims file and offer a well-reasoned opinion as to whether it is at least as likely as not (50 percent or greater probability) that any currently diagnosed left shoulder disorder had its onset in service or is otherwise related to service, to include his in-service fall. A complete rationale must be given for all opinions and conclusions expressed. The examiner is advised that the Veteran is competent to report history and symptoms, and that his reports must be considered in formulating the requested opinion. If the examiner rejects the Veteran’s reports, the examiner should provide a rationale for doing so. 2. Obtain an addendum medical opinion, or a VA examination if necessary, from an appropriate medical professional to determine the current nature and etiology of the Veteran’s left hand disorder. The examiner must thoroughly review the claims file and offer a well-reasoned opinion as to whether it is at least as likely as not (50 percent or greater probability) that any currently diagnosed left hand disorder had its onset in service or is otherwise related to service, to include his in-service fall. A complete rationale must be given for all opinions and conclusions expressed. The examiner is advised that the Veteran is competent to report history and symptoms, and that his reports must be considered in formulating the requested opinion. If the examiner rejects the Veteran’s reports, the examiner should provide a rationale for doing so. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel