Citation Nr: 19149079 Decision Date: 06/24/19 Archive Date: 06/24/19 DOCKET NO. 18-11 024 DATE: June 24, 2019 ORDER Entitlement to an initial rating in excess on 10 percent for painful scars of the left lower extremity, status post fasciotomy for chronic exertional compartment is denied. Entitlement to an initial compensable rating for neuritis of the musculocutaneous nerve of the left lower extremity, status post fasciotomy for chronic exertional compartment syndrome is denied. FINDINGS OF FACT 1. The Veteran’s left lower extremity scars are described as sore and hypersensitive. 2. The Veteran’s neuritis of the musculocutaneous nerve of the left lower extremity, status post fasciotomy for chronic exertional compartment syndrome results in mild incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for painful scars of the left lower extremity, status post fasciotomy for chronic exertional compartment syndrome greater than 10 percent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.14, 4.118, Diagnostic Code (DC) 7804. 2. The criteria for entitlement to an initial compensable percent for lower left leg neuritis related to exertional compartment syndrome, lower left extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.14, 4.118, DC 5262 - 8622. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1994 to May 2014. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Increased Rating Disability evaluations are determined by the application of the schedule of ratings which is based on average impairment of earning capacity. See U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. Evaluation of a service-connected disability requires a review of the Veteran’s entire medical history regarding that disability. 38 C.F.R. §§ 4.1, 4.2. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 1. Painful scars of the left lower extremity, status post fasciotomy for chronic exertional compartment syndrome The Veteran has two scars related to a fasciotomy performed August 2012. On his February 2019 VA Form 9, the Veteran stated that he was not disputing the number of scars that are on his leg. Under DC 7804, which applies to scars that are unstable or painful, a 10 percent evaluation is warranted for one or two scars that are unstable or painful. A 20 percent evaluation is warranted for three or four scars that are unstable or painful. A maximum 30 percent evaluation is warranted for five or more scars that are unstable or painful. 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 if one or more scars are both unstable and painful, 10 percent should be added to the evaluation that is based on the total number of unstable or painful scars. Note 3 provides that scars evaluated under DC 7800, 7801, 7802, and 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, DC 7804. The Veteran, through his representative, contends that his scars are unstable. However, there is no medical evidence in the record to support that finding. In fact, the June 2018 VA examination specifically found that the Veteran’s scars were not unstable. The Veteran was afforded a VA examination in October 2014. The VA examiner noted that the Veteran had soreness of the two scars and sometimes tingling in his left foot. The Veteran was provided an additional VA examination in June 2018. The examiner noted that the scars were painful but stable. The Veteran described the scars as hypersensitive and pressure on the scars caused tingling on the bottom of the leg. However, in an addendum opinion, the examiner noted that the tingling on the bottom of the foot is attributable to the Veteran’s service-connected peripheral nerve disability. This symptom will be addressed below. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent under Diagnostic Code 7804 because the Veteran’s scar is not manifest by three or four scars that are unstable or painful. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scars are not of the head, face, or neck, are not deep and nonlinear, and are not associated with underlying soft tissue damage. Although they are superficial and not associated with underlying soft tissue damage, they do not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7800 through 7802, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a disability rating in excess of 10 percent for his scars. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Lower left leg neuritis related to exertional compartment syndrome The Veteran is currently assigned a noncompensable rating for left leg neuritis related to the exertional compartment syndrome 38 C.F.R. § 4.114, DCs 5262-8622, pertaining to the tibia and fibula. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Under DC 8622 (musculocutaneous nerve, superficial peroneal) a noncompensable percent rating is warranted for a mild incomplete paralysis, a 10 percent rating is warranted for moderate incomplete paralysis, 20 percent for severe incomplete paralysis, and 30 percent for complete paralysis. 38 C.F.R. § 4.124a, DC 8622. A note preceding the Schedule of Ratings for Diseases of the Peripheral Nerves provides that the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve. The note further states that when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. In August 2012 the Veteran underwent a fasciotomy to relieve pain associated with his exertional induced compartment syndrome. The record indicates that in the years that followed the Veteran complained of mild to no pain. In June 2013 the Veteran rated the pain at 1 out of 10 (with 10 being the worst); in February 2014 the rated his pain at 2-3 out of 10; and in March 2014 the Veteran described the pain as slight. The Veteran was afforded a VA examination in October 2014 which revealed normal muscle strength in his left ankle and no atrophy. Range of motion and muscle strength in his left knee were normal; atrophy was not noted. It was documented that the Veteran experienced a tingling in his left foot and ankle as a result of the chronic exertional compartment syndrome and fasciotomy. Muscle strength testing of the left lower extremity revealed that the Veteran maintained full muscle strength. His knee and ankle reflexes were normal. In his February 2015 notice of disagreement, the Veteran stated that he is unable to run or walk for extend periods and when he tries to engage in these activities he experiences numbness and tingling in his toes with a loss of range of motion in his calf muscles. In June 2018, the Veteran was afforded an additional VA examination. At the examination the Veteran reported pain on prolonged walks and that he is not able to run. Muscle testing revealed normal muscle strength and the Veteran’s reflexes were found to be clinically normal. Sensory testing did not reveal any deficits and there were no trophic changes. The Veteran’s gait was described as normal and the examiner stated that there were no other pertinent physical findings, complications, or symptoms attributable to the Veteran’s neuritis. The VA examiner described the Veteran’s symptoms as resulting in “mild” incomplete paralysis. It was noted that the Veteran’s disability resulted in tingling and numbness of the left lower leg. Based on the foregoing, the Board finds that a compensable rating is not warranted for neuritis of the left lower extremity. The evidence of record indicates that the Veteran’s disability results in sensory symptoms which include tingling and numbness. The Veteran’s sensory function, gait, muscle strength, and reflexes have been found to be normal. The examinations have found no other symptoms attributable to the Veteran’s disability other than the sensory deficits noted above. His disability has been described as resulting in mild incomplete paralysis. As noted above, in order to establish entitlement to an increased rating, the evidence must show moderate incomplete paralysis. In this case, the preponderance of the evidence is against the Veteran’s claim for an initial compensable rating for service-connected neuritis of the musculocutaneous nerve of the left lower extremity, status post fasciotomy for chronic exertional compartment syndrome. M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Palatt, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.