Citation Nr: 18147978
Decision Date: 11/06/18	Archive Date: 11/06/18

DOCKET NO. 16-38 281
DATE:	November 6, 2018
ORDER
Entitlement to a compensable disability rating for keloids, moderate, old lacerations of the left elbow and right forearm (keloid scars) is denied.
FINDING OF FACT
The nonlinear, superficial keloid scars on the Veteran’s left elbow and right forearm are neither painful nor unstable and do not limit the function of any affected body part. 
CONCLUSION OF LAW
The criteria for a compensable disability rating for keloid scars of the left elbow and right forearm are not met.  38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.31, 4.118, DC 7805 (2018).
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran had active service with the United States Army from June 1971 to June 1974.  This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. 
The record also reflects that the Veteran had submitted a timely notice of disagreement (NOD) with respect to a February 2017 determination that denied service connection for palmar pustular psoriasis of the bilateral hands.  See VA Form 21-0958, dated February 8, 2018.  The record shows that receipt of the NOD has been acknowledged by the RO in in the electronic Veterans Appeals Control and Locator System (VACOLS) and that the RO is actively working on the appeal.  Therefore, the Board is not taking jurisdiction over this issue just to remand for a statement of the case and it too will be the subject of a later Board decision, if ultimately necessary.
Increased Rating
The Veteran is seeking a compensable disability rating for his service-connected keloid scars of the left elbow and right forearm.
Disability ratings are determined by comparing a veteran’s present symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity.  38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018).  When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran.  38 C.F.R. § 4.3. 
The Veteran’s entire history is considered when assigning disability ratings.  38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).  A review of the recorded history of a disability is necessary in order to make an accurate rating.  38 C.F.R. §§ 4.2, 4.41.  The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue.  Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999).  The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal.  Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).
Under the provisions of 38 C.F.R. § 4.118, DCs 7800-7805, scars are rated based on varying manifestations.  The Veteran’s keloid scars of the left elbow and right forearm, are currently rated as 0 percent (noncompensable) disabling under DC 7805 which provides that any scars (including linear scars) disabling effects not considered in a rating provided under DCs 7800, 7801, 7802, and 7804 should be evaluated under an appropriate diagnostic code.
However, DC 7800 is not applicable as it relates specifically to scars of the head, face, or neck.  A compensable evaluation under DC 7801 is warranted for deep (associated with underlying soft tissue damage) scars of any area of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.).  A compensable evaluation under DC 7802 is warranted for superficial (not associated with underlying soft tissue damage) scars of any area of greater than 144 square inches (929 sq. cm.).  A compensable evaluation under DC 7804 requires one or two scars that are unstable or painful.  Note (1) to this diagnostic code provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.  Note (2) to this diagnostic code provides that if one or more scars are both unstable and painful, 10 percent is added to the evaluation based on the total number of unstable or painful scars.  Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code when applicable.  38 C.F.R. § 4.118.
In every instance where the rating schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.  38 C.F.R. § 4.31.
The pertinent evidence in this case consists almost entirely of clinical findings from VA examination in February 2014.  The Veteran reported scarring dating to the 1970s after an industrial accident with laceration by commercial fan blade.  He had complicated healing of the area with hypertrophic scar and attempts were made to cauterize the wound in the area of dehiscence.  Since that time the Veteran has worked for over 30 years as bricklayer, as a shipyard rigger for about 6 years, and for the past 5 years, he has worked in security.  The Veteran has had no treatment since leaving active duty, but thinks the size of the scar has spread.  His primary current symptom was chronic arthritic type pain in right elbow, arm and shoulder.  He also complained of intermittent scar sensitivity to touch.
Examination revealed four superficial and non-linear scars located on the right upper extremity that measured 3 cm by 1.24 cm, 1.25 cm by 2.25 cm, 8 cm by 1.25 cm, and 11 cm by 3.5 cm.  The approximate total area of the scars was 39.56 cm.  The scars were not painful or unstable with loss of covering of skin over the scars.  The scars did not limit the Veteran’s motion of function of the right upper extremity.  There were no other pertinent physical findings, complications, conditions, signs and/or symptoms such as muscle or nerve damage associated with any scar.  The scars did not impact the Veteran’s ability to work.  The examiner noted that the width of the fourth scar was variable and that she took approximately half at widest width of 3.5 cm and half at 1 cm width, then added together to account for the irregularity of the scar surface.  She also noted the while the scars were hypertrophic, she was unable to call them keloids as they did not extend beyond the wound edges.
Further review of the claims file shows that the Veteran has not sought or received ongoing treatment for the keloid scars, following this examination nor has he contended otherwise.
Applying the Veteran’s symptomatology to the rating criteria, the Board finds that a compensable evaluation for keloid scars is not warranted.  Specifically, the Veteran’s scars are superficial and he did not clearly describe them as painful or unstable on VA examination and no such conditions were identified by the VA examiner.  The scars do not involve the head, face, or neck and the medical evidence does not suggest scars of a size warranting a compensable evaluation, i.e., an area or areas of 144 square inches (929cm or greater).  There have been no other pertinent physical findings, complications, signs and/or symptoms (such as muscle or nerve damage) associated with the scars and the scars have been found to have no impact on the Veteran’s ability to work.  Without any medical evidence of greater impairment, the claim must be denied.  A compensable evaluation is therefore not warranted under DCs 7800, 7801, 7802, 7804, or 7805.  See 38 C.F.R. § 4.118.  As the evidence clearly indicates that the service-connected disability is a scar disability, the Board does not find a basis for considering the criteria for other skin disorders, that entail different symptoms and therapies.
Accordingly, the Board finds that the Veteran’s impairment due to scars is more consistent with a noncompensable disability rating and that the level of disability necessary to support the assignment of a 10 percent rating or higher is absent.  A preponderance of the evidence is against the claim and there is no reasonable doubt to be resolved.
 
THOMAS H. O'SHAY
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J.R. Bryant