Citation Nr: 21000086 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-16 015 DATE: January 4, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent for a left first rib resection scar is denied. REMANDED Entitlement to a compensable rating for a left first rib resection is remanded. FINDING OF FACT The Veteran has one scar that is painful. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for a left first rib resection scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1977 to June 1997. These matters come before the Board of Veterans’ Appeals (Board) from a September 2015 Rating Decision. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) via video conferencing in March 2019. This matter was previously before the Board in August 2019. As a result of the development that occurred as a result of this claim, the Veteran has been separately service-connected for the left first rib scar and for the left first rib resection. Initial increased disability rating greater than 10 percent for a left first rib resection scar The Veteran contends that he is entitled to a higher rating for his left first rib resection scar. This scar is evaluated under Diagnostic Code 7804 for unstable or painful scars. 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. 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 Veteran complains of, and claims in this appeal, only one painful scar, and the evidence does not show additional painful scars. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s left first rib resection 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 that 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. Notably, the recent VA examination could not identify any musculoskeletal or muscular manifestations related to the Veteran’s scar. 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, numbness or itchiness of the scar, or difficulty working above his head. His reports of such symptoms are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, in this regard, the Board reiterates that he admits that he has only one scar associated with his left rib resection. 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 a left rib resection scar. 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. REASONS FOR REMAND Compensable rating for a left first rib resection The Veteran’s service-connected left first rib resection is evaluated under 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5297. This diagnostic code provides a 10 percent rating where one rib has been removed or where two or more ribs have been resected without regeneration. Id. Here, there is conflict in the records as to whether the Veteran’s left first rib has been entirely removed. The initial report from May and June 1982 indicates that he underwent a surgical resection of his left first rib. This is consistent with a June 1992 report indicating an absence of the majority of the left first rib by surgical history. However, a radiologist report from February 1997 indicates that his left first rib is surgically absent, and a neurologist consultation from March 1997 indicates that his left first rib had been entirely removed. Chest X-rays from October 2010, reported in January 2011, indicate that there had been a complete resection of the left first rib. In March 2016, the Veteran submitted an opinion from an Army hospital physician who describes a left rib radiograph series from April 2013 that does not appear to be of record that he describes as showing a “complete resection” of the Veteran’s left first rib. On remand, clarification as to whether the Veteran’s left first rib has been removed—that is whether it is entirely absent or whether it has been only partially removed and resected—is necessary. Accordingly, this matter is REMANDED for the following actions: Obtain an addendum opinion from an appropriate clinician regarding whether what has been described as a “complete resection” of the Veteran’s left first rib actually means the complete removal of the left first rib. If this opinion cannot be provided without an additional examination, the Veteran should be scheduled for an appropriate examination along with any required tests or radiographs. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Steven H. Johnston, 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.