Citation Nr: 21006009 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-00 682A DATE: February 3, 2021 ORDER An initial rating in excess of 10 percent for skin cancer with squamous and basal cell carcinoma and actinic keratosis is denied. The assignment of a separate rating for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis, evaluated as 10 percent disabling as of May 21, 2018, is proper; the appeal is denied. As of January 28, 2020, but no earlier, a 20 percent rating, but no higher, for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis is granted, subject to the laws and regulations governing the payment of monetary awards. The assignment of a separate rating for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis, evaluated as 30 percent disabling as of November 9, 2020, is proper; the appeal is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis manifested as scars of the head, face, or neck that are at least one-quarter inch wide at their widest part, with hypopigmentation and abnormal texture in an area less than six square inches (39 square centimeters (cm)), without additional characteristics of disfigurement, visible or palpable tissue loss, or gross distortion or asymmetry of one feature or paired set of features, and, prior to May 21, 2018, were not painful and/or unstable. 2. As of May 21, 2018, the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis resulted in two painful, but not unstable, scars on the lower lip and the right hand. 3. As of January 28, 2020, the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis resulted in one painful and unstable scar on the lower lip. 4. As of November 9, 2020, the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis resulted in more than five painful, but not unstable, scars over his body. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for skin cancer with squamous and basal cell carcinoma and actinic keratosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code (DC) 7800. 2. The assignment of a separate rating for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis, evaluated as 10 percent disabling as of May 21, 2018, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7804. 3. As of January 28, 2020, but no earlier, the criteria for a 20 percent rating, but no higher, for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7804. 4. The assignment of a separate rating for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis, evaluated as 30 percent disabling as of November 9, 2020, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1963 to June 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In October 2019, the Board remanded the case for additional development and it now returns for further appellate review. During the course of the appeal, a June 2018 rating decision awarded a separate rating for residual painful scar of the lower lip, status post skin cancer biopsy, evaluated as 10 percent disabling, effective May 21, 2018, and, in a November 2020 rating decision, such disability was recharacterized as residual painful scars associated with associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis and an increased rating of 30 percent was awarded, effective November 9, 2020. Thus, as such scarring pertains to the head, face, and neck and the separate rating was assigned pursuant to Diagnostic Code 7800, Note (4), as articulated below, the Board has assumed jurisdiction over the propriety of such separate rating. 1. Entitlement to an initial rating in excess of 10 percent for skin cancer with squamous and basal cell carcinoma and actinic keratosis. 2. Propriety of the assignment of a separate rating for residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis, evaluated as 10 percent disabling as of May 21, 2018, and 30 percent disabling as of November 9, 2020. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Since July 27, 2011, the date of service connection, the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis are rated as 10 percent disabling pursuant to DC 7800. 38 C.F.R. § 4.118. As noted previously, a June 2018 rating decision awarded a separate rating for residual painful scar of the lower lip, status post skin cancer biopsy, evaluated as 10 percent disabling, effective May 21, 2018, and, in a November 2020 rating decision, such disability was recharacterized as residual painful scars associated with associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis and an increased rating of 30 percent was awarded, effective November 9, 2020, pursuant to DC 7804 through application of Note 4 to DC 7800. Id. As an initial matter, the Board observes that VA examinations conducted throughout the appeal period reflects that the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis affected less than 5 percent of exposed areas and the entire body were affected, and were treated by topical steroid cream on a near constant basis, described as one to two times a week and two to three times a month. Thus, the Board has considered the applicability of DC 7806 pertinent to the evaluation of dermatitis or eczema; however, such provides that such skin disorder should be rated as disfigurement of the head, face, or neck (DC 7800), or scars (DCs 7801-7805), depending on the predominant disability. In the instant case, the record reflects that the predominant disability associated with the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis is scarring. Thus, the Board finds that such disability has been appropriately rated under DC 7800 and 7804, and further consideration of 7806 is not necessary. Under DC 7800, a 10 percent rating is assigned when one characteristic of disfigurement is present and 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, lips), or; with two or three characteristics of disfigurement. A 50 percent rating is warranted for visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features, or; with four or five characteristics of disfigurement. A maximum rating of 80 percent is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features, or; with six or more characteristics of disfigurement. Note (1) provides that the eight characteristics of disfigurement for purposes of evaluation under 38 C.F.R. § 4.118 are: Scar five or more inches (13 or more centimeters) in length; Scar at least one-quarter inch (0.6 centimeters) wide at the widest part; Surface contour of scar elevated or depressed on palpation; Scar adherent to underlying tissue; Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 square centimeters); Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 square centimeters); Underlying soft tissue missing in an area exceeding six square inches (39 square centimeters); Skin indurated and inflexible in an area exceeding six square inches (39 square centimeters). Note (2) indicates that tissue loss of the auricle is rated under DC 6207, and anatomical loss of the eye is rated under DC 6061 or DC 6063, as appropriate. Note (3) provides that VA is to consider unretouched color photographs when evaluating under these criteria. Additionally, Note (4) reflects that VA is to separately evaluate disabling effects other than disfigurement that are associated with individual scars of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply 38 C.F.R. § 4.25 to combine the evaluation(s) with the evaluation assigned under DC 7800. Finally, Note (5) indicates that the characteristics of disfigurement may be caused by one scar or by multiple scars; the characteristics that are required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation. DC 7801 pertains to burn scars or scars due to other causes, not of the head, face, or neck, that are, prior to August 13, 2018, deep and nonlinear and, after such date, associated with underlying soft tissue damage. Under this DC, a 10 percent rating is assigned when the scar(s) cover an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). Higher ratings are available for scars of greater area. DC 7802 pertains to burn scars or scars due to other causes not of the head, face, or neck that are, prior to August 13, 2018, superficial and nonlinear and, after such date, not associated with underlying soft tissue damage. Under this DC, a single 10 percent rating is assigned when the scar(s) cover an area or areas of 144 square inches (929 sq. cm) or greater. Under DC 7804, one or two scars that are unstable or painful warrant a 10 percent rating. A 20 percent rating is warranted where there are three or four scars that are unstable or painful, and a 30 percent rating is warranted where there are five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code when applicable. DC 7805 provides that other scars (including linear scars) and other effects of scars evaluated under DC 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-04 under an appropriate DC. During the pendency of the appeal, VA amended the criteria for rating the skin, to include scars. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32,592 (July 13, 2018). As pertinent to the instant appeal, such amendment changed DC 7801 by removing the term “deep and nonlinear” and replacing it with “associated with underlying soft tissue damage,” and changed DC 7802 by removing the term “superficial and nonlinear” and replacing it with “not associated with underlying soft tissue damage.” Such also amended the accompanying notes to read: Note (1): For the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk. Note (2): A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under § 4.25. 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 DC. With regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its “intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied.” The Veteran’s claim in this case was pending prior to the August 13, 2018, effective date of the new criteria and, therefore, the Board will consider both the old and new criteria. Throughout the appeal period, VA and private treatment records reflect ongoing treatment for skin cancer with squamous and basal cell carcinoma and actinic keratosis affecting various parts of the body; however, such records do not reflect that the Veteran’s skin disability results in more severe symptomatology than as detailed in the examinations conducted during the course of the appeal period. In this regard, the Veteran was afforded a VA examination in July 2013, at which time he reported that his first incident of skin issues began in August 1980 when he found out he had basal cell carcinoma, which was surgically removed. He denied any complications from the surgical incision. The Veteran further reported that there had been numerous additional skin cancer (squamous and basal cell) and actinic keratosis, which were frozen and treated. He indicated that his last treatment was in November 2012, which consisted of the removal of a squamous cell from his right hand, and a number of actinic keratosis that were frozen. Physical examination revealed scars from skin cancer removal which were hypopigmented, to include: (1) on the mid-forehead, noted to measure 1 cm by 0.5 cm; (2) on the right cheek, noted to measure 1 cm by 1 cm; (3) on the left upper temporal area behind the ear, noted to measure 1.5 cm by 1 cm; and (4) on the left lower temporal area behind the ear, noted to measured 2 cm by 0.5 cm. There was no tenderness or breakdown of the skin. None of the scars were painful or unstable; there was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue; an approximate total area of 3.5 sq. cm. was affected; there was no distortion of facial features, tissue loss for the head, face and neck, asymmetry of facial features, or visible or palpable tissue loss; and did not result in limitation of function. A superficial non-linear scar was also noted on the left upper extremity, which measured 1 cm by 0.5 cm and affected a total area of 0.5 cm, but such was not painful or unstable. A January 2015 VA skin diseases Disability Benefits Questionnaire (DBQ) completed by the Veteran’s private treatment provider reflects diagnoses of squamous cell carcinoma and actinic keratosis. Such report indicates that treatment for a benign/malignant neoplasm/metastases had been completed and the Veteran was in a watchful, waiting status; he underwent cryotherapy in July 2014; and he had numerous actinic keratoses that were currently under treatment. A May 21, 2018, VA examination report reflects the Veteran’s report of multiple scars on his face, scalp, bilateral hands, and chest from excision of his skin cancers (basal cell carcinoma and squamous cell carcinoma). He had a history of numerous actinic keratosis that was treated with cryotherapy; and was required to have his skin checked every three months. Physical examination revealed scars on the Veteran’s face and scalp to include: (1) on the mid-forehead, noted to measure 4 cm by 0.4 cm; (2) on the right temple, noted to measure 3 cm by 0.3 cm; (3) on the left temple, noted to measure 2 cm by 0.3 cm; (4) on the right cheek, noted to measure 1.5 cm by 0.2 cm; (5) on the lower lip; described as painful; noted to measure 1 cm by 0.4 cm; (6) on the upper posterior scalp, noted to measure 2 cm by 0.2 cm; (7) on the mid-posterior scalp, noted to measure 2 cm by 0.3 cm; (8) on the lower posterior scalp, noted to measure 4 cm by 0.2 cm; and (9) behind the left ear, noted to measure 2 cm by 0.4 cm. Other than the scar on the lower lip, none of the scars were painful and none were unstable; there was no abnormal pigmentation; no tenderness, elevation, depression, adherence to underlying tissue, or missing underlying soft tissue; no distortion of facial features, tissue loss for the head, face and neck, asymmetry of facial features, or visible or palpable tissue loss; and did not result in limitation of function. Additional scars that were noted include: (1) on the right hand (dorsum), described as painful, linear, and tender to palpation, but not unstable, and noted to measure 3 cm by 1.5 cm; (2) on the left hand (dorsum lateral), described as linear and not painful or unstable, and noted to measure 5 cm by 0.2 cm; (3) on the left hand (dorsum mid), described as linear and not painful or unstable, and noted to measure 3 cm by 0.2 cm; and (4) on the right anterior chest, described as linear and not painful or unstable, and noted to measure 2 cm by 0.8 cm. A January 28, 2020, VA examination report reveals scars on the Veteran’s face and scalp to include: (1) on the mid-forehead, noted to measure 4 cm by 0.4 cm; (2) on the right temple, noted to measure 3 cm by 0.3 cm; (3) on the left temple, noted to measure 2 cm by 0.3 cm; (4) on the right cheek, noted to measure 1.5 cm by 0.2 cm; (5) on the lower lip; described as painful with frequent loss of covering of the skin over the scar (unstable) and abnormal texture; noted to measure 1 cm by 0.4 cm; and had an approximate total area of 0.24 sq. cm; (6) on the upper posterior scalp, noted to measure 2 cm by 0.2 cm; (7) on the mid-posterior scalp, noted to measure 2 cm by 0.3 cm; (8) on the lower posterior scalp, noted to measure 4 cm by 0.2 cm; and (9) behind the left ear, noted to measure 2 cm by 0.4 cm. Such scars were not tender to palpation; did not have elevation, depression, adherence to underlying tissue, or missing underlying soft tissue; no distortion of facial features, tissue loss for the head, face and neck, asymmetry of facial features, or visible or palpable tissue loss; and did not result in limitation of function. Additional scars that were noted include: (1) on the left hand (dorsum); noted to measure 3 cm by 0.5 cm; and had an approximate total area of 1.5 sq. cm; (2) on the upper back, noted to measure 1 cm by 0.6 cm; and (3) on the mid-back, noted to measure 1.2 cm by 0.6 cm. Both back scars had an approximate total area of 1.32 sq. cm. Such scars were not painful or unstable, tender to palpation, had underlying soft tissue damage, or affected the Veteran’s ability to work. A November 9, 2020, VA examination report reflects the Veteran’s report of irritating scarring all over the exposed parts of his body, with the scarring on his lip being the most painful. He further reported that the scarring on his hands bothered him continuously. Physical examination revealed 8 right hand scars that each measured 0.7 cm by 0.7 cm, to include one that was reddish. Such scars had an approximate total area of 3.92 sq. cm, and all were tender to palpation. The examiner further noted 8 left hand scars. Six of the Veteran’s left hand scars were noted to measure 0.7 cm by 0.7 cm; a seventh left hand scar was noted to measure 0.5 cm by 0.2 cm; and an eighth left hand scar was noted to measure 3 cm by 0.3 cm. Such scars had an approximate total area of 3.94 sq. cm; and all were tender to palpation. All scars on the Veteran’s hands were noted to be painful; however, such were not unstable and there was no underlying soft tissue damage. Additional scars that were noted include two near the right nipple and three near the left shoulder that each measured 1 cm by 1 cm, with an approximate total area of 5 sq. cm. One of the scars near the Veteran’s right nipple was noted to be tender. Such scars were not unstable and there was no underlying soft tissue damage. The examiner further noted 9 back scars that each measured 1 cm by 1 cm, with an approximate total area of 9 sq. cm. Such scars were not tender to palpation or unstable, and did not have underlying soft tissue damage. Furthermore, the examiner indicated that the Veteran had scars on his face and scalp to include: (1) on the forehead, noted to measure 1 cm by 1 cm; (2) on the right temple, noted to measure 1 cm by 1 cm; (3) on the left temple, noted to measure 1 cm by 1 cm; (4) on the upper lip; described as painful and tender; noted to measure 1 cm by 1 cm; and (5) on the left cheek, noted to measure 2 cm by 0.5 cm. The Veteran had 5 additional scars on his left cheek and forehead that each measure 1 cm by 1 cm. Such scars were not unstable; there was no abnormal pigmentation; no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue; no distortion of facial features, tissue loss for the head, face and neck, asymmetry of facial features, or visible or palpable tissue loss; and did not result in limitation of function. Based on the foregoing, the Board finds that an initial rating in excess of 10 percent for the Veteran’s skin cancer with squamous and basal cell carcinoma and actinic keratosis is not warranted under DC 7800. In this regard, the July 2013 VA examiner found that the Veteran had scars that were at least one-quarter inch wide at the widest part (right cheek and left upper temporal area). While such examiner further noted that the scars on the Veteran’s face and scalp were hypopigmented, the area affected did not exceed six square inches. Additionally, while the January 2020 VA examiner indicated that the Veteran’s lower lip scar had an abnormal texture, the area affected did not exceed six square inches. Furthermore, none of the aforementioned examinations, nor any other evidence of record, reflects that the Veteran’s scarring of the head, face, or neck results in a scar measuring five or more inches, surface contour of a scar was elevated or depressed on palpation, scar was adherent to the underlying tissue, scar was hypo- or hyper-pigmented in an area exceeding six square inches, scar texture was abnormal in an area exceeding six square inches, underlying soft tissue was missing in an area exceeding six square inches, or skin was indurated and inflexible in an area exceeding six square inches. Specifically, other than measuring at least one-quarter inch wide at their widest part, the Veteran’s scars of the head, face, and neck did not result in any other characteristics of disfigurement, and there is no evidence of distortion of facial features, asymmetry of facial features, or visible or palpable tissue loss. Consequently, an initial rating in excess of 10 percent for the Veteran’s scars of the head, face, and neck is not warranted. In regard to the propriety of the separate rating assigned for the Veteran’s residual painful scars associated with skin cancer with squamous and basal cell carcinoma and actinic keratosis, the Board has first considered whether the Veteran is entitled to a separate rating for painful and/or unstable scarring prior to May 21, 2018; however, there is no evidence demonstrating that his scars were painful or unstable prior to such date. Specifically, neither the July 2013 VA examination nor the January 2015 DBQ reflected the present of painful or unstable scars. Thus, a separate rating under DC 7804 is not warranted prior to May 21, 2018. However, as of such date, the Veteran had two painful, but not unstable, scars located on the lower lip and right hand, thus warranting the currently assigned 10 percent rating. Thus, a higher rating is not warranted as of such date as there are no more than two painful scars, and none were unstable. However, as of January 28, 2020, but no earlier, the Board finds that a rating of 20 percent, but no higher, is warranted under DC 7804 as the evidence demonstrates that presence of one painful and unstable scar on the Veteran’s lower lip. In this regard, Note (2) of DC 7804 indicates that, if one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is passed on the total number of unstable or painful scars. Thus, as the Veteran is currently in receipt of a 10 percent rating under DC 7804 for one or two scars that are unstable or painful, an additional 10 percent must be added as one scar is both stable and painful. Consequently, as of such date, a 20 percent rating is warranted. However, as there are no additional painful or unstable scars, a higher rating under such DC is not warranted. Finally, the Veteran is not entitled to a rating in excess of 30 percent as of November 9, 2020, under DC 7804. In this regard, while he had more than five painful scars over his body, none were found to be unstable. Specifically, while the November 2020 VA examination report reflects that the Veteran’s bilateral hand (16) and upper lip (1) scars were painful and a scar near the right nipple was tender, none were noted to also be unstable. The Board has also considered whether higher or separate ratings are warranted under DCs 7801 and 7802. In this regard, the Board notes that a November 2020 rating decision awarded separate noncompensable ratings for residual scars of the anterior trunk, posterior trunk, and right upper extremity pursuant to DC 7802. However, as the evidence fails to demonstrate that the Veteran’s scars are deep, or associated with underlying tissue damage, or encompass an area of 144 square inches or greater, additional higher or separate ratings are not warranted under DC 7801 or 7802. In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his skin and scar disabilities are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected skin cancer, to include residual scarring; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning additional staged ratings is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the initial rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran’s favor, which has resulted in a partial award of an increased rating for residual scarring. However, insofar as the Board has denied higher or separate ratings, the preponderance of the evidence is against such aspects of the Veteran’s claims. Therefore, the benefit of the doubt doctrine is not applicable and such initial rating claims must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.