Citation Nr: 21072076 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 16-48 490 DATE: December 2, 2021 ORDER Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with major depressive disorder for the period prior to February 16, 2021 is denied. Entitlement to a rating in excess of 70 percent for PTSD with major depressive disorder for the period since February 16, 2021 is denied. Entitlement to a rating in excess of 30 percent for service-connected painful scars of the right anterior thigh and left anterior elbow and forearm is denied. Entitlement to an initial compensable rating for nonpainful scars of the right anterior thigh and left anterior elbow and forearm is denied. Entitlement to a rating in excess of 20 percent for the residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion (Muscle Group XV) is denied. Entitlement to a rating in excess of 10 percent for the service-connected residuals of grenade shrapnel wound to the left elbow muscle impairment (Muscle Group V) is denied. Entitlement to an initial rating in excess of 10 percent for residuals of grenade shrapnel wound of the left forearm muscle affecting the flexion of wrist and fingers (Muscle Group VII) is denied. FINDINGS OF FACT 1. For the period prior to February 16, 2021, the Veteran's PTSD with major depressive disorder was manifested by symptoms consistent with occupational and social impairment with reduced reliability and productivity; neither occupational and social impairment with deficiencies in most areas nor total occupational and social impairment was shown. 2. For the period since February 16, 2021, the Veteran's PTSD has not resulted in total occupational and social impairment due to gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living; disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. 3. The Veteran's painful scars of the right anterior thigh and left anterior elbow and forearm is evaluated at 30 percent, the maximum schedular rating available under Diagnostic Code 7804 for five or more scars that are unstable or painful. 4. The Veteran's nonpainful scars of the right anterior thigh and left anterior elbow and forearm are not painful, are superficial, collectively measure less than 144 sq. in. (929 sq. cm.), and do not limit function. 5. The Veteran's residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion (Muscle Group XV) are productive of no more than a moderately severe muscle injury. 6. The Veteran's residuals of grenade shrapnel wound to the left elbow muscle impairment (Muscle Group V) are productive of no more than a moderate muscle injury. 7. The Veteran's residuals of grenade shrapnel wound of the left forearm muscle affecting the flexion of wrist and fingers (Muscle Group VII) are productive of no more than a moderate muscle injury. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 50 percent for PTSD with major depressive disorder for the period prior to February 16, 2021 are not met. 38 U.S.C. § 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (2020). 2. The criteria for entitlement to a disability rating in excess of 70 percent for PTSD with major depressive disorder for the period since February 16, 2021 are not met. 38 U.S.C. § 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (2020). 3. The criteria for a rating in excess of 30 percent for painful scars of the right anterior thigh and left anterior elbow and forearm anterior trunk have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.118 Diagnostic Code 7804 (2020). 4. The criteria for an initial compensable disability rating for nonpainful scars of the right anterior thigh and left anterior elbow and forearm anterior trunk have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.118 Diagnostic Code 7802 (2020). 5. The criteria for a rating in excess of 20 percent for residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion (Muscle Group XV) have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.10, 4.14, 4.40, 4.45, 4.56, 4.59, 4.73, Diagnostic Code 5315 (2020). 6. The criteria for a rating in excess of 10 percent for residuals of grenade shrapnel wound to the left elbow muscle impairment (Muscle Group V) have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.10, 4.14, 4.40, 4.45, 4.56, 4.59, 4.73, Diagnostic Code 5305 (2020). 7. The criteria for a rating in excess of 10 percent for residuals of grenade shrapnel wound of the left forearm muscle affecting the flexion of wrist and fingers (Muscle Group VII) have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.10, 4.14, 4.40, 4.45, 4.56, 4.59, 4.73, Diagnostic Code 5305 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army on active service from September 1966 to September 1968. Service records show he served in Vietnam from October 1967 to September 1968, and was wounded while on active duty. He was awarded the Combat Infantryman Badge and the Purple Heart medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran withdrew his request for a hearing before the Board of Veterans Appeals (Board) in August 2017. 38 C.F.R. § 20.704 (e). In December 2018, this claim was remanded for additional development. In an August 2020 rating decision, the agency of original jurisdiction (AOJ) granted a 60 percent evaluation for service-connected peptic ulcer disease. This is the highest evaluation afforded for peptic ulcer disease under the criteria. The issue is thus considered fully granted and is no longer on appeal. In an August 2020 rating decision, the AOJ restored the separate compensable evaluation for residuals of grenade shrapnel residuals, left forearm muscle (Muscle Group V, Code 5305) impairment, 10 percent effective May 8, 2007 and granted separate service connection for left forearm muscle (Muscle Group VII, Code 5307) impairment, assigning a 10 percent evaluation effective May 13, 2013. As these issues are part and parcel of the service-connected grenade shrapnel wound residuals, and higher evaluations are available, these issues remain on appeal. AB v. Brown, 6 Vet. App. 35 (1993). In June 2021, the Board remanded these issues for additional development. In a September 2021 rating decision, the RO granted a 70 percent disability rating for PTSD, effective February 16, 2021. The Board notes that the increase from 50 to 70 percent for the PTSD disability did not constitute a full grant of the benefits sought. Accordingly, the issue of entitlement to a rating in excess of 70 percent for PTSD for the period since February 16, 2021 remains in appellate status. AB v. Brown, 6 Vet. App. 35, 39 (1993). The September 2021 rating decision also granted service connection for left upper extremity peripheral neuropathy at an initial 20 percent evaluation and for right lower extremity peripheral neuropathy with a noncompensable evaluation. The Veteran has not expressed disagreement with these evaluations and they are not currently before the Board. Increased Ratings Laws and Regulations The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case, the claims are denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2020). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2020). The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2020). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2020). The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his PTSD, scar and shrapnel wound disabilities. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities. His statements have been consistent with the medical evidence of record and are probative for resolving the matters on appeal. The Board will consider not only the criteria of the currently assigned diagnostic codes, but also the criteria of other potentially applicable diagnostic codes. PTSD The Veteran has a current 50 percent disability rating for the period from September 7, 2012 to February 15, 2021 and a 70 percent disability rating for the period since February 16, 2021 for his PTSD under Diagnostic Code 9411. The Board notes that psychiatric disabilities other than eating disorders are rated pursuant to the criteria for General Rating Formula. See 38 C.F.R. § 4.130. Under the general rating formula for mental disorders, a noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent evaluation is warranted if there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A rating of 30 percent is assigned when the Veteran exhibits occupational and social impairment with occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating requires occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affected the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. A 100 percent rating is assigned when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The evidence considered in determining the level of impairment for psychiatric disorders under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the rating code. Disability ratings are assigned according to the manifestation of particular symptoms, but the use of the term "such as" in the General Rating Formula demonstrates that the symptoms after the phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Accordingly, the evidence considered in determining the level of impairment from psychiatric disorder under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in Diagnostic Code 9411. See Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436 (2002). When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (2020). One factor for consideration is the Global Assessment of Functioning (GAF) score, which is a scale reflecting the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (citing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)). According to the DSM-IV, GAF scores ranging between 61 to 70 reflect some mild symptoms [e.g., depressed mood and mild insomnia] or some difficulty in social, occupational, or school functioning [e.g., occasional truancy, or theft within the household], but generally functioning pretty well, and has some meaningful interpersonal relationships. GAF scores ranging from 51 to 60 reflect more moderate symptoms [e.g., flat affect and circumstantial speech, occasional panic attacks] or moderate difficulty in social, occupational, or school functioning [e.g., few friends, conflicts with peers or co- workers]. Scores ranging from 41 to 50 reflect serious symptoms [e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting] or any serious impairment in social, occupational or school functioning [e.g., no friends, unable to keep a job]. Scores ranging from 31 to 40 reflect some impairment in reality testing or communication [e.g., speech is at times illogical, obscure, or irrelevant] or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood [e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up other children, is defiant at home, and is failing at school]. VA has changed its regulations, and now requires use of DSM-5 effective August 4, 2014. Among the changes, DSM-5 eliminates the use of the GAF score in evaluation of psychiatric disorders. The change was made applicable to cases certified to the Board on or after August 4, 2014; and is not applicable to cases certified to the Board prior to that date. 79 Fed. Reg. 45093 (Aug. 4, 2014). Factual Background and Analysis The Veteran filed a claim for an increased rating that was received by VA on May 15, 2013. The Veteran underwent a VA examination in January 2013. The examiner summarized the Veteran's level of occupational and social impairment with regards to all mental diagnoses as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The Veteran had been married 4 times and his current marriage, which began 2006, "had its ups and downs". He had 3 children with his second wife and he was "somewhat" close with these children. He currently worked as a bailiff in the county courthouse and attended church and family activities with his wife and family. He denied homicidal or violent behaviors. The Veteran's symptoms included suspiciousness and flattened affect. The Veteran also reported that he had nightmares and flashbacks at times. He was competent to manage his financial affairs. The examiner noted that the Veteran did not pose a threat of danger or injury to himself or others. The Veteran underwent a VA examination in March 2014. The examiner summarized the Veteran's level of occupational and social impairment with regards to all mental diagnoses as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. It was noted that the Veteran remained fairly close with his 3 siblings. He was on his fourth marriage which he described as "good". He also had a good relationship with his 3 children from a previous marriage. He relied on friends and coworkers for support and attended church regularly. He had worked as a court bailiff for the past 5 years and reported some problems with getting along with others. He reported having nightmares and intrusive thoughts. His symptoms included anxiety, chronic sleep impairment and disturbances of motivation and mood. He was competent to manage his financial affairs. The examiner noted that the Veteran did not pose a threat of danger or injury to himself or others. The Veteran underwent a VA examination in October 2019. The examiner summarized the Veteran's level of occupational and social impairment with regards to all mental diagnoses as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The Veteran had been married to his fourth wife for 14 years and lived with her and his adult son. While he related well with his spouse, he would become irritated with her and raise his voice at her. He no longer went deer hunting and also had problems looking at the television due to flashbacks. He had an out of town friend and work associates amongst his friendships. He attended church and would occasionally do yard work and shopping. He did not go to movies or restaurants as he did not like crowds. His symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships. On examination he was oriented and appropriately dressed. He exhibited no cognitive deficits but his affect was restricted and tearful when discussing trauma related content. The examiner did not believe that the Veteran was considered a current or imminent risk. The examiner noted that the Veteran did not demonstrate problems with attention and concentration and that his ability to adhere to a full-time work schedule appeared intact. The Veteran underwent a VA examination in February 2021. The Veteran reported that he only slept 2 to 4 hours a night and his fourth marriage was faltering due to irritability. He had occasional blow ups at work which resulted in occupational problems. The examiner summarized the Veteran's level of occupational and social impairment with regards to all mental diagnoses as occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood. He currently lived with his fourth wife but they began talking about divorce. His adult son was no longer in the household. Since his last examination, he had not added friends to his circle. He seldom left his home because he felt overwhelmed with anxiety. He often self-isolated in his "man cave" where he allowed himself to relax. He continued to work as a bailiff where he reported that he sometimes had problems with the public because of being short-tempered. He occasionally missed work when he was going through a bad period. His symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, an inability to establish and maintain effective relationships and impaired impulse control. On examination he was neatly dressed, groomed and oriented times 4 with some irritability. His movements were slow but fluid and his speech was normal with linear thought process. His mood was dysthymic and his affect was tearful. He denied suicidal ideation, homicidal ideation or delusions. His recent memory, concentration and attention were mildly impaired. The examiner noted that the Veteran had hypervigilance, depressed mood, intense startle and irritability. He no longer enjoyed his primary past times. He had impaired impulse control such as unprovoked irritability with periods of violence. Period prior to February 16, 2021 After reviewing evidence of record as a whole, the Board finds that the assignment of a disability rating greater than 50 percent for the Veteran's service-connected PTSD for the period prior to February 16, 2021 is not warranted. In this regard, the evidentiary record was negative for speech that was intermittently illogical, obscure or irrelevant; spacial disorientation; or near-continuous panic or depression affecting his ability to function independently. Moreover, the rating criteria for a 70 percent evaluation require that a claimant be unable to establish or maintain social relationships. While the Veteran reported having issues related to his interpersonal relationships, his social impairment more closely contemplates the currently assigned 50 percent evaluation for this time period. Notably, the Veteran had difficulty in establishing and maintaining effective work and social relationships as he had difficulty interacting with others. However, the Veteran on VA examination in October 2019 reported that while he got irritated with his wife, he had a good relationship with her. Moreover, the rating criteria for a 70 percent evaluation require that a claimant be unable to establish or maintain social relationships. The Veteran's social impairment during this period more closely contemplates a 50 percent evaluation as he again with continued to be married to his wife, lived with his wife and 1 child and had friends and work associates. The Veteran's thinking had also consistently been found to be intact and unimpaired and there was no evidence of delusions or impaired thought processes. There was also no evidence of paranoia or suicidal or homicidal ideation. As noted above, the Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, disturbances of mood and motivation and difficulty in establishing and maintaining effective work and social relationships. However, while the Board accepts that the Veteran's PTSD had effects on his functioning, the lay and medical evidence of record does not demonstrate significant deficiencies in most areas for this time period. Indeed, at no point in this time period did the VA examiner or any other examiner or treating physician find that the Veteran's mood disorder caused occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, as is required for the assignment of a 70 percent rating; or cause total occupational and social impairment, as is required for the assignment of a 100 percent rating. In fact, the notes that the January 2013, March 2014 and October 2019 VA examiners also specifically described the Veteran's symptoms as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication, which fits squarely for the criteria for a 10 percent evaluation under the General Rating Formula. Despite the fact that this description actually corresponds squarely with a lesser disability rating, the Board will still assign the current 50 percent disability rating for PTSD. However, a rating in excess of 50 percent is clearly not available based on these findings. Thus, while the record demonstrates that the Veteran did have some social and occupational impairment which impacted his quality of life, the greater weight of evidence demonstrates that it is to a degree less that is contemplated by the 50 percent rating currently assigned. Furthermore, even resolving any reasonable doubt in the Veteran's favor, the Board finds that he does not meet the requirements for an evaluation greater than the current 50 percent schedular rating. While the Veteran had some of the criteria for a 70 percent rating, see Mauerhan, 16 Vet. App. at 442, the Board concludes his overall level of disability does not exceed a 50 percent rating. Again, in determining that a rating in excess of 50 percent is not warranted, the Board has considered the Veteran's complaints regardless of whether they are listed in the rating criteria, but concludes that the Veteran's level of social and occupational impairment does not warrant a rating in excess of a 50 percent rating. Accordingly, this evidence demonstrates that the Veteran did not have deficiencies in most of the areas in the criteria for a 70 percent rating nor had he been shown to have most of the symptoms listed as examples in the criteria. As the criteria for the next higher (70 percent) rating for a psychiatric disorder have not been met, it logically follows that criteria for an even higher rating (100 percent) have not been met. There is no showing that the Veteran had gross impairment of thought processes or communication, persistent delusions, exhibited grossly inappropriate behavior; intermittent inability to perform activities of daily living as a result of his psychiatric symptoms, or disorientation to time or place. As discussed, the evidence also weighs strongly against finding that his disability was manifested by total social impairment as the Veteran had been able to maintain a relationship with his wife. Thus, the Board finds that the preponderance of the evidence is against the claim as the Veteran's symptoms more closely approximated the criteria for a 50 percent disability rating, and neither a 70 or 100 percent rating. For all the foregoing reasons, the Veteran's claim for entitlement to a rating in excess of 50 percent for service-connected PTSD with depressive disorder for the period prior to February 16, 2021 must be denied. Period Since February 16, 2021 A after reviewing evidence of record as a whole, the Board finds that the assignment of a disability rating greater than 70 percent for the Veteran's PTSD is not warranted for the period since February 16, 2021. In not granting a 100 percent schedular rating for the Veteran's service-connected PTSD, the Board is not minimizing the severity of the Veteran's symptoms. The Board notes that the evidence demonstrates that the Veteran experienced significant social impairment as a result of his PTSD as he is socially withdrawn. Also, while treatment records demonstrate that the Veteran experienced significant occupational and social impairment, the Board again notes that the maximum rating of 100 percent requires total occupational and social impairment. Significantly, at no point did any VA examiner or treating physician find that the Veteran's PTSD caused total occupational and social impairment, as is required for the assignment of a 100 percent rating. As noted above, the maximum rating of 100 percent requires total occupational and social impairment. The VA treatment records and the February 2021 VA examination show no gross impairment in thought processes or communication, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, or memory loss for names of own relatives, own occupation, or own name. Additionally, there were no reports of suicidal or homicidal ideation or delusions. The February 2021 VA examiner also specifically described social and occupational impairment as occupational and social impairment with deficiencies in most areas which corresponds squarely with the schedular requirements for the assignment of a 70 percent disability rating for PTSD under the General Rating Formula. Accordingly, in this case, the overall evidence of record does not reflect that the Veteran's symptomatology is so severe as to merit a 100 disability rating for the period since February 16, 2021. Thus, for all the foregoing reasons, the Board finds that a rating in excess of 70 percent for PTSD for the period since February 16, 2021 is not warranted. Scars Laws and Regulations The Veteran has a current 30 percent disability rating under Diagnostic Code 7804 for painful scars of the right anterior thigh and left anterior elbow and forearm and an initial noncompensable evaluation for nonpainful scars of the right anterior thigh and left anterior elbow and forearm, under Diagnostic Code 7802. 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. 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. 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). 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. Factual Background and Analysis The Veteran filed a claim for an increased rating that was received by VA on May 15, 2013. The Veteran underwent a VA examination in February 2014. The Veteran had scars on the right anterior thigh status post gunshot wound and scars of the left anterior elbow and forearm status post gunshot wound. The Veteran had 5 or more painful scars of the trunk or extremities. The scar on his left arm was more painful than the others and when trying to lift something, the radial scar tissue pulled the scar upwards. The scar on his right leg was also painful and tender. None of the scars were unstable with frequent loss of covering of skin over the scar. No scars were both painful and unstable. The left upper extremity had 3 scars that were superficial non-linear scars. Scar number 1 was 9 x 1.5cm, scar number 2 was 2 x 1cm and scar number 3 was 2.5 x 1cm. The right lower extremity had 3 scars that were superficial non-linear scars. Scar number 1 was 6 x 1.5cm, scar number 2 was 2 x 1.5 cm and scar number 3 was 3.5 x 1.5 cm. The total area of the left upper extremity scars was 18cm squared and the total area of the right lower extremity scars was 17.25cm squared. None of the scars resulted in limitation of function. The examiner noted that upon flexing the left arm, the antecubital scar was noted to be pulled deeper into the arm/muscle substance of the nearby biceps. The Veteran's cars did not impact his ability to work. The Veteran underwent a VA examination in November 2019. He had a shrapnel injury to his right thigh and a shrapnel injury to his left arm. The Veteran reported intermittent pain in both the right thigh and left arm as often as 1 time per day lasting for 14 of an hour to an hour. The Veteran also reported tenderness of the scar of the left arm and a pulling sensation in the region when his arm is stretched out. He reported having loss of strength, weakness and pain. None of the scars were unstable with frequent loss of covering of skin over the scar. No scars were both painful and unstable. The left upper extremity had 3 scars that were superficial non-linear scars. Scar number 1 was 9 x 0.2cm, scar number 2.6 was 2 x 0.2cm and scar number 3 was 1.5 x 0.2cm. Scar number 1 had underlying soft tissue damage. The right lower extremity had 3 scars that were superficial non-linear scars. Scar number 1 was 5 x 1cm, scar number 2 was 2 x 1cm and scar number 3 was 2.4 x 1cm. The total area of the scars without underlying tissue damage for the left upper extremity was 0.82 cm squared and the total area of the right lower extremity scars without underlying tissue damage was 9.4cm squared. The total area of the scars with underlying tissue damage for the left upper extremity was 1.8 cm squared. None of the scars resulted in limitation of function. The examiner noted that the scar above the antecubital fossa was adherent to the biceps tendon so that when the Veteran flexed his arm it drew the central area of the scar proximally. He still had full range of motion of the arm and elbow. The Veteran's scars did not impact his ability to work and the scars in and of themselves did not contribute to any impairment. The Veteran underwent a VA examination in December 2020. It was noted that the Veteran had painful scars of the right anterior thigh and left anterior elbow/forearm. For the left upper extremity, scar number 1 was healed and painful while scars 2 and 3 were healed and stable. For the right upper extremity, scar number 1 was healed and painful while scars 2 and 3 were healed and stable. The left elbow painful scar was an 8/10 with sharp, pulling pain while the lower right extremity painful scar felt like pins and needles. None of the scars were unstable with frequent loss of covering of skin over the scar. The left upper extremity had 3 scars that were superficial non-linear scars. Scar number 1 was 9.5 x 1.5cm, scar number 2 was 2 x 0.2cm and scar number 3 was 2.5 x 0.3cm. Scar number 1 was tender to palpitation. The right lower extremity had 3 scars that were superficial non-linear scars. Scar number 1 was 7 x 0.7cm, scar number 2 was 2 x 1cm and scar number 3 was 3.5 x 1cm. Scar number 1 was tender to palpitation. The total area of the scars without underlying tissue damage for the left upper extremity was 15.4 cm squared and the total area of the right lower extremity scars without underlying tissue damage was 9.7cm squared. None of the scars resulted in limitation of function and none impacted his ability to work. The examiner indicated that pain was noted on palpation of the scars of the left anterior forearm/elbow region and right anterior thigh. Painful Scars As noted above, the Veteran currently has a 30 percent evaluation for painful scars of the right anterior thigh and left anterior elbow/forearm under Diagnostic Code 7804. Based on the evidence, the Board does not find that the Veteran is entitled to a rating in excess of 30 percent for painful scars of the right anterior thigh and left anterior elbow and forearm. Notably, the Veteran is currently in receipt of the maximum 30 percent rating for unstable scars under Diagnostic Code 7804 as under both the old and new rating criteria, a maximum 30 percent rating is warranted for five or more scars that are unstable or painful. The Board notes that potentially, a finding separate ratings for each individual scar under the old criteria could be more advantageous to the Veteran as separate 10 percent ratings could possibly warranted for superficial and painful scars. However, the VA examiners each indicated that only 2 of the scars were painful which would warrant separate 10 percent evaluations. As a result, the Board finds that the current 30 percent evaluation under Diagnostic Code 7804 for five or more scars that are unstable or painful is the most advantageous evaluation for the Veteran. The Board additionally notes that Diagnostic Code 7805 is not applicable to any of the scar disabilities as the scars do not cause limitation of function. The Board also notes that Diagnostic Code 7800 is not applicable as it relates specifically to scars of the head, face, or neck. Therefore, a rating in excess of 30 percent for painful scars of the right anterior thigh and left anterior elbow and forearm under Diagnostic Code 7804 is not warranted, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Nonpainful scars As noted above, the Veteran currently has an initial noncompensable evaluation for nonpainful scars of the right anterior thigh and left anterior elbow and forearm under Diagnostic Code 7802. Based on the evidence, the Board does not find that the Veteran is entitled to an initial compensable rating for nonpainful scars of the right anterior thigh and left anterior elbow and forearm. Notably, under both the old and revised versions of Diagnostic Code 7802, a 10 percent rating is warranted for scars that have an area or areas of 144 square inches (929 sq. cm.) or greater. The evidence demonstrates that the nonpainful scars of the right anterior thigh and left anterior elbow and forearm do not have an area or areas of 144 square inches (929 sq. cm.) or greater. Moreover, a compensable rating is not warranted under the old rating criteria of Diagnostic Code 7803 pertaining to superficial and unstable scars as the scars were not reported as unstable. Further, a compensable rating is not warranted under the old and new rating criteria of Diagnostic Code 7801 as the scars were not reported as deep and nonlinear, or cause limited motion. Additionally, as the scars were not reported as painful or unstable, a compensable 10 percent rating is not warranted under Diagnostic Code 7804. The Board notes that Diagnostic Code 7805 is not applicable to any of the scar disabilities as the scars do not cause limitation of function. The Board also notes that Diagnostic Code 7800 is not applicable as it relates specifically to scars of the head, face, or neck. Therefore, an initial compensable rating for nonpainful scars of the right anterior thigh and left anterior elbow and forearm under Diagnostic Code 7802 is not warranted, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Shrapnel Wounds The Veteran currently has a 20 percent rating for the residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion under Muscle Group V, Diagnostic Code 5315, a 10 percent rating for residuals of grenade shrapnel residuals, left forearm muscle under Muscle Group V, Diagnostic Code 5305 and a 10 percent rating for left forearm muscle under Muscle Group VII, Diagnostic Code 5307. Diagnostic Code 5305 pertains to Muscle Group V regarding the flexor muscles of the elbow including the biceps, brachialis, and brachioradialis. The functions of these muscles include elbow supination (long head of biceps is stabilizer of shoulder joint) and flexion of elbow. Under Diagnostic Code 5305, a zero percent evaluation is provided for slight muscle disability of either the dominant or non-dominant side of the body. A 10 percent rating requires moderate disability of the minor and major arm. A 20 percent rating and a 30 percent rating are assigned for the minor and major arm, respectively, if impairment of this muscle group is moderately severe. A 30 percent rating and a 40 percent rating are assigned for the minor and major arm, respectively, if impairment of this muscle group is severe. Diagnostic Code 5307 pertains to Muscle Group VII regarding the muscles arising from internal condyle of humerus, flexors of the carpus and long flexors of fingers and thumb, and pronator. The functions of these muscles include flexion of wrist and fingers. Under Diagnostic Code 5307, a zero percent evaluation is provided for slight muscle disability of either the dominant or non-dominant side of the body. A 10 percent rating requires moderate disability of the minor and major arm. A 20 percent rating and a 30 percent rating are assigned for the minor and major arm, respectively, if impairment of this muscle group is moderately severe. A 30 percent rating and a 40 percent rating are assigned for the minor and major arm, respectively, if impairment of this muscle group is severe. Diagnostic Code 5315 provides evaluations for a disability of Muscle Group XV. This muscle group includes the adductor longus, adductor brevis, adductor magnus, and gracilis. The functions of these muscles are adduction of hip, flexion of hip, and flexion of knee. Under Diagnostic Code 5315, a moderate injury warrants a 10 percent rating, a moderately severe injury warrants a 20 percent rating, and a severe injury warrants a 30 percent rating. 38C.F.R. §4.73, Diagnostic Code 5315. Disabilities resulting from muscle injuries are classified as slight, moderate, moderately severe, or severe. 38 C.F.R. § 4.56 (d). The United States Court of Appeals for Veterans' Claims (Court), citing Robertson v. Brown, 5 Vet. App. 70 (1993), has held that 38 C.F.R. § 4.56 (d) is essentially a totality-of-the-circumstances test and that no single factor is per se controlling. Tropf v. Nicholson, 20 Vet. App. 317 (2006). Factors to be considered in evaluating disabilities residual to healed wounds involving muscle groups are set forth in 38 C.F.R. §§§ 4.55 and 4.56. A through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. (a) An open comminuted fracture with muscle or tendon damage will be rated as a severe injury of the muscle group involved unless, for locations such as in the wrist or over the tibia, evidence establishes that the muscle damage is minimal. (b) A through-and-through injury with muscle damage shall be rated as no less than a moderate injury for each group of muscles damaged. (c) For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement. (d) Under Diagnostic Codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe or severe as follows: (1) Slight disability of muscles-(i) Type of injury. Simple wound of muscle without debridement or infection. (ii) History and complaint. Service department record of superficial wound with brief treatment and return to duty. Healing with good functional results. No cardinal signs or symptoms of muscle disability as defined in paragraph (c) of this section. (iii) Objective findings. Minimal scar. No evidence of fascial defect, atrophy, or impaired tonus. No impairment of function or metallic fragments retained in muscle tissue. (2) Moderate disability of muscles--(i) Type of injury. Through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. (ii) History and complaint. Service department record or other evidence of in-service treatment for the wound. Record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. (iii) Objective findings. Entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue. Some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. (3) Moderately severe disability of muscles--(i) Type of injury. Through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Entrance and (if present) exit scars indicating track of missile through one or more muscle groups. Indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. (4) Severe disability of muscles--(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability: (A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile. (B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle. (C) Diminished muscle excitability to pulsed electrical current in electrodiagnostic tests. (D) Visible or measurable atrophy. (E) Adaptive contraction of an opposing group of muscles. (F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle. (G) Induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56. Factual Background and Analysis The Veteran underwent a VA examination in March 2014. The Veteran had a right anterior thigh muscle injury from residuals of a gunshot wound and a left anterior elbow and forearm injury from residuals of a gunshot wound. He had penetrating and non-penetrating muscle injuries. The Veteran reported that the nerves in his right leg were sensitive and had gotten worse over time. He had a left arm pulling and tearing sensation that had also worsened. He had injuries to Muscle Group VII, Muscle Group XIV and Muscle Group XV. On the left, he had occasional fatigue-pain. Muscle strength testing was normal and there was no muscle atrophy. There was x-ray evidence of small metallic densities in the right femur and left forearm. The Veteran's muscle injuries did not impact his ability to work. The Veteran underwent a VA examination in November 2019. The Veteran had a right anterior thigh muscle injury from residuals of a gunshot wound and a left anterior elbow and forearm injury from residuals of a gunshot wound. He had penetrating and non-penetrating muscle injuries. The Veteran reported increased pain in both the left arm and right thigh. He had injuries to Muscle Group V, Muscle Group VII and Muscle Group XV. He had decreased strength in the right thigh extensor and abduction muscle areas. He had loss of muscle power in Muscle Group XV and had a lower threshold for fatigue in Muscle Group V, Muscle Group VII and Muscle Group XV. Muscle strength testing revealed less than normal strength (4/5) in right hip flexion (Muscle Group XVI) and right knee extension (Muscle Group XIV). There was no muscle atrophy. The Veteran's muscle disabilities impacted his ability to work as there was no prolonged standing or walking without an opportunity to rest, no strenuous physical activity and no squatting to lift because of residual right leg weakness. The Veteran underwent a VA examination in December 2020. The Veteran had a right anterior thigh muscle injury from residuals of a gunshot wound and a left anterior elbow and forearm injury from residuals of a gunshot wound. He had penetrating and non-penetrating muscle injuries. He had injuries to Muscle Group V, Muscle Group XIV and Muscle Group XV. The muscle injuries affected muscle substance or function as there was atrophy of the muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle. He had occasional weakness in Muscle Group V, Muscle Group XIV and Muscle Group XV. Muscle strength testing revealed less than normal strength (4/5) in left elbow flexion (Muscle Group V), in left elbow extension (Muscle Group VI), in right hip flexion (Muscle Group XVI) and in right knee extension (Muscle Group XIV). There was no muscle atrophy. The Veteran's muscle disabilities did not impact his ability to work. Muscle Group XV As noted above, the Veteran has a current 20 percent rating for the residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion under Muscle Group XV, Diagnostic Code 5315. In order to warrant an increased 30 percent rating under Diagnostic Code 5315, a severe injury to the muscle group would have to be demonstrated. Based on the evidence, the Board does not find that the Veteran is entitled to a rating in excess of the current 20 percent disability rating for his residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion as a severe injury to the muscle group has not been demonstrated. Notably, the objective medical evidence does not indicate that the Veteran demonstrates signs and symptoms of severe impairment to Muscle Group XV as there is no indication of loss of deep facia or muscle substance or evidence of severe muscle impairment. On the most recent VA examination in December 2020, there was only occasional weakness in Muscle Group V while muscle strength testing revealed less than normal strength (4/5) in right hip flexion (Muscle Group XVI) and in right knee extension (Muscle Group XIV). There was also no muscle atrophy and the examiner found that the Veteran's muscle disabilities did not impact his ability to work. As a result, the Board finds that the Veteran is accurately compensated for a moderately severe muscle injury. Accordingly, a rating in excess of 20 percent for a severe muscle injury for the Veteran's residuals of grenade shrapnel wound to the muscles of the right thigh affecting hip adduction and flexion, and knee flexion under Diagnostic Code 5315 is not warranted, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Muscle Group V As noted above, the Veteran has a current 10 percent rating for the residuals of grenade shrapnel wound to the left elbow muscle impairment under Muscle Group V, Diagnostic Code 5305. In order to warrant an increased 20 percent rating under Diagnostic Code 5305 for the minor arm, a moderately severe injury to the muscle group would have to be demonstrated. Based on the evidence, the Board does not find that the Veteran is entitled to a rating in excess of the current 10 percent disability rating for his residuals of grenade shrapnel wound to the left elbow muscle impairment as a moderately severe injury to the muscle group has not been demonstrated. Notably, the objective medical evidence does not indicate that the Veteran demonstrates signs and symptoms of moderately severe impairment to Muscle Group V as there is no indication of loss of deep facia or muscle substance or evidence of moderately severe muscle impairment. On the most recent VA examination in December 2020, there was only occasional weakness in Muscle Group V while muscle strength testing revealed less than normal strength (4/5) in left elbow flexion (Muscle Group V). There was also no impaired deep tendon reflexes or sensory impairment. As a result, the Veteran's reported signs and symptoms are consistent with moderate impairment to muscle group V involving the minor extremity, and do not warrant a rating in excess of 10 percent under Diagnostic Code 5305. Specifically, there is no objective evidence of palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscle. There was also no muscle atrophy and the examiner found that the Veteran's muscle disabilities did not impact his ability to work. As a result, the Board finds that the Veteran is accurately compensated for a moderate muscle injury. Accordingly, a rating in excess of 10 percent for a severe muscle injury for the Veteran's residuals of grenade shrapnel wound to the left elbow muscle impairment under Diagnostic Code 5305 is not warranted, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Muscle Group VII As noted above, the Veteran has a current 10 percent rating for the residuals of grenade shrapnel wound of the left forearm muscle affecting the flexion of wrist and fingers under Muscle Group V, Diagnostic Code 5307. In order to warrant an increased 20 percent rating under Diagnostic Code 5307 for the minor arm, a moderately severe injury to the muscle group would have to be demonstrated. Based on the evidence, the Board does not find that the Veteran is entitled to a rating in excess of the current 10 percent disability rating for his residuals of grenade shrapnel wound of the left forearm muscle affecting the flexion of wrist and fingers as a moderately severe injury to the muscle group has not been demonstrated. Notably, the objective medical evidence does not indicate that the Veteran demonstrates signs and symptoms of moderately severe impairment to Muscle Group VII as there is no indication of loss of deep facia or muscle substance or evidence of moderately severe muscle impairment. On the most recent VA examination in December 2020, there was only occasional weakness in Muscle Group VII while muscle strength testing revealed less than normal strength (4/5) in left elbow extension (Muscle Group VI). There was also no impaired deep tendon reflexes or sensory impairment. As a result, the Veteran's reported signs and symptoms are consistent with moderate impairment to muscle group VII involving the minor extremity, and do not warrant a rating in excess of 10 percent under Diagnostic Code 5307. Specifically, there is no objective evidence of palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscle. There was also no muscle atrophy and the examiner found that the Veteran's muscle disabilities did not impact his ability to work. As a result, the Board finds that the Veteran is accurately compensated for a moderate muscle injury. Accordingly, a rating in excess of 10 percent for a severe muscle injury for the Veteran's residuals of grenade shrapnel wound of the left forearm muscle affecting the flexion of wrist and fingers under Diagnostic Code 5307 is not warranted, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.