Citation Nr: 21076930 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 18-40 382 DATE: December 28, 2021 ORDER Service connection for a lumbar spine disability is granted. Service connection for a cervical spine disability is granted. Service connection for a wound to the back of head, to include residuals of a TBI, is denied. A compensable rating prior to June 25, 2010 for right forearm scar is denied. A rating of 10 percent but no higher as of June 25, 2010 for a right forearm scar is granted. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) prior to April 11, 2012 is remanded. FINDINGS OF FACT 1. The Veteran's current lumbar spine disability is at least as likely as not related to active service. 2. The Veteran's current cervical spine disability is at least as likely as not related to active service. 3. The preponderance of the evidence is against finding that a wound to the back of the head to include any residuals of a TBI began during active service, or is otherwise related to an in-service injury or disease. 4. Prior to June 25, 2010, the Veteran's right arm forearm scar was neither unstable nor painful. 5. As of June 25, 2010, the Veteran's right forearm scar was painful. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar spine disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a cervical spine disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a residuals of a wound to the back of the head to include TBI residuals are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for a compensable rating prior the June 25, 2010 is not warranted; however the criteria for a rating of 10 percent but no higher as of June 25, 2010 is met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1966 to December 1967. He served in the Republic of Vietnam from December 1966 to December 1967. In July 2019 the Board denied entitlement to TDIU. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court), which issued an order in June 2020 granting a Joint Motion for Partial Remand (JMPR) filed by the Veteran's representative and the VA Office of the General Counsel. The Court's order vacated the portion of the Board's July 2019 decision that denied entitlement to TDIU. Subsequently, in December 2020, the Board remand this appeal for additional development that has now been completed. While in remand status, a June 2021 rating decision granted service connection posttraumatic stress disorder and TDIU, both effective April 11, 2012. It also granted special month compensation, based on housebound (100 + 60), from August 13, 2013. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be 1) evidence of a current disability; 2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and 3) causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for a lumbar spine disability 2. Entitlement to service connection for a cervical spine disability The Veteran contends that his lumbar and cervical spine disabilities were caused by an in-service incident when he was hit by a truck. A May 1967 service treatment record shows that the Veteran was treated for right forearm weakness and finger extensions due to traumatic injury. A March 1968 report of medical examination for disability evaluation shows the Veteran was treated in service for a right elbow injury in 1967 after he was struck by a truck. The Veteran reported symptoms affecting the right upper extremity. Orthopedic evaluation shows that the Veteran suffered a blow in the region of the right elbow (which is service-connected) which reportedly resulted in the loss of function of the middle ring and little finger. No complaints pertinent to an injury on the right thigh area were assessed. There were no complaints or diagnosis regarding the Veteran's cervical spine or thoracolumbar spine. A May 1977 VA medical certificate and history report shows that the Veteran was treated for a right upper extremity injury incurred during active service in 1967. No complaints or reports concerning the cervical spine or thoracolumbar spine were noted. An August 1979 report of medical examination for disability evaluation shows the Veteran reported he was not working because of a right leg and right arm injury incurred in 1967. The Veteran also reported emotional problems. The Veteran was noted to undergo a right forearm surgery after getting hit by a truck during service. No complaints or reports concerning the cervical spine or thoracolumbar spine were noted. A July 1980 report of medical examination for disability evaluation shows that the Veteran reported problems with his right elbow and right lower extremity. The Veteran was noted to have dragged his right lower extremity when walking. The Veteran was diagnosed with cervical myelopathy involving the right upper and lower extremity. X-rays of the cervical spine were normal with no fractures, bone destruction, or significant arthritis changes. The examiner also noted no objective orthopedic physical findings pertaining to the cervical, dorsal, or lumbosacral spine. A February 1982 private treatment record shows that the Veteran reported a three year history of difficulty with walking and lower back pain due to a severe head and back injury from a truck accident in Vietnam which he also reported caused a loss of consciousness. A May 1982 treatment record from the same medical facility noted that a myelogram indicated a prolapse disc L4/L5. A February 1985 VA treatment record shows that the Veteran reported a back injury in 1967 and that at the same event he blacked out for 5 to 10 seconds. A November 1985 report of medical examination for disability evaluation shows that the Veteran reported lower back pain, intense pain in the back of the head, and weakness on right side of the body. The Veteran was assessed with cervical myelopathy. An August 2006 VA cervical and lumbar spine CT report shows that the Veteran was assessed with multilevel spine degenerative arthrosis changes. Notes on the report showed the Veteran reported being hit by a truck in Vietnam that also caused a TBI. An October 2009 VA treatment record shows that a CT scan of the skull, showed no evidence of intracranial hemorrhage or midline shift, mass effect or edema. A June 2013 private independent medical evaluation shows that the Veteran's medical records were reviewed to include a post-service treatment records. Regarding the lumbar spine disability, the private examiner reported that the Veteran has had persistent low back pain and spondylosis as early as 1982. The Veteran's self-reports of back pain since the in-service truck accident were noted. The private examiner also noted that medical literature supported that previous trauma was a mechanical factor that may predispose to such degenerative changes, thus, the Veteran's degenerative condition was as likely as not caused by the blunt force trauma experienced during active service. A November 2014 VA treatment record from a VA neurologist, reported that it was likely that the Veteran's advancing damage to his spinal cord was due to the injury he sustained in 1967. The VA neurologist reported that that a complete review of the service treatment records could not be accomplished. The examiner also opined that it was greater than 50 percent probability that the Veteran's in-service injury caused his cervical spinal cord injury. A December 2015 VA back disability benefits questionnaire (DBQ) shows that the Veteran was diagnosed with thoracolumbar degenerative disc disease with spinal stenosis. The examiner opined that it was less likely than not that the back disability was incurred in active service to include as due to the in-service 1967 truck accident. The examiner noted that the Veteran's service treatment records did not mention any back complaint or diagnosis at the time of the 1967 accident. Additionally, there were no other reports of complaints for a back issues during service or until many years after discharge. A January 2018 VA neck DBQ shows that the examiner opined that it was less likely than not that the Veteran's suffered an injured neck during military service. The examiner reviewed the claims file noted that there were no indication of neck pain during active service. Regarding the lumbar spine disability, the examiner also determined that it was less likely than not that the Veteran's current back pain was a continuation of back pain experienced during active service. The examiner noted that the service treatment records showed no reports or treatments for back pain. A March 2018 independent medical evaluation report shows that the Veterans in-service truck accident was the cause of his neck and lumbar spine conditions. The examiner noted that the Veteran getting hit with a truck could cause a later back disability. The examiner also noted that although there was a lack of medical records concerning the back at the time of accident in 1967 and at separation from service, it did not mean that the Veteran's was not experiencing back pain. The examiner remarked that medical literature demonstrated posttraumatic arthritis can occur years after blunt trauma. A June 2020 VA spine addendum DBQ shows that the VA examiner reviewed the March 2018 private opinion regarding the Veteran's back condition. The VA examiner reported while the private report concluded that the Veteran's in-service accident "could" have an impact, there was no indications from the service treatment records that it did have an impact, as there were no comments regarding back pain and on report of medical history done in December 1967, he reported no recurrent back pain. The competent evidence of record establishes a current disability, to include as noted, for example, by the December 2015 VA back DBQ reflecting diagnoses of thoracolumbar degenerative disc disease with spinal stenosis. Additionally, the Veteran's service treatment records show an in-service accident in March 1967. These matters turn on whether there is a between the current disabilities and his active service. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, reasonable doubt shall be resolved in favor of the claimant. 38 U.S.C. § 5107(b). Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102 (2020). An accurate determination of etiology is not a condition precedent to granting service connection; nor is definite etiology or obvious etiology. Alemany v. Brown, 9 Vet. App. 518 (1996); 38 U.S.C. § 5107(b). The Board is aware of the conflicting medical evidence as to whether the Veteran's lumbar spine and cervical spine disabilities are related to active service. However, the Board concludes that in this case, as it now stands, the relevant positive and negative medical evidence regarding a nexus to service is in approximate balance. The Board finds that none of the medical opinions are more probative than the other opinions of record. The Veteran's June 2013 private examination report, November 2014 VA examination report, and March 2018 private examination report concluded that the Veteran's cervical and lumbar spine disabilities were related to his in-service truck accident. The other VA examination reports of record, in contrast, determined that the Veteran's cervical and lumbar spine disabilities were not related to active. Each medical opinion is supported by a reasoned analysis of medical facts. Neives-Rodriguuez v. Peake, 22 Vet. App. 295, 304 (2008). Based on this, the Board finds that the medical opinions in this case are of equal weight as to whether the Veteran's tinnitus is related to his active service. When evidence is in relative equipoise, reasonable doubt must be decided in the appellant's favor. As such, service connection for lumbar spine and cervical spine disabilities are warranted. 3. Entitlement to service connection for a wound to the back of head to include residuals of a TBI The Veteran contends that service connection is warranted for a wound to the back of the head, to include a residuals from a TBI. The Veteran reported that the incident during active service where he was struck by a truck also caused a head injury. A review of the Veteran's service treatment records show no reports or treatments for any head injuries. As noted above, service treatment records after the in-service truck accident only show complaints and treatment affecting the right elbow. The Veteran's December 1967 clinical separation examination shows a normal separation, to include no clinical finds of any head injury. Additionally, the corresponding Report of Medical History reflects that there were no self-reports of a head injury or periods of unconsciousness. When recounting his in-service injuries at a March 1968 VA examination within a year of discharge from service, the Veteran did not self-reports of residuals of a head injury or related complaints. Upon examination, the Veteran's head, face, and neck were negative. An August 1979 VA examination report showed that the Veteran reported getting hit by a truck during active service which hurt his arm. The Veteran did not report that the truck accident caused any head injury. A February 1982 private treatment record shows that the Veteran reported he experienced a head injury and loss of consciousness during active service as the result of a truck accident. A November 1985 VA examination report shows that the Veteran self-reported a head injury during active service. An August 2006 VA treatment record shows that the Veteran self-reported experiencing a TBI during active service. A June 2013 private examination report shows that the examiner reported that based on the Veteran's statement, he lost consciousness and had blurred vision after the head injury during active service. The examiner also reported that the Veteran's remarked he was diagnosed with skull fracture, but no records were available for review. The examiner opined that it was at least as likely as not that the high impact collision during active service could also have resulted in blunt trauma alone, and based only of the Veteran's lay statements that such trauma could have caused a head injury. A January 2018 VA examination report shows that after a review of the claims file that the Veteran did not have a diagnosis of any residuals of a traumatic brain injury. The examiner, a specialista physiatrist, noted the Veteran's self-reports of experiencing a head injury from the truck accident during active service, but noted that there were no notations or reports of any head injury. Additionally, the examiner noted that there were no other residuals of a head injury. No scars of the head were evaluated. The examiner noted that in head CTs many years after separation from service revealed mild to moderate chronic ischemic changes. The examiner also reviewed the private examination report from June 2013, that noted reports of skull fractures, however, the examiner noted that there were no skull fractures shown in the CT and MRI reports with the claims file. The examiner also noted that there were no self-reports of any head injury or residuals thereof, until 1982. Thus, given the lack of documentation or notations, it was less likely than not that the Veteran suffered a brain injury during his active service. Upon review of the foregoing evidence, the Board concludes that the evidence of record is against a finding that the Veteran's self-reports of a head injury were incurred in or related to active service. The Board finds the VA opinion of record to be highly persuasive and probative regarding the issue of whether the Veteran's residual of a head injury is related to active service. The January 2018 VA examiner generally opined that the Veteran's reported residual of a head injury was less likely as not due to the in-service truck accident. The Board places great probative weight on the VA opinion in this case, as it is consistent with the evidence of record and based upon specialized medical knowledge and skill (see 2/05/2021 C&P Exam (containing the 2018 VA examiner's curriculum vitae), as well as a review and analysis of the Veteran's medical history, to include consideration of relevant facts such as the details in the service treatment records regarding the accident, the separation examination report, and the post-service treatment record, such a diagnostic imaging. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (stating that a medical report must be read as a whole in the context of the claim and, even an opinion lacking in detail may be provided some probative value based upon the amount of information and analysis contained therein); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (stating that medical reports must be read as a whole and in the context of the evidence of record). The Board notes that the June 2013 private opinion diagnosed the Veteran with a fracture of the skull, based upon the Veteran's statements. However, the Board finds that the private examination report is not supported when view in light of other relevant evidence of record. For example, the examiner reported that the Veteran experienced skull fractures, however, CT and MRI reports show no skull fractures. Therefore, the examiner's opinion was based on an inadequate factual basis and has no to low probative value and weight. The Board acknowledges the Veteran's assertions that his head condition are related to service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of any head injury residual falls outside the realm of common knowledge of a lay person. This is a medically complex issue. It is support by the fact that the Veterans Benefits Administration has a policy in place to require that a designated specialistphysiatrist, psychiatrist, neurologist, or neurosurgeonmust first make a diagnosis of TBI before a generalist clinician can conduct a TBI examination. See, e.g., VA Office of Inspector General, Report No. 16-04558-249, VA Policy for Administering Traumatic Brain Injury Examinations (Sept. 10, 2018). In this regard, while the Veteran can competently report his symptoms, any opinion regarding whether his diagnosed head injury or TBI is related to his military service requires medical expertise of the brain and neurological systems, that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Veteran's statements regarding etiology are not competent and the Board assigns no probative value or weight to the Veteran's assertions that a head injury to include a TBI is related to his in-service truck accident. The Board also acknowledges the Veteran's assertions that he has suffered from head injury residuals since service. The Veteran is certainly competent to report symptoms such as head pain. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, as described above, this issue is medically complex, as it requires knowledge of internal medical processes that extend beyond immediately observable cause-and-effect relationships that are of the type that the courts have found to be beyond the competence of lay witnesses. Head injury and TBI residuals are not medical conditions a lay person is competent to diagnose as specialized training, to likely include reading of diagnostic tests, is needed. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives no weight to the Veteran's statements regarding a diagnosis or as to etiology as they are not competent. Thus, the lay statements as to a disability in this case cannot serve to enable an award of service connection here and are outweighed by the competent medical and other evidence of record. Additionally, in the present case, the Board finds that the Veteran's statements regarding onset and continuity of his symptoms regarding his head injury at the time of the 1967 accident, while competent, are not fully credible. In this regard, the Veteran has made inconsistent and contradictory statements regarding the onset of his current symptoms. Specifically, in his self-reports at separation from service, he denied having experienced any head injuries or loss of consciousness in 1967. Additionally, at a VA general medical (and orthopedic) examination in 1968, less than a year after discharge, the Veteran, in the section for "Present complaint", did not describe symptomatology related to a head injury. Meanwhile, the record tends to show that the Veteran first reported experiencing a head injury attributable to active service in 1982, more than 15 years after separation from service. Overall, the probative evidence tends to weigh against a finding of an in-service head injury. The absence of post-service findings, diagnosis, self-reports, or treatment for many years after service is one factor that tends to weigh against a finding of continuous head injury or TBI symptoms after service separation. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (stating that the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). Here, as noted above, the contemporaneous service records and relevant post-service treatment report do not indicate that the Veteran report symptomatology related to a head injury at or nearly approximate to the established in-service accident when he had the opportunity to report such if he was experiencing any observable symptoms. It appears that the Veteran's service treatment records are complete. See 4/30/1971 VA 21-3101; 1/20/2021 Other. The Board also finds the alleged in-service head injury would have been recorded, even if the right arm was most affected, due to the serious nature of head injuries and the importance of provide quick and appropriate medical treatment to an injury to this part of the body. It is important to point out that the Board does not find that the Veteran's lay statements lack credibility merely because they are unaccompanied by contemporaneous medical evidence. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (quoting Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence."). Rather, the current lay statements are found to lack credibility because they are inconsistent with and directly contradicted by other lay and medical evidence of record, including the Veteran's own statements, showing that the Veteran did not report any head injury until many years after service. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (finding Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Caluza v. Brown, 7 Vet. App. 498, 512 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (upholding Board's finding that a Veteran was not credible because lay evidence about a wound in service was internally inconsistent with other lay statements that he had not received any wounds in service). In sum, the preponderance of the competent, credible, and probative evidence weighs against an in-service head injury and nexus. As such, service connection is not warranted. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 50910 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. The intent of the rating schedule is to recognize painful motion with joint and periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a). 4. Entitlement to a compensable rating prior to January 24, 2018, and in excess of 10 percent thereafter for a right elbow scar. The Veteran contends a compensable rating prior to January 24, 2018 and in excess of 10 percent thereafter is warranted for scar on the right elbow. The Veteran's left elbow scar is currently under 38 C.F.R. § 4.118, Diagnostic Code 7804. During the pendency of this appeal, the applicable rating criteria for skin disorders, found at 38 C.F.R. § 4.118, were substantively amended. When regulations are revised during the course of an appeal, the Board is generally required to consider the claim in light of both the former and revised schedular criteria and to apply the regulation more favorable to the Veteran. The new rating criteria, however, may be applied only prospectively from the effective date of the change forward, unless the regulatory change specifically permits retroactive application. VAOPGCPREC 3-2000 (Apr. 10, 2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (emphasis added). The Board has an independent obligation to consider all potentially applicable provisions of law and regulation and to apply the diagnostic criteria in a manner that maximizes benefits. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991); Bradley v. Peake, 22 Vet. App. 280 (2008). Thus, the Board has considered all applicable criteria in evaluating the Veteran's claims. The pertinent skin regulations are as follows. The Board acknowledges that the rating criteria for many skin disabilities were revised during this appeal, effective from August 13, 2018. However, 38 C.F.R. § 4.118, Codes 7804-05 were not included as part of this revision. See Final Rule, Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32,592 (July 13, 2018). The revisions introduced a General Rating Formula for skin conditions and amended Diagnostic Codes 7801 and 7802 by characterizing multiple scars by 6 body zones affected rather than by extremity. Claims pending prior to the effective date, such as this one, may be rated under either the amended or pre-amended criteria, depending on which is more advantageous. Diagnostic Code 7804 was not affected by the recent amendments. Under that code, scars that are unstable or painful can be assigned a rating of 30 percent with five or more scars that are unstable or painful. A rating of 20 percent requires three or four scars that are unstable or painful. A rating of 10 percent requires one or two scars that are unstable or painful. Under the Diagnostic Code 7805, any disabling effects of other scars (including linear scars), and other effects of scars rated under Diagnostic Codes 7800, 7801, 7802, and 7804 not considered in a rating provided under Diagnostic Codes 7800-7804 are to be rated under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805. A July 2005 VA examination report shows that the Veteran's right elbow scar was assessed with limitation of motion, asymptomatic, and well healed. A July 2006 VA scar examination report shows that the Veteran was assessed with a right forearm scar from active service. The Veteran reported that the scar was asymptomatic. The scar was lateral to the olecranon process, extending down the right arm for 12 centimeters. The scar was noted to be without ulceration nor keloid formation. No adherence to underlying tissue was assessed. No instability, no depression, no elevation was assessed. The scar was superficial without any deep involvement. There was no inflammation, keloid, nor edema. No tenderness of the scar was assessed. A June 2010 scar examination report shows that the Veteran was assessed with a right elbow scar with no skin breakdown but pain was reported. The scar was assessed with as 16 centimeters in length and 1 centimeter in width. Pain was noted to impact occupational activities. Otherwise, it was superficial and without inflammation, edema, or keloid formation. A January 2018 VA scars examination report shows that the Veteran was assessed with two scars on the right elbow. The examiner note that only one of the scars were painful. The examiner noted that the second scar from a 2013 surgery was painful to palpation while the scar incurred in 1967 evoked no reaction. The scars were not unstable (i.e., stable). Regarding limitation of function, the examiner only noted that the scar from 2013 surgery was tender and painful. No other pertinent findings or complications were assessed. Regarding other functional impact, the scar from the 2013 surgery limited the Veteran's ability to keep his arm in any way but a protective position. A May 2021 VA scars disability benefits questionnaire (DBQ), shows that the Veteran was assessed with two medial scars to the right elbow. The examiner noted that both scars were not painful or unstable. The first scar was measured as 12 centimeters in length and 1 centimeter in width. The second scar was measured as 10 centimeters in length and 1 centimeter in width. Both scars were not reported as tender to palpation. Limitation of function or other pertinent findings were not assessed. After a review of the relevant medical and lay evidence of record, the Board finds that a 10 percent rating but no higher is warranted as of June 25, 2010, and a compensable rating prior to June 25, 2010 is not warranted under Diagnostic Code 7804. Here, prior to June 25, 2010, there is no probative competent evidence that his right forearm scar was painful or unstable, as noted from the Veteran's self-reports and VA medical evidence. Therefore, a compensable rating under Diagnostic Code 7804 is not warranted. As of June 25, 2010, the Board finds that a 10 percent rating for one painful scar under Diagnostic Code 7804 is warranted as during the June 2010 VA examination, the Veteran reported pain at the scar site. Therefore, the criteria for a 10 percent rating as of June 25, 2010 is warranted. The Board finds a higher rating is not warranted as he has not been assessed with three to four scars that were painful or unstable. Therefore, a higher rating is not warranted. Additionally, the Board finds that that the competent and probative evidence does not tend to show a separation rating under Diagnostic Code 7805 is warranted. While the Veteran's has showed some guarding of the right forearm, range of motion of the right forearm has not been shown to be so impaired that a separate compensable rating for limitation of motion is warranted. While the Veteran held his right arm in a guarding position during one of the VA examinations, a review of the other relevant evidence of record does not show any shoulder or arm limitations that would warrant a compensable rating. For example the 2021 VA scars examination indicated no functional impairment from the two scars. Accordingly, the Board finds a preponderance of the evidence is against a finding that a compensable evaluation of the right forearm scar is warranted prior the June 25, 2010, and a 10 percent rating, but no higher, is warranted thereafter under diagnostic Code 7804. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND Entitlement to a TDIU prior to April 11, 2012 is remanded. The Veteran's TDIU may be dependent on the rating assigned for lumbar spine and cervical spine disabilities for which service connection is being granted in this decision. Accordingly, TDIU is to adjudicated following the assignment of a disability rating for Veteran's lumbar spine and cervical spine disabilities. This matter is REMANDED for the following action: Assign a disability ratings for the Veteran's service-connected lumbar and cervical spine disabilities, then adjudicate his claim for a TDIU. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, 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.