Citation Nr: 21000550 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 14-38 055 DATE: January 5, 2021 ORDER Entitlement to a rating in excess of 30 percent disabling for cervical spine disability is denied. Entitlement to a rating in excess of 30 percent disabling for right upper extremity (RUE) radiculopathy is denied. Prior to August 26, 2016, entitlement to an initial 30 percent rating, but no higher, for status post cervical surgery scar is granted subject to controlling regulations applicable to the payment of monetary benefits. Effective August 26, 2016, entitlement to a rating in excess of 10 percent disabling for painful scars of the chin and cervical spine is denied. Effective August 26, 2016, entitlement to a rating in excess of 30 percent disabling for disfiguring scars of the chin and cervical spine is denied. FINDINGS OF FACT 1. Throughout the appeal period, the cervical spine disability was not manifested by unfavorable ankylosis or IVDS with incapacitating episodes having a total duration of at least 4 weeks during the past 12 months. 2. The Veteran is left-hand dominant; therefore, his right arm is his minor arm. 3. The Veteran’s RUE radiculopathy did not more nearly approximate severe incomplete paralysis of the upper, middle or lower radicular groups. 4. Prior to August 26, 2016, the Veteran’s status post cervical surgery scar was manifested by no more than two characteristics of disfigurement of the head, face or neck. 5. Effective August 26, 2016, the Veteran’s scars of the chin and cervical spine were not manifested by four or more characteristics of disfigurement of the head, face or neck. 6. Effective August 26, 2016, the Veteran’s scars of the chin and cervical spine were not manifested by three or more scars that were painful. The Veteran’s scars of the chin and cervical spine have not manifested by an unstable scar. CONCLUSIONS OF LAW 1. Throughout the appeal period, the criteria for a rating in excess of 30 percent disabling for cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, Diagnostic Code (DC) 5238. 2. The criteria for a rating in excess of 30 percent disabling for RUE radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.124a, DCs 8510-8513. 3. Prior to August 26, 2016, the criteria for a 30 percent rating, but no higher, for status post cervical surgery scar have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.118, DC 7800. 4. Effective August 26, 2016, the criteria for a rating in excess of 10 percent disabling for painful scars of the chin and cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.118, DCs 7804, 7805. 5. Effective August 26, 2016, the criteria for a rating in excess of 30 percent disabling for disfiguring scars of the chin and cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.118, DCs 7800. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1979 to July 1996. This matter is before the Board of Veterans’ Appeals (Board) on appeal from November 2012 (RUE radiculopathy, scar) and August 2013 (cervical spine) rating decisions by a Department of Veterans Affairs Regional Office (RO). In April 2019, the Veteran testified at a Travel Board hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. In an August 2019 Decision, the Board granted entitlement to service connection for obstructive sleep apnea and withdrew the Veteran’s claim for entitlement to a total disability rating based on individual unemployability (TDIU). The Board also remanded the issues on appeal and instructed the Agency of Original Jurisdiction (AOJ) to obtain VA examinations. The Board notes that the requested VA examinations were obtained in August 2020 and have been associated with the claims file. Accordingly, after reviewing the actions of the AOJ, the Board finds there was substantial compliance with the requested development. Dyment v. West, 13 Vet. App. 141 (1999); Stegall v. West, 11 Vet. App. 268 (1998). During the pendency of the appeal, an August 2020 rating decision combined the Veteran’s service-connected status post cervical surgery scar and chin scar under one rating, and assigned a 10 percent rating pursuant to DC 7804 effective August 26, 2016. The August 2020 rating decision additionally granted a separate combined 30 percent evaluation pursuant to DC 7800 effected August 26, 2016, the date of the Veteran’s second cervical spine surgery. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more nearly approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, and the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When rating musculoskeletal disabilities on the basis of limited motion of a joint, VA must consider functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered only in conjunction with diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). The regulations preclude the assignment of separate ratings for the same manifestations under different diagnoses. The critical element is that none of the symptomatology for any of the conditions is duplicative of or overlapping with symptomatology of the other conditions. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259 (1995). Cervical Spine Disability and RUE Radiculopathy The Veteran’s increased rating claims on appeal stem from a November 2011 claim for a TDIU. In development of that claim, the Veteran underwent a VA examination related to his cervical spine and RUE radiculopathy, and a November 2012 rating decision granted an increased 30 percent evaluation for RUE radiculopathy effective November 17, 2011; the date of the claim. A subsequent August 2013 rating continued the currently assigned 30 percent evaluation for cervical spine disability. Factual Background The evidence of record includes an August 2012 cervical spine MRI study revealing a prior anterior interbody fusion of C4, C5 and C6, straightening of the cervical spine and mild decrease in disc height with anterior endplate spurring seen at C3-C4 and C6-C7 levels. At C3-C4, a moderate-sized diffuse posterior disc osteophyte complex was seen more prominent towards the right side which indented and mildly flattened the cord at that level and caused at least moderate central canal stenosis. A 5 mm focus of increased T2 signal within the cord at that level was noted as likely myelomalacia. Also, moderate to severe right foraminal encroachment and mild left foraminal encroachment was noted. At C6-C7, mild to moderate diffuse posterior focal central and right paracentral disc osteophyte complex which indented thecal sac anteriorly and contacted the cord without compressing it. There was mild narrowing of the central canal. There was also mild right neural foraminal encroachment. See VA Medical Records Received August 2020. The Veteran underwent a VA cervical spine examination in September 2012. During that examination, the Veteran was noted to have had two cervical spine surgeries with IVDS and RUE radiculopathy involving the upper, middle and lower radicular groups. The Veteran reported being in constant pain. The examiner noted ROM consisting of forward flexion to 10 degrees with pain noted at end of ROM. The examiner also noted functional loss due to less movement than normal and pain on movement. Muscle strength and reflex testing were normal. Sensory testing revealed decreased sensation to light touch for the right shoulder, inner/outer forearm and hand/fingers. No related neurological abnormalities such as bowel or bladder problems were found. The Veteran’s cervical spine disability was found to be manifested by RUE extremity radiculopathy including symptoms of moderate numbness. The RUE radiculopathy was not manifested by constant pain, intermittent pain, or paresthesias and/or dysesthesias. The RUE radiculopathy was found to be moderate in severity. Additionally, the examiner found the Veteran’s cervical spine manifested by IVDS, but that the Veteran had not had any episodes of acute signs and symptoms that required bed rest prescribed by a physician or treatment by a physician in the past 12 months. No finding as to ankylosis was included. In September 2013, an MRI study revealed multilevel changes including moderate to severe central canal stenosis noted at C3-C4, with abnormal cervical cord signal. In November 2014, the Veteran denied any bowel or bladder control problems. Another November 2014 VA medical record noted that the Veteran had a history of chronic neck pain and that he was unable to turn his neck and wore a cervical collar to keep his cervical bones from rubbing together. See VA Medical Records Received August 2020. A December 2014 MRI study revealed bony fusion of the cervical spine at C4-C5 and C5-C6, prominent anterior osteophyte at C6-C7, and some posterior and anterior osteophyte formation at C3-C7. Decreased T1 signal and increased T2 signal was noted in the cervical cord at the level of upper portion of C4 as on prior study and suggesting myelomalacia changes. There was broad based posterior disc osteophyte complex, some thickening of ligamenta flava appearing to cause at least moderate central canal stenosis causing probable moderate to marked central canal stenosis with flattening of the spinal cord at that level. Uncovertebral osteophytes and some hypertrophic degenerative changes at the right facet joint were seen to appear to cause moderate to marked narrowing of the right neural foramen, and moderate narrowing of left neural foramen at C3-C4. See VA Medical Records Received August 2020. In March 2016, the Veteran was noted as bowel continent. See VA Medical Records Received August 2020. In August 2016, the Veteran underwent a C3-C4 anterior cervical discectomy and fusion. See Private Medical Records Received September 2016 and January 2017. In September 2016, the Veteran submitted a cervical spine disability benefits questionnaire (DBQ). The physician noted diagnoses for cervical spondylosis, degenerative disc disease (DDD), IVDS, radiculopathy, myelopathy and ankylosis. However, the examination report also shows that the physician noted the Veteran’s cervical spine was not manifested by ankylosis. The Veteran reported flare-ups that immobilized him with pain described as unbearable. The Veteran also reported functional loss due to migraine headaches, numbness and pain in both arms and hands, having a hard time swallowing, shoulder pain and throbbing sensation, and an inability to drive. The Veteran was unable to perform ROM testing. The physician noted functional loss due to less movement than normal, weakness, excess fatigability, pain on movement, swelling, instability of station, disturbance of locomotion, interference with sitting and interference with standing. Muscle strength testing revealed active movement against some resistance for bilateral shoulder adduction, abduction, flexion and rotation, elbow flexion and extension, wrist flexion and extension, and finger flexion and extension. The Veteran was not found to have muscle atrophy. A sensory examination revealed decreased sensation to the bilateral shoulder area, inner/outer forearm, and hand/fingers. With regard to IVDS, the physician noted that the Veteran had at least 6 weeks of incapacitating episodes over the past 12 months. The physician further noted bilateral radiculopathy affecting the upper, middle and lower radicular groups manifested by moderate constant and intermittent pain, and moderate paresthesias and/or dysesthesias. The Veteran’s bilateral radiculopathy was found to be moderate in severity. In an August 2016 letter from the Veteran’s treating physician, Dr. D.G., the Veteran was noted to have a history of cervical myelopathy with worsening strength in his upper and lower extremities and that he required a wheelchair. See Private Medical Records Received September 2016. In April and July 2019, VA medical records show the Veteran was not found to have any bowel problems. See VA Medical Records Received August 2020. At an April 2019 Board hearing, the Veteran testified his cervical spine symptoms had worsened since his last surgery, including worsening neurological symptoms including complete numbness in his BUE if he turned his head left or right. In addition, the Veteran testified that his neck hurt when moving up, down or side to side, and that he could only turn his head a little bit before it became painful. The Veteran also testified that his RUE radiculopathy had worsened resulting in his inability to use his right hand for activities of daily living. In May 2019, an MRI study revealed a surgical change consistent with fusion of C3 through C6 level. Orthopedic plate and screws were present anterior to the fused C3 and C4 vertebral bodies. Disc space narrowing and degenerative changes were demonstrated involving the C6-C7 disc space. There was encroachment to the neural foraminal bilaterally at the C2-C3 level. On the axial images, a small extradural defect was present posterior and slightly right lateral to midline at the C2-C3 level, which was found to possibly represent spurring, but minimal disc protrusion could not be excluded. Bilateral neural foraminal encroachment at the C3-C4 level was seen and mild/moderate acquired spinal stenosis was demonstrated the C3-C4 level. There was bilateral neural foraminal encroachment at the C4-C5 level and bilateral neural foraminal encroachment at the C6-C7 level. Additionally, a 5 mm area of increased signal intensity on T2 images involving the cervical spinal cord at the C3-C4 level was found to most likely represent an area of myelomalacia. See VA Medical Records Received August 2020. A June 2019 VA medical record noted that with regard to any bowel or bladder dysfunction, that the Veteran only had urinary leakage and that he sometimes wore undergarments. Additionally, a June 2019 VA medical record noted that the Veteran had abnormal cervical spine ROM described as very limited and guarded. See VA Medical Records Received August 2020. A November 2019 VA rheumatology consultation record noted a nontender cervical spine and limited ROM. Strength testing was normal for the proximal and distal BUE. See VA Medical Records Received August 2020. The Veteran underwent a VA cervical spine examination in August 2020. The examiner diagnosed the Veteran with degenerative arthritis and IVDS. The Veteran was noted as left-handed. The Veteran reported pain in both arms and legs, with pain increased with walking, generalized weakness and incontinence of urine and stool. The Veteran denied any flare-ups. He did report having functional loss due to an inability to stand because his legs gave out approximately 90 percent of the time. He also reported being able to take a few steps with a walker at times. ROM testing revealed forward flexion to 5 degrees and extension to 0 degrees, with pain noted in all ROM tested. The examiner also noted objective evidence of localized tenderness or pain on palpation of the joint moderate in severity, and localized in the diffuse posterior neck. The Veteran was unable to perform repetitive-use testing due to significant pain. The examiner found that repeated-use over time did not result in pain, weakness, fatigability or incoordination that significantly limited functional ability, and further found that repeated use over time did not further reduce ROM. Muscle strength testing revealed active movement against some resistance for bilateral elbow flexion and extension, wrist flexion and extension, and finger flexion and extension. A reflex examination revealed a hypoactive bilateral bicep and triceps. A sensory examination noted that the right shoulder area was absent for sensation to light touch, and decreased for left shoulder, bilateral inner/outer forearm, and bilateral hand/finger. The Veteran’s cervical spine disability was found manifested by favorable ankylosis of the entire cervical spine. The examiner determined that there were no associated neurological abnormalities such as bowel or bladder problems caused by the cervical myelopathy. In addition, the examiner noted that the cervical spine disability was manifested by IVDS that did not require bed rest prescribed by a physician or treatment by a physician in the past 12 months. The examiner also noted RUE radiculopathy manifested by moderate constant pain, severe intermittent pain, mild paresthesias and/or dysesthesias, and mild RUE numbness. The RUE radiculopathy was found to be mild in severity and affected the upper, middle and lower radicular groups. Cervical Spine Disability The cervical spine disability has been rated 30 percent disabling pursuant to 38 C.F.R. § 4.71a, DC 5238. Schedular ratings for disabilities of the spine are provided by application of the General Rating Formula for Diseases or Injuries of the Spine or by application of the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. 38 C.F.R. § 4.71a. The General Formula specifies that the criteria and ratings apply with or without symptoms such as pain, whether or not it radiates, stiffness, or aching in the area affected by residuals of injury or disease. 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases or Injuries of the Spine, the diagnostic code criteria pertinent to cervical spine disabilities provides that a 30 percent rating is warranted when there is forward flexion of the cervical spine 15 degrees or less, or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. Ankylosis is defined, for VA compensation purposes, as a condition in which all or part of the spine is fixed in flexion or extension. 38 C.F.R. § 4.71a, General Rating Formula for Diseases or Injuries of the Spine, Note (5). Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases or Injuries of the Spine, Note (1). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent rating is assigned where there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is assigned where there are incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is assigned where there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is assigned where there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a; Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). Initially, the Board notes that from August 26, 2016 to March 31, 2017, the Veteran was in receipt of a temporary total 100 percent rating based on surgical or other treatment necessitating convalescence. As that rating represents the highest possible rating available, that period is not on appeal. After a review of the evidence of record, the Board finds that throughout the period on appeal, the Veteran’s cervical spine disability has been shown to be manifested by forward flexion limited to, at worst, 5 degrees. See August 2020 VA Examination. In addition, the Veteran’s cervical spine disability has been found manifested by favorable ankylosis of the entire cervical spine. See August 2020 VA Examination. The Board notes that a 30 percent disability rating represents the highest available rating based on limitation of motion under the General Rating Formula for Diseases and Injuries of the Spine. Therefore, based on ROM findings, the Veteran is currently in receipt of the highest rating available throughout the entire period on appeal. The Veteran is further in receipt of the highest rating available for favorable ankylosis of the cervical spine. The Board has considered higher ratings; however, the evidence of record establishes that the Veteran’s cervical spine disability has not been manifested by unfavorable ankylosis. The Board has also considered rating the Veteran’s cervical spine disability under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In this regard, the Board recognizes the September 2016 DBQ which noted that the Veteran had at least 6 weeks of incapacitation episodes over the past 12 months. However, the DBQ was submitted shortly after the Veteran underwent a C3-C4 anterior cervical discectomy and fusion surgical procedure. As additionally noted above, from August 26, 2016 (the date of the Veteran’s second surgical procedure) to March 31, 2017, the Veteran was in receipt of a temporary total 100 percent rating based on surgical or other treatment necessitating convalescence. Therefore, as the September 2016 DBQ documents a period of incapacitation for which the Veteran received temporary benefits, that DBQ is not relevant to this inquiry on appeal. Instead, the Board finds the cumulative September 2012 and August 2020 VA examination reports the most probative evidence of record regarding the manifestations of the Veteran’s IVDS. In this regard, both examination reports documented that the Veteran had not had any episodes of acute signs and symptoms that required bed rest prescribed by a physician or treatment by a physician in the past 12 months. A review of the medical evidence of record outside the period for which the Veteran was in receipt of a temporary total 100 percent rating also does not demonstrate that he had been prescribed bed rest, nor has the Veteran or his representative asserted such. Therefore, based on the evidence of record, a higher 40 or 60 percent evaluation is not warranted based on the rating criteria for IVDS. Accordingly, based on the General Rating Formula for Diseases and Injuries of the Spine, the Board finds that a rating in excess of 30 percent is not warranted. Lastly, the Board has considered separate ratings based on associated neurological disabilities. The Veteran is service connected for left upper extremity (LUE) radiculopathy, and the rating of that disability is not on appeal. The Board also notes that the Veteran is already service connected for erectile dysfunction and a neurogenic bladder condition. The ratings of those disabilities are not on appeal. With regard to impairment of bowel function, although the Veteran self-reported bowel incontinence, following evaluation, the August 2020 VA examiner determined that such was not associated with his cervical spine. In sum, the preponderance of the evidence of record is against a rating in excess of 30 percent throughout the entire period on appeal. The claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). RUE Radiculopathy The Veteran’s RUE radiculopathy has been rated 30 percent disabling pursuant to 38 C.F.R. § 4.124a, DC 8510. Under DC 8510, which evaluates paralysis of the upper radicular group, mild incomplete paralysis of either extremity is rated 20 percent disabling, moderate incomplete paralysis of the affective nerve is rated 40 percent disabling for the major extremity and 30 percent disabling for the minor extremity, severe incomplete paralysis is rated 50 percent disabling for the major extremity and 40 percent disabling for the minor extremity, and complete paralysis of the affected nerve is rated 70 percent disabling for the major extremity and 60 percent disabling for the minor extremity. The rating criteria under DC 8511 (middle radicular group) and 8512 (lower radicular group) mirrors that for DC 8510. Under Diagnostic Code 8513, incomplete paralysis of all radicular groups, mild incomplete paralysis of either extremity is rated 20 percent disabling, moderate incomplete paralysis of the affected nerves is rated 40 percent disabling for the major extremity and 30 percent disabling for the minor extremity, severe incomplete paralysis is rated 70 percent disabling for the major extremity and 60 percent disabling for the minor extremity, and complete paralysis of the affected nerve is rated 90 percent disabling for the major extremity and 80 percent disabling for the minor extremity. 38 C.F.R. § 4.124a. In rating diseases of the peripheral nerves, the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. Words such as “severe,” “moderate,” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. A disability that has its own diagnostic code may not be rated under another diagnostic code. Copeland v. McDonald, 27 Vet. App. 333 (2015). However, radiculopathy does not have its own diagnostic code. All potentially applicable diagnostic codes thus must be considered. The diagnostic code used is fact dependent, and an explained change generally is permissible. Butts v. Brown, 5 Vet. App. 532 (1993); Pernorio v. Derwinski, 2 Vet. App. 625 (1992). DCs 8610 through 8613 and 8710 through 8713 are for neuritis and neuralgia of the radicular group nerve respectively. The same basic rating scheme for paralysis thereof applies to these disabilities. Nevertheless, there are a few special rules as well. The maximum rating for neuritis characterized by organic changes such as loss of reflexes, muscle atrophy, sensory disturbances, and constant pain which is at times excruciating is equal to that for severe incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating for neuritis not characterized by such organic changes is equal to that for moderate incomplete paralysis. Id. Neuralgia, characterized by dull and intermittent pain, is rated as injury of the involved nerve just like neuritis. 38 C.F.R. § 4.124. The maximum rating is equal to that for moderate incomplete paralysis. Id. After a review of the evidence of record, the Board finds that entitlement to a rating in excess of 30 percent disabling is not warranted. Initially, as noted above, an August 2020 rating decision granted entitlement to service connection for LUE radiculopathy and assigned an initial 20 percent evaluation effective September 12, 2016. That rating is currently not on appeal. The evidence shows that the Veteran’s RUE radiculopathy did not more nearly approximate severe incomplete paralysis of the upper, middle or lower radicular groups at any point during the appeal. Specifically, the Board notes that during the September 2012 VA examination, the examiner found the Veteran’s RUE radiculopathy moderate in severity. While the Veteran reported that his cervical spine disability resulted in constant pain, the RUE radiculopathy was not manifested by constant or intermittent pain, paresthesias and/or dysesthesias. The only RUE radiculopathy symptom found present was moderate numbness. With regard to the September 2016 DBQ, as noted above, that was issued shortly after the Veteran underwent his second cervical spine surgery, and the Veteran was awarded a temporary total 100 percent disability rating for this period on appeal. For the above cited reasons, the Board finds that the September 2016 DBQ is not probative to the inquiry on appeal. However, the Board finds it instructive that the physician also found the Veteran’s RUE radiculopathy to be moderate in severity. Additionally, a later November 2019 VA medical record noted normal muscle strength testing for the proximal and distal BUE. Similarly, although the August 2020 VA examination report did reflect sensory examination showing the absence of sensation to light touch affecting the right shoulder area, when considered along with the other RUE symptomatology, the findings did not more nearly approximate the criteria for severe radiculopathy. The Veteran’s RUE radiculopathy did not demonstrate organic changes including loss of reflexes, muscle atrophy, and constant pain that, at times, was excruciating. 38 C.F.R. § 4.123. As noted above, the examiner determined that the RUE radiculopathy manifested by moderate constant pain, severe intermittent pain, mild paresthesias and/or dysesthesias, and mild RUE numbness. The RUE radiculopathy was found to be mild in severity and affected the upper, middle and lower radicular groups. Accordingly, the Board finds that the criteria for a rating in excess of 30 percent for moderate RUE radiculopathy have not been met. The Board has considered all other potentially applicable diagnostic codes, but has found that no other diagnostic code would result in a more favorable rating. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.71a, DC 5243; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Scars The Veteran’s increased rating claim for his residual cervical spine surgical scar stems from a November 2011 claim for a TDIU. In development of that claim, the Veteran underwent a VA examination related to his service-connected cervical spine disability and a November 2012 rating decision granted service connection for residual surgical scar and assigned a non-compensable evaluation effective November 17, 2011; the date of the claim. The Veteran had previously been service-connected for a chin scar. As noted above, a subsequent August 2020 rating decision combined the Veteran’s service-connected status post cervical surgery scar and chin scar under one rating, and assigned a 10 percent rating based on painful scars pursuant to 38 C.F.R. § 4.118, DC 7804, effective August 26, 2016. The August 2020 rating decision additionally granted a separate combined 30 percent evaluation pursuant to 38 C.F.R. § 4.118, DC 7800, effected August 26, 2016, the date of the Veteran’s second cervical spine surgery. The evidence of record includes a September 2012 VA scar examination. The examiner noted a chin scar that measured 3 x 0.2 cm. The scar was not found to be painful or unstable. Additionally, the chin scar was not found to be manifested by elevation, depression, adherence to underlying tissue or missing underlying soft tissue, abnormal pigmentation or texture, or distortion of the facial features and tissue loss for the face or neck. The chin scar was additionally not found to result in any limitation of function or other condition. The examination report also includes photographs documenting scars located on the back of the neck and chin. The Veteran underwent a C3-C4 anterior cervical discectomy and fusion surgery on August 26, 2016. See Private Medical Records Received September 2016 and January 2017. At a April 2019 Board hearing, the Veteran testified that his cervical spine scar was irritating him a lot and was sore, painful and itchy. A May 2019 VA medical record noted a small 2 cm area scar with alopecia located at the left mandibular area. See VA Medical Records Received August 2020. Lastly, the Veteran underwent a VA scar examination in August 2020. The examiner noted two residual cervical surgery scars that caused disfigurement of the posterior neck. The Veteran reported tenderness to the scars. The examiner also noted that one scar was painful, but it was not found to be unstable. One scar measured 5 x 1 cm, and the second measured 3 x 0.2 cm. The scars were not found characteristic of elevation, depression, adherence to underlying tissue, missing underlying soft tissue, surface contour depressed on palpation, adherent ot underlying tissue, missing underlying soft tissue, abnormal pigmentation or texture, or to result in gross distortion or asymmetry of facial features or visible or palpable tissue loss. Skin conditions are rated pursuant to 38 C.F.R. § 4.118. The Board notes that the applicable rating criteria for skin disorders under 38 C.F.R. § 4.118 were amended most recently in August 2018. However, the 2018 revisions did not substantively change the Codes applicable to the Veteran’s scars. Under 38 C.F.R. § 4.118, scars are rated under DC 7800 (scars of the head, face, or neck or other disfigurement of the head, face or neck), 7801 (scars not of the head, face of neck, that are deep and nonlinear), 7802 (scars not of the head, face or neck that are superficial and nonlinear), and 7804 (scars that are unstable or painful). Pursuant to DC 7800, a 10 percent rating is warranted for scars that are located on the head, face, or neck when there is one characteristic of disfigurement. A 30 percent rating is warranted when there is 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, or lips), or; with two or three characteristics of disfigurement. A 50 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features, or; with four or five characteristics of disfigurement. An 80 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features, or; with six or more characteristics of disfigurement. Id. For purposes of evaluation of under 38 C.F.R. § 4.118, the eight characteristics of disfigurement are: a scar that is five or more inches, or thirteen centimeters, in length; a scar that is at least one-quarter of an inch, or 0.6 centimeters, wide at the widest part; surface contour of the scar that is elevated or depressed on palpation; a scar that is adherent to underlying tissue; skin that is hypo- or hyper-pigmented in an area exceeding six square inches, or 39 square centimeters; skin texture that is abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches, or 39 square centimeters; underlying soft tissue that is missing in an area exceeding six square inches, or 39 square centimeters; and skin that is indurated and inflexible in an area exceeding six square inches, or 39 square centimeters. 38 C.F.R. § 4.118, Diagnostic Code 7800, Note 1. Pursuant to DC 7804, a rating of 10 percent is warranted for one or two scars that are unstable or painful, and a 20 percent evaluation is warranted for three or four scars that are unstable or painful. A 30 percent evaluation is warranted for five or six scars that are unstable or painful. 38 C.F.R. § 4.118. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Note (1). If one or more scars are both unstable and painful, an additional 10 percent is added to the rating that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, DC 7800, Note (2). DC 7805 provides for scars to be rated on limitation of function of the affected part. 38 C.F.R. § 4.118, DC 7805. Turning to the period on appeal prior to August 26, 2016, after a review of the evidence of record, the Board finds that an initial 30 percent evaluation is warranted based on two characteristics of disfigurement. This finding is based on the September 2012 VA examination report. Although the VA examiner only provided findings as to the Veteran’s chin scar, as noted above, the examination report also includes photographs of scars located on the back of the neck. A review of those photos shows scars that are elevated as well as with an abnormal skin texture. The scars do not appear to be five or more inches in length, at least one-quarter of an inch, or 0.6 centimeters, wide at the widest part, adherent to underlying tissue; hypo- or hyper-pigmented in an area exceeding six square inches, or 39 square centimeters, underlying soft tissue that is missing in an area exceeding six square inches, or 39 square centimeters, or skin that is indurated and inflexible in an area exceeding six square inches, or 39 square centimeters. At the very least, according to the photographs of the neck and chin scar, the evidence of record does not evidence 4 or more characteristics of disfigurement. Therefore, prior to August 26, 2016, the Board finds that rating the Veteran’s post cervical surgery scar under DC 7800 provides the Veteran with a more beneficial outcome, and an increased 30 percent evaluation is warranted. As the post cervical surgery scar was not manifested by four or more characteristics of disfigurement, a higher 50 percent evaluation is not for application. Additionally, prior to August 26, 2016, the Veteran’s post cervical surgery scar was not shown to be manifested by pain or an unstable scar. Therefore, prior to August 26, 2016, a compensable rating under DC 7804 is not warranted. Turning to the period on appeal as of August 26, 2016, the Board finds that a rating in excess of 30 percent disabling for scars of the chin and cervical spine is not warranted. In this regard, the August 2020 VA examination report does not document any current characteristics of disfigurement. Specifically, the examiner noted that the Veteran’s status post cervical surgery scar was not found characteristic of elevation, depression, adherence to underlying tissue, missing underlying soft tissue, surface contour depressed on palpation, adherent to underlying tissue, missing underlying soft tissue, abnormal pigmentation or texture, or to result in gross distortion or asymmetry of facial features or visible or palpable tissue loss. Even if the Board were to consider the prior finding of scars that were elevated and of abnormal texture, in addition to the current finding of a scar noted as 1 cm wide, the Veteran’s scars have not been shown to be manifested by four or more characteristics of disfigurement. Therefore, a higher 50 percent evaluation is not warranted. With regard to the separate rating for a painful scar under DC 7804, a review of the August 2020 VA examination shows that only one scar was found painful. None of the scars were found to be unstable. Therefore, as the Veteran does not have three or four scars that are painful, or a scar that is both painful and unstable, a rating in excess of 10 percent disabling under DC 7804 is not warranted. Lastly, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). (Continued on the next page)   In sum, the Board finds that an initial 30 percent rating, but no higher, is warranted under DC 7800, prior to August 26, 2016. That claim is granted. As of August 26, 2016, the Board finds that the preponderance of the evidence is against a rating in excess of 30 percent under DC 7800, or in excess of 10 percent under DC 7804. Those claims are denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.130; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lamb, 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.