Citation Nr: 21064801 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-40 452 DATE: October 21, 2021 ORDER For the entirety of the appeal period, an initial 10 percent rating, but no higher, for the service-connected residual thyroidectomy scar is granted. For the entirety of the appeal period, a separate initial rating of 30 percent, but no higher, for difficulty swallowing, as a disabling effect from residual thyroidectomy scar, is granted. FINDINGS OF FACT 1. For the entirety of the appeal period, the Veteran's residual thyroidectomy scar has been adherent to underlying tissue. 2. For the entirety of the appeal period, the Veteran has experienced difficulty swallowing as a disabling effect from her residual thyroidectomy scar. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for an initial 10 percent rating, but no higher, for service-connected residual thyroidectomy scar are met. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.118, Diagnostic Code (DC) 7800. 2. For the entire appeal period, the criteria for an initial 30 percent rating, but no higher, for difficulty swallowing, as a disabling effect of the service-connected residual thyroidectomy scar, have been met. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.118, Diagnostic Code (DC) 7805-7203. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1995 to February 1999. In February 2020, the Board of Veterans' Appeals (Board) remanded the current claim, along with claims for service connection for migraine headaches and gastroesophageal reflux disorder (GERD) for further evidentiary development. In October 2020, the Agency of Original Jurisdiction (AOJ) granted service connection for migraine headaches and GERD. As the Veteran has not yet filed a NOD contesting either the effective date or the level of compensation assigned following the grant of service connection, these issues are not part of the current appeal. Grantham v. Brown, 111 F.3d 1156 (Fed. Cir. 1997). In July 2021, the AOJ assigned a 10 percent rating for the Veteran's residual thyroidectomy scar from June 25, 2014. Because the maximum benefit was not granted now or during the pendency of the appeal period, the issue of entitlement to a higher evaluation remains on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). Entitlement to an initial compensable rating prior to June 25, 2014 and an initial rating greater than 10 percent from June 25, 2014 for the service-connected residual thyroidectomy scar The Veteran seeks a higher rating for her residual thyroidectomy scar. Currently, this scar is evaluated under Diagnostic Code 7800. This Diagnostic Code pertains to burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. Note (1) to Diagnostic Code 7800 provides the 8 characteristics of disfigurement, for purposes of rating under 38 C.F.R. § 4.118, are: Scar is 5 or more inches (13 or more cm.) in length; Scar is at least one-quarter inch (0.6 cm.) wide at the widest part; Surface contour of scar is elevated or depressed on palpation; Scar is adherent to underlying tissue; Skin is hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); Skin texture is abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); Underlying soft tissue is missing in an area exceeding six square inches (39 sq. cm.); Skin is indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Diagnostic Code 7800 provides that a skin disorder with one characteristic of disfigurement of the head, face, or neck is rated 10 percent disabling. A skin disorder of the head, face, or neck 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 with two or three characteristics of disfigurement, is rated 30 percent disabling. A skin disorder of the head, face, or neck 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 with four or five characteristics of disfigurement, is rated 50 percent disabling. A skin disorder of the head, face, or neck 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 with six or more characteristics of disfigurement, is rated 80 percent disabling. Turning now to the pertinent evidence of the record, the Board notes that, at the August 2013 VA Examination, the Veteran had a scar related to the treatment of her thyroid condition. It was stated that the scar was not adherent to any underlying tissue and was not painful or unstable. In November 2013, the Veteran indicated that her scar indeed was adherent to underlying tissue and that she was not asked about that at the August 2013 VA Examination. She felt uncomfortable every time she swallowed when eating or drinking because of her scar. See November 2013 Notice of Disagreement (NOD). At the June 2014 VA Examination, the Veteran stated that her scar moved with swallowing and talking. She explained that the scar caused her voice level to drop and difficulty during singing. On examination, the scar was painful and linear and adhered to the underlying tissue. At the May 2020 VA Examination, the Veteran reported that the size and shape of the scar did not change since the last examination. She reported that the scar moved up and down when she swallowed. She also explained that occasionally small bits of suture material would come up through the scar to the surface of her skin. The scar became red when it happened. The scar was not painful but was adherent to underlying tissue. There was limitation of function, which was described as some discomfort with swallowing. During the pendency of this appeal, the criteria for rating skin and scar disabilities were revised, effective August 13, 2018. The August 13, 2018 skin amendments revised Diagnostic Codes 7801 and 7802. See 38 C.F.R. § 4.118(b) (August 13, 2018). However, the August 13, 2018 skin amendments presented no changes to the rating criteria for Diagnostic Codes 7800, 7804, and 7805. These codes are exactly same both prior to, and after, August 13, 2018. Because Diagnostic Codes 7801 and 7802 evaluates scars other than the head, face, or neck, their amendments are not applicable in this determination. After a thorough consideration of the evidence of the record, the Board finds that, for the entirety of the appeal period (prior to, and following, June 25, 2014), the Veteran's residual thyroidectomy scar was adherent to underlying scar tissue, which warrants a 10 percent rating under Diagnostic Code 7800. The Veteran has continuously asserted that the scar was adherent and moved when swallowing. The Board finds her assertions to be credible. A higher rating under Diagnostic Code 7800 is not warranted because she does not have any other disfigurements or gross distortion or asymmetry. With regard to the Veteran's additional complaints, the Board notes that Diagnostic Code 6515 evaluates chronic laryngitis. A 10 percent rating for chronic laryngitis manifested by hoarseness with inflammation of cords or mucous membrane. A 30 percent rating is warranted for chronic laryngitis with hoarseness with thickening of nodules of cords, polyps, submucous, infiltration, or pre-malignant changes on biopsy. Also, Diagnostic Code 7203 evaluates stricture of the esophagus. Under the rating criteria, a 30 percent rating is assigned for moderate stricture of the esophagus. Severe symptoms, specifically described as permitting liquids only, is assigned a 50 percent rating. An 80 percent rating is granted when stricture of the esophagus permits passage of liquids only with marked impairment of general health. 38 C.F.R. § 4.114, Diagnostic Code 7203. The Board has considered which of these diagnostic codes more nearly contemplates the Veteran's symptoms. It appears that the predominant symptom she experiences is difficulty swallowing. Thus, Diagnostic Code 7203 more closely contemplates difficulty swallowing and any other symptoms related to the throat. The Board finds that the Veteran's reported symptoms of difficulty swallowing while eating and drinking and difficulties involving voice dropping and difficulty singing are most analogous to an individual with a moderate stricture of the esophagus. A 30 percent rating under Diagnostic 7203 is warranted in this matter. The Veteran's symptoms do not appear to be so severe as to preclude eating solid foods, and a higher evaluation is not warranted under this Diagnostic Code. In reaching this decision, the Board acknowledges that the Veteran is also service connected for GERD. This disability does not result in stricture of the esophagus or symptoms of difficulty swallowing. Thus, assigning a separate rating for difficulty swallowing as a result of her residual thyroidectomy scar does not result in impermissible pyramiding. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board further notes that there is another scar located over the superior to the proximal right clavicle area, secondary to thyroid surgical site. See June 2014 VA Examination Report (receipt date noted as January 2015 in claims file). It was described as linear and superficial with no underlying tissue damage. However, on the diagnosis prompt of the examination report, only one scar was noted (the scar subject to this current appeal). The May 2020 Examination did not note another scar. Further, the Veteran has not expressed experiencing any symptoms from another scar. Therefore, based on this evidence, the Board determines that an additional scar is not present. In summation, for the entirety of the appeal period, the Veteran is entitled to a 10 percent rating under Diagnostic code 7800 for her service-connected residual thyroidectomy scaras well as a separate 30 percent rating under hyphenated code (CONTINUED ON NEXT PAGE) 7805-7203 for her difficulty swallowing, as a disabling effect from the service-connected residual thyroidectomy scar. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Middleton, 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.