Citation Nr: 20005256 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 14-08 242 DATE: January 22, 2020 ORDER Entitlement to an initial compensable evaluation for hydrocele, residuals of post-surgery for varicocele of the left testicle is denied. Entitlement to an initial compensable evaluation for residual scar, post-surgery for varicocele of the left testicle is denied. FINDINGS OF FACT 1. The symptoms of the Veteran’s service-connected hydrocele do not more nearly approximate voiding or renal dysfunction. 2. Increased sensitivity and pain in the Veteran’s left testicle does not result in functional impairment. 3. The Veteran’s anterior trunk scar is stable, not painful, and measures .4 sq. cm. CONCLUSIONS OF LAW 1. The criteria for an initial compensable disability rating for the service-connected hydrocele have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 4.7, 4.31, 4.115a, 4.115b, Diagnostic Codes 7523, 7524, 7529 (2018). 2. The criteria for an initial compensable disability rating for the Veteran’s residual scar, post-surgery for varicocele of the left testicle, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Codes 7801, 7802, 7804 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Navy from December 1988 to September 1992. This case initially came before the Board of Veterans’ Appeals (Board) from a June 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. In that decision, the RO granted service connection for hydrocele and residual scar, residuals of post-surgery for varicocele of the left testicle and assigned noncompensable ratings. After additional evidence was received, the RO continued the noncompensable ratings. The Veteran timely appealed the initial ratings assigned. In February 2018, the Board remanded these claims for further development. Specifically, the Veteran’s claim was returned to the Agency of Original Jurisdiction (AOJ) with directives to schedule the Veteran for a VA examination to determine the current severity of his service-connected residuals, post-surgery for varicocele of the left testicle. VA examinations were conducted in April 2018 and August 2019. For the reasons discussed below, these examinations complied with the Board’s remand instructions and were adequate to decide the claims. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Board decisions must be based on the entire record, with consideration of all the evidence. 38 U.S.C. § 7104. The law requires only that the Board address its reasons for rejecting evidence favorable to the veteran. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entirety of the record. Lay witnesses are competent to report (1) symptoms observable to a layperson; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Ratings are assigned based on the average impairment of earning capacity resulting from a service-connected disability. 38 C.F.R. § 4.1. Where two disability ratings are potentially applicable, the higher rating 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. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In deciding this appeal, the Board has considered whether staged ratings, i.e., separate ratings for different periods of time, based on the facts found, are warranted. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). 1. Entitlement to an initial compensable evaluation for hydrocele, residuals of post-surgery for varicocele of the left testicle The Veteran was granted service connection and assigned a noncompensable disability rating, effective November 2011, in an August 2012 rating decision. The Veteran contends that his current disability is more severe than currently rated. The Veteran’s hydrocele is currently evaluated under 38 C.F.R. § 4.115b, Diagnostic Codes 7599-7529. See 38 C.F.R. § 4.27 (hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen; disabilities requiring rating by analogy will be coded first the numbers of the most closely related body part and “99”). This hyphenated diagnostic code may be read to indicate that an unlisted genitourinary disorder is the service-connected disorder, and it is rated as if the residual condition is benign neoplasms of the genitourinary system under Diagnostic Code 7529. In accordance with Diagnostic Code 7529, benign neoplasms of the genitourinary system, the Veteran’s disability should be rated as voiding dysfunction or renal dysfunction, whichever is predominant. In male reproductive organ conditions disability benefits questionnaires (DBQs) completed in April 2018 and August 2019, the Veteran was diagnosed with hydrocele. At each examination, the Veteran noted increased sensitivity to pressure in his left testicle. The Veteran stated the sensitivity began following his surgery for varicocele of the left testicle. Both examinations noted that the Veteran does not experience voiding dysfunction or renal dysfunction. The Veteran did not have penis abnormality. The Veteran’s left and right testicles were both noted as abnormal. The Veteran’s left testicle was considerably softer than normal, and one-third the size or less than a normal testicle. His epididymis was abnormal with tenderness to palpation. Each examination noted that The Veteran’s hydrocele did not result in functional impairment of his ability to work. The August 2019 VA examiner also noted: The [V]eteran does not have any voiding dysfunction or renal dysfunction. Hydrocele are not known to medically to cause any edema in the legs and ankles. Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. Pain generally increases with the size of the inflammation. Therefore, the pain and sensitivity to pressure in the scrotum is related to the hydrocele. Based on the above discussed medical examinations, the Board finds that the Veteran’s hydrocele does not meet the requirements for an initial compensable disability evaluation un Diagnostic Code 7529. A compensable rating is not warranted under the criteria for a voiding or renal dysfunction because, as noted in the April 2018 and August 2019 male reproductive system conditions DBQs, the Veteran does not experience voiding or renal dysfunction. Moreover, the examiner addressed the question of whether the Veteran’s edema was due to the hydrocele and found that it was not. In addition, although the examiner found that the pain was related to the hydrocele, pain is not a symptom that warrants a higher rating under the criteria for either renal dysfunction or voiding dysfunction. Moreover, although pain is a symptom that is not contemplated by the criteria, there is no indication that it caused marked interference with employment or frequent hospitalization. A remand for referral for an extraschedular rating is therefore not warranted. See Thun v. Peake, 22 Vet. App. 111 (2008), aff’d sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The Board acknowledges the Veteran’s statements that his hydrocele is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469 (1994). As shown above, however, neither the Veteran’s statements nor medical evidence demonstrates that the criteria for an initial compensable disability evaluation have been met. For the foregoing reasons, the preponderance of the evidence is against an initial compensable rating for hydrocele. Therefore, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. 2. Entitlement to an initial compensable disability rating for a residual scar, post-surgery for varicocele of the left testicle The Veteran was granted service connection and assigned a noncompensable disability rating, effective November 2011, for a residual scar in an August 2012 rating decision. The Veteran contends that his current disability is more severe than currently rated. The Veteran’s residual scar was evaluated under Diagnostic Code 7801. 38 C.F.R. § 4.118. Diagnostic Code 7801 provides ratings for burn or other scars (not on the head, face, or neck) that are deep and nonlinear. Deep and nonlinear scars involving an area or areas of at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm.) are rated 10 percent. In addition, Diagnostic Code 7802 provides a sole disability rating of 10 percent for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear: Area or areas of 144 square inches (929 sq. cm.) or greater. An August 2019 scars/disfigurement DBQ noted a single, anterior trunk scar 4 cm in length and .1 cm in width. The examiner specifically found that the scar was not unstable or painful. The scar does not meet the required criteria of 39 sq. cm for a 10 percent disability rating under Diagnostic Code 7801. 38 C.F.R. § 4.118. The scar also does not meet the required criteria of 929 sq. cm for a 10 percent disability rating under Diagnostic Code 7802. Id. However, an additional, separate compensable evaluation may be granted for one or more painful or unstable scars under Diagnostic Code 7804. Id. Under Diagnostic Code 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of the skin over the scar. Id. at Note (1). An additional 10 percent may be added if a scar is both unstable and painful. Id. at Note (2). Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code when applicable. Id. at Note (3). Although the Veteran indicated that he experienced pain in his testicle, he did not contend or state that his anterior trunk scar is painful or unstable and the medical evidence reflects that it is not. Accordingly, a separate compensable disability rating is not warranted under Diagnostic Code 7804. (Continued on the next page)   For the foregoing reasons, the preponderance of the evidence is against an initial compensable rating for residual scar, post-surgery for varicocele of the left testicle. Therefore, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Riordan, 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.