Citation Nr: 21000446 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 15-19 322 DATE: January 5, 2021 ORDER Entitlement to an increased evaluation in excess of 10 percent for left wrist strain is denied. Entitlement to a compensable evaluation for dog bite scars of the bilateral upper extremities is denied. Entitlement to an increased evaluation in excess of 30 percent for painful dog bite scars of the bilateral upper extremities is denied. FINDINGS OF FACT 1. The Veteran’s left wrist disability has been manifested at worse no more than plantar flexion limited to 35 degrees, dorsal flexion limited to 20 degrees and without clinical evidence of ankylosis. 2. The Veteran’s dog bite scars of the bilateral upper extremities are not unstable and does not exceed 39 square centimeters. 3. The Veteran’s painful dog bite scars are assigned a 30 percent rating, which is the maximum schedular rating authorized for unstable or painful scars under Diagnostic Code 7804. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 10 percent for a left wrist strain have not been met. 38 U.S.C. §§ 1155, 5108; C.F.R. § 4.71a, Diagnostic Code 5215. 2. The criteria for an initial compensable disability evaluation for dog bite scars of the bilateral upper extremities have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.118, Diagnostic Codes 7800, 7801, 7802, 7805. 3. The criteria for an initial rating in excess of 30 percent for painful dog bite scars of the upper extremities have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in active duty service with the Air Force from February 1972 to February 1976. This matter is on appeal from a May 2014 rating decision. The Veteran was afforded a June 2018 hearing before the undersigned Judge. A transcript of the hearing has been associated with the claims record. The Board remanded this appeal in August 2018 for additional development. For the purposes of clarification, the August 2018 Board decision remanded the issue for “evaluation of dog bite scars of the right elbow and left wrist” to evaluate for potential underlying disabilities. During the pendency of the appeal, an August 2020 rating decision granted service connection for right elbow degenerative arthritis with flexion limitation; service connection for right elbow limitation of supination; and a new and separate evaluation for painful dog bite scars of the upper extremities evaluated at 30 percent under Diagnostic Code (DC) 7804. As the separate evaluation for the Veteran’s painful dog bite scars of the upper extremities is essentially part and parcel of the Veteran’s same appeal for an increased rating for dog bite scars that was remanded, the Board will also consider the evaluation of the painful dog bite scars granted under DC 7804. As such, the issues before the Board are for an increased evaluation in excess of 10 percent for left wrist strain; a compensable evaluation for dog bite scars of the upper extremities; and an increased evaluation in excess of 30 percent for painful dog bite scars. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7 (2019). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 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. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Fenderson v. West, 12 Vet. App. 119 (1999). The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where an increase in the disability rating is at issue, the present level of the veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the relevant overall temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). 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. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Any reasonable doubt will be resolved in favor of granting the Veteran’s claim. 38 U.S.C. § 5107 (West 2014); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. § 3.102. Left wrist strain The Veteran is currently service connected for left wrist strain evaluated at 10 percent under DC 5215. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. Although the first sentence of 38 C.F.R. § 4.59 refers only to arthritis, the regulation applies to joint conditions other than arthritis. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). The Veteran is right-hand dominant. As such, minor, as opposed to major, disability ratings are applicable. 38 C.F.R. § 4.69. Under Diagnostic Code 5215, a 10 percent rating is warranted where palmar flexion is limited in line with the forearm, or where dorsiflexion is less than 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5215. This is the maximum schedular rating based on limitation of motion of the wrist under this diagnostic code. Diagnostic Code 5214 applies to ankylosis of the wrist. Diagnostic Code 5214 provides the following ratings for a major extremity: 30 percent for favorable ankylosis in 20 degrees to 30 degrees dorsiflexion; 40 percent for ankylosis in any other position except favorable; and 50 percent for unfavorable ankylosis in any degree of palmar flexion or with ulnar or radial deviation. Diagnostic Code 5214 notes that extremely unfavorable ankylosis will be rated as loss of use of hands under Diagnostic Code 5125. 38 C.F.R. § 4.71a. Normal range of motion for the wrist is 80 degrees palmar flexion and 70 degrees dorsiflexion. 38 C.F.R. § 4.71, Plate I. Review of the medical treatment record shows in May 2013 the Veteran complained of pain in his left wrist for more than a year that was aggravated by lifting, sitting and any motion. The Veteran was afforded a July 2013 VA examination. The Veteran’s range of motion (ROM) found his left wrist palmar flexion measured to 30 degrees without pain and dorsiflexion to 20 degrees without pain. The Veteran was able to perform repetitive testing without loss of motion. The examiner noted that after repetitive testing, the Veteran’s left wrist palmar flexion and dorsiflexion improved to measure at 40 degrees palmar flexion and 30 degrees dorsiflexion. The Veteran did not report flareups, but the examiner found that reduced and weakened movement of the left wrist contributed to functional loss; the examiner did not find that pain, weakness, fatigue or incoordination significantly impacted functional ability. The Veteran demonstrated 3/5 strength and the examiner found no evidence of ankylosis. The examiner found that due to pain and weakness in the left wrist, the Veteran would be unable to lift much weight and at most could only lift 10 pounds a few times a day. At the Veteran’s June 2018 hearing, the Veteran testified that he always had pain in his wrist to include swelling. The Veteran also stated that at his last VA examination the examiner only checked the motion of his wrist and his scars. The Veteran also described having decreased strength and inability to throw or lift his arm above his head, however it appears these statements were relating to his right elbow disability. In a June 2019 VA examination for scars, the examiner found that nerve conduction velocity (NCV) test findings were consistent with left side carpal tunnel syndrome. In July 2019 the Veteran reported pain in his left wrist and right elbow and expressed frustration that he has not been able to get it treated. An August 2019 X-ray test found degenerative changes in the left wrist first carpal metacarpal joint. In November 2019 the Veteran complained of chronic pain in the left wrist; the treating provider found physical examination was within normal limits with no evidence of acute distress. The Veteran was afforded a December 2019 VA examination. The Veteran reported symptoms of a constant dull ache in his left wrist. The Veteran reported flareups of increased pain occurring daily lasting 2 to 3 hours with overuse and cold or damp weather. The Veteran reported that pain and decreased motion resulted in decreased ability to use his left arm, decreased productivity and adverse job performance. Upon physical examination, the Veteran’s left wrist flexion was measured at 70 degrees; dorsiflexion at 40 degrees; ulnar deviation at 30 degrees; and radial deviation at 10 degrees. The Veteran reported pain on all motions with functional loss. The examiner found pain with weight bearing. The Veteran was able to demonstrate repetitive testing without loss of motion. The examiner noted the Veteran reported during flareups his ROM would decrease by 50 percent; although the examiner noted that a flareup was not directly observed at the examination, the examiner found the Veteran’ flexion at 35 degrees; dorsiflexion at 20 degrees; ulnar deviation at 15 degrees; and radial deviation at 5 degrees and found the examination medically consistent with the Veteran’s statements describing functional loss during flareups. The Veteran demonstrated 4/5 strength no atrophy. The examiner found no evidence of ankylosis. The examiner also found evidence of the Veteran’s left ulnar and left radial nerve affected with no other findings or observations. Considering the pertinent facts in light of applicable rating criteria, the Board finds that an evaluation in excess of 10 percent is not warranted for the Veteran’s service-connected left wrist disability. As noted above, in order to receive an increased rating to 20 percent, there must be a showing of ankylosis of the minor wrist in 20 to 30 degrees of dorsiflexion or worse. 38 C.F.R. § 4.71a, Diagnostic Code 5214. Otherwise, a 10 percent rating is the highest rating that may be assigned for limitation of motion of a minor wrist without ankylosis, on the basis of either limitation of dorsiflexion less than 15 degrees, or plantar flexion limited in line with the forearm. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Although the medical treatment records and Veteran states that he experiences pain in his left wrist, he still retains movement in his wrists. Moreover, the VA examinations specifically indicated that the Veteran did not have ankylosis of the left wrists. As such, the Board finds that an evaluation in excess of 10 percent for left wrist strain is not warranted as there has been no evidence of ankylosis. The Board notes that the Veteran’s current 10 percent rating contemplates painful motion, weakness, giving way, and limited range of motion in palmar flexion, dorsiflexion, radial deviation and ulnar deviation. No higher ratings based on limitation of motion of the wrist are possible under Diagnostic Code 5215 as the maximum allowable rating is again 10 percent for limitation of motion. As such, a higher rating for limitation of dorsiflexion or palmar flexion is not warranted. Id. In evaluating the Veteran’s current level of disability, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. The medical evidence shows that the Veteran has, at different times, complained of painful motion. However, the VA examiners found that upon repetitive testing there was no additional functional loss due to pain, weakness, fatigue, or incoordination. The examiners also did not indicate that the Veteran’s reported symptoms resulted in complete loss of use of the left hand or effectively resulted in ankylosis of the left wrist. As a result, the Board finds that the currently assigned 10 percent rating fully contemplates the Veteran’s reports of painful motion. 38 C.F.R. § 4.59. The Board notes that at the Veteran’s December 2019 VA examination the Veteran reported pain on all motions. The Court has clearly indicated that painful motion does not equate to limited motion. Mitchell, 25 Vet. App. at 41. In fact, the Court considered the argument that pain throughout all ranges should warrant the maximum rating and found that the “Secretary has persuasively argued that such an interpretation would lead to absurd results.” Id. at 43. Indeed, nothing in the case law supports the contention that a Veteran should be given maximum disability ratings simply because he or she may experience pain throughout the range of motion. Id. at 43. Rather, pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination, and endurance to constitute a functional loss and it is the presence of this functional loss that is the relevant question in assigning disability ratings. Id. As explained above, although there may be pain on all movement, there is no objective evidence that the Veteran’s pain results in additional functional loss that would warrant an increased schedular rating during this period. The Veteran’s statements of limitations are deemed credible and probative evidence, but such evidence does not show that any additional limitation due to pain does not more nearly approximate a finding of ankylosis of the minor wrist in 20 to 30 degrees of dorsiflexion or worse. See 38 C.F.R. § 4.45, 4.71a, Diagnostic Code 5214; DeLuca, 8 Vet. App. at 202; Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Board also carefully considered the Veteran’s lay statements relating to the severity of his left wrist strain. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a left wrist disability as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). As such, the evidence of record demonstrates that the Veteran’s left wrist is limited at most to palmar flexion of 35 degrees, dorsal flexion limited to 20 degrees, ulnar deviation limited to 15 degrees, radial deviation limited to 5 degrees, and without clinical evidence of ankylosis. Accordingly, even when considering the DeLuca factors, without evidence of ankylosis in the Veteran’s left wrist, a higher evaluation is not available based on limitation of motion. See 38 C.F.R. § 4.71a, Diagnostic Codes 5215. Accordingly, as the preponderance of the evidence is against the claim for a rating in excess of 10 percent for service-connected left wrist disability, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Dog bite scars of the bilateral upper extremities The Veteran is currently service connected for dog bite scars of the bilateral upper extremities with a noncompensable evaluation under DC 7805. As noted above, an August 2020 rating decision granted a new and separate evaluation for painful dog bite scars of the bilateral upper extremities evaluated at 30 percent under DC 7804, separately evaluated to provide the prospect of the greatest benefit to the Veteran. The increased evaluation to 30 percent was based on the criteria of Diagnostic Code 7804 (Scar(s), unstable or painful). The separate noncompensable evaluation was rated under Diagnostic Code 7805 (other scars (including linear scars) and other effects of scars already evaluated under diagnostic codes 7800, 7801, 7802, and 7804). Both evaluations were based on the findings of a June 2019 VA examination for scars. In evaluating skin and scar residuals, the Board notes that during the appeal period, changes were made to certain Diagnostic Codes under 38 C.F.R. § 4.118. Effective August 13, 2018, VA amended its regulations governing skin disabilities. VA’s intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). As the Veteran filed his claim before the August 13, 2018 effective date, the Board will consider whether either the old or new rating criteria is more favorable to the Veteran. Under the old rating criteria, Diagnostic Code 7805 provided that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase “(including linear scars)” with “and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804.” 38 C.F.R. § 4.118, Diagnostic Code 7805 (August 13, 2018). Diagnostic Code 7800 (which was unchanged by the 2018 amendments), contemplates scars of the head, face, or neck. 38 C.F.R. § 4.118, Diagnostic Code 7800. Under Diagnostic Code 7800, for disfigurement of the head, face, or neck, a 10 percent disability rating is warranted for scarring with one characteristic of disfigurement. A 30 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or two or three of the characteristics of disfigurement. A 50 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or four or five characteristics of disfigurement. An 80 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or six or more characteristics of disfigurement. 38 C.F.R. § 4.118. The eight characteristics of disfigurement for the purposes of rating under 38 C.F.R. § 4.118 are: scar of 5 in. or more (13 or more centimeters (cm.)) in length; scar at least 1/4 in. (0.6 cm.) wide at its widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding 6 sq. in. (39 sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 sq. in. (39 sq. cm.); underlying soft tissue missing in an area exceeding 6 sq. in. (39 sq. cm.); and skin indurated and inflexible in an area exceeding 6 sq. in. (39 sq. cm.). Id., Note (1). The pre-amended Diagnostic Code 7801 provided 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. 38 C.F.R. § 4.118, Diagnostic Code 7801 (2017). In contrast, the amended Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801 (August 13, 2018). Both the old and new criteria provide that a 10 percent rating is awarded 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 warranted 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 warranted 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 7801. Note (1) to the pre-amended Diagnostic Code 7801 stated that a deep scar is one associated with underlying soft tissue damage. Prior to August 13, 2018, Diagnostic Code 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, Diagnostic 7802 (2017). The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (August 13, 2018). Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater. Under both the old and new rating criteria, Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. 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, Diagnostic 7804. In every instance where the schedule does not provide a 0 percent rating for a diagnostic code, a 0 percent rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Veteran was afforded a July 2013 VA examination. The examiner noted that the Veteran was bitten on the right elbow and left wrist during his service as a dog handler. The examiner found the Veteran with no scars or disfigurement of the head, face or neck. Upon physical examination, the examiner found linear scars on the Veteran’s right upper extremity measuring as follows: Scar #1: 5 x 0.5 cm[.] Scar #2: 1 x 0.5cm [.] The examiner found linear scars on the left upper extremity measuring as follows: Scar #1: 1.5 x 0.5cm[.] Scar #2: 1 x 0.5cm [.] Scar #3: 1 x 0.5cm [.] Scar #4: 1 x 0.5cm [.] The examiner found no evidence that the scars were painful or unstable. The examiner found the scars did not result in functional impact. Review of the medical treatment record shows the Veteran complained of chronic pain in his right elbow and left wrist resulting in weakness, loss of strength and reduced range of motion. At the Veteran’s June 2018 hearing the Veteran testified that he was unable to lift his arm over his head or perform throwing motions. The Veteran was afforded a November 2019 VA examination. The examiner found the Veteran with scars on the trunk or extremities but found no scars or disfigurement of the head, face or neck. Upon physical examination, the examiner found scars on the Veteran’s right upper extremity measuring as follows: Scar #1: 5 x 0.5 cm[.] Scar #2: 11 x 0.5cm [.] The examiner found both scars tender to palpitation and with underlying soft tissue damage. The examiner found scars on the left upper extremity measuring as follows: Scar #1: 1.5 x 0.5cm[.] Scar #2: 1 x 0.5cm [.] Scar #3: 1 x 0.5cm [.] Scar #4: 1 x 0.5cm [.] The examiner found the first scar tender to palpation and all scars on the left upper extremity with underlying soft tissue damage. The examiner summarized the Veteran’s scars of the right upper extremity to cover an approximately total area of 3.0 cm squared; and scars of the left upper extremity to cover an approximately total area of 2.25 cm squared. The examiner did not find any of the scars of the trunk or extremities to be unstable. The examiner found 5 or more of the Veteran’s scars to be painful. The examiner found there was underlying nerve damage in the right elbow and left wrist resulting in pain during use. The examiner noted the Veteran was a retired autoworker whose type of work would have required full use of the hands; therefore, the examiner found the Veteran would have suffered from decreased in job productivity. After review of the record, the Board finds a compensable evaluation for dog bite scars of the bilateral upper extremities and an increased evaluation in excess of 30 percent for painful dog bite scars is not warranted. Diagnostic Code 7801 provides that scars other than on the head, face, or neck that are deep, nonlinear, and cover an area of at least 6 square inches (39 square (sq.) centimeters (cm.)) warrant a compensable evaluation. Id., Diagnostic Code 7801. A deep scar is one associated with underlying soft tissue damage. Id. Here, although the June 2019 VA examiner found scars with underlying soft tissue damage, there was no evidence these scars cover an area of at least 6 square inches. Hence, Diagnostic Code 7801 is not for application. Diagnostic Code 7802 provides that scars, other than on the head, face, or neck, that are superficial and nonlinear, and cover an area of at least 144 square inches (929 sq. cm.) warrant a compensable evaluation. Id, Diagnostic Code 7802. A superficial scar is one not associated with underlying soft tissue damage. Id. In this case, the Veteran’s scars do not cover a surface area of 144 square inches (929 sq. cm) or greater; therefore, a compensable rating is not available under Diagnostic Code 7802. As noted above, the Veteran was granted a new and separate evaluation for 30 percent under DC 7804. Diagnostic Code 7804 was never amended and provides a 10 percent rating for one or two scars that are unstable or painful, a 20 percent rating is warranted for three or four scars that are unstable or painful and a maximum 30 percent rating warranted for five or more scars that are either unstable or painful. The June 2019 VA examiner found five or more scars being painful, allowing the highest evaluation under that diagnostic code of 30 percent. Because there were no findings of unstable scars, a higher evaluation of 40 percent is not warranted for scars which are unstable or painful unless the evidence shows five or more painful or unstable scars, with at least one scar being both painful and unstable. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (2) (If one or more scars are both unstable and painful, 10 percent is added to the evaluation that is based on the total number of unstable or painful scars). Although the Veteran has stated impairment in his left wrist and right elbow and the June 2019 VA examiner noted the Veteran had underlying nerve damage in both the right elbow and left wrist; the Veteran was granted service connection for a right elbow disability at 30 percent and already service connected for a left wrist disability evaluated at 10 percent. Therefore, a separate compensable rating based upon limitation of the affected body part under DC 7805 is not permissible, as such would violate the rule against pyramiding. See 38 C.F.R. § 4.14. The Veteran’s dog bite scars of the bilateral upper extremities do not meet any of the requirements for a compensable rating under the applicable scar diagnostic codes apart from DC 7804, thus a noncompensable rating must be assigned under Diagnostic Code 7805. The Veteran is rated at the maximum available rating for multiple painful scars under DC 7804. There is no evidence of record to suggest that the Veteran’s scars are more appropriately rated under another diagnostic code. The Veteran has not presented argument or evidence otherwise. As such, higher evaluations under the diagnostic code for scars are not available to the Veteran, as he has, in effect, the highest rating possible under those codes for the reasons stated. Therefore, based on the objective medical evidence, the Board finds the preponderance of the evidence is against the claims for a compensable evaluation for dog bite scars of the bilateral upper extremities and an increased evaluation in excess of 30 percent for painful dog bite scars of the bilateral upper extremities. As a preponderance of the evidence is against the award of an increased evaluation, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.