Citation Nr: 18152813 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 15-31 420A DATE: November 26, 2018 ORDER An initial rating in excess of 20 percent prior to June 1, 2017, and in excess of 40 percent thereafter for left ankle pigmented villonodular synovitis (PVNS), exclusive of the time periods where temporary total ratings have been assigned, is denied. For the entire appeal period, a rating of 20 percent, but no higher, for left lower extremity deep vein thrombosis (DVT) is granted, subject to the laws and regulations governing the payment of monetary benefits. An initial rating of 10 percent, but no higher, prior to February 28, 2017, and a rating of 30 percent, but no higher, thereafter for painful left ankle surgical scars is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. For the appeal period prior to June 1, 2017, the Veteran’s left ankle PVNS is manifested by no more than moderate limited motion of the ankle, to include consideration of functional loss due to symptoms such as pain, weakness, swelling, fatigability, incoordination, or repetitive motion, or as a result of repetitive motion and/or flare-ups, without ankylosis, malunion of the os calcis or astragalus, or astragalectomy. 2. As of June 1, 2017, the Veteran’s left ankle PVNS is manifested by symptoms and functional impairment approximating loss of use of the foot, without amputation. 3. For the entire appeal period, the Veteran’s left lower extremity DVT is manifested by, at most, swelling, pain, and cramping in the calf with persistent edema, incompletely relieved by elevation of the extremity, with beginning stasis pigmentation. 4. For the appeal period prior to February 28, 2017, the Veteran had two surgical scars of the left ankle that are painful, without evidence that such are unstable, of a size to warrant a compensable rating, or result in any disabling effects. 5. As of February 28, 2017, the Veteran had seven surgical scars of the left ankle that are painful, without evidence that such are unstable, of a size to warrant a compensable rating, or result in any disabling effects. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent prior to June 1, 2017, and in excess of 40 percent thereafter for left ankle PVNS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5271, 5167. 2. For the entire appeal period, the criteria for a rating of 20 percent, but no higher, for left lower extremity DVT have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.104, DC 7121. 3. Prior to February 28, 2017, the criteria for an initial rating of 10 percent, but no higher, for painful left ankle surgical scars have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, DC 7804. 4. As of February 28, 2017, the criteria for an initial rating of 30 percent, but no higher, for painful left ankle surgical scars have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from May 2002 to July 2002, from October 2002 to February 2003, and from May 2003 to June 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in October 2014 and May 2016 by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2016, the Veteran and his spouse testified at a Decision Review Officer (DRO) hearing at the RO and, in September 2017, he testified at a Board hearing before the undersigned Veterans Law Judge. Both hearing transcripts have been associated with the record. In March 2018, the Board remanded the case for further development. While on remand, a July 2018 rating decision increased the ratings for the Veteran’s left ankle PVNS and left lower extremity DVT to 40 percent and 20 percent, respectively, effective June 1, 2017. The case now returns to the Board for further appellate review, and the Board has recharacterized such claims herein to reflect consideration of the newly assigned staged ratings. Increased Rating Claims Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 1. Entitlement to an initial rating in excess of 20 percent prior to June 1, 2017, and in excess of 40 percent thereafter for left ankle PVNS. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). In the instant case, the record reflects that the Veteran’s ankles were examined by VA in September 2014, April 2015, November 2015, and May 2018. Upon a review of the VA examination reports, the Board notes that there was evidence of pain on weight-bearing noted during the April 2015 and November 2015 examinations, but no evidence of abnormal weight-bearing at the May 2018 examination. Additionally, in July 2018, the examiner was requested to review the VA examinations containing range of motion findings pertinent to the Veteran’s left ankle PVNS conducted in September 2014, April 2015, and November 2015 and offer an opinion as to the range of motion findings for pain on both active and passive motion, and on weight-bearing and nonweight-bearing. In July 2018, a VA examiner concluded that, given that the right ankle had completely normal ROM and the left ankle had 0 degrees ROM (due to his February 2017 fusion surgery), it was likely that these ROMs held true for all of the above-mentioned scenarios: active/passive motion, weight-bearing/nonweight-bearing. He further stated that ROM of the opposite joint had already been included. In this regard, while the examiner did not specifically address the ROM findings from the prior examinations, the Board finds that, as the Veteran has been assigned the highest possible rating based on limitation of motion prior to June 1, 2017, and the only way to establish an increased rating would be to demonstrate ankylosis, there is no prejudice to him in the Board proceeding with a decision at this time. Further, while the 2014 and 2015 examinations do not reflect passive ROM testing, the evidence does not suggest, and the Veteran has not argued, that his range of ankle motion would be further limited in such capacity. Moreover, as a general matter of course, active ROM testing usually results in further limitation than passive ROM testing. Massie v. Shinseki, 25 Vet. App. 123, 131 (2011); see Robinson v. Peake, 21 Vet. App. 545, 553 (2008) (holding that the Board is not required “to assume the impossible task of inventing and rejecting every conceivable argument in order to produce a valid decision”), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009); cf. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (“having initially failed to raise the procedural issue, the Veteran should not be able to resurrect it months or even years later when, based on new circumstances, the Veteran decides that raising the issue is now advantageous”). Furthermore, as discussed herein, the examiners addressed the impact of functional loss of his left ankle PVNS, to include during flare-ups. Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The Veteran is service-connected for left ankle PVNS effective June 2, 2014. Private and VA treatment records during the appeal period reflect complaints of left ankle pain, swelling, tenderness to touch, numbness, weakness, and instability; however, the Veteran’s ROM of the left ankle not shown to be more limited than as reflected at the VA examinations conducted during the appeal period. Specifically, at a September 2014 VA examination, the Veteran reported pain and instability, with flare-ups. Upon physical examination, he had zero to 5 degrees of plantar flexion pre-repetitive and post-repetitive motion; and zero to 35 degrees of dorsiflexion pre-repetitive and post-repetitive motion. There was also objective evidence of pain elicited with deep palpation to the lateral ankle. The September 2014 VA examiner further concluded that the examination neither supports nor contradicts the Veteran’s statement describing function loss with repetitive use over time and during flare-ups. The examiner explained that she was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over periods of time or during flare-ups because the Veteran was not examined after repetitive use over time or during flare-ups. Sharp, supra. At an April 2015 VA examination, the Veteran reported flare-ups, and pain while walking, sleeping, and standing. He also reported numbness in his toes and swelling around the left ankle. Additionally, he stated that he had weakness and pain in the Achilles tendon area, and reported that his left ankle gives out every other day. Upon physical examination, the Veteran had zero to 15 degrees of plantar flexion ROM; and zero to 40 degrees of dorsiflexion ROM, with no additional loss after 3 repetitions, as clarified in a May 2015 addendum. The examiner noted objective evidence of pain and tenderness around the left ankle joint and moderate pain on movement. The Veteran reported that he had flare-ups every 2 days, which usually lasted 24 hours. The examiner indicated that there was left ankle instability or dislocation suspected, but the anterior drawer and talar tilt tests were negative. The examiner also noted that a stress fracture of the lower left leg had resolved. Therefore, the April 2015 examiner concluded that the examination neither supports nor contradicts the Veteran’s statement describing function loss with repetitive use over time and during flare-ups. The examiner explained that she was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over periods of time or during flare-ups because there was no conceptual or empirical basis for making such a determination without directly observing function under such conditions. Id. At an November 2015 VA examination, the Veteran reported constant flare-ups, swelling, and pain with sitting and walking. He also reported pain in the Achilles tendon area. Upon physical examination, the Veteran had zero to 20 degrees of plantar flexion ROM, and zero to 20 degrees of dorsiflexion ROM. The examiner noted that the range of motion contributed to a functional loss because it was hard to get clearance of the foot during the middle of stride with ROM. There was pain noted on examination, but it did not result in or cause functional loss. The examiner further noted that there was tenderness all around the circumference of the ankle joint. The examiner indicated that there was left ankle instability or dislocation suspected and the talar tilt test was positive, but the anterior drawer test was negative. The examiner also noted that a stress fracture of the lower left leg had resolved. Therefore, the November 2015 examiner concluded that the examination neither supports nor contradicts the Veteran’s statement describing function loss with repetitive use over time. The examiner explained that he was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over periods of time because he did not observe the Veteran under such conditions. Id. An August 2016 private treatment record shows an evaluation of the left ankle, which revealed mild swelling. The Veteran had normal alignment of the ankle and the hindfoot. Upon physical examination, he had a plantar flexion of 20 to 25 degrees, and there was no instability of the ankle. He had palpable pulses and intact sensation to light touch. In February 2017, the Veteran underwent a fusion of his left ankle. A May 2017 private treatment record indicates that the Veteran had pain and stiffness since the fusion of the left ankle. The private physician indicated that the Veteran had atrophy of the left lower extremity, but no measurements were provided. The private physician further noted that the Veteran had ankylosis of the left side in a good weight-bearing position. Pursuant to the March 2018 Board remand, the Veteran was afforded another VA examination. At such time, the Veteran reported swelling to the joint, tenderness to touch, and pain while walking, with flare-ups. The examiner noted the Veteran’s February 2017 ankle fusion surgery. Upon physical examination, the Veteran had no ROM due to his ankle fusion. The examiner noted that the Veteran had reduction in muscle strength. In this regard, the rate strength for his plantar flexion and dorsiflexion was 0/5. However, the Veteran did not have muscle atrophy. The examiner indicated that the Veteran had ankylosis on the left side at 0 degrees for plantar flexion and dorsiflexion, which resulted in the loss of use of the left foot. In July 2018, a VA examiner opined that there was no objective evidence contained in the Veteran’s record that demonstrated that his PVNS affected any other joints, aside from his left ankle, or caused neurologic impairment. Left Ankle PVNS prior to June 1, 2017 Prior to June 1, 2017, the Veteran was assigned an initial 20 percent rating for his left ankle PVNS pursuant to 38 C.F.R. § 4.71a, DC 5271, exclusive of the time periods where temporary total ratings have been assigned. DC 5271 provides for a maximum 20 percent rating for marked limitation of ankle motion. The normal range of motion in the ankle includes 20 degrees of dorsiflexion and 45 degrees of plantar flexion. See 38 C.F.R. § 4.71, Plate II. Also included within 38 C.F.R. § 4.71a are multiple DCs that evaluate other impairment resulting from ankle disorders, including DC 5270 (ankylosis), DC 5272 (ankylosis of the subastragalar or tarsal joint), DC 5273 (malunion of the os calcis or astragalus), and DC 5274 (astragalectomy). After reviewing the evidence of record, the Board finds that an initial rating in excess of 20 percent is not warranted for the Veteran’s left ankle PVNS prior to June 1, 2017. In this regard, such was manifested by subjective complaints of pain, swelling, and giving way, which resulted in marked limitation of ankle motion. Consequently, he was assigned the maximum schedular rating under DC 5271. The Board also considered whether the Veteran’s left ankle PVNS disability presents any additional manifestations that would warrant the assignment of a separate rating. However, as there is no evidence of malunion of os calcis or astragalus, or an astragalectomy of the left ankle, a higher or separate rating is not warranted under DCs 5273 or 5274, respectively, at any point during the appeal period. With regard to a separate rating under DCs 5270 or 5272 for ankylosis of the ankle or subastragalar or tarsal joint, in September 2018, the Veteran, through his representative, argued that he is entitled to a separate rating for ankylosis under DC 5270. In this regard, he noted that the April 2015 VA examiner reported that the Veteran had ankylosis of the left ankle. However, in May 2015, the examiner provided clarification of such statement by indicating that the ankylosis diagnosis was a typo. Moreover, the November 2015 VA examiner noted that the Veteran did not have ankylosis, and both examinations reflected that the Veteran was capable of range of motion of his left ankle, albeit limited. Rather, ankylosis was not shown until the February 2017 fusion surgery. Consequently, a higher or separate rating under DCs 5270 or 5272 for ankylosis is not warranted. Furthermore, as the July 2018 VA examiner opined that there was no objective evidence that demonstrated that his PVNS affected any other joints, aside from his left ankle, or caused neurologic impairment, higher or separate ratings for PVNS of other joints, or based on neurologic impairment is not warranted. Left Ankle PVNS as of June 1, 2017 Following the assignment of a temporary total rating as a result of the Veteran’s left ankle fusion surgery from February 28, 2017, to May 31, 2017, he was assigned a 40 percent rating for loss of use of his left foot as of June 1, 2017, pursuant to 38 C.F.R. § 4.71a, DC 5167, and special monthly compensation (SMC). DC 5167 provides for a maximum 40 percent rating with SMC for the loss of use of the foot. In July 2018, a VA examiner explained that the Veteran’s ankylosis of the left ankle resulted in the loss of use of his foot and, based on the resulting functional impairment, such would be equally served by an amputation with prosthesis. Therefore, Veteran has been assigned the maximum rating for such disability under DC 5167 with SMC since June 1, 2017. There is no basis to assign a higher rating under any applicable laws and regulations. 2. Entitlement to rating in excess of 10 percent prior to June 1, 2017, and in excess of 20 percent thereafter for left lower extremity DVT. The Veteran filed a claim in March 2016 seeking an increased rating for his service-connected left lower extremity DVT, currently evaluated as 20 percent disabling. The appeal period before the Board begins on March 15, 2015, one year prior to the date VA received the Veteran’s claim for an increased rating. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The Veteran’s left lower extremity DVT is evaluated under DC 7121 pertaining to post-phlebitic syndrome (which refers to the long-term complications of DVT) of any etiology. Under such rating criteria, a 10 percent rating is warranted for intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery. A 20 percent rating is warranted for persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. A 40 percent rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent rating is warranted for persistent edema or subcutaneous indurations, stasis pigmentation or eczema, and persistent ulceration. A maximum 100 percent rating is warranted for massive board-like edema with constant pain at rest. 38 C.F.R. § 4.104, DC 7121. These criteria are successive and cumulative. As such, to establish entitlement to a higher rating, the Veteran must have all of the symptoms listed for the rating criteria. See Middleton v. Shinseki, 727 F.3d 1172 (Fed. Cir. 2013) (holding that the use of the conjunctive “and” means that all successive and cumulative elements of a higher rating must be met in order to warrant that rating). The medical evidence related to the Veteran’s March 2016 claim for an increased rating for his left lower extremity DVT consists of VA examination reports dated in April 2016 and May 2018, as well as the Veteran’s private and VA treatment records dated throughout the appeal period. In this regard, a July 10, 2015, VA treatment record indicates that the Veteran had increased edema around his left ankle with some ascending pitting edema causing hyperpigmentation of the soft tissue. Additionally, a September 2015 VA treatment note shows that the Veteran had edema of the left ankle without pitting. In a December 2015 VA treatment record, the Veteran reported lower leg pain and that his leg was still swollen since his DVT and left ankle surgery. Upon examination, it was noted that the Veteran’s left leg looked bigger than the right leg. His left calf measurement was 17.25 inches and his right calf measurement was 17.0 inches. There was no definite local tenderness and normal local temperature overlaying the skin. Homan’s sign was negative and there was no local redness. The Veteran’s left leg was grossly intact neurovascularly and he did not have a rash. Additionally, gray-scale imaging, pulsed Doppler, and color Doppler sonography from the left common femoral vein down through the popliteal vein and proximal deep calf veins of the left lower extremity revealed no evidence of DVT. In a February 2016 VA treatment record, the Veteran reported that his left leg edema had worsened. It was noted that he was seen in December 2015 and he stated that he had the same edema in the leg since then. Later that month, it was observed that the Veteran had trace edema, but both calves had a measurement of 44 cm, and there was no evidence of cyanosis or clubbing. At the April 2016 VA examination, the Veteran reported that, following his June 2014 left ankle surgery, he developed left lower extremity DVT. The examiner noted that there were no documented reoccurrences and, in December 2015, no DVT was seen on testing. Upon examination, the examiner indicated that there was local temperature and normal overlying skin intact, with no local redness. The Homan’s sign was negative and there was no evidence of pain. The examiner found that the Veteran had intermittent edema of the left extremity. At the September 2017 Board hearing, the Veteran testified that he consistently had symptoms associated with left lower extremity DVT, which included edema, cramping, and his left leg was warm to touch. Pursuant to the March 2018 Board remand, the Veteran was afforded another VA examination in May 2018 VA. At such time, the Veteran reported that he had constant swelling in his left lower extremity, regardless of his elevation of the leg. He stated that he had fatigue and pain that woke him up, and he took asprin for treatment. He also stated that the calf pain had progressed to worsening with multicomponent in nature, which was aggravated by lifting, carrying, bending, squatting, twisting, pulling and pushing as well as prolonged standing and walking, climbing and running. He further reported that such symptoms were relieved by rest/pain medications. The frequency of his calf pain was daily lasting 30 minutes to one hour at a time. The examiner indicated that the Veteran had edema on his left lower extremity on the day of the examination, but noted negative Doppler studies in 2015 and 2018. The examiner found that the Veteran had persistent edema of the left extremity. A July 2018 VA examiner’s opinion found that the Veteran had a history of left lower extremity DVT dating back to July 2014; however, he did not have an active diagnosis of DVT. In this regard, his most recent left lower extremity venous Doppler ultrasounds in 2015, 2017, and 2018 did not demonstrate active DVT. He had residual symptoms, which consisted of stasis pigmentation and edema; however, the examiner concluded that, it was not possible to determine nature, frequency or severity of his symptoms based on the information provided in the Veteran’s record. The examiner further explained that there was no evidence of current aching, fatigue, subcutaneous induration, ulceration, or associated pain. He further stated that the associated swelling/edema were present both in upright and supine positions as well as with and without compression hosiery. Based on the foregoing, the Board finds that a rating of 20 percent for the Veteran’s left leg DVT is warranted for the entire appeal period stemming from his March 2016 claim. However, a rating in excess of 20 percent is not warranted. In this regard, while such disability is manifested by swelling, pain, and cramping in the calf with persistent edema, incompletely relieved by elevation of the extremity, with beginning stasis pigmentation, and is aggravated by lifting, carrying, bending, squatting, twisting, pulling, pushing, prolonged standing, walking, climbing and running, it does not result in more severe symptomatology of persistent stasis pigmentation or eczema, ulceration, subcutaneous indurations, or massive board-like edema with constant pain at rest so as to warrant a higher rating. 38 C.F.R. § 4.104, DC 7121. 3. Entitlement to an initial compensable rating for left ankle surgical scars. 4. Entitlement to an initial rating in excess of 10 percent for painful left ankle surgical scars. The Veteran contends that he is entitled to higher initial ratings for his left ankle surgical scars. In this regard, he was assigned an initial noncompensable rating for left ankle surgical scars pursuant to 38 C.F.R. § 4.118, DC 7802, effective June 19, 2014. Thereafter, he was assigned a separate initial 10 percent rating for painful left ankle surgical scars pursuant to 38 C.F.R. § 4.118, DC 7804, effective November 2, 2015. However, as the Board herein determines that such scars have been painful throughout the entire appeal period stemming from the initial award of service connection on June 19, 2014, the Board has assigned one rating for all scars. Scars are rated under 38 C.F.R. § 4.118, DCs 7800 through 7805. DC 7800 pertains 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. As the scars in this case does not involve the head, face, or neck this DC is not for application. DC 7801 pertains to burn scars or scars due to other causes, not of the head, face, or neck that are deep and nonlinear. 38 C.F.R. § 4.118. Under this DC, a 10 percent rating is to be assigned when the scar(s) cover an area or areas of at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm). Area or areas of at least 12 square inches (77 sq. cm) but less than 72 square inches (465 sq. cm) is assigned a 20 percent rating. Area or areas of at least 72 square inches (465 sq. cm) but less than 144 square inches (929 sq. cm) is assigned a 30 percent rating. Area or areas of 144 square inches (929 sq. cm) or greater is assigned a 40 percent rating. The Board notes that the evidence of record does not indicate that the Veteran’s surgical scars are deep and nonlinear, or that they involve a total area of at least 6 square inches (39 sq. cm). See November 2015 and May 2018 VA examinations. DC 7802 pertains to burn scars or scars due to other causes not of the head, face, or neck that are superficial and nonlinear. 38 C.F.R. § 4.118. Under this DC, a 10 percent rating is assigned when the scar(s) cover an area or areas of 144 square inches (929 sq. cm) or greater. No other rating is provided by this DC. Note (1) states that a superficial scar is one not associated with underlying soft tissue damage. In this case, it does not appear that the scar has the requisite measurement for a compensable rating under this DC. DC 7804 provides that one or two scars that are unstable or painful warrant a 10 percent evaluation. 38 C.F.R. § 4.118. A 20 percent rating is warranted when three or four scars are unstable or painful. Id. A 30 percent rating is warranted when five or more scares are unstable or painful. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. at Note (1). If one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id. at Note (2). Scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. Id. at Note (3). In this case, the objective evidence of record reveals that the Veteran has surgical scars that are painful, but not unstable. In this regard, at the September 2017 Board hearing, the Veteran testified that his initial 2 scars were painful for the entire appeal period stemming from the June 19, 2014, grant of service connection. Moreover, he testified that he had an ankle fusion in February 2017, which resulted in additional painful scars. In this regard, at the May 2018 VA examination, the examiner noted that the Veteran had a total of seven scars from his previous ankle surgeries. Consequently, as the Veteran’s left ankle scars have been painful, but not unstable, throughout the appeal period, the Board finds that, prior to February 28, 2017, an initial rating of 10 percent for two scars is warranted and, as of such date, an initial rating of 30 percent for seven scars is warranted pursuant to DC 7804. DC 7805 provides that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an appropriate diagnostic code. 38 C.F.R. § 4.118. Here, the record does not reflect that the Veteran’s surgical scar is manifested by limitation of motion or other disabling effects. None of the evidence of record supports a consideration of a compensable rating under DC 7805, to include the Veteran’s own contentions. Therefore, the Board finds the assignment of an initial rating of 10 percent is warranted prior to February 28, 2018, for two painful surgical scars under DC 7804, and a rating of 30 percent for seven painful scars thereafter, which is the maximum rating under 7804. However, the Board finds that, as the evidence does not show that the Veteran’s surgical scars of the left ankle are unstable, of a size to warrant a compensable rating, or result in any disabling effects, no higher or separate ratings are warranted. 5. Other Considerations In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his symptoms associated with his left ankle PVNS, left lower extremity DVT, and left ankle surgical scars are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether staged ratings under Fenderson, supra, and Hart, supra, are appropriate for the Veteran’s service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout the aforementioned periods on appeal. Therefore, assigning additional staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial and increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching the determinations in the instant case, the Board considered and applied the benefit of the doubt doctrine where applicable. However, to the extent that the Board herein denies higher or separate ratings for the Veteran’s disabilities on appeal, the preponderance of the evidence is against such aspect of his claims. Therefore, it is not applicable and the claims must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brennae L. Brooks, Associate Counsel