Citation Nr: 18161268 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 07-15 285 DATE: December 31, 2018 ORDER Entitlement to a rating in excess of 30 percent for residuals of larynx injury manifested by laryngitis (hoarseness) is denied. Entitlement to a separate 30 percent rating, but no higher, for residuals of larynx injury manifested by stenosis of the larynx is granted from June 23, 2008. Entitlement to a separate 10 percent rating, but no higher, for residuals of larynx injury manifested by stenosis of the larynx is granted from June 18, 2017. Entitlement to an initial rating in excess of 10 percent for left heel ulcer is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran’s residuals of larynx injury have included hoarseness, shortness of breath, and right vocal cord paralysis. 2. Prior to June 23, 2008, the Veteran’s residuals of larynx included pulmonary function test results showing FEV-1 of 101 percent predicated. 3. From June 23, 2008, the Veteran’s residuals of larynx included pulmonary function test results showing FEV-1 of 66 percent predicated. 4. From June 18, 2017, the Veteran’s residuals of larynx included pulmonary function test results showing FEV-1 of 71 to 80 percent predicated. 5. Throughout the period on appeal, the Veteran’s left heel ulcer has been manifest by pain, callouses, and flakey skin. It has not been manifested by a deep liner scar covering an area of at least 77 square centimeters, a superficial scar covering an area of 929 square centimeters or greater, or three or more scars that painful or unstable. CONCLUSIONS OF LAW 1. Throughout the rating period on appeal, the criteria for a rating in excess of 30 percent for residuals of larynx injury manifested by laryngitis (hoarseness) have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.97, Diagnostic Code 6516. 2. From June 23, 2008, the criteria for a separate 30 percent rating, but no higher, for residuals of larynx injury have been met. 38 U.S.C. §§1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.97, Diagnostic Code 6520. 3. From June 18, 2017, the criteria for a separate 10 percent rating, but no higher, for residuals of larynx injury have been met. 38 U.S.C. §§1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.97, Diagnostic Code 6520. 4. Throughout the rating period on appeal, the criteria for an initial rating in excess of 10 percent for left heel ulcer have not been met. 38 U.S.C. §§ 1155, 5107 (2017); 38 C.F.R. §§ 3.102, 4.118, Diagnostic Codes 7801-7805 (1994, 2002, 2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from October 1962 to October 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) located in Philadelphia, Pennsylvania. Jurisdiction has been transferred to the RO in Providence, Rhode Island, which, in pertinent part, granted service connection for a left heel ulcer and assigned an initial noncompensable rating, effective February 6, 1994, and which denied a rating in excess of 30 percent for residuals of an injury to the larynx. Before the appeal was certified to the Board, in a September 2008 rating decision, the RO increased the rating for the Veteran’s left heel ulcer to 10 percent, effective February 7, 2008. The Veteran testified before a Veterans Law Judge (VLJ) at a Board hearing in February 2010. A transcript of the hearing is of record. In April 2010, the Board remanded the matter for additional evidentiary development. In correspondence dated in December 2011, the Veteran was notified that the VLJ who conducted the February 2010 hearing had retired. The Veteran was provided the opportunity to testify at another hearing but he did not respond to the letter. Therefore, the Board will presume that the Veteran does not want another hearing and will proceed with a decision on the claims on appeal. In an October 2013 decision, the Board granted a 10 percent rating for left heel ulcer from February 6, 1994. The Board remanded the remaining issues on appeal for additional evidentiary development. The Board’s award of a 10 percent rating was effectuated in a March 2014 rating decision. In March 2017, the Board again remanded the matter for additional evidentiary development. A review of the record shows that the RO has complied with the remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Claims Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where a claimant appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). Where a claimant appeals the initial rating assigned for a disability when a claim for service connection for that disability has been granted, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an [initial] rating on appeal was erroneous...” Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found. Id. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). 1. Entitlement to a rating in excess of 30 percent for residuals of larynx injury The Veteran’s residuals of larynx injury have been rated under Diagnostic Code 6516, which contemplates active or inactive laryngitis and tuberculous, and Diagnostic Code 6520, which contemplates stenosis of the larynx, including residuals of laryngeal trauma. Under Diagnostic Code 6516, chronic laryngitis manifested by hoarseness, with thickening or nodules of cords, polyps, submucous infiltration or pre-malignant changes on biopsy is rated as 30 percent disabling. 38 C.F.R. § 4.97, Diagnostic Code 6516. This is the maximum rating available under this diagnostic code. Under Diagnostic Code 6520, a 10 percent rating is warranted where FEV-1 is from 71 to 80 percent predicted, with Flow-Volume loop compatible with upper airway obstruction. A 30 percent evaluation is warranted if the evidence establishes that there is FEV-1 of 56 to 70 percent predicted, with Flow-Volume Loop compatible with upper airway obstruction. A 60 percent evaluation is warranted if the evidence establishes that there is FEV-1 of 40 to 55 percent predicted, with Flow-Volume Loop compatible with upper airway obstruction. A 100 percent evaluation is warranted if the evidence establishes that there is forced expiratory volume in 1 second (FEV-1) less than 40 percent of predicted value, with Flow-Volume Loop compatible with upper airway obstruction; or permanent tracheostomy. 38 C.F.R. § 4.97, Diagnostic Code 6520 (2017). Factual Background Turning to the evidence, VA clinical records note treatment for residuals of larynx injury. Notably, in a February 2005 operation report, in was noted that the Veteran underwent an awake laryngoscopy and bronchoscopy. The post-operative and pre-operative diagnoses were dyspnea. A direct laryngoscopy and bronchoscopy was conducted in April 2005 for increased shortness of breath. The Veteran underwent a VA respiratory examination in August 2005. At that time, it was noted that he had difficulty in breathing and shortness of breath, especially on exertion. The Veteran had dyspnea on exertion after walking a half a block. He also had hoarseness and phlegm. He did not have intermittent cough, hemoptysis, or asthma. Occupationally, the Veteran was working as an electrician which required him to climb ladders. He stated that his job caused severe problems with shortness of breath. It was noted that the Veteran was not taking any medication and was not on oxygen. On physical examination, there was no evidence of cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, weight loss or weight gain, or restrictive diseases. Pulmonary function test results, post-bronchodilator values showed: FVC of 3.303, which was 86 percent predicated; FEV-1 of 2.54, which was 101 percent predicated; FEV-1/FVC was 118, which was determined to be normal; and MVV was 49.51, which was 43 percent predicated. There was no evidence of diffusion defect. The examiner diagnosed status-post laryngeal dilation with moderate functional disability. The Veteran was also provided a VA sinus examination in August 2005. At the time of the examination, he was not on any medication and did not have problems breathing through the nose. There was no purulent discharge, evidence of chronic sinusitis, allergy attacks, or incapacitating episodes. The Veteran did not have dyspnea at rest, however, he had dyspnea on exertion. He did not have any speech impairment, but informed the examiner that sometimes people had a hard time understanding him. In any event, the examiner documented that he could understand the Veteran very well. A scar over the anterior neck was noted. On physical examination, there was no evidence of allergy attacks, bacterial rhinitis, nasal obstruction, or sinusitis. The examiner diagnosed status-post laryngeal dilation with residual functional disability. Subsequent VA clinical records show continued treatment for the Veteran’s residuals of larynx injury. In March 2006, the Veteran presented with complaints of shortness of breath without chest pain. He was provided a direct laryngoscopy, tracheal dilation. In a June 2007 private larynx examination, it was noted that the Veteran sounded slightly hoarse but had no stridor stertor. His oral cavity and oropharyngeal examinations were clear. Palpation of the neck was normal, but a well-healed scar was present. A flexible endoscopy through the left nasal cavity revealed what appeared to be a left vocal cord paralysis and paretic cord on the right. He had a 3 millimeter to 4 millimeter gap with phonation. The physician was able to visualize the proximal trachea. VA clinical records show that in July 2007 and January 2008, the Veteran underwent tracheal dilation for his laryngotracheal stenosis. The Veteran was provided a VA nose, sinus, larynx, and pharynx examination in February 2008. It was noted that since the initial tracheal reconstruction, he had required 4 additional tracheal dilatations due to the recurrence of scar tissue at the surgical site. The Veteran also had recurrent subglottic tracheal stenosis and vocal cord paralysis. There was no history of neoplasm, nasal allergy, osteomyelitis, sinusitis, or difficulty breathing. Hoarseness was present. In addition to hoarseness, the Veteran also experienced difficulty breathing, which gradually but progressively worsened, ultimately requiring tracheal dilatation for improvement. On physical examination, there was no evidence of sinus disease, nasal polyps, septal deviation, hypertrophy of turbinates from bacterial rhinitis, rhinoscleroma, tissue loss, scarring, deformity, Wegner’s granulomatosis, or granulomatous infection. Hoarseness was present. The examiner reported that he was not able to answer the question regarding the appearance of the larynx, as it likely required a direct laryngoscopy. Private treatment records show that in June 2008 the Veteran underwent a pulmonary stress test. The physician indicated that the response to the cardiopulmonary stress testing was inconclusive for ischemia based on failure to attain greater than or equal to 85 percent maximum predicated heart rate. The Veteran’s exercise tolerance was fair and there were no exercise induced arrhythmias. The Veteran had FEV-1 was 66 percent predicated. An additional VA nose, sinus, larynx, and pharynx examination was provided in August 2010. There was no history of neoplasm, nasal allergy, osteomyelitis, or sinusitis. There was no difficulty breathing. However, hoarseness was noted. On physical examination, there was no evidence of sinus disease, nasal polyps, septal deviation, permanent hypertrophy of turbinates from bacterial rhinitis, tissue loss, Wegner’s granulomatosis, or granulomatous infection. However, there was evidence of left nasal obstruction, apparently to 30 percent. In the report of an April 2014 VA examination, it was noted that the Veteran reported ongoing constant hoarseness with occasional worsening after increased use of his words. He also reported occasional shortness of breath and constant loud/heavy breathing with a sensation of restriction of his airway intermittently that caused him to stop while walking to catch his breath. The examiner noted that the Veteran has chronic laryngitis. Symptoms of the assessed disability included hoarseness and right vocal cord paralysis. Laryngeal stenosis was also present. In a July 2014 addendum, the examiner reported that the Veteran had a pulmonary function test in July 2014. The results showed normal spirometry, lung volumes, and diffusion. There was no significant bronchodilator response. A final VA examination was provided in June 2017, at which time larynx injury with residual laryngeal stenosis, laryngotracheal stenosis, and chronic laryngitis were assessed. The Veteran reported that his current symptoms were shortness of breath and hoarseness. With regards to larynx and pharynx conditions, the examiner noted that the Veteran had chronic laryngitis. Symptoms associated with the condition included hoarseness, which was almost constant but worsened with prolonged speaking, and right vocal cord paralysis and laryngotracheal stenosis. A scar from a previous tracheotomy was noted. Pulmonary function test showed FEV-1 of 71 to 80 percent predicated. The Flow-Volume Loop was not compatible with upper airway obstruction. There were no other significant diagnostic test findings and/or results. Analysis Applying the criteria set forth above to the facts in this case, the Board finds that the preponderance of the evidence is against a rating in excess of 30 percent for residuals of larynx injury manifested by laryngitis (hoarseness). However, the Board finds that a separate 30 percent rating from June 23, 2008 and a separate 10 percent rating from June 18, 2017 for residuals of larynx injury manifested by stenosis of the larynx is warranted. Specifically, the respiratory difficulties contemplated by Diagnostic Code 6520 reflect a different set of symptoms from the hoarseness contemplated under Diagnostic Code 6516. Thus, assignment of separate ratings is permissible and does not constitute pyramiding under 38 C.F.R. 4.14. At the outset, the Board notes that a 30 percent rating is the maximum schedular rating under Diagnostic Code 6516. Thus, a higher rating is not warranted under the rating criteria. 38 C.F.R. § 4.97, Diagnostic Code 6516. The Board has also considered the increased rating claim under Diagnostic Code 6520. Prior to June 23, 2008, the Veteran’s residuals of larynx were manifested by pulmonary function test results showing FEV-1 101 percent. As detailed above, at the time of the August 2005 VA examination, pulmonary function test results showed FEV-1 of 101 percent. At no time during this stage of the appeal does the evidence show pulmonary function tests results showing FEV-1 of 71 to 80 percent. Accordingly, a compensable rating under Diagnostic Code 6520 is not warranted prior to June 23, 2008. 38 C.F.R. § 4.97. From June 23, 2008, the Veteran’s residuals of larynx have included right vocal cord paralysis and stenosis of the subglottic region with pulmonary function test results showing FEV-1 of 56 to 70 percent predicated. In this regard, findings from a private June 2008 pulmonary function test showed that the Veteran had a FEV-1 of 66 percent predicated. Such findings are contemplated by the 30 percent rating. 38 C.F.R. § 4.97, Diagnostic Code 6520. However, the Veteran’s residuals of larynx injury were not manifested by a FEV-1 of 40 to 55 percent predicted, with Flow-Volume Loop compatible with upper airway obstruction. As such, the next-higher 60 percent rating is not warranted. Thus, from June 23, 2008, a separate 30 percent rating is warranted. As of June 18, 2017, the Veteran’s residuals of larynx included right vocal cord paralysis and stenosis of the subglottic region with pulmonary function test results showing FEV-1 of 71 to 80 percent. Notably, at the time of the June 2017 VA examination, the examiner reported that pulmonary function test showed FEV-1 of 71 to 80 percent predicated. Such findings are contemplated by the 10 percent rating criteria. 38 C.F.R. § 4.97, Diagnostic Code 6520 (2017). However, the evidence does not show that the Veteran’s residuals of larynx injury have manifested by a FEV-1 of 56 to 70 percent predicted, with Flow-Volume Loop compatible with upper airway obstruction such. Neither the Veteran nor his representative have identified any evidence to suggest otherwise. As such, the next-higher 30 percent rating is not warranted. Thus, from June 18, 2017, a separate 10 percent rating is warranted. The Board has also considered the applicability of other potential diagnostic codes. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, the Board finds that a higher rating is not warranted based on any other provision of the rating schedule at any time throughout the period of appeal. The Board observes that a scar has been associated with the residuals of larynx injury. However, service connection for the scar has been previously awarded. The Veteran has not expressed disagreement with the assigned rating. For the reasons set forth above, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 30 percent for residuals of larynx injury under Diagnostic Code 6516. However, a separate 30 percent rating is warranted from June 23, 2008 and a separate 10 percent rating is warranted form June 18, 2017 under Diagnostic Code 6520. 2. Entitlement to an initial rating in excess of 10 percent for left heel ulcer The Veteran’s left heel spur has been assigned a 10 percent disability rating under Diagnostic Code 7804, which contemplates unstable or painful scars. In the November 2005 rating decision on appeal, the RO granted service connection for left heel ulcer and assigned an effective date of February 6, 1994. The Board notes that the criteria for evaluating scars were revised in October 23, 2008. See 73 Fed.Reg. 54, 708 (Sep. 23, 2008). The October 2008 revisions apply to all applications for benefits received by VA on or after October 23, 2008. A veteran whom VA rated before such date under diagnostic codes 7800, 7801, 7802, 7803, 7804, or 7805 of 38 C.F.R. 4.118 may request review under these clarified criteria, irrespective of whether his or her disability has worsened since the last review. However, the effective date of any award, or any increase in disability compensation, based on this amendment will not be earlier than the effective date of this rule. 73 Fed. Reg. 54708 (Sept. 23, 2008). Here, the Veteran has not specifically requested consideration under the amended 2008 provisions. Therefore, the Board will consider the Veteran’s claim under the pre-amended rating criteria. The pre-amended criteria, in effect since August 30, 2002, provide as follows: Diagnostic Code 7801, for scars, other than the head, face, or neck, that are deep or that cause limited motion, provides a 10 percent evaluation when the area or areas exceed six square inches (39 square centimeters). Scars in an area or areas exceeding 12 square inches (77 sq. cm.) are rated 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 sq. cm.) are rated 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 sq. cm.) are rated 40 percent disabling. Note (2) provides that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801(2007). Diagnostic Code 7802, which governs scars other than the head, face, or neck, that are superficial and do not cause limited motion, provides a 10 percent rating when the area or areas are 144 square inches (929 sq. cm) or greater. Note (2) defines a superficial scar as one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (2007). Diagnostic Code 7803 provides a 10 percent rating for scars that are superficial and unstable. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7803 (2007). Diagnostic Codes 7804, provides 10 percent rating for scars that are superficial and painful on examination. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2007). Diagnostic Code 7805 provides that any other scars should be rated on limitation of function of the affected part. 38 C.F.R. § 4.118 (2007). Factual Background Turning to the evidence of record, VA treatment records show that in January 1994, the Veteran underwent a tracheal resection with primary anastomosis. In a March 1994 VA clinical record, it was noted that he had been followed they podiatry clinic for an ulceration on the posterior aspect of the left heel, which was slowly resolving with daily wound care. In the report of an August 1994 VA trachea and bronchi examination, it was noted that while the Veteran was in the hospital following the January 1994 surgery for his tracheo-laryngeal injury, a heel ulcer developed. The heel ulcer continued to cause discomfort, but was completely healed at the time of the examination. On physical examination, it was noted that the extremities showed a blister-type of formation over the posterior and inferior aspects of the calcaneal area on the left. Callous formation appeared to be diminished and almost appeared as though there was a blister formation. The examiner indicated that such findings probably represented an incipient ulceration that was healing. There was no clubbing, cyanosis, or edema. The skin had good turgor. The examiner concluded that secondary to the repair of the tracheo-laryngeal problems, while in the hospital, the Veteran sustained a decubitus type of injury to the left heel. Subsequent VA clinical records from April 2004 to October 2007 demonstrate treatment for the left heel ulcer. In an April 2007 VA podiatry note, the appellant reported that he had a callous on the back of his left heel due to a previous ulcer. He stated that he treated the condition with lotion. On physical examination, there was mild flaking, hyperkeratotic tissue on the posterior aspect of the left heel. The physician diagnosed callous posterior aspect of the left heel. In a June 2015 VA podiatry note, it was reported that the Veteran had a callous on the back of his left heel due to a previous ulcer. The callous was not painful. In an August 2007 VA clinical record, it was noted that the Veteran presented with complaints of painful recurrent hyperkeratosis since January 1994. The Veteran was provided a VA skin examination in February 2008. It was noted that since the 1994 tracheal resection with anastomosis in 1994, the Veteran’s ulcer healed but with recurrent painful callous formation that required intermittent treatment. The examiner diagnosed hyperkeratosis and cicatrix of the left heel, status-post left heel ulcer. The Veteran stated that he developed a pressure ulcer on his left heel during the recuperative period after his tracheal resection in 1994. He recalled that it took at least one month to completely scar over. However, it was immediately painful and interfered with his walking/weight-bearing. The Veteran reported that the scar formed a more painful callous, which further hampered his walking/weight-bearing. The examiner indicated that the skin symptoms included scarring/hyperketosis of the left heel. There were no systemic symptoms. The appellant used a topical treatment that was neither a corticosteroid or an immunosuppressive. On physical examination, there was diffuse hyperkeratosis (callous formation) with hyperpigmentation of the left heel only. It was nontender to palpation. The area involved was 5 centimeters by 5 centimeters (less than 1 percent of the total skin area). VA clinical records following the VA examination show continued podiatry treatment. In a July 2008 record, it was reported that the Veteran had recurring left posterior heel callous. An additional VA podiatry examination was provided in July 2010. The Veteran could not recall the details of any treatment for the condition at the time of the examination. Notwithstanding, it was noted that there was constantly a build-up scar tissue that was painful. It was most noticeable with any type of walking or pressure. Additional symptoms included weakness, swelling, and redness. The disability was symptomatic at rest. It ached with standing and walking. It was noted that the Veteran self-medicated the condition. He reported flare-ups with walking greater than 2 blocks, climbing ladders, or placing any pressure against the area. The Veteran stated that during flare-ups he is incapacitated and must resume a non-weight-bearing attitude. He denied use of shoe inserts, special shoes or other assistive devices. On physical examination, there was an area of thickened dark brown to black skin on the posterior lateral and inferior aspect of the left heel, measuring 5.9 centimeters by 3.4 centimeters by 0.02 centimeters. It was indurated with hyperkeratotic. There was on pain on direct palpitation. The surrounding area was very dry and flaking. There was no loss of vibratory sensation in either foot. There was some diminished loss of protective sensation with monofilament 10 gram at the area of discoloration and thickness. There was no evidence of hypertrophy or keloid formation. There was a thick nucleated callous on the dorsal lateral aspect of the fifth toe of the left foot. The Veteran also had thick keratosis in the left heel. With regards to skin, there was severe xerosis. Both soles were very dry and flaking. The Veteran was able to stand, squat, supinate, pronate, and rise on the heels and toes with the assistance of a hand rail. It was noted that the Veteran tried to avoid heel contact during the maneuvers and reported pain while trying to stand on the heel. Following examination, the examiner diagnosed diffuse keratosis of the left heel. There was no evidence of keloid, hypertrophic left heel scar, or left heel ulcer. VA clinical record show continued left heel treatment. Notably, in a March 2011 podiatry record, it was documented that the Veteran presented with complaints of painful recurrent hyperkeratosis of the left heel. In the report of an April 2014 VA foots conditions examination, left heel pain was assessed. However, the examiner indicated that the Veteran did not have a current diagnosis. Notwithstanding, with regard to foot injuries, the examiner described chronic left heel pain from previous heel ulcer. He determined that the condition was moderate in severity. Contributing factors of the disability was pain on weight-bearing. A final VA foot examination was provided in June 2017. The examiner diagnosed left heel fissure with residual scar. The Veteran reported foot pain with walking distances and skin that is constantly open and dry. The claimed condition was treated with Vaseline for the skin and moleskin to decrease friction/rubbing. The examiner noted that there was a heel fissure with a 2 centimeter by 5 centimeter scar, which was mild in severity. He determined that the foot disability did not chronically compromise weight bearing. A VA skin examination was also provided in June 2017. Left heel fissure was diagnosed. It was noted that there was an underlying hyperkeratosis to the left foot. The skin was cracked and open, but only the epidermis was affected. The examiner determined that the foot ulcer was no longer present, but the fissure is related to the previously affected area. She noted that it is commonly known that once a wound is healed, the new skin is different. The new skin is at an increased risk of opening, pain, and numbness. Further, while the types of wounds often heal, there is residual loss of sensation, paresthesia, and dysesthesia. She opined that the pain from walking was related to such symptoms. Analysis Applying the criteria above to the facts in this case, the Board finds that a rating in excess of 10 percent for left heel ulcer is not warranted under the pre-amended or amended rating criteria. A rating in excess of 10 percent is not warranted under the relevant rating criteria in this case, that in effect prior to October 23, 2008. In this regard, the evidence available to the Board does not suggest that the Veteran’s left heel ulcer is manifested by three or four scars that are unstable or painful. As such, a rating in excess of 10 percent is not warranted under Diagnostic Code 7805. 38 C.F.R. § 4.118, Diagnostic Code (2002, 2017). Additionally, the evidence does not suggest that the appellant has a deep and nonlinear scar exceeding 12 square inches (77 sq. cm.). During the February 2008 VA examination, the examiner noted that the left heel was nontender to palpation and involved an area that was 5 centimeters by 5 centimeters. There was no report of underlying tissue damage. At the time of the July 2010 VA examination, the examiner noted that the Veteran’s measured 5.9 centimeters by 3.4 centimeters by 0.02 centimeters. However, there was no indication that there was a deep and nonlinear scar. Further, at the time of the June 2017 VA foot examination, it was documented that the Veteran’s scar was 2 centimeters by 5 centimeters. In light of the foregoing, a rating in excess of 10 percent is not warranted for the deep liner scar. 38 C.F.R. § 4.118, Diagnostic Code 7801. The Board has considered whether a separate rating is warranted for the superficial non-linear scar; however, the evidence does not show that Veteran’s left heel ulcer involves an area or areas at least 144 sq. inches (929 sq. cm.), or greater. Thus, a separate rating is not warranted for the superficial non-linear scar. 38 C.F.R. § 4.118, Diagnostic Code 7802. Pursuant to Diagnostic Code 7805, the Board has considered whether a higher rating is warranted based on limitation of function of the left foot. In this regard, the Board has considered the Veteran’s report of pain in the heel on weight bearing. However, such symptom is contemplated by the assigned disability rating. Therefore, an additional rating under Diagnostic Code 7805 is not warranted. 38 C.F.R. § 4.118. (Continued on the next page)   The Board has also considered the applicability of other potential diagnostic codes. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, the Board finds that a higher rating is not warranted based on any other provision of the rating schedule at any time throughout the period of appeal. For the reasons set forth above, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 10 percent for the Veteran’s left heel ulcer and the claim must be denied. ERIC S.LEBOFF Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel