Citation Nr: 20030100 Decision Date: 04/29/20 Archive Date: 04/29/20 DOCKET NO. 19-08 537 DATE: April 29, 2020 ORDER Entitlement to an initial compensable rating for a left knee scar is denied. FINDING OF FACT Throughout the period on appeal, the preponderance of the evidence does not show objective evidence of a painful or unstable scar on examination of the Veteran’s service-connected left knee scar. CONCLUSION OF LAW Throughout the period on appeal, the criteria for an initial compensable rating for a left knee scar have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.118, Diagnostic Code 7805. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2011 to July 2015. The Board of Veterans’ Appeals (Board) notes that the Veteran originally initiated an appeal regarding the issues of: 1) entitlement to an initial rating in excess of 10 percent for temporomandibular joint (TMJ) syndrome, an initial increase was granted which increased the rating to 30 percent; 2) entitlement to an initial compensable rating for hypertension, an initial increase was granted which increased the rating to 20 percent; 3) entitlement to an initial rating in excess of 10 percent for left knee sprain, postoperative, which remained denied; and 4) entitlement to an initial compensable rating for a left knee scar, which also remained denied; and the Veteran did not perfect the appeal as to all of these issues. All of these issues were addressed in the January 2019 statement of the case (SOC). In the March 2019 substantive appeal, the Veteran limited her appeal to include only the issue of entitlement to an initial compensable rating for a left knee scar. Accordingly, the remaining issues are not in appellate status. Entitlement to an initial compensable rating for a left knee scar Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14 (2017); Esteban v. Brown, 6 Vet. App. 259, 262 (1994). While it is necessary to consider the complete medical history of the Veteran’s condition in order to evaluate the level of disability and any changes in condition, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991); Francisco v. Brown, 7 Vet. App. 55 (1994). In deciding the Veteran’s increased evaluation claim, the Board has considered the determinations in Fenderson v. West, 12 Vet. App. 119 (1999) and Hart v. Mansfield, 21 Vet. App. 505 (2007), and whether the Veteran is entitled to an increased evaluation for separate periods based on the facts found during the appeal period. The Veteran’s left knee scar is rated under Diagnostic Code 7805. Pursuant to the rating schedule, a 10 percent rating is assigned for one or two scars that are unstable or painful. A 20 percent rating is assigned for three or four scars that are unstable or painful. A 30 percent rating is assigned for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7805. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. at Note (1). If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id. at Note (2). Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804 may also receive an evaluation under this diagnostic code, when applicable. Id. at Note (3). The Veteran seeks entitlement to an initial compensable rating for a left knee scar. The Veteran contends that her left knee scar has scar tissue underneath the scar that is painful itself, she tries to massage her left knee scar, but she does not get relief from the pain. The Veteran additionally contends that her left knee scar is painful when sitting and moving, it throbs due to the scar tissue, and that she has had this pain under her scar since she had her surgery in June 2014. In February 2015, the Veteran originally filed a claim for entitlement to service connection for her in-service June 2014 left knee repair surgery. An October 2014 service treatment record (STR) shows that the physician noted that the Veteran’s left knee scar scope sites were well-healed and there was good scar mobility, no adhesions, good patellar mobility. The Veteran was afforded a VA knee examination in March 2015. The March 2015 examiner noted that the Veteran had a 0.2 cm2 scar related to her left knee repair surgery, but that the scar was not painful and/or unstable. In December 2015, the Agency of Original Jurisdiction (AOJ) granted the claim for left knee sprain, postoperative, and also granted service connection for a left knee scar and assigned a noncompensable rating. The Veteran was afforded another VA knee examination in September 2018 to determine the severity of the Veteran’s service-connected left knee sprain, postoperative. The September 2018 examiner noted that the Veteran did not have any scars (surgical or otherwise) related to her left knee disorder. The Veteran was afforded a VA scars examination in December 2018. The December 2018 examiner noted that the Veteran had an 8 cm2 scar, and that the scar was not unstable or tender to palpation. In light of the above, the Board finds that throughout the entire period on appeal, there has been no objective evidence of painful or unstable scars. While the Veteran is competent to report about pain, multiple VA examiners during the period reported that while the Veteran had one left knee scar, it was neither painful nor unstable. In other words, the Veteran’s reports do not outweigh the objective evidence of record. Moreover, attachment to any scar tissue has not been objectively noted. On review, the objective findings are contemplated in the noncompensable rating currently assigned under Diagnostic Code 7805 for this period. There is no probative evidence during this period of limitation of function or further disabling effects due to the service-connected left knee scar.   Therefore, a compensable evaluation is not warranted for the entire period on appeal. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against assignment of a higher rating, that doctrine is not applicable. See 38 U.S.C. § 5107 (b). MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jennifer A. Frazier, 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.