Citation Nr: 21075537 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 09-34 749 DATE: December 20, 2021 ORDER Entitlement to an initial evaluation in excess of 30 percent for bilateral plantar fasciitis is denied. Entitlement to an evaluation in excess of 10 percent for an anterior trunk scar is denied. Entitlement to total rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran's bilateral plantar fasciitis is not manifested by at least marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances nor the loss of use of a foot even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups at any time during the pendency of the appeal. 2. The preponderance of the evidence shows that the Veteran's anterior trunk scar is not deep or cause limited motion in an area or areas exceeding 12 square inches (77 sq. cm.), are not made up of three or four scars, and do not otherwise impair function at any time during the pendency of the appeal. 3. The Veteran's service-connected disabilities precluded substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for ratings in excess of 30 percent for bilateral plantar fasciitis have not been met at any time during the pendency of the appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2020); 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5269 (2021); 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 2. The criteria for a rating in excess of 10 percent for an anterior trunk scar have not been met at any time during the pendency of the appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.6, 4.118, Diagnostic Codes 7801 to 7805. 3. The criteria for TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from October1974 to October 1977 and January 1991 to March 1991. The Veteran also had a period of service with a Reserve Component. In January 2013, the Board of Veterans' Appeal (Board), among other things, Remanded the claim for an increased rating for an anterior trunk scar. In March 2014, a Veterans' Law Judge not the undersigned issued a decision that denied the claim for a compensable rating for an anterior trunk scar. The Veteran appealed the March 2014 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a March 2015 order, which incorporated the parties Joint Motion for Remand (JMR), the Court vacated and remanded the March 2014 Board decision. In May 2015, the Board, among other things, Remanded the claims for increased ratings for an anterior trunk scar and bilateral plantar fasciitis. In November 2016, a Veterans' Law Judge not the undersigned issued a decision that denied the claim for an increased rating for an anterior trunk scar and Remanded the claim for an increased rating for bilateral plantar fasciitis. Parenthetically, the Board notes that the denial of the claim for an increased rating for the anterior trunk scar in the November 2016 decision was not appealed to the Court, the November 2016 Board decision is final, and the claim for an increased rating for the anterior trunk scar again comes to the Board from a subsequent May 2018 rating decision. In July 2017, a Veterans' Law Judge not the undersigned issued a decision that denied the claim for an initial evaluation in excess of 30 percent for bilateral plantar fasciitis. The Veteran appealed the July 2017 Board decision to the Court. In a May 2019 decision, Judge Pietsch vacated and remanded the July 2017 Board decision. In April 2020, the Board Remanded the claim for an initial evaluation in excess of 30 percent for bilateral plantar fasciitis as well as the claim for an evaluation in excess of 10 percent for the anterior trunk scar and for a TDIU. Lastly, the Board notes that the Veteran has a number of appeal streams. In this regard, the Veteran's appeals streams include, among other things, a claim of clear and unmistakable error in the May 1991 rating decision that initially denied service connection for bilateral plantar fasciitis. However, because the claim for clear and unmistakable error is not inextricably intertwined with the above claim for an initial evaluation in excess of 30 percent for bilateral plantar fasciitis as well as because none of these other appeal streams have been certified to the Board, the Board finds that no further action as to them is required at this time. This delay is needed to ensure that the Veteran is afforded full due process in these matters. See 38 C.F.R. § 3.103; Gray v. McDonald, 27 Vet. App. 313, 327 (2015) (Due process protections apply to disability compensation proceedings before the Board) (citing Cushman v. Shinseki, 576 F.3d 1290 (Fed.Cir.2009)); see also Carter v. McDonald, 794 F.3d 1342, 1346 (Fed. Cir. 2015) (regulatory requirement of notice in § 1.525(d) can only sensibly be construed to require that the notice to counsel be timely, which requires, at a minimum, notice before the expressly stated deadline has passed). We do not wish to delay this case further. The Concerns Raised by the Court Decision as well as post-Remand Compliance Initially, the Board finds that the post-Remand development addressed the concerns raised by the Court decision and substantially complied with the Board Remands. The Board has reached this conclusion because, and as directed by the Court decision, it finds that the December 2015, December 2016, June 2018, July 2018, December 2018, and August 2020 VA examinations both addressed the concerns raised by the Court and substantially complied with the instructions contained in the Remands, to include answering the questions asked by the Board in those Remands, because when taken together they provide all needed information to rate the Veteran's disorders under all applicable rating criteria and, as to the bilateral plantar fasciitis, include range of motion studies that considered the Veteran's complaints of pain and ranges of motion during flare-ups as well as with and without weight bearing and resistance in passive and active range of motion. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order); Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board also finds that the post-Remand development substantially complied with the Remands because while the appeal was at the regional office (RO) it obtained and associated with the record all identified and available VA and private treatment records to include the VA treatment records dated from 2015 to 2016 that were identified in the Court decision. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request is required). Lastly, and as directed in the Court decision, the Board finds that the below decision adjudicate the Veteran's claims taking into account all evidence found in the claims file to include the evidence identified in the Veteran's June 2017 argument. Therefore, the Board finds that further delay by remanding these issues to provide the Veteran with a new VA examination or to obtain additional records is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). The Rating Claims The Veteran contends that his bilateral plantar fasciitis and anterior trunk scar are more severely disabling than represented by the ratings assigned at all times during the appeal. In this regard, disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation 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. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). I. Bilateral Plantar Fasciitis The Veteran's bilateral plantar fasciitis is rated as 30 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5276. i. The Recent Amendments to the Musculoskeletal Rating Criteria Initially, the Board notes that during the pendency of the appeal VA amended some of its' criteria for rating musculoskeletal disabilities effective February 7, 2021, to include for the first time adding a Diagnostic Code 5269 to rate plantar fasciitis. See 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 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. The Board cannot apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). In this case, the regulation does not provide for retroactive application. 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). However, since the maximum rating under new Diagnostic Code 5269 for rating plantar fasciitis is 30 percent absent the loss of use of a foot and because, as explained below, the Veteran does not have the loss of use of a foot, the Board finds that the amendment does not change how this Veteran's disorder is rated. See Owens, supra. Therefore, the Board finds that a Remand to provide the Veteran with notice of these new rating criteria and have the claim adjudicating applying it is not required. See Sabonis, supra. ii. The Old and New Rating Criteria Under Diagnostic Code 5276, a 30 percent rating is warranted if the disability is manifested by severe bilateral pes planus evidenced by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A 50 percent rating is warranted for marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. As noted above, effective February 7, 2021, VA amended the Diagnostic Codes by, among other thing, adding Diagnostic Code 5269 for rating plantar fasciitis. Specifically, new Diagnostic Code 5269 provides a 30 percent rating for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. Note(1) also provides a 40 percent rating with the actual loss of a foot. As noted above, prior to February 7, 2021, the Board will apply the prior rating criteria. See Kuzma, supra. From February 7, 2021, onward, the Board applies the criteria that is more favorable to the Veteran. Id. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Moreover, the United States Court of Appeals for Veterans Claims (Court) in Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016) held that the provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to the evaluation of musculoskeletal disabilities under Diagnostic Codes predicated on range of motion measurements. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. Furthermore, in Jones Shinseki, 26 Vet. App. 56, 61-63 (2012) the Court held that the Board may not deny entitlement to an increased rating on the basis of relief provided by medication when those effects are specifically contemplated by the rating criteria. Lastly, in Chavis v. McDonough, 34 Vet. App. 1, 3-4 (2021) the Court held that ankylosis of the spine may be shown based on symptoms of fixation of the joint equivalent to ankylosis. iii. Correia, and Sharp Compliance Next, in adjudicating below whether the Veteran meets the criteria for a higher evaluation for his plantar fasciitis, the Board has not overlooked the Court's holdings in Correia, supra, and Sharp, supra. Tellingly, the Board finds that the record is adequate to address the concerns raised by the Court in both these cases because the June 2018, December 2018, and August 2020 VA examinations, when taken together, provide range of motion studies that consider the Veteran's foot motion taking into account his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups. Therefore, the Board finds that further delay by remanding this issue to provide the Veteran with a new VA examination is not required. See Sabonis, supra. iv. The Merits of the Plantar Fasciitis Rating Claims As to ratings in excess of 30 percent for the Veteran's bilateral plantar fasciitis under Diagnostic Code 5276, the Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as the Court's holdings in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), his functional losses do not equate to the criteria required for at least a 50 percent rating because the most probative evidence of record shows that his adverse symptomatology did not include marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances, at all times during the appeal. See Owens, supra. The Board has reached this conclusion because at the August 2015, April 2016, December 2016, June 2018, July 2018, December 2018, and August 2020 VA examinations it was opined as follows: August 2015, it was opined that, while he wore orthotics, the Veteran did not have marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation as well as opined that there was no objective evidence of plantar fasciitis; April 2016, it was opined that there was no evidence of clinical plantar fasciitis at the time of the August 2015 VA examination; but did have a heel spur on the left; December 2016, it was opined that, while he wore orthotics, the Veteran did not have marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation as well as opined that, currently, he only had plantar fasciitis in the right foot; June 2018, the Veteran denied having flare-ups, reported that he used orthotics, and the examiner opined that he had no functional loss in either lower extremity attributable to claimed condition; December 2018, it was opined that the Veteran did not have marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation; and August 2020, it was opined that, while he wore orthotics, the Veteran did not have marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation. The Board finds these examiners opinions the most probative evidence of record because they are supported by the examinations as well as the Veteran's treatment records. See Owens, supra. Moreover, while the Veteran's treatment records document his complaints and treatment for bilateral plantar fasciitis, the Board finds that above VA examiners findings are not contradicted by any other medical evidence of record. Id. Furthermore, the Board finds that the Veteran is not qualified to opine that he has problems with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation because these are medical findings. See Davidson, supra. In reaching this conclusion, the Board has not overlooked the fact that the Court decision specifically asked it to consider if, as to the December 2016 VA examination, it met the criteria for legal adequacy and whether the examiner substantially complied with the Remand instructions. However, and as explained above, the Board finds that all the VA examinations met these criteria. Therefore, the Board finds that the criteria for a rating in excess of 30 percent for the Veteran's bilateral plantar fasciitis are not met under Diagnostic Code 5276 at any time during the pendency of the appeal. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. As to a rating in excess of 30 percent for the Veteran's bilateral plantar fasciitis under new Diagnostic Code 5269 from February 7, 2021, the Board notes that the 30 percent rating already in place is the maximum rating possible under Diagnostic Code 5269 without the loss of use of a foot. Moreover,, the Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as the Court's holdings in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), his functional losses do not equate to the criteria required for a 40 percent rating because the most probative evidence of record shows that his adverse symptomatology did not include the loss of use of a foot. See Owens, supra. The Board has reached this conclusion because at the August 2015 VA examination it was opined that he did not even have plantar fasciitis, at the December 2016 VA examination it was opined that he only had plantar fasciitis in the right foot, and at the June 2018, December 2018, and August 2020 VA examinations the adverse symptomatology attributed solely to his service-connected plantar fasciitis, as opposed to heel spurs, arthritis, etc..., was minimal. Moreover, the Board finds these VA examiners findings the most probative evidence of record because they are supported by the examinations as well as the Veteran's treatment records. See Owens, supra. Additionally, while the Veteran's treatment records document his complaints and treatment for plantar fasciitis, the Board finds that above VA examiners findings are not contradicted by any other medical evidence of record because treatment records also never document loss of use of either foot. Id. Furthermore, the Board finds that the Veteran is not qualified to say that his plantar fasciitis caused the loss of use of a foot because this is a medical finding. See Davidson, supra. Therefore, the Board finds that the criteria for a rating in excess of 30 percent for the Veteran's bilateral plantar fasciitis are not met under new Diagnostic Code 5269 at any time from February 7, 2021. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. As to higher evaluation for the Veteran's bilateral plantar fasciitis under one of the other criteria for rating foot disorders (see 38 C.F.R. § 4.71a; Diagnostic Codes 5277 to 5284 (i.e., weak foot, claw foot, anterior Metatarsalgia, hallux valgus, hallux rigidus, hammer toe, tarsal or metatarsal bones malunion or nonunion, and foot injuries), the Board notes that the 30 percent rating already assigned his disability already meets or exceeds the maximum rating possible under all these Diagnostic Codes except for a claw foot and the record is negative for a diagnoses of claw foot. See 38 C.F.R. § 4.71a; Also see VA examinations dated in August 2015, April 2016, December 2016, July 2018, December 2018, and August 2020; Colvin, supra. Therefore, the Board finds that a higher rating under these other criteria under which foot disorders are rated is not warranted at any time during the pendency of the appeal. See 38 C.F.R. § 4.71a; Diagnostic Codes 5277 to 5284; Butt's, supra; Hart, supra; Fenderson, supra. In reaching all of the above conclusions, the Board has also not overlooked the claims from the Veteran regarding his adverse symptomatology. See Davidson, supra. However, the Board finds the above examiners opinions as to the Veteran's adverse symptomatology more probative than the lay claims from the appellant to the contrary even though his symptomatology is observable by a lay person because the examiners have medical training. See Black, supra. The fact that the Veteran is having problems is not in dispute, the only question is the degree based on the criteria, which the examiners have clearly indicated. II. The Anterior Trunk Scar The Veteran's anterior trunk scar is rated as 10 percent disabling under 38 C.F.R. § 4.118, Diagnostic Code 7804. Under the rating criteria that has been in effect since before the Veteran filed his claim, Diagnostic Code 7801 provides that, scars, other than the head, face, or neck, that are deep or that cause limited motion in an area or areas exceeding 6 square inches (39 sq. cm.) are rated 10 percent disabling. Scars that are deep or that cause limited motion in an area or areas exceeding 12 square inches (77 sq. cm.) are rated 20 percent disabling. Scars that are deep or that cause limited motion in an area or areas exceeding 72 square inches (465 sq. cm.) are rated 30 percent disabling. Scars that are deep or that cause limited motion in an area or areas exceeding 144 square inches (929 sq.cm.) are rated 40 percent disabling. Note (1) to Diagnostic Code 7801 provides that scars in widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk, will be separately rated and combined in accordance with 38 C.F.R. § 4.25. Note (2) provides that a deep scar is one associated with underlying soft tissue damage. Under Diagnostic Code 7802, scars, other than the head, face, or neck, that are superficial and nonlinear that are of an area or areas of 144 square inches (929 square centimeters) or greater warrant a 10 percent disability rating. A superficial scar is not one associated with underlying soft tissue damage. See Note (1). Diagnostic Code 7804 provides that unstable or painful scars are rated as follows: 10 percent for one or two scars; 20 percent for three or four scars; and 30 percent for five or more scars. 38 C.F.R. § 4.118. Diagnostic Code 7805 directs that any other disabling effects of a scar not described in Code 7802 or 7804, are to be evaluated under an appropriate Diagnostic Code. Id. As to ratings in excess of 10 percent for the anterior trunk scar under Diagnostic Code 7801, the Board notes that the February 2013, November 2015, and August 2020 VA examiners all opined that the Veteran had only one trunk as well as opined that it was painful. As to the scar's size, it was opined that it measured 0.12 cm long and 8.2 cm wide with an approximate total area of 49.98 cm2 in February 2013, measured 2.8 cm long and 17.5 cm wide with an approximate total area of 49.00 cm2 in November 2015, and measured 1.0 cm long and 4.0 cm wide with an approximate total area of 4.00 cm in August 2020. On the other hand, the July 2018 VA examiner reported that the Veteran had four painful scars with "Scar 1" measuring 1.25 cm long and 0.3 cm wide, "Scar 2" measuring 2.3 cm long and 0.2 cm wide, "Scar 3" measuring 3.0 cm long and 0.2 cm wide, and "Scar 4" measuring 4.3 cm long and 0.2 cm wide as well as with opined that the total area for all of 4 scars was approximately 2.035 cm. Tellingly, for the purpose of determining if the Veteran meets the criteria for a rating in excess of 10 percent for the anterior trunk scar under Diagnostic Code 7801 the question before the Board is the total area of the scar or scars, not how many scars he has. In this regard, the Board finds it significant that February 2013, November 2015, July 2018, and August 2020 VA examinations are uniform in reporting that the Veteran's service connected trunk scar or scars does not cover an area or areas exceeding 12 square inches (77 sq. cm.). See Colvin, supra. Next, the Board notes that the Veteran's treatment records periodically document his complaints regarding his service-connected anterior trunk scar. However, the Board finds that nothing in these records shows his adverse symptomatology to be worse than what was reported by the above VA examiners because they also do not show the trunk scar covers an area or areas exceeding 12 square inches (77 sq. cm.). See Colvin, supra. Moreover, neither the Veteran nor his representative has provided VA with alternative measurements as to the area covered by the anterior trunk scar. See Davidson, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran's anterior trunk scar or scars are not deep or cause limited motion in an area or areas exceeding 12 square inches (77 sq. cm.). See Owens, supra. Therefore, the board finds that a rating in excess of 10 percent is not warranted for the Veteran's anterior trunk scar under Diagnostic Code 7801 at any time during the pendency of the appeal. See 38 C.F.R. § 4.118; Fenderson, supra; Hart, supra. As to a rating in excess of 10 percent for the anterior trunk scar under Diagnostic Code 7802, the Board notes that the 10 percent rating already in place is the maximum rating possible under Diagnostic Code 7802. Accordingly, the Board finds that a rating in excess of 10 percent for the anterior trunk scar is not warranted under Diagnostic Code 7802 at any time during the pendency of the appeal. See 38 C.F.R. § 4.118; Fenderson, supra; Hart, supra. As to a rating in excess of 10 percent for the anterior trunk scar under Diagnostic Code 7804, as noted above, the July 2018 VA examiner reported that the Veteran had 4 painful trunk scars. However, the February 2013, November 2015, and August 2020 VA examiners all opined that he had only 1 painful trunk scar. The Board also notes that the RO December 2018 as well as in December 2020 obtained medical opinions to reconcile the July 2018 VA examiner's report with the February 2013 and November 2015 examiners report. In this regard, the Board finds it significant that the August 2020 VA examiner, after a review of the record on appeal, including the earlier VA examinations, opined that the Veteran had only 1 trunk scar due to his 4 abdominal surgeries because the 4 surgeries were performed via the same scar. Likewise, the Board finds that the Veteran treatment supported the August 2020 VA examiner's opined that the Veteran, despite have 4 abdominal surgeries, had only 1 trunk scar because each of the surgeries were performed via the same scar. Given the above, the Board finds that the most probative evidence of record are the February 2013, November 2015, and August 2020 VA examination reports in which it was opined that the Veteran had only 1 trunk scar because these opinions are supported by the examinations and the appellant's treatment records. See Owens, supra. Likewise, the Board notes that while the Veteran's treatment records periodically document his complaints regarding his service-connected anterior trunk scar, nothing in these records shows his adverse symptomatology includes 3 or more trunk scars. See Colvin, supra. Similarly, the Board finds the opinions by the February 2013, November 2015, and August 2020 VA examiners that the Veteran has only 1 trunk scar more probative than any lay claims from the Veteran or his representative to the contrary because the VA examiners have greater medical training. See Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). Therefore, the Board finds that the preponderance of the evidence of record shows that the Veteran's anterior trunk scar does not meet the criteria for an increased rating under Diagnostic Code 7804 because he does not have 3 or more scars. See Owens, supra. Accordingly, the Board finds that a rating in excess of 10 percent for the anterior trunk scar is not warranted under Diagnostic Code 7804 at all times during the pendency of the appeal. See 38 C.F.R. § 4.118; Fenderson, supra; Hart, supra. As to a rating in excess of 10 percent for the anterior trunk scar under Diagnostic Code 7805, the Board notes the Veteran told the February 2013 VA examiner that his mid-line abdominal scar will be painful with "sharp stabbing pains" and that lifting does seem to exacerbate pain. Similarly, the appellant told the August 2020 VA examiner that he had pain at the scar with twisting motions, the pain is sharp, and the pain stays with him for 30-40 minutes or until he stops moving. However, at the February 2013, November 2015, July 2018, and August 2020 VA examinations the Veteran's adverse symptomatology was limited to pain. Moreover, the VA examiners were uniform in opining that the scar did not result in limitation of function except for panful twisting. These medical opinions are not contradicted by any other medical evidence of record. See Colvin, supra. Next, the Board notes that while the Veteran's treatment records periodically document his complaints regarding his service-connected anterior trunk scar, nothing in these records shows his adverse symptomatology to be worse than what was reported by the above VA examiners. See Colvin, supra. Similarly, the Board finds the opinions by February 2013, November 2015, July 2018, and August 2020 VA examiners that the Veteran's only adverse symptomatology was pain more probative than any lay claims from the Veteran or his representative to the contrary because the VA examiners have greater medical training. See Black, supra. Given the above, the Board finds that the preponderance of the evidence of record shows that the anterior trunk scar does not produce any other disabling effects not described in Diagnostic Code 7802 or 7804 that entitle the Veteran to a higher evaluation under a different Diagnostic Code because its' only objective adverse symptomatology is pain and this adverse symptomatology is both contemplated by and compensated for by Diagnostic Code 7804. Id. Accordingly, the Board finds that a rating in excess of 10 percent for the anterior trunk scar is not warranted under Diagnostic Code 7805 at all times during the pendency of the appeal. See 38 C.F.R. § 4.118; Fenderson, supra; Hart, supra. The TDIU Claim The Veteran claims, in substance, that he was entitled to a TDIU because his service-connected disabilities prevent him from working. This is a key issue, and has to some degree been overshowed by technical issues (the application of caselaw that did not exist at the time the RO initially address those issue) cited above. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation because of a service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. In calculating if the Veteran met the above schedular criteria VA combines the Veteran's service-connected orthopedic disorders. The existence or degree of non-service-connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran's service-connected disabilities render his incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned where the schedular rating is less than total if a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). Generally, total disability will be considered to exist when there is present any impairment of mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Further, marginal employment, defined as an amount of earned annual income that does not exceed the poverty threshold determined by the United States Department of Commerce, Bureau of the Census, shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). The record shows that the Veteran was service-connected for the following disabilities: Ventral hernia rated as 40 percent disabling; Pseudeofolliculittis barbe rated as 30 percent disabling; Plantar fasciitis rated as 30 percent disabling; Tinnitus rated as 10 percent disabling; Anterior trunk scars rated as 10 percent disabling; Hypertension rated as 40 percent disabling from February 11, 2016, and 10 percent disabling from June 1, 2016; Back disability rated as 10 percent disabling; Right inguinal hernia rated as 0 percent disabling; and Erectile dysfunction rated as 0 percent disabling. In summary, the Board finds that this record shows that the Veteran met the schedular requirements of 38 C.F.R. § 4.16(a)(1) to (4) during the pendency of the appeal because he has one disability rated as 40 percent or higher and he has a combined rating of 80 percent or higher. The next question for the Board to consider is when, if ever, his service-connected disabilities rendered him incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). In this regard, the Veteran's VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability (TDIU Claim Form), dated in May 2018, reported that he had not worked full-time in May 2014 but became too disabled to work full time in April 2013 because of his service-connected disabilities. As to his work history, the Veteran reported that from 2004 to 2013 he worked as a security officer. As to his education, the Veteran reported that he had 4-years of high school. As to the Veteran's being able to work performing jobs that require sedentary employment and non-sedentary employment, including his past employment as a security officer as well as other possible employment that could make use of his work experience and 4-years of high school, the Board finds that the medical records show that the problems caused by his service-connected ventral hernia, pseudofolliculitis barbe, plantar fasciitis, tinnitus, anterior trunk scars, hypertension, back disability, and right inguinal hernia adversely impact his ability to work in any field because of the overall impairment they had to his body and mind to include the stamina needed to work a full-day, concentrate on the tasks required by employment, and interact effectively with co-workers and/or customers as well as carry out the tasks required by employment. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) (holding that the determination of whether a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question and that it is an adjudicative determination properly made by the Board or the regional office). The Board also finds that his service-connected ventral hernia, plantar fasciitis, tinnitus, anterior trunk scars, hypertension, back disability, and right inguinal hernia would have made it dangerous for the Veteran and his co-workers for him to work in most non-sedentary employments. Id. Similarly, the Board finds that that the ventral hernia, plantar fasciitis, tinnitus, anterior trunk scars, hypertension, back disability, and right inguinal hernia would have made it very difficult for him to work in most sedentary employments because of the problems that they would have caused in carrying out the duties required by such employment. Id. Given the above, the Board finds that the Veteran's service-connected disabilities prevent him from securing or following a "substantially gainful" occupation given his prior vocational history, work experience, and the impact his service-connected ventral hernia, pseudofolliculitis barbe, plantar fasciitis, tinnitus, anterior trunk scars, hypertension, back disability, and right inguinal hernia have on obtaining and maintaining substantially gainful non-sedentary employment and sedentary employment, including in his past employment as a security officer, because of the problems they would cause in any work environment. Further development of this issue is simply not warranted in light of the history of this case. Therefore, the Board concludes that the most probative evidence of record shows that the Veteran's service-connected disabilities render him incapable of substantial gainful employment given his prior vocational history, work experience, and the impact his service-connected disabilities have on all employment and the claim for a TDIU is granted. See 38 U.S.C. § 510738 C.F.R. §§ 3.102, 4.16(a). In reaching the above conclusion, the Board has not made any finding as to the effective date of the award of the TDIU because this issue is not before us. Conclusion In reaching the above conclusions, the Board considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the preponderance of the evidence is against the claims to the extent outlined above, the Board finds that the doctrine is not for application. See also, e.g., Ortiz, supra; Gilbert, supra. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.T. Werner, 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.