Citation Nr: 21005768 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 14-34 981 DATE: February 2, 2021 ORDER Entitlement to initial disability ratings in excess of 30 percent for keloids from December 30, 2009, to August 15, 2013, and from November 13, 2017, are denied. Entitlement to an initial disability rating of 30 percent, but no higher, for keloids from August 15, 2013 to November 13, 2017, is granted. Entitlement to a separate initial disability rating of 10 percent, but no higher, for keloids of the head, face or neck from December 30, 2009, to August 15, 2013, is granted. FINDINGS OF FACT 1. For the pendency of the appeal, the preponderance of the evidence shows that the Veteran’s keloid disability of the trunk and extremities was manifest by five or more painful, but not unstable, scars. 2. For the period of December 30, 2009, to November 13, 2017, the preponderance of the evidence shows that the Veteran’s keloids of the face, head, or neck were manifest by one characteristic of disfigurement. 3. For the period of December 30, 2009, to November 13, 2017, the preponderance of the evidence shows that the Veteran’s keloids of the face, head, or neck were manifest by one characteristic of disfigurement. 4. From November 17, 2017, the preponderance of the evidence shows that the Veteran’s keloids of the face, head, or neck were manifest by two characteristics of disfigurement. 5. For the pendency of the appeal, the preponderance of the evidence does not show that the Veteran’s keloids were manifest by underlying soft tissue damage; deep and nonlinear scars; total surface area of 144 square inches; additional characteristics of facial disfigurement (visible or palpable tissue loss, or gross distortion or asymmetry); or received constant or near-constant systemic therapy. CONCLUSIONS OF LAW 1. The criteria for initial disability ratings in excess of 30 percent for keloids from December 30, 2009, to August 15, 2013, and from November 13, 2017, are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, DCs 7801 to 7806. 2. The criteria for an initial disability rating of 30 percent, but no higher, for keloids from August 15, 2013 to November 13, 2017, are met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, DCs 7801 to 7806. 3. The criteria for a separate initial disability rating of 10 percent for keloids of the head, face or neck from December 30, 2009, to August 15, 2013, are met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, DCs 7801 to 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from March 1981 to February 1989. These matters come before the Board of Veterans' Appeals (Board) on appeal of a November 2010 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). In April 2018 and June 2020, the Board remanded these matters for additional development. They have returned to the Board for further appellate review. The Veteran was awarded service connection for keloids (claimed as keloids and surgical scars from keloid removal) with an evaluation of 30 percent, effective December 30, 2009. The Veteran appealed for an increased initial rating. During the pendency of the appeal, April 2014 and March 2020 rating decisions added separate and increased ratings for the Veteran’s service-connected keloids. As the increased ratings were not granted for the entire claims period or for the highest available disability rating, the April 2014 and March 2020 decisions are considered partial grants. See AB v. Brown, 6 Vet. App. 35 (1993). These decisions effectively split the issue of entitlement to increased rating into three separate time periods: December 30, 2009, to August 15, 2013; August 15, 2013, to November 13, 2017; and from November 13, 2017. As reflected on the title page of this decision, the Board has recharacterized the Veteran’s increased rating claims to accommodate the staged ratings. In this regard, the Board notes that a TDIU (a 100% individual unemployment rating) has been granted. The Board is now simply addressing the remaining issues. Increased Ratings 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 Diagnostic Codes. 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 to evaluate a disability 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 diagnosis, and demonstrated symptomatology. 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 in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, 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. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). Entitlement to initial increased disability ratings for keloids. The Veteran’s service-connected keloid disabilities are currently rated and staged as follows: • 30 percent under DC 7804 for painful scars from December 30, 2009, to August 15, 2013. • 20 percent under DC 7804 for painful scars from August 15, 2013, to November 13, 2017. • 30 percent under DC 7804 for painful scars from November 13, 2017. • 10 percent under DC 7800 for scars of the face, head, or neck from August 15, 2013, to November 13, 2017. • 30 percent under DC 7800 for scars of the face, head, or neck from November 13, 2017. • 0 percent under DC 7802 for scars, right lower extremity, left lower extremity, right upper extremity, left upper extremity, and anterior trunk, from August 15, 2013. • 0 percent under DC 7802 for scars, posterior trunk, from November 13, 2017. The March 2020 rating decision also awarded the Veteran entitlement to service connection for tenderness of the testicles secondary to his keloid disability with a 0 percent rating under DC 7599-7524, effective November 7, 2019. The Veteran contends that the symptoms of his keloid disability are productive of higher ratings. Staged ratings (problems that change over time), are complex to address given the fact that the problem changes. The rating criteria used to evaluate scars and other disabilities of the skin are found at 38 C.F.R. § 4.118. DC 7800 through 7805 set forth the relevant provisions for rating scars. 38 C.F.R. § 4.118. As a preliminary matter, the Board notes that, while this appeal was pending, VA published a final rule amending its regulations on skin disabilities, effective August 13, 2018. The amendment, in pertinent part, added a General Rating Formula for the Skin (General Rating Formula) for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822, and 7824, and amended diagnostic codes 7801,7802,7817,7819,7825, 7826, 7827, and 7829. See 83 Fed. Reg. 32,592 (July 13, 2018). The August 13, 2018 skin amendments amended Diagnostic Codes 7801 and 7802 by characterizing multiple scars by 6 body zones affected rather than by extremity. In addition, under the amendments, two or more skin conditions may be combined in accordance with § 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used. See 38 C.F.R. § 4.118 (b) (August 13, 2018). There are no changes to Diagnostic Codes 7800, 7804, and 7805 under the August 13, 2018, amended version of the skin criteria. In other words, Diagnostic Codes 7800, 7804, and 7805 are exactly the same both prior to and after August 13, 2018. Claims pending prior to the August 2018 effective date will be considered under both the old and new rating criteria, and whichever criteria is more favorable to the Veteran will be applied. In this case, all relevant rating criteria will be considered, to include the rating criteria in effect prior to and after the 2018 amendments. Under the scar regulations in effect prior to and since August 13, 2018, DC 7800 provides the rating criteria for burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. A 10 percent rating is warranted when there is one characteristic of disfigurement. A 30 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips), or; with two or three characteristics of disfigurement. A 50 percent rating is assigned for visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement. An 80 percent rating is assigned for visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement. 38 C.F.R. § 4.118, DC 7800. The 8 characteristics of disfigurement, for purposes of evaluation under § 4.118, are: (1) scar 5 or more inches (13 or more cm.) in length, (2) scar at least one-quarter inch (0.6 cm.) wide at its widest part, (3) surface contour of scar elevated or depressed on palpation, (4) scar adherent to underlying tissues, (5) skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.), (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.), (7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.), and (8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). 38 C.F.R. § 4.118, DC 7800, Note (1). Under the former criteria, Code 7801, for scars other than those on the head, face, or neck, that are deep and nonlinear a 10 percent rating is warranted if the area is at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). A 20 percent rating is assigned for an area or areas of at least 12 square inches (77 sq. cm. but less than 72 square inches (465 sq. cm.). A 30 percent rating is warranted if the area is at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.). A 40 percent rating is warranted if the area is at least 144 square inches (929 sq. cm.) or greater. A Note associated with this Code specifies that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Code 7801 (2018). Under the new criteria for Code 7801, for scars other than those on the head, face, or neck, that are associated with underlying soft tissue damage, a 10 percent rating is warranted if the area is at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm.). A 20 percent rating is assigned for an area or areas of at least 12 square inches (77 sq. cm. but less than 72 square inches (465 sq. cm.). A 30 percent rating is warranted if the area is at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.). A 40 percent rating is warranted if the area is at least 144 square inches (929 sq. cm.) or greater. 38 C.F.R. § 4.118, Code 7801 (2019). Under the previous version of DC 7802, a maximum 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are superficial and nonlinear, affecting an area or areas of 144 square inches (929 sq. cm.) or greater. Note (1) to DC 7802 defines a "superficial" scar as one not associated with underlying soft tissue damage. See 38 C.F.R. § 4.118. Under the amended version of DC 7802, a maximum 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with soft tissue damage, affecting an area or areas of 144 square inches (929 sq. cm.) or greater. Both old and amended regulations provide a maximum of 10 percent rating for scar(s) with area(s) of 144 square inches (929 sq. cm.) or greater. The revisions to DC 7804 remove the requirement that the scars be nonlinear and added the definitions of superficial and deep as part of the pertinent criteria. As a result of these changes, the Notes explaining the meaning of deep and superficial were removed. Also Note (1) was added reflecting that there were six zones of the body, which are defined as each extremity, anterior trunk, and posterior trunk. Note (2) was also added reflecting that a separate evaluation may be assigned for each affected zone of the body under DC 7802 if there are multiple scars, or a single scar, affecting multiple zones of the body. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code. 38 C.F.R. § 4.118, DC 7802. The former rating criteria for Code 7804, remained unchanged under the new criteria. The criteria for unstable or painful scars, provides for a 10 percent disability rating for one or two scars are unstable or painful. A 20 percent rating is assigned for three or four scars that are unstable or painful. The highest evaluation, 30 percent is assigned for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7804. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1). If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (2). Scars evaluated under Diagnostic Code 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (3). Under the scar regulations in effect prior to and since August 13, 2018, DC 7805 directs that any disabling effect(s) not considered under DCs 7800-7804 be evaluated under an appropriate diagnostic code. Pursuant to 38 C.F.R. § 4.118, DC 7806 prior to August 13, 2018, a noncompensable rating was warranted when the skin condition covered less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12 month period. A 10 percent disability rating was warranted for at least 5 percent, but less than 20 percent of the entire body, or at least 5 percent but less than 20 percent of the exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent disability rating was warranted for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or, systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating was warranted for more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or, constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118 (prior to August 13, 2018). Under the General Rating Formula for the Skin, effective August 13, 2018, a 0 percent rating is provided for no more than topical therapy required over the past 12-month period and at least one of the following: (i) characteristic lesions involving less than 5 percent of the entire body affected; or (ii) characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is provided for at least one of the following: (i) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; (ii) at least 5 percent, but less than 20 percent, of exposed areas affected; or (iii) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is provided for at least one of the following: (i) characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (ii) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is provided for at least one of the following: (i) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (ii) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. 38 C.F.R. § 4.118 (effective August 13, 2018). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has held that under DC 7806, "systemic therapy" means "treatment pertaining to or affecting the body as a whole," whereas topical therapy means "treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied." Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. July 14, 2017). The Federal Circuit held that although a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, this possibility does not mean that all large scale applications of topical corticosteroids amount to systemic therapy. See Burton v. Wilkie, 30 Vet. App. 292 (2018). The Veteran’s treatment records show a long history of treatment for his service-connected keloids and keloid removal scars. As part of the development of this appeal, the Veteran has been provided four VA examinations. In August 2010, the Veteran was provided a VA examination for scars. The examiner noted four keloids or keloid removal scars on the Veteran’s face, head, or neck. The largest scar measured 4 cm by 1 cm. The examiner made the following observations of that scar: painful, no signs of edema, no abnormal texture, no hypo pigmentation, no hyper pigmentation, no underlying soft tissue loss, not indurated, not inflexible, contour is not elevated or depressed, not adherent to underlying tissue, and no other disabling effects. The examiner also found keloid or keloid removal scars on the right axillary, left axillary, chest, and right lateral flank. The found 5 scars in the Veteran’s groin region. The examiner noted that the keloids in the Veteran’s groin had been treated with surgery and radiation, resolving the keloids. However, the examiner found that the remaining removal scars in the Veteran’s groin were still painful. In January 2014, the Veteran was provided a VA examination for scars and disfigurement. The examiner noted 4 facial scars. The examiner made the following observations of the facial scars: linear; no tenderness or pain elicited with palpation directly over scar; mildly hypopigmented but difficult to visualize; no skin breakdown or inflammation; no abnormal texture, depression or elevation; no underlying soft tissue loss; and no adherence to underlying tissue. The examiner measured the largest scar at 4 cm by 1 cm. The examiner found no gross distortion or asymmetry of facial features or visible palpable tissue loss. The examiner found 5 scars on the Veteran’s trunk and extremities that were not painful or unstable. The examiner found 5 scars in the Veteran’s groin region. None of the groin scars were found to be unstable. For 3 of the groin scars, the examiner found mild tenderness elicited with palpation directly over the scar. The examiner did not find any limitation of function resulting from the Veteran’s scars. The examiner did not find any other pertinent physical findings, complications, conditions, signs and/or symptoms (such as muscle or nerve damage) associated the Veteran’s scars. In November 2019, the Veteran was provided a VA examination for scars and disfigurement. The examiner noted two scars on the right upper extremity (7.5 sq. cm.), two scars on the left upper extremity (6 sq. cm.), 3 scars on the right lower extremity (6 sq. cm.), two scars on the left lower extremity (2 sq. cm.), 1 scar on the anterior trunk (8 sq. cm.), and one scar on the posterior trunk (2 sq. cm.). The total area of all the Veteran’s trunk and extremities scars was approximately 31.5 sq. cm. The examiner found none of the scars to be unstable or to have underlying tissue damage. The examiner found all 5 groin scars and the posterior truck scar to be tender to palpitation. The examiner noted 5 scars of the head, face, and neck. The largest scar measured 4 cm by 1 cm. The examiner found one scar with surface contour depressed on palpation. The examiner found all 5 scars had hypopigmentation. The approximate combined total area for hypopigmentation was 7.2 sq. cm. The examiner found no gross distortion or asymmetry of facial features or visible or palpable tissue loss. The examiner did not find any limitation of function resulting from the Veteran’s scars. The examiner attributed pain in the Veteran’s testicles to keloids or keloid scars of the left groin. The examiner did not find any other pertinent physical findings, complications, conditions, signs and/or symptoms (such as muscle or nerve damage) associated the Veteran’s scars. In July 2020, the Veteran was provided a VA examination for medical opinion as to the treatment of his service-connected keloids and keloid removal scars. The examiner identified all topical corticosteroids or other immunosuppressive drugs and topical medications that act like a corticosteroid or other immunosuppressive drug used to treat the Veteran’s keloids and scars. The examiner found that none of the medications are intended to affect the body as a whole. The examiner explained that all the listed medications are topical in nature and intended to exert a local effect. The examiner noted that absorption of any topical medication via the skin is possible, none of the medication listed affect the body as a whole. With Veteran’s treatment history and examinations in mind, the Board will consider the availability of increased, alternative, or separate disability rating for the three time periods at issue in this appeal. Diagnostic Code 7804 The Veteran’s current disability rating under DC 7804 arises from painful scars on his groin and back. The problem has been rated as follows: • From December 30, 2009 to August 15, 2013, the Veteran is rated at 30 percent for 5 painful scars in his groin region. • From November 13, 2017, the Veteran is rated at 30 percent for 5 painful scars in his groin region and 1 on his back. • From August 15, 2013, to November 13, 2017, the Veteran is rated at 20 percent for 3 painful scars in his groin region. As discussed above, DC 7804 provides a 20 percent rating for three or four scars that are unstable or painful and a 30 percent for five or more scars that are unstable or painful. The temporary reduction of his disability rating to 20 percent is the result of the January 2014 VA examination that described the Veteran’s three right groin scars as tender and two left groin scars as not tender. However, the Veteran has consistently maintained that his two left groin scars were painful during this time period. In this regard, the Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Considering the records of the Veteran’s frequent and continued treatment for his keloids during this time period and acknowledging that prior and subsequent VA examinations found the keloids in questions to be tender or painful, the Board finds that the Veteran's reports of his pain symptoms of his groin keloids are credible. Accordingly, the Board finds that the Veteran is entitled to an increased disability rating of 30 percent for his service-connected keloids under DC 7804 from August 15, 2013, to November 13, 2017. With this increase, the Veteran is now in receipt of a 30 percent disability rating for the pendency of the claim. Under 7804, a higher 40 percent rating is provided where there is evidence of at least one of the Veteran’s five or more painful scars is also shown to be unstable. However, the three VA examinations and the Veteran’s treatment records do not indicate that any of the Veteran’s painful scars are also unstable. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1). Accordingly, the Board finds that, for the pendency of the appeal, the preponderance of the evidence shows that the Veteran’s keloid disability was manifest by five or more painful, but not unstable, scars. Therefore, the Board finds that the criteria for a rating in excess of 30 percent under DC 7804 are not met. See 38 C.F.R. § 4.118; Fenderson, supra. Diagnostic Code 7800 The Veteran’s keloids of the face, head, and neck are separately rated under DC 7800 at 10 percent from August 15, 2013, to November 13, 2017, and at 30 percent from November 13, 2017. The 10 percent rating is based on a finding of one characteristic of disfigurement and the 30 percent rating is based on a finding of two characteristics of disfigurement. See 38 C.F.R. § 4.118, DC 7800. Prior to August 15, 2013, the Veteran is not rated for keloids of the face, head, and neck. However, the August 2010 VA examination shows that the Veteran has 4 head, face, or neck keloid scars. One of the four scars was measured as more than one half inch in width, a characteristic of disfigurement under DC 7804. Accordingly, the Board finds that the Veteran is also entitled to separate initial disability rating of 10 percent for his service-connected keloids of the face, head, or neck under DC 7800 from December 30, 2009, to August 15, 2013. With this increase, the Veteran’s keloids of the face, head, or neck are now rated as 10 percent disabling from December 30, 2009, to November 13, 2017. The record for this time period, including VA examinations, do not show additional characteristics of disfigurement, visible or palpable tissue loss, or gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips). Accordingly, the Board finds that, for the period of December 30, 2009, to November 13, 2017, the preponderance of the evidence shows that the Veteran’s keloids of the face, head, or neck were manifest by one characteristic of disfigurement. Therefore, the Board finds that the criteria for a rating in excess of 10 percent under DC 7800 are not met. See 38 C.F.R. § 4.118; Fenderson, supra. From November 17, 2017, the record, including the November 2019 VA examination, shows two characteristics of disfigurement for the Veteran’s keloids of the face, head, or neck: scar width greater than on half inch and surface contour depressed on palpation. The record does not show additional characteristics of disfigurement, visible or palpable tissue loss, or gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips). Accordingly, the Board finds that, from November 17, 2017, the preponderance of the evidence shows that the Veteran’s keloids of the face, head, or neck were manifest by two characteristics of disfigurement. Therefore, the Board finds that the criteria for a rating in excess of 30 percent under DC 7800 are not met. See 38 C.F.R. § 4.118; Fenderson, supra. Diagnostic Code 7801 Under the new criteria, DC 7801 is applicable to scars other than those on the head, face, or neck, that are associated with underlying soft tissue damage. Under the old criteria, DC 7801 is applicable to scars other than those on the head, face, or neck, that are deep and nonlinear. There is no indication, nor is it contended, that the appellant's service-connected keloids or keloid removal scars are associated with underlying soft tissue damage or deep and nonlinear. Diagnostic Code 7802 DC 7802 provides a maximum 10 percent rating for scars with a total area of 144 square inches (929 sq. cm.) or greater. There is no indication, nor is it contended, that the appellant's service-connected keloid scars of the right lower extremity, left lower extremity, right upper extremity, left upper extremity, posterior trunk, and anterior trunk have a total area of 144 square inches. Diagnostic Code 7805 DC 7805 directs that any disabling effect(s) not considered under DCs 7800-7804 be evaluated under an appropriate diagnostic code. As noted above, the Veteran has been service connected for tenderness of the testicles secondary to his service-connected keloid scars, effective November 7, 2019. However, there is no indication, nor is it contended, that the appellant's service-connected keloid disability residual scarring of have been manifested by any other disabling effects during the period on appeal. Diagnostic Code 7806 Alternatively, the Board has also considered the application of DC 7806 for dermatitis to the Veteran’s keloid condition by analogy. See 38 C.F.R. § 4.20. As discussed above, DC 7806 provides for a higher 60 disability percent rating where more than 40 percent of the entire body or more than 40 percent of exposed areas affected by the skin condition; or, constant or near-constant systemic therapy Here, the record does not show, nor is it contended, that more than 40 percent of the Veteran’s body or 40 percent of exposed areas are affected by his keloids. And, the July 2020 examiner found that the medications used to treat the Veteran’s keloids during the pendency of the appeal are not considered systemic. Thus, the Board finds that an alternative and increased rating under DC 7806 is not warranted. Accordingly, the Board finds that, during the pendency of the appeal, the preponderance of the evidence shows that the Veteran’s keloids do not affect 40 percent of the Veteran’s body, do not affect 40 percent of exposed areas, or received constant or near-constant systemic therapy. Therefore, the Board finds that the criteria for an alternative rating in excess of 30 percent for the Veteran’s keloids under DC 7806 are not met. See 38 C.F.R. § 4.118; Fenderson, supra. In summary, the Board finds that the Veteran is entitled to an increased initial disability rating of 30 percent, but no higher, for keloids from August 15, 2013 to November 13, 2017, and a separate initial disability rating of 10 percent for keloids of the head, face or neck from December 30, 2009, to August 15, 2013. The Board finds that initial disability ratings in excess of 30 percent for keloids from December 30, 2009, to August 15, 2013, and from November 13, 2017, are not warranted. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, where the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Neither the Veteran nor his representative has identified any other rating criteria that would provide higher rating or additional ratings. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. VanValkenburg, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.