Citation Nr: 20049976 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 15-40 609 DATE: July 28, 2020 ORDER Entitlement to an initial 10 percent rating prior to October 17, 2019 for a scar on the dorsal surface of the right hand is granted. FINDING OF FACT Prior to October 17, 2019, the Veteran’s scar on the dorsal surface of her right hand was shown to be painful. CONCLUSION OF LAW The criteria for an initial rating of 10 percent, and no higher, prior to October 17, 2019, for a scar on the right hand have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.118 (Diagnostic Code 7804). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from November 1981 to November 2002. This matter comes before the Board of Veterans’ Appeals (Board) from the March 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in August 2018 and was remanded for the Veteran to undergo VA scar and neurological examinations to determine the current severity of her right hand scar condition. Subsequently, the Veteran underwent these examinations in November 2019. Additionally, the Board instructed the Agency of Original Jurisdiction (AOJ) to request the Veteran to provide any treatment records for her hand scar since April 2011. The AOJ sent an authorization form and letter to the Veteran in July 2019 and no response has been received. The Board therefore finds that there was substantial compliance with the prior remand order, as is discussed more fully below, and the Board may continue with its determination. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to an initial compensable evaluation for a scar on the dorsal surface of the right hand prior to October 17, 2019 The Veteran contends that she is entitled to an initial compensable rating for her right hand scar. The Veteran was originally granted service connection for a stable scar dorsum of the right hand in a March 2012 rating decision under Diagnostic Code 7805. 38 C.F.R. § 4.118. Subsequently, in a May 2020 rating decision, the Veteran was granted service connection for scar of the dorsal surface on the right hand, evaluated as 10 percent disabling with an effective date of October 17, 2019, under diagnostic code 7804. 38 C.F.R. § 4.118. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Codes 7804 and 7805 were not changed by the August 13, 2018, amendments. Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Additionally, as noted above, the Veteran’s scar is also rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate Diagnostic Code. On the Veteran’s April 2011, application for benefits, she stated that her right hand scar is tender. In December 2011, the Veteran underwent a VA scars/disfigurement examination. The examiner noted that the Veteran has a scar on her right hand and the Veteran claimed that her scar is tender. The examiner stated that the Veteran’s scar is superficial, curvilinear, stable, nontender on the proximal, medial half of the right hand dorsum and does not limit motion or function. The examiner noted that the Veteran’s scar was not painful or unstable. Additionally, the scar was noted to be 2.2 cm in length. However, in her March 11, 2013 Notice of Disagreement, the Veteran submitted a statement that said that she has had constant pain in her right hand scar for over 30 years. She also stated that she informed the VA examiner of her right hand scar pain. She reported that he has no feelings around the scar and at times the area starts to tingle. The Veteran concluded that she has been told by doctors that there is nothing they could do for her hand as she severed nerves and muscles to which there was no surgery that could be performed to fix it. Pursuant to the Board’s August 2018 remand, the Veteran underwent a VA scars examination in October 2019. The examiner noted that the Veteran has one scar on her right hand that causes numbness on the top of her hand, pain around the scar, tingling, and a burning sensation. The examiner stated that the Veteran’s scars are not unstable with frequent loss of covering of skin and are not due to burns. The examination reported that the Veteran’s scar is 2 by 0.2 centimeters and is located on the dorsal surface of the right hand. Additionally, the Veteran was not noted to have any scars on the face, head, or neck. The examiner stated that the Veteran’s scar does not result in limitation of function, to include limitation of motion, and the Veteran does not have any other pertinent physical findings, complications, conditions, signs, and/or symptoms. Furthermore, the examiner said that the Veteran’s scar is not tender on palpation during examination. However, the Veteran reported that her scar is tender by pressing deep into the scar into the muscle. The examiner stated that this is a common report by claimants with scars being tender when there is no evidence of tenderness during palpation. The examiner stated that examination of the hand joint is normal and the Veteran’s radial nerve neuropathy is associated with the scar. (The Veteran is already in receipt of service connection for distal radial nerve neuropathy of the right hand associated with her scar evaluated as 20 percent disabling). No functional impairment was noted. The Board finds that the evidence is in favor of the assignment of a compensable rating under Diagnostic Code 7804 prior to October 17, 2019 because the Veteran’s right hand scar is manifest by one scar that is painful. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s right hand scar is not of the head, face, or neck, is not deep and nonlinear, and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does 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 effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. The Board acknowledges that the Veteran has testified that the area around her scar tingles and she experiences a burning sensation. Here, the Veteran has already been granted service connection for distal radial neve neuropathy of the right hand, which contemplates and compensates the Veteran for her nerve related symptom manifestations related to her scar disability. She was provided a 20 percent rating for the neuropathy effective from October 17, 2019. The Board finds that the evidence prior to that date does not provide a basis for assigning such a rating effective from an earlier date. The VA hand examination conducted in December 2011 noted that the Veteran reported a loss of feeling on the top of her hand along with loss of strength. However, examination did not reveal any functional loss and strength was full. The examiner noted that sensory examination was objectively intact for light touch, pin prick and vibration in spite of the complaints of lack of sensation. Furthermore, the Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include pain and tenderness, and her reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the Board finds that the Veteran’s right hand scar warrants an initial 10 percent rating prior to October 17, 2019. Notably, in her March 2013 notice of disagreement, the Veteran stated that her right hand scar has been painful for over 30 years and she informed the December 2011 VA examiner that. The Board finds her testimony credible. A higher rating is not warranted for any period on appeal as the medical and lay evidence does not demonstrate that the Veteran’s right hand scar is both unstable and painful or any of the other disabling effects under diagnostic code 7805. 38 C.F.R. § 4.118. Therefore, an initial rating of 10 percent, and no higher, for the Veteran’s right hand scar is warranted. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Mountford, 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.