Citation Nr: 18129698 Decision Date: 08/27/18 Archive Date: 08/27/18 DOCKET NO. 16-18 686 DATE: August 27, 2018 ORDER The claim of entitlement to an evaluation of 30 percent for service-connected left lower extremity injury, status post gunshot wound, is granted. The claim of entitlement to an evaluation of 20 percent for service-connected left buttock injury, status post gunshot wound, is granted. The claim of entitlement to an evaluation in excess of 10 percent for service-connected left forearm injury, status post gunshot wound, is denied. The claim of entitlement to an evaluation in excess of 10 percent for service-connected residuals of infectious hepatitis is denied. The claim of entitlement to an initial compensable evaluation for service-connected deep scar of the left lower extremity is denied. The claim of entitlement to an initial compensable evaluation for service-connected superficial scar of the left lower extremity is denied. The claim of entitlement to an initial compensable evaluation for service-connected scars of the left buttock and left upper extremity is denied. REMANDED The claim of entitlement to an initial evaluation in excess of 20 percent for service-connected lumbar spine disability is remanded. The claim of entitlement to a total disability based upon individual unemployability due to service-connected disabilities is remanded. FINDINGS OF FACT 1. The Veteran’s left lower extremity injury, status post-gunshot wound, most nearly approximates severe injury to Muscle Group XI. 2. The Veteran’s left buttock injury, status post-gunshot wound, most nearly approximates a moderate injury to Muscle Group XVII. 3. The Veteran’s left forearm injury, status post-gunshot wound, most nearly approximates a moderate injury to Muscle Group VI. 4. The Veteran’s residuals of infectious hepatitis are nonsymptomatic. 5. The Veteran’s deep scar of the left lower extremity is non-linear, small, stable, and not painful. 6. The Veteran’s superficial scar of the left lower extremity is non-linear, small, stable, and not painful. 7. The Veteran’s left buttock scar is vertical, small, stable, and not painful. 8. The Veteran’s left upper extremity scar is not present on medical examination. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to an evaluation of 30 percent, but no more, for service-connected left lower extremity injury, status post-gunshot wound, have been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.56, 4.71, 4.73, Diagnostic Code 5311 (2018). 2. The criteria for establishing entitlement to an evaluation of 20 percent for service-connected left buttock injury, status post-gunshot wound, have been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.56, 4.71, 4.73, Diagnostic Code 5317 (2018). 3. The criteria for establishing entitlement to an evaluation in excess of 10 percent for service-connected left forearm injury, status post-gunshot wound, have not been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.56, 4.71, 4.73, Diagnostic Code 5306 (2018). 4. The criteria for establishing entitlement to an evaluation in excess of 10 percent for service-connected residuals of infectious hepatitis have not been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, Diagnostic Code 7345 (2018). 5. The criteria for establishing entitlement to an initial compensable evaluation for service-connected deep scar of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, 4.118, Diagnostic Codes 7800-7805 (2018). 6. The criteria for establishing entitlement to an initial compensable evaluation for service-connected superficial scar of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, 4.118, Diagnostic Codes 7800-7805 (2018). 7. The criteria for establishing entitlement to an initial compensable evaluation for service-connected scars of the left buttock and left upper extremity have not been met. 38 U.S.C. §§ 1155, 5103 (2012); 38 C.F.R. §§ 3.159, 4.118, Diagnostic Codes 7800-7805 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from April 1948 to January 1950, and from January 1951 to October 1952. The Veteran’s service was under honorable conditions. Amongst other commendations, the Veteran is the recipient of the of the Purple Heart and the Korean Service Medal with one Bronze Star. These matters are on appeal of August 2012, November 2013, and February 2016 rating decisions. The Veteran was notified in November 2017 of his scheduled hearing in December 2017. In November 2017, he stated that he chose not to attend the hearing and requested adjudication of his claim without a hearing. As such, the Board may proceed to adjudicate this claim. See 38 C.F.R. § 20.704(e) (2018). Increased Rating – General Legal Criteria Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2018). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321 (a), 4.1 (2018). 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. In accordance with 38 C.F.R. §§ 4.1, 4.2 (2018) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service-connected disabilities at issue. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability. In both initial rating claims and normal increased rating claims, the Board must discuss whether "staged ratings" are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). VA must consider all favorable lay evidence of record. 38 U.S.C. § 5107 (b); Caluza v. Brown, 7 Vet. App. 498 (1995). The Veteran is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). Disabilities evaluated on the basis of limitation of motion require VA to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare-ups. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner should also determine the point, if any, at which such factors cause functional impairment. Mitchell v. Shinseki, 25 Vet. App. 32, 43-4 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3 (2018); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Muscle Injury – General Legal Criteria Muscle injuries are evaluated in accordance with 38 C.F.R. § 4.56. The pertinent provisions of 38 C.F.R. § 4.56 are as follows: (a) An open comminuted fracture with muscle or tendon damage will be rated as a severe injury of the muscle group involved unless, for locations such as in the wrist or over the tibia, evidence establishes that the muscle damage is minimal. (b) A through-and-through injury with muscle damage shall be rated as no less than a moderate injury for each group of muscles damaged. (c) For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement. (d) Under Diagnostic Codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe or severe as follows: (1) Slight disability of muscles-(i) Type of injury. Simple wound of muscle without debridement or infection. (ii) History and complaint. Service department record of superficial wound with brief treatment and return to duty. Healing with good functional results. No cardinal signs or symptoms of muscle disability as defined in paragraph (c) of this section. (iii) Objective findings. Minimal scar. No evidence of fascial defect, atrophy, or impaired tonus. No impairment of function or metallic fragments retained in muscle tissue. (2) Moderate disability of muscles--(i) Type of injury. Through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. (ii) History and complaint. Service department record or other evidence of in-service treatment for the wound. Record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. (iii) Objective findings. Entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue. Some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. (3) Moderately severe disability of muscles--(i) Type of injury. Through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Entrance and (if present) exit scars indicating track of missile through one or more muscle groups. Indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. (4) Severe disability of muscles--(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability: (A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile. (B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle. (C) Diminished muscle excitability to pulsed electrical current in electrodiagnostic tests. (D) Visible or measurable atrophy. (E) Adaptive contraction of an opposing group of muscles. (F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle. (G) Induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56. The Board notes that section 4.56(d), which sets forth classification of muscle injuries as slight, moderate, moderately severe or severe, employs a totality-of-the-circumstances test, and no single factor is per se controlling in determining the rating for a muscle injury. Tropf v. Nicholson, 20 Vet. App. 317, 325 (2006); see Robertson v. Brown, 5 Vet. App. 70, 74 (1993). The diagnostic criteria pertaining to Muscle Group VI are found at 38 C.F.R. § 4.73, Diagnostic Code 5306. This muscle group involves the extension of the elbow (long head of triceps stabilizer of the shoulder joint). This provision further provides: extensor muscles of the elbow (1) triceps; (2) anconeus. 38 C.F.R. § 4.73, Diagnostic Code 5306. For the nondominant forearm, ratings of zero, 10, 20, and 30 percent are provided for slight, moderate, moderately severe, and severe injuries, respectively. 38 C.F.R. § 4.73, Diagnostic Code 5306. The diagnostic criteria pertaining to Muscle Group XI are found at 38 C.F.R. § 4.73, Diagnostic Code 5311. This muscle group involves the posterior and lateral crural muscle and muscles of the calf, the function of which includes propulsion and plantar flexion of foot; stabilization of arch; flexion of toes; and flexion of knee. Ratings of zero, 10, 20, and 30 percent are provided for slight, moderate, moderately severe, and severe injuries, respectively. 38 C.F.R. § 4.73, Diagnostic Code 5311. The rating criteria provided for limitation of motion of the knee and leg are found at 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Diagnostic Code 5260 provides ratings for limitation of flexion. Flexion of either leg limited to 60 degrees is noncompensable, flexion limited to 45 degrees merits a 10 percent rating, limitation of flexion to 30 degrees warrants a 20 percent evaluation, and a 30 percent evaluation requires that flexion be limited to 15 degrees. Diagnostic Code 5261 provides ratings of 0 percent for extension limited to 5 degrees, 10 percent for extension limited to 10 degrees, 20 percent for extension limited to 15 degrees, 30 percent for extension limited to 20 degrees, 40 percent for extension limited to 30 degrees, and 50 percent for extension limited to 45 degrees. For rating purposes, normal range of motion of the knee is from zero to 140 degrees. See 38 C.F.R. § 4.71, Plate II (2018). The diagnostic criteria pertaining to Muscle Group XVII are found at 38 C.F.R. § 4.73, Diagnostic Code 5317. This muscle group involves pelvic girdle group 2, which includes gluteus maximus, gluteus medius, and gluteus minimus. The function of these muscles includes extension of hip; abduction of thigh; elevation of opposite side of pelvis; and tension of fascia lata and iliotibial (Maissiat's) band, acting with XIV in postural support of body steadying pelvis upon head of femur and condyles of femur on tibia. Ratings of zero, 20, 40, and 50 percent are provided for slight, moderate, moderately severe, and severe injuries, respectively. 38 C.F.R. § 4.73, Diagnostic Code 5317. Factual Background – Muscle Injuries Service treatment records demonstrate that the Veteran sustained gunshot wounds from enemy fire to the left lower leg, left forearm, and left hip/buttock on April 25, 1951. The Veteran was hospitalized and his left leg was casted due to a compound fracture of the fibula. He underwent an operation to remove the shrapnel from his left hip/buttock; however, his left lower leg retained residual foreign bodies. His left arm did not require any surgical treatment. The Veteran’s residuals included several scars and numbness and aching of his left lower leg, especially in cold weather. The Veteran remained hospitalized in Tokyo General Hospital in Japan for approximately 35 days. Thereafter, he was sent to Camp Atterbury, where he was hospitalized for several months for both his gunshot wounds and infectious Hepatitis. A record dated in June 1951 notes diagnoses of a perforating wound to the left lower leg without significant artery or never damage; a comminuted compound fracture of the left fibula middle-third; a lacerating wound to the left buttock without significant artery or nerve involvement; and a perforating wound to the left forearm without significant artery or never damage. The report of a September 1952 separation examination was abnormal, only in noting a scar over the left buttock, but was otherwise normal. Post-service records include an October 1953 VA examination, which notes diagnoses of scars of bullet wounds of the left lower leg, left hip, and left forearm, with residuals of the left leg injury, to include retained foreign bodies. Examination revealed one-centimeter scars below the left antecubital fossa and on the dorsal aspect of the arm at the site the bullet exited. There was no evidence of deformity, tenderness, or limitation of motion. There was a well-healed linear scar over the left gluteus maximus muscle which was the site of surgery to remove the shrapnel; there was no tenderness or altered function. There were several scars over the left leg, to include a two-centimeter scar overlying the insertion of the gastrocnemius muscle; there was soft tissue and tenderness on pressure. X-rays demonstrate evidence of an old healed fracture through the middle third of the fibula with considerable sclerosis of the medullary cavity at the fracture site, as well as a bone defect, a residual of a shell fragment wound. There were several small retained shell fragment wounds at the fracture site and one lodged within the fibula. There was no evidence of infection. The adjacent right fibula was intact. In an August 2010 letter, M.A., M.D., the Veteran’s private physician, reported that the Veteran had been his patient for the past 15 years. M.A. noted that the Veteran still retained shrapnel in his left lower extremity. He also noted a disparity in the Veteran’s leg length, with the left one fourth inch shorter, resulting in increased difficulty with balance and ambulation. Subsequent treatment records dated in 2012 through 2016 note the Veteran’s report of left lower leg pain near the site of the injury. The reports of March 2012 and November 2015 VA examinations note that the Veteran sustained several penetrating muscle injuries to his left lower leg, left buttock, and left forearm in April 1951, while stationed in Korea due to enemy fire. He was hospitalized for several weeks and his left lower extremity was casted due to a comminuted compound fractured fibula. He retained foreign bodies in his left lower extremity near and through the fibula. The Veteran denied the use of any assistive devices. Examinations revealed that the Veteran was right-hand dominant. Location of the muscle injuries were as follows: Group XI – muscles of the foot, ankle, and calf (left foot); Group VI – muscles of the elbow (left forearm); and Group XVII – muscles of the pelvic girdle (left buttock/hip). There was no evidence of a history of an extensive muscle hernia of any muscle or a history of injury to facial muscles. There was evidence of scars caused by muscle injuries, to include minimal scars, entrance and exit scars indicating short track of missile through muscle tissue, and ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track of the left lower extremity. There was no evidence that the muscle injuries affected muscle function. There was no evidence of loss of power, weakness, lowered threshold fatigue, fatigue-pain, impairment of coordination, or uncertainty of movement. Muscle strength testing was 5/5 for Muscle groups XI, VI, and XVII. There was no evidence of muscle atrophy. X-rays dated in November 2015 revealed evidence of retained shell fragments and/or shrapnel in the left lower extremity (Muscle Group XI). 1. Entitlement to an evaluation in excess of 20 percent for a service-connected left lower extremity injury, status post gunshot wound. The Veteran’s left lower extremity disability has been rated as moderately severe (20 percent disabling) under Diagnostic Code 5311, injuries to Muscle Group XI, since October 2, 1952, the day following separation from service. In July 2013, the Veteran initiated a claim for an increased rating, indicating that his left lower extremity injury had worsened. For the following reasons, the Veteran’s left lower extremity, status post gunshot wound, has, throughout the pendency of the claim, most nearly approximated the criteria for severe muscle injury to Muscle Group XI. The above evidence reflects that during service, the Veteran was hospitalized for a prolonged period of time primarily for treatment for his left lower extremity. He underwent surgery for the removal of shrapnel, but still retains several foreign bodies near and through his left fibula. Furthermore, his left fibula was casted for several weeks, due to a residual comminuted compound fracture. There were several scars over the left leg, to include soft tissue and tenderness on pressure. X-rays revealed considerable sclerosis of the medullary cavity at the fracture site, several foreign bodies near and through the fibula, as well as a bone defect, a residual of a shell fragment wound. Throughout the pendency of the claim, the Veteran experienced cardinal signs and symptoms such as left lower extremity shrapnel pain, as noted during private treatment. Significantly, during the March 2012 VA examination, the examiner noted that there were ragged depressed and adherent scars indicating wide damage to muscle groups in missile track associated with the Veteran’s left lower extremity muscle injury. Moreover, the Veteran’s reported signs and symptoms have been consistent throughout the pendency of the claim and the Board finds them credible. As the Veteran's symptoms have thus approximated the criteria indicating severe muscle injury, an evaluation of 30 percent is warranted. See 38 C.F.R. § 4.73, Diagnostic Code 5311. Although the Board has granted the maximum schedular rating for the entire appeal period under Diagnostic Code 5311, it must consider whether a higher rating is warranted under any other potentially applicable diagnostic code. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991) (regardless of the precise basis of the RO's rating, the Board has a duty to acknowledge and consider all regulations that are potentially applicable). As noted, the Veteran is currently rated under Diagnostic Code 5311. There were no ankle range of motion findings on the March 2012 and November 2015 VA examinations, and the Veteran did not assert that he experienced any limitation of motion of his left ankle or foot. In addition, the maximum schedular rating for limitation of motion of the ankle is 20 percent, and there is no indication that there was ankylosis of the ankle warranting a higher rating under the diagnostic codes applicable to the ankle, Diagnostic Codes 5270 through 5274. Further, although there are other diagnostic codes applicable to muscle injuries, Diagnostic Code 5311 is the most analogous diagnostic code to rate the Veteran’s left lower extremity injury, as it references the crural muscles. In addition, regarding the Veteran’s left lower extremity scars, separate ratings for these scars have been assigned, and the issues will be addressed below. Moreover, the severe rating criteria under Diagnostic Code 5311 specifically takes into account the scars and they have been considered in granting the increased 30 percent evaluation. See 38 C.F.R. § 4.14 (2018) (noting that the evaluation of the same disability or the same manifestations of a disability under various diagnoses constitutes prohibited pyramiding); but see Esteban v. Brown, 6 Vet. App. 259 (1994) (finding that when a veteran has separate and distinct manifestations from the same injury he should be compensated under different diagnostic codes). For the foregoing reasons, the evidence reflects that the left lower extremity injury, status post gunshot wound has most nearly approximated severe muscle injury throughout the pendency of the claim. As this is the maximum schedular rating and there is no other potentially applicable diagnostic code under which the Veteran can receive a higher or separate rating, a 30 percent rating, but no higher, is warranted. As the preponderance of the evidence is against any higher or separate rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 2. Entitlement to an evaluation in excess of 10 percent for service-connected left buttock injury, status post gunshot wound. The Veteran’s left buttock disability has been rated as 10 percent disabling under Diagnostic Code 5317, injuries to Muscle Group XVII since October 2, 1952, the day following separation from service. In July 2013, the Veteran initiated a claim for an increased rating, indicating that his left buttock disability had worsened. With regard to the injuries sustained to Muscle Group XVII, the Board has reviewed the evidence of record and using the totality of the circumstances approach articulated in Tropf, the Board finds that the Veteran’s left buttock disability demonstrates “moderate” impairment, and warrants the next higher 20 percent evaluation pursuant to Diagnostic Code 5317. In making this determination and in finding that the evidence does not show that the Veteran had moderately severe or severe injuries of the left buttock, the Board acknowledges that the Veteran underwent an operation in April 1951 for the removal of shrapnel, with complaints of pain and tenderness when sitting, but there are no objective findings of residuals of debridement and the left buttock healed without residuals aside from a scar. In addition to the absence of objective findings that the left buttock wound exhibited residuals of debridement and/or prolonged infection, there are also no current objective findings of any loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue. Moreover, there is no evidence indicating any loss of range of motion in his left buttock, and left buttock strength has consistently been 5/5. The Board has also considered whether an increased evaluation may be assigned on the basis of functional loss due to the Veteran's subjective complaints of pain under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202, 204-205 (1995); VAOPGCPREC 36-97, 63 Fed. Reg. 31,262 (1998). Here, the left buttock disability does not demonstrate any loss of range of motion and, that considered with the lack of any functional loss, the Board finds that there is insufficient evidence of objective pain on motion, or any other functional loss, to warrant an increased rating. Consideration has been given as to whether a higher rating is warranted under any other potentially applicable diagnostic code. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). However, Diagnostic Code 5317 is the most appropriate and beneficial code to rate the left buttock disability. Further, Section 38 C.F.R. § 3.350 (Special Monthly Compensation) is not for application here, as the evidence does not show loss of use of both buttocks. In addition, with regard to the Veteran’s left buttock scar, service connection was recently granted and a separate rating was assigned for this scar. Thus, the issue will be addressed below. For all these reasons, a rating of 20 percent, but no more, for injury to the left buttock (Muscle Group XVII) is warranted pursuant to Diagnostic Code 5317. For the foregoing reasons, the evidence reflects that the left buttock injury, status post gunshot wound has most nearly approximated moderate muscle injury throughout the pendency of the claim. Therefore, a rating of 20 percent, but no higher, is warranted pursuant to Diagnostic Code 5317. As the preponderance of the evidence is against any higher or separate rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 3. Entitlement to an evaluation in excess of 10 percent for service-connected left elbow injury, status post gunshot wound. The Veteran’s nondominant left elbow disability has been rated as moderate (10 percent disabling) under Diagnostic Code 5306, injuries to Muscle Group VI since October 2, 1952, the day following separation from service. In July 2013, the Veteran initiated a claim for an increased rating, indicating that his left elbow disability had worsened. Upon review of the record, the Board finds that the Veteran’s left elbow injury does not demonstrate the next higher 20 percent evaluation. Overall, the Veteran's in-service wound is not shown to be consistent with a moderately severe injury. See Tropf v. Nicholson, 20 Vet. App. 317 (2006). For example, the evidence does not show that the Veteran has such symptoms as indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. There is no evidence indicating any loss of range of motion in his left elbow, and left arm strength has consistently been 5/5. The March 2012 and November 2015 VA examination reports demonstrate that there was no history of muscle hernia, or fascial defects associated with muscle injury, no impact on muscle substance or function, and that there was no objective evidence of weakness, tenderness, or atrophy. The Veteran was functionally independent with all self-care activities and household activities. X-rays were negative for foreign bodies retained near the left forearm. There were no cardinal signs or symptoms of a muscle disability see, including loss of power, weakness, lowered threshold of fatigue, fatigue pain, impairment of coordination, or uncertainty of movement. In summary, the evidence does not support a conclusion that the criteria for more than a 10 percent evaluation have been met, and the findings are insufficient to show more than a moderate injury. As the preponderance of the evidence indicates that the Veteran's disability is not more than moderate, the Board concludes that the disability picture for the Veteran's service-connected left elbow injury, status post gunshot wound, (minor) arm, Muscle Group VI, does not more nearly approximate the criteria for a 20 percent evaluation under Diagnostic Code 5306. Consideration has been given as to whether a higher rating is warranted under any other potentially applicable diagnostic code. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). As noted, the Veteran is currently rated under Diagnostic Code 5306. There is no evidence of any loss of range of motion of the left forearm, and the Veteran has not asserted that he experienced any limitation of motion of his left forearm. Thus, the Veteran’s left forearm disability does not warrant a rating in excess of 10 percent under Diagnostic Codes 5206, limitation of flexion, or Diagnostic Code 5207, limitation of extension. The Board has also considered whether an increased evaluation may be assigned on the basis of functional loss due to the Veteran's subjective complaints of pain under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202, 204-205 (1995); VAOPGCPREC 36-97, 63 Fed. Reg. 31,262 (1998). Here, the left forearm does not demonstrate any loss of range of motion and, that considered with the lack of any functional loss, to include primarily findings showing 5/5 strength, and the lack of evidence of neurologic deficit or muscle atrophy, the Board finds that there is insufficient evidence of objective pain on motion, or any other functional loss, to warrant an increased rating. Accordingly, the criteria for a rating in excess of 10 percent have not been met, as there is no evidence of functional loss due to loss of left forearm range of motion under Diagnostic Codes 5206 or 5207, even with consideration of 38 C.F.R. §§ 4.40 and 4.45. In addition, with regard to the Veteran’s left forearm scar, service connection was recently granted and a separate rating was assigned for this scar. Thus, the issue will be addressed below. As the preponderance of the evidence is against any higher or separate rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 4. Entitlement to an evaluation in excess of 10 percent for service-connected residuals of infectious hepatitis. The Veteran currently receives a rating of 10 percent for his residuals of infectious hepatitis under 38 C.F.R. § 4.114, Diagnostic Code 7345. In July 2013, he initiated a claim, asserting that his condition had worsened. Under Diagnostic Code 7345, a noncompensable rating is assigned for nonsymptomatic residuals of infectious hepatitis; a 10 percent rating requires intermittent fatigue, malaise, and anorexia, or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period; and a 20 percent rating requires daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period. 38 C.F.R. § 4.114, Diagnostic Code 7345. The Veteran underwent VA examinations in March 2012 and November 2015. The examiners noted a history of a liver condition, hepatitis, unspecified diagnosed in November 1951. The examiners noted that the Veteran did not require continuous medication to control his liver condition. They further noted that the Veteran was not a liver transplant candidate. The examiners indicated that he had never been diagnosed with Hepatitis C. Upon examination, there was no evidence of signs or symptoms attributable to chronic or infectious liver disease, cirrhosis of the liver, biliary cirrhosis, or cirrhotic phrase of sclerosing cholangitis, to include fatigue, malaise, anorexia, nausea, vomiting, arthralgia, weight loss, right upper quadrant pain, hepatomegaly, weight loss, ascites, hepatic encephalopathy, hemorrhage, portal hypertension, splenomegaly, or persistent jaundice. There was no evidence of scars due to the in-service infectious hepatitis. The Veteran’s laboratory tests were also within normal limits. There was no evidence of any incapacitating episodes due to the liver condition in the past 12 months. The examiners concluded that the exam was unremarkable. Competency of evidence differs from weight and credibility. Although the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his disability according to the appropriate diagnostic codes. Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). On the other hand, such competent evidence concerning the nature and extent of the Veteran's disability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. In sum, the preponderance of the evidence of record does not support a rating in excess of 10 percent for residuals of infectious hepatitis. Therefore, the Board finds that a rating in excess of 10 percent for the Veteran's residuals of infectious hepatitis is not warranted. As the preponderance of the evidence is against a higher rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 5. Entitlement to an initial compensable evaluation for service-connected deep scar of the left lower extremity. See Argument Below at Number 7 6. Entitlement to an initial compensable evaluation for service-connected superficial scar of the left lower extremity. See Argument Below at Number 7 7. Entitlement to an initial compensable evaluation for service-connected scars of the left buttock and left upper extremity. The Veteran is currently in receipt of service connection for a deep scar of the left lower extremity; a superficial scar of the left lower extremity; and a scar on his left buttock and left upper extremity, associated with his status post gunshot and shrapnel wounds. In this regard, his scars are currently rated as noncompensable under Diagnostic Code 7805, which evaluates scars and their effects under Diagnostic Codes 7800, 7801, 7802, and 7804. Diagnostic Code 7800 and 7801 pertain to burn scars and scars of the head, face or neck. As the Veteran's scars are not the result of a burn, nor are they on the head, face, or neck, they may be rated under 7801, 7802, or 7804. Under Diagnostic Code 7801, scars due to causes other than burns and not of the head, face, or neck, that are deep and nonlinear warrant a 10 percent rating if the area or areas are of at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). 38 C.F.R. § 4.118, Diagnostic Codes 7800-7805. Under Diagnostic Code 7802, scars due to causes other than burns and not of the head, face, or neck, that are superficial and nonlinear warrant a 10 percent rating if the area or areas are of 144 square inches (929 square centimeters) or greater. Id. Under Diagnostic Code 7804, one or two scars that are unstable or painful are assigned a 10 percent evaluation. Three to four scars that are unstable or painful warrant a 20 percent evaluation. Five or more scars that are unstable or painful warrant a 30 percent evaluation. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. 4.118, DC 7804, Note 1. In this case, the Veteran underwent VA examinations in August 2012 and November 2015. The examiners noted that the Veteran’s scars, to include the left lower extremity and left buttock, were not painful or unstable. The total area of the deep non-linear left lower extremity scar was 17.5 square centimeters. The total area of the superficial non-linear left lower extremity scar was 3 square centimeters. The total area of the vertical left buttock scar was 7 square centimeters. The examiners found that there was no evidence of visible scarring of the left upper extremity scar was not provided. The Veteran did not report any pain, and the evidence of record reflects that the pain associated with the areas are not due to the scars. The scars themselves are not painful or unstable, and they are not large enough to warrant a compensable evaluation under Diagnostic Code 7801, 7802, or 7804. Therefore, noncompensable evaluations have been properly assigned. Accordingly, initial compensable ratings for a deep scar of the left lower extremity, a superficial scar of the left lower extremity, and a superficial scar of the left buttock are not warranted. As the preponderance of the evidence is against a higher or separate rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. REASONS FOR REMAND 1. Entitlement to an initial evaluation in excess of 20 percent for service-connected lumbar spine disability is remanded. The Veteran contends that his service-connected lumbar spine disability has worsened. VA has a duty to assist the Veteran by obtaining VA and/or private outpatient treatment records identified by the Veteran. In January 2018, the Veteran asserted that he received ongoing treatment for his low back disability by D.M., M.D., located in Ohio. The AOJ must obtain these private treatment records and associate them with the record. 38 C.F.R. § 3.159(c)(1) (2018). In addition, the AOJ must also obtain ongoing VA outpatient treatment records dated in June 2016, to the present, and associate them with the record. 38 C.F.R. § 3.159(c)(2). 2. Entitlement to service connection for a total disability based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. The outcome of the TDIU claim is in part dependent on the outcome of the increased rating claim on appeal. Therefore, the TDIU claim is inextricably intertwined with the increased rating claim and must also be remanded. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following actions: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims, to include VA outpatient treatment records dated in June 2016, to the present, and private treatment records from D.M., M.D., located in Ohio. If any requested records are unavailable, or the search for such records otherwise yields negative results, that fact should be clearly documented in the record and the Veteran so notified in accordance with 38 C.F.R. § 3.159(e). All steps taken to attempt to obtain the above records should clearly be documented in the record. 2. Then, the AOJ should readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran’s satisfaction, he and his representative should be provided a supplemental statement of the case and an appropriate period of time for response before the case is returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Sara Schinnerer, Counsel