Citation Nr: 19166839 Decision Date: 08/28/19 Archive Date: 08/28/19 DOCKET NO. 15-16 979 DATE: August 28, 2019 ORDER New and material evidence has been added to the claims file and the claim for service connection for a low back disability is reopened. New and material evidence has been added to the claims file and the claim for service connection for pseudofolliculitis barbae is reopened. New and material evidence has been added to the claims file and the claim for service connection for bilateral hearing loss is reopened. New and material evidence has been added to the claim file and the claim for service connection for GERD (claimed as chest condition) is reopened. New and material evidence has been added to the claims file and the claim for service connection for a left wrist disability is reopened. Entitlement to service connection for a low back disability is granted. Entitlement to service connection for pseudofolliculitis barbae is granted. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for GERD (claimed as a chest condition) is granted. Entitlement to service connection for a left wrist disability is granted. Entitlement to service connection for a right wrist disability is granted. Entitlement to service connection for a traumatic brain injury (TBI) is granted. Entitlement to service connection for sleep apnea is granted. Entitlement to a compensable rating for a right shoulder scar is denied. Entitlement to a rating in excess of 70 percent for PTSD is denied. Entitlement to an increased rating of 30 percent, but no higher, for a right shoulder disability for the entirety of period on appeal is granted. Entitlement to a rating in excess of 10 percent for tinnitus is dismissed. FINDINGS OF FACT 1. New and material evidence has been added to the claims file and the claims for service connection for a low back disability, pseudofolliculitis, bilateral hearing loss, GERD, and a left wrist disability are reopened. 2. The evidence added to the record since the May 2008 rating decision, when viewed by itself or in the context of the entire record, relates to an unestablished fact that is necessary to substantiate the claims of service connection for low back disability, pseudofolliculitis barbae, bilateral hearing loss, GERD, and a left wrist disability. 3. The Veteran’s lumbar strain is etiologically related to the nature of the Veteran’s active service. 4. Pseudofolliculitis barbae was incurred in active service and has continued since. 5. The Veteran does not have a current bilateral hearing loss disability for VA purposes. 6. The Veteran GERD was caused by the treatment of his service connected right shoulder disability via the continual use NSAIDs. 7. The Veteran’s bilateral wrist strain and degenerative joint disease is etiologically related to the nature of the Veteran’s active service. 8. The Veteran’s TBI is etiologically related to the loss of consciousness from an explosion in in active service. 9. The Veteran’s sleep apnea was caused by his service connected GERD. 10. The Veteran’s scar is not deep and non-linear measuring a minimum of at least 6 square inches (39 sq. cm.), nor does it have an area or areas of 144 square inches (929 sq. cm.) or greater, and neither is it painful or unstable. 11. Throughout the entire period on appeal, the Veteran’s PTSD most closely approximates occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 12. For the entirety of the period on appeal, the Veteran’s right shoulder disability is productive of significant functional impairment due to pain and fatigue upon use, but not ankylosis in the major upper extremity, limitation of range of motion to 25 degrees from the side, or fibrous union of the humorous in the major upper extremity. 13. On September 6, 2016, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran, through his authorized representative, that a withdrawal of his appeal for entitlement to an increased rating in excess of 10 percent for tinnitus was requested. CONCLUSIONS OF LAW 1. The May 2008 rating decision that denied service connection for a low back disability, pseudofolliculitis, bilateral hearing loss, GERD, and a left wrist disability is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 20.200, 20.302, 20.1103. 2. With respect to the Veteran’s claim for service connection for a low back disability, pseudofolliculitis barbae, bilateral hearing loss, GERD, and a left wrist disability, the criteria to reopen these claims have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. The criteria for entitlement to service connection for a low back disability have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for pseudofolliculitis barbae have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 C.F.R. § 3.385 5. The criteria for entitlement to service connection for GERD (claimed as a chest condition) have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for a right wrist disability have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to service connection for a left wrist disability have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for entitlement to service connection for a traumatic brain injury (TBI) have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for entitlement to service connection for sleep apnea have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for entitlement to a compensable rating for a right shoulder scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.118, Diagnostic Code 7805. 11. The criteria for entitlement to an increased rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 12. The criteria for entitlement to a 30 percent rating, but no higher, for a right shoulder disability have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5200, 5201, 5202, 5203. 13. The criteria for withdrawal of the appeals with respect to the issue of entitlement to an increased rating in excess of 10 percent for tinnitus by the Veteran (or his authorized representative) have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Coast Guard from January 2003 to February 2003 and the United States Army from November 2003 to April 2004 and from December 2004 to November 2007. New and Material Evidence Initially, the Board notes that whenever a claim to reopen is filed, regardless of how it was characterized by the agency of original jurisdiction, the Board must make a de novo determination as to whether new and material evidence has been received. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996) (whether new and material evidence has been submitted must be asked and answered by the Board de novo whenever a claim to reopen is filed). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). New and material evidence has been added to the claims file and the claim for service connection for a low back disability, pseudofolliculitis barbae, bilateral hearing loss, GERD, and a left wrist disability are reopened. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, consideration need not be limited to consideration of whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA’s duty to assist or through consideration of an alternative theory of entitlement. 38 C.F.R. § 3.156(a); Shade v. Shinseki, supra. The Veteran’s testimony in November 2018 that he had symptoms of a low back, pseudofolliculitis barbae, bilateral hearing loss, GERD, and a left wrist disability while on active duty is new in that it was not previously of record. It is also material because it relates to unestablished facts necessary to substantiate the Veteran’s claim for service connection for a low back disability, pseudofolliculitis barbae, bilateral hearing loss, GERD, and a left wrist disability. Specifically, due to the prior lack of evidence showing treatment during the Veteran’s service, this new evidence is material because it relates to an element that was previously not shown, an in-service incurrence. See Shade, supra. Accordingly, the Board finds that new and material evidence has been submitted, and the claims for service connection for a low back disability, pseudofolliculitis barbae, bilateral hearing loss, GERD, and a left wrist disability are reopened. 38 U.S.C. § 5108. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (“[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence”). Service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which he served, his medical records, and all pertinet medical and lay evidence. See 38 C.F.R. § 3.303 (a); see also Jandreau v. Nicholson, supra; and Buchanan v. Nicholson, supra. Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b).). 1. Entitlement to service connection for a low back disability Turning to a current disability, the Board finds that the Veteran has current back disability diagnosed as a lumber strain in a March 2008 VA examination. On the matter of in-service incurrence, the Veteran has provided a December 2018 private medical examination report wherein his medical examiner took a detailed history from the Veteran regarding his low back disability and found that the Veteran’s military service required him to move heavy equipment which injured his low back. Importantly, the private medical examiner’s findings are corroborated by an October 2006 service treatment record wherein the Veteran complained of back pain. On the matter of etiology, the Board finds that the December 2018 private examiner’s positive opinion, which linked his type of work on active duty to his lower back disability, is the only medical opinion of record. The private examiner provided a detailed point-by-point rationale for the basis of his decision and cited evidence in the claims file and the Veteran’s lay statements in coming to his conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (Most of the probative value of a medical opinion comes from its reasoning and the Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion). Considering the forgoing, the Board finds that all the elements for service connection for the Veteran’s low back have been met, and thus, service connection is warranted. 2. Entitlement to service connection for pseudofolliculitis barbae The Board notes that the December 2018 private medical examination report included the notation that the Veteran has a current diagnosis of pseudofolliculitis barbae and noted he had a full beard at the time of his examination. Turning to an in-service incurrence, the Veteran’s February 2004 service treatment record includes a notation that the Veteran was to be put on a shaving profile due to pseudofolliculitis barbae. Turning to etiology, the December 2018 private medical examination notes that the Veteran’s lay statement and his current diagnosis of pseudofolliculitis barbae are related. Importantly, the Veteran provided a February 2019 statement to the Board detailing that he has suffered from pseudofolliculitis barbae since his separation from service. The Board finds the Veteran’s contentions are credible and corroborated by the later December 2018 private medical examination. In view of the foregoing, the Board finds that with consideration of service treatment records demonstration of pseudofolliculitis barbae in service, the Veteran’s competent and credible statements as to the ongoing presence of symptoms of pseudofolliculitis barbae since service, and the December 2018 private medical examination report, all elements of service connection have been met and service connection is warranted. 3. Entitlement to service connection for bilateral hearing loss Turning to the Veteran’s contention of service connection for bilateral hearing loss, the Board notes that there is no evidence in the claims file that the Veteran’s hearing loss symptoms have amounted to a current disability for VA purposes. Upon examination in March 2008, the Board notes that the Veteran hearing loss did not meet the criteria to qualify as a disability for VA purposes as stipulated in 38 C.F.R. § 3.385. The Board observes that there are no other findings showing a change in the hearing or complaints. The Board acknowledges that testimony was taken on the issue of hearing loss in December 2018, however, this testimony was limited to the Veteran’s service exposure to acoustic trauma. The Board observes that the Veteran’s March 2008 VA examination followed this acoustic trauma and the Veteran has not provided evidence of worsening of hearing loss since this March 2008 VA examination. Thus, all indications are that his hearing has remained the same. In sum, VA has no duty to provide him with another examination because it has provided him with an examination and the record does not show that anything has changed since that examination. Therefore, the Board finds the Veteran failed the first prong of the three prong test for service connection for his claim for bilateral hearing as he does not have a current disability for which he can be service connected. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (there can be no valid claim for service connection in the absence of a present disability). Accordingly, the preponderance of the evidence is against the Veteran’s claim, and entitlement to service connection for bilateral hearing loss is denied. 4. Entitlement to service connection for GERD (claimed as a chest condition) The Veteran in his December 2018 testimony clarified that his chest condition was more accurately characterized as GERD as such the Board has recharacterized the issue above. The Veteran contends, and the record supports that the Veteran’s GERD is related to his use of nonsteroidal anti-inflammatory medication (NSAID) for pain relief for his service connected right shoulder. The Board notes that the Veteran has been diagnosed with GERD most recently documented in a September 2016 VA treatment note. The Veteran has also been service connected for a right shoulder disability per a May 2008 rating decision. Thus, the only remaining issue is an etiology between the Veteran’s right shoulder and his GERD. This relationship was established in a December 2018 private medical report. Wherein a private medical examiner found that the Veteran’s current GERD was likely related to the NSAID that the Veteran takes as a result of the Veteran’s service-connected right shoulder. The private examiner noted that the Veteran’s medical records show that the Veteran has taken multiple anti-inflammatories (NSAID) for musculoskeletal pain related to his service-connected right shoulder, and that the medical literature indicates that chronic use of NSAIDs causes GERD. The private examiner concluded that the Veteran’s GERD is due to the Veteran’s service-connected right shoulder. Considering the foregoing, the Board finds that service connection is warranted for the Veteran’s GERD. 5. Entitlement to service connection for a right and left wrist disabilities The Veteran has a current bilateral wrist disability as noted in his March 2008 VA examination which diagnosed the Veteran with bilateral wrist strain and his later December 2018 private medical examination which diagnosed the Veteran with bilateral degenerative joint disease of the wrists. Turning to in service incurrence, the Veteran has provided testimony that his wrists began to hurt while in service due to his lifting of heavy equipment and work on large vehicles. These statements are corroborated by the Veteran’s DD-214 which details the Veteran’s MOS as “Wheeled vehicle mechanic.” The Board thus finds that the Veteran is competent to report pain in his wrist a readily observable malady and that he is credible in this regard as his MOS demonstrates that he worked with heavy equipment which would have necessitated a strain on his wrist. In considering this testimony, the Board observes that service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which he served, his medical records, and all pertinent medical and lay evidence. See 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, supra; and Buchanan v. Nicholson, supra. On the matter of etiology, the Board finds that the December 2018 private examiner’s positive opinion is the only medical opinion of record. The private examiner provided a detailed point-by-point rationale for the basis of his decision and cited evidence in the claims file and the Veteran’s lay statements in coming to his conclusion that the Veteran’s bilateral wrist disability is related to the nature of his military service including the lifting and operation of heavy equipment. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Considering the forgoing, the Board finds that all the elements for service connection for the Veteran’s bilateral wrist disability have been met, and thus, service connection is warranted. 6. Entitlement to service connection for a traumatic brain injury (TBI) The Veteran has a current diagnosis of TBI as documented in an August 2011 VA treatment record. Turning to in service incurrence, the Veteran’s August 2011 VA treatment record includes the notation that the was exposed to a blast while in service and briefly loss consciousness. These statements are corroborated by the Veteran’s DD-214 which details that the Veteran served in a “designated imminent danger pay area.” The Board thus finds that the Veteran is competent to report an explosion and loss of conciseness as these events are capable of lay observation and that he is credible in this regard as his MOS demonstrates that he served in a designated imminent danger pay area where such an explosion is a possibility. In considering this testimony, the Board observes that service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which he served, his medical records, and all pertinent medical and lay evidence. See 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, supra; and Buchanan v. Nicholson, supra. Considering the foregoing, the Board finds that the Veteran was exposed to an explosion in service and briefly lost consciousness. Turning to etiology, the Veteran provided a February 2019 private examination report wherein a private examiner found that the Veteran’s current TBI is related to the above noted explosion in service. He provided a detailed point-by-point rationale for the basis of his decision and cited evidence in the claims file and the Veteran’s lay statements in coming to his conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) Considering the forgoing, the Board finds that all the elements for service connection for the Veteran’s TBI have been met, and thus, service connection is warranted. 7. Entitlement to service connection for sleep apnea as secondary to the Veteran service connected GERD. At the onset, the Board observes that the Veteran is now service connected for GERD per this decision and has been diagnosed with sleep apnea as noted in most recently in a November 2017 VA treatment record. Thus, the only remaining issue is on relationship between the Veteran’s service connected GERD and his sleep apnea. Board On the matter of etiology, the Board finds that the December 2018 private examiner’s positive opinion, which found that the Veteran’s GERD caused his sleep apnea, is the only medical opinion of record. The private examiner provided a detailed point-by-point rationale for the basis of his decision and cited evidence in the claims. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 Considering the forgoing, the Board finds that all the elements for service connection for the Veteran’s sleep apnea have been met, and thus, service connection is warranted. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations 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. If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. When evaluating musculoskeletal disabilities based on limitation of motion, a higher rating must be considered where the evidence demonstrates additional functional loss due to pain, pursuant to 38 C.F.R. §§ 4.40 and 4.45. The United States Court of Appeals for Veterans’ Claims held in Mitchell v. Shinseki, that “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” 25 Vet. App. 32, 38 (2011). 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. The diagnostic codes pertaining to range of motion do not subsume §§ 4.40 and 4.45. The rule against pyramiding does not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including use during flare-ups. DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board will also consider entitlement to staged ratings to compensate for times since the claim was filed when the disability may have been more severe than at other times during the appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 9. Entitlement to a compensable rating for a right shoulder scar Diagnostic Code 7800 refers to scars of the face, head, or neck. 38 C.F.R. § 4.118. As the record reflects that the Veteran does not have scars of the face, head, or neck associated with his cyst scar, this diagnostic code is not applicable. Diagnostic Code 7801 provides disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. A 10 percent rating is assigned when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is assigned when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is assigned when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118. Diagnostic Code 7802 provides a 10 percent rating for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear, the area of which covers 144 square inches (929 square centimeters) or greater. Note (1) states that a superficial scar is one not associated with underlying soft tissue damage. Note (2) provides that if multiple qualifying scars are present, or if a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect the extremity, assign separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck. 38 C.F.R. § 4.118. Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is assigned for one or two such scars. A 20 percent rating is assigned for three to four scars, and a 30 percent disability rating is assigned for five or more scars. Note (1) states 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, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118. The Board observes that outside of the Veteran’s bare contention that he is entitled to a higher rating for his right shoulder scar neither he nor his representative have provided any basis for this contention. Upon review of the claims file, the Board notes that the only evidence on the matter is from the February 2011 VA examination. This examiner observed that the Veteran’s scar is linear, measures 4 cm by 1, is not painful, has no skin breakdown, and is superficial with no underlying tissue damage. Considering this is the only evidence on the matter, the Board can find no basis to warrant an increased rating for the Veteran’s right shoulder scar. 10. Entitlement to an increased rating in excess of 70 percent for PTSD The Board notes at the onset, that the Veteran withdrew this claim via an earlier representative in September 2016. However, VA did not receive the withdrawal before the September 2016 statement of the case (SOC) was issued. Paradoxically, the Veteran’s representative at the time responded with a perfunctory substantive appeal. The Board notes that the Veteran’s current representative testified in December 2018 that evidence would be forthcoming on the issue of the Veteran’s rating for PTSD. The Board has received only a statement from the private medical examiner Dr. Bash that the Veteran’s PTSD most closely approximates a 70 percent rating which the Veteran currently holds. The Board interprets this evidence to indicate that the Veteran is satisfied with the current 70 percent rating assigned. Nonetheless, the Board finds that review of the evidence fails to show that the Veteran’s PTSD causes total occupational and social impairment. A 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.30, Diagnostic Code 9411 (2018). There is no evidence of record that the Veteran has suffered from any of the listed symptoms in the Diagnostic Code for a total rating, other than memory loss. Additionally, there is no indication that he has symptoms that equate in severity, frequency or duration to total occupational and social impairment. There is no evidence that his PTSD has impacted his employment, when he worked, and no evidence that it has affected his family or social relationships such that there is total social impairment. Therefore, the Board finds that the evidence supports the Veteran’s current 70 percent rating. 11. Entitlement to an increased rating in excess of 20 percent for a right shoulder disability The Veteran is currently service connected for a right shoulder disability, with a rating of 20 percent assigned for the entirety of the appeal period, under DC 5201. Ratings furnished under DC 5201are based on limitation of motion and associated functional limitations. The right arm is the Veteran’s dominant arm. In the Veteran’s case, there has never been any evidence of ankylosis of the shoulder joint, nor of malunion of the humerus, nor of impairment of the clavicle or scapula. Thus, evaluation under Diagnostic Codes 5200, 5202 and 5203 are inappropriate. Diagnostic Code 5201 is the only Diagnostic Code appropriately applied to the Veteran’s right shoulder disorder. Under DC 5201 for limitation of motion of the major arm, a 30 percent rating is assigned when the range of motion is limited to midway between side and shoulder level, and a 40 percent rating is assigned when range of motion of the arm is limited to 25 degrees from the side. The Veteran underwent a VA examination of his right shoulder in February 2011. Range of motion testing revealed normal flexion, abduction, internal and external rotation. But noted, weakness without further range of motion limitation. The evidence in favor of an increased rating is limited to a short medical statement from a private medical examiner, Dr. Bash, who provided commentary on the earlier February 2011 VA examination noting that the Veteran has right shoulder weakness and flare-ups up 3 times a week. Considering the evidence of record, the Board finds that the Veteran’s right shoulder disability more closely approximates a 30 percent rating, but no higher. While the record does not contain limitation of motion at midway between the shoulder and side, the Board finds that the Veteran has demonstrated functional impairment in the form of flare-ups and weakness of the right shoulder that warrant additional compensation, and thus preponderate in favor of an increased rating of 30 percent rating for his right shoulder disability for the entirety of the appeal period. The Board does not find that his functional impairment warrants a higher rating than 30 percent. The Board acknowledges the Veteran’s private examiner’s statement that the Veteran’s right shoulder warrants a 40 percent rating, however, the examiner did not provide range of motion testing results to support this higher evaluation or any other explanation to support his conclusion. Nor is there other treatment evidence of record to support limitation of motion at he 40 percent level of 25 degrees from the side. Further, the Board finds that the functional impairment described by the examiner more nearly approximates a 30 percent rating for limitation of motion as it also does not demonstrate loss of motion to within 25 degrees of the side. The Board finds that the Veteran is adequately compensated for his symptoms, even during flareups, by the assigned 30 percent rating. 12. Entitlement to an increased rating in excess of 10 percent for tinnitus An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or by his authorized representative. 38 C.F.R. § 20.204. In the present case, the Veteran, through his authorized representative, has withdrawn his appeal for an increased rating for tinnitus, hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal and this issue is therefore dismissed. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Acosta, 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.