Citation Nr: 21007232 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 11-23 023 DATE: February 9, 2021 ORDER Entitlement to an increased evaluation for left knee degenerative joint disease status post ACL repair associated with limitation of flexion, rated at 10 percent from April 17, 2014 to June 1, 2015 is denied. Entitlement to an increased evaluation for left knee degenerative joint disease status post ACL repair associated with limitation of extension, rated at 20 percent from February 27, 2009 and 40 percent from April 17, 2014 to June 1, 2015 is denied. Entitlement to an increased evaluation for left knee laxity, rated at 0 percent from February 27, 2009 and 20 percent from April 17, 2014 to June 1, 2015 is denied. Entitlement to a disability rating of 60 percent for left knee total knee replacement from September 1, 2016 is granted. Entitlement to an increased evaluation for left knee scar, rated at 0 percent from September 7, 2016 is denied. Entitlement to an increased evaluation for right knee degenerative joint disease status post ACL repair associated with limitation of flexion, rated at 10 percent from February 27, 2009 and 0 percent from April 17, 2014 to October 16, 2017 is denied. Entitlement to an increased evaluation for right knee degenerative joint disease with limitation of extension, rated at 30 percent from April 17, 2014 to October 16, 2017 is denied. Entitlement to an increased evaluation for right knee degenerative joint disease with instability, rated at 20 percent from April 17, 2014 to October 16, 2017 is denied. Entitlement to an increased evaluation for right knee scar, rated at 0 percent from September 7, 2016 is denied. FINDINGS OF FACT 1. From April 17, 2014 to June 1, 2015, the Veteran’s left knee degenerative joint disease status post ACL repair did not manifest in flexion limited to 30 degrees or less. 2. From February 27, 2009, the Veteran’s left knee degenerative joint disease status post ACL repair did not manifest in extension limited to 20 degrees or more and from April 17, 2014 to June 1, 2015 it did not manifest in extension limited to 45 degrees or more. 3. From February 27, 2009, the Veteran’s left knee disability was not manifested by slight laxity and from April 17, 2014 to June 1, 2015, the Veteran’s left knee disability was manifested by no more than moderate laxity. 4. From September 1, 2016, the Veteran’s left knee replacement manifested in chronic residuals consisting of severe painful motion or weakness in the affected extremity. 5. The Veteran’s residual left knee scar was not associated with underlying soft tissue damage; did not cover an area of 144 square inches (929 sq. cm.); was not painful or unstable; and did not manifest any other disabling effects. 6. From February 27, 2009, the Veteran’s right knee degenerative joint disease status post ACL repair did not manifest in flexion limited to 30 degrees or less and from April 17, 2014 to October 16, 2017 it did not manifest in flexion limited to 45 degrees or less. 7. From April 17, 2014 to October 16, 2017, the Veteran’s right knee degenerative joint disease did not manifest in extension limited to 30 degrees or more. 8. From April 17, 2014 to October 16, 2017, the Veterans right knee degenerative joint disease was manifested by no more than a moderate instability of the joint. 9. The Veteran’s residual right knee scar was not associated with underlying soft tissue damage; did not cover an area of 144 square inches (929 sq. cm.); was not painful or unstable; and did not manifest any other disabling effects. CONCLUSIONS OF LAW 1. From April 17, 2014 to June 1, 2015, the criteria for a rating in excess of 10 percent for left knee degenerative joint disease status post ACL repair associated with limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 2. From February 27, 2009, the criteria for a rating in excess of 20 percent for left knee degenerative joint disease status post ACL repair have not been met. From April 17, 2014 to June 1, 2015, the criteria for a rating in excess of 40 percent for left knee degenerative joint disease status post ACL repair have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5261. 3. From February 27, 2009, the criteria for a compensable rating for left knee laxity have not been met. From April 17, 2014 to June 1, 2015, the criteria for a rating in excess of 20 percent for left knee laxity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 4. The criteria for a 60 percent rating for left total knee arthroplasty residuals effective September 1, 2016 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5055. 5. The criteria for a compensable disability rating for left knee scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. 6. From February 27, 2009, the criteria for a rating in excess of 10 percent for limitation of flexion for right knee degenerative joint disease status post ACL repair have not been met. From April 17, 2014 to October 16, 2017, the criteria for a compensable rating for limitation of flexion for right knee degenerative joint disease status post ACL repair have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 7. From April 17, 2014 to October 16, 2017, the criteria for a rating in excess of 30 percent for right knee degenerative joint disease with limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5261. 8. From April 17, 2014 to October 16, 2017, the criteria for a rating in excess of 20 percent for right knee degenerative joint disease with instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 9. The criteria for a compensable disability rating for right knee scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January to April 1988 and from January 2005 to February 2009, and periods of National Guard service. He died in June 2018. The appellant, who is his widow, has been substituted as the claimant. The Regional Office accepted her as the substitute appellant in a July 2018 letter. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the August 2009 Rating Decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board. In May 2017, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. These matters were remanded for additional development in January 2018. The RO substantially complied with the remand and recertified the appeal to the Board. The January 2018 Board remand included the issues of entitlement service connection for obstructive sleep apnea and to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities. The September 2020 rating decision granted entitlement to service connection for obstructive sleep apnea and to individual unemployability effective February 27, 2009. As these issues resulted in complete grants of the benefits sought, they are no longer before the Board. Increased Ratings Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity in civilian occupations resulting from such diseases and injuries, and the residual conditions. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate disability codes (DCs) identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, 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. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. Id. § 4.3. In every instance where the schedule does not provide a zero percent evaluation for a DC, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. Id. § 4.31. A veteran’s entire history is reviewed when making a disability determination. 38 C.F.R. § 4.1. However, the present level of the disability is of primary concern where the issue is entitlement to an increase in the rating for a disability for which service connection has already been established. See Francisco v. Brown, 7 Vet. App. 55 (1994). In such cases, when the factual findings show distinct time periods during which a claimant exhibits symptoms of the disability at issue and such symptoms warrant different evaluations, staged evaluations may be assigned. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and painful joints are entitled to at least the minimum compensable rating for the joint. In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. The final sentence provides that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint.” The Court found that, to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59. Correia, 28 Vet. App. at 169-170. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). In Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the Court addressed the adequacy of medical opinions that decline to present clear estimations by citing that such estimations would be mere speculation. The Court explained that case law and VA guidelines do not require direct observation of functional impairment after repetitive use or during a flare-up as a prerequisite to offering a DeLuca opinion. DeLuca v. Brown, 8 Vet. App. 202 (1995). Indeed, it is not expected that such observation will usually occur; therefore, VA examiners should offer opinions based on estimates derived from information procured from all relevant sources, including the lay statements of Veterans. VA examiners have a duty to elicit information from the Veteran when attempting to describe functional loss associated with pain during unobserved exacerbations. If a non-speculative opinion still cannot be offered, the VA examiner must explain the basis for this conclusion. It must be apparent that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large and not a limitation (whether based on lack of expertise, insufficient information, or unprocured testing) of the individual examiner. Knee Disorders 38 C.F.R. § 4.71a includes multiple diagnostic codes that evaluate impairment resulting from knee disorders, including Diagnostic Code 5055 (prosthetic knee replacement), Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (other impairment, including recurrent subluxation or lateral instability), Diagnostic Code 5258 (dislocated semilunar cartilage), Diagnostic Code 5259 (symptomatic removal of semilunar cartilage), Diagnostic Code 5260 (limitation of flexion), Diagnostic Code 5261 (limitation of extension), Diagnostic Code 5262 (impairment of the tibia and fibula), and Diagnostic Code 5263 (genu recurvatum). Under Diagnostic Code 5055, a prosthetic knee replacement warrants a 100 percent rating for 1 year following implantation of prosthesis. With chronic residuals consisting of severe, painful motion or weakness in the affected extremity, the rating is 60 percent. With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to Diagnostic Code 5256, 5261, or 5262. Minimum rating is 30 percent. Under Diagnostic Code 5256, a 30 percent rating may be assigned for ankylosis of a knee at a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating may be assigned for ankylosis of a knee in flexion between 10 degrees and 20 degrees. A 50 percent rating may be assigned for ankylosis of a knee between 20 degrees and 45 degrees. A 60 percent rating may be assigned for extremely unfavorable ankylosis of a knee in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a; Diagnostic Code 5256. Diagnostic Code 5257 provides for a 10 percent rating for slight recurrent subluxation or lateral instability of the knee, a 20 percent rating for moderate recurrent subluxation or lateral instability, and a 30 percent rating for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a. Under Diagnostic Code 5258, a 20 percent rating is assigned for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Under Diagnostic Code 5259, removal of semilunar cartilage that is symptomatic warrants a 10 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Under Diagnostic Code 5260, flexion of the leg limited to 60 degrees warrants a 0 percent rating, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, extension limited to 5 degrees warrants a 0 percent rating, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Flexion of the knee to 140 degrees is considered full and extension to 0 degrees is considered full. 38 C.F.R. § 4.71, Plate II. Under Diagnostic Code 5262, a 10 percent rating is available when there is malunion of the tibia and fibula with slight knee or ankle disability; a 20 percent rating is available when there is malunion of the tibia and fibula with moderate knee or ankle disability; a 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability; and a maximum rating of 40 percent is warranted for nonunion of the tibia and fibula with loose motion, requiring brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262. Under Diagnostic Code 5263, a 10 percent rating is warranted for genu recurvatum. 38 C.F.R. § 4.71a, Diagnostic Code 5263. Separate ratings may be assigned for knee disability under Diagnostic Code 5257 and 5003 where there is x-ray evidence of arthritis in addition to recurrent subluxation or lateral instability. See generally VAOPGCPREC 23- 97 and VAOPGCREC 9-98. A precedent opinion by VA General Counsel holds that separate ratings may be assigned in cases where a service-connected knee disability includes both a compensable limitation of flexion under Diagnostic Code 5260 and a compensable limitation of extension under Diagnostic Code 5261, provided that the degree of disability is compensable under each set of criteria. VAOPGCPREC 09-04; 69 Fed. Reg. 59990 (2004). Scars The Veteran’s scars are rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7805 was not changed by the August 13, 2018, amendments. Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 should be evaluated under an appropriate Diagnostic Code. 1. Entitlement to an increased evaluation for left knee disabilities. The Veteran appealed for a higher rating for his service-connected left knee disability. Beginning February 27, 2009, it was rated at 0 percent and 20 percent from April 17, 2014 to June 1, 2015 under 38 C.F.R. § 4.71a, Diagnostic Code 5257 for laxity. From April 17, 2014 to June 1, 2015, the Veteran’s left knee was also rated at 10 percent under Diagnostic Code 5260 for limitation of flexion. From February 27, 2009, it was rated at 20 percent and from April 17, 2014 to June 1, 2015 it was rated at 40 percent under Diagnostic Code 5261 for limitation of extension. Following a left total knee replacement on June 1, 2015, the Veteran was in receipt of a 100 percent rating until August 31, 2016. From September 1, 2016 the Veteran’s left knee has been rated at 30 percent disabling under Diagnostic Code 5055. From September 7, 2016, the Veteran’s left knee scar was rated at 0 percent under Diagnostic Code 7805. Based on the evidence, the Board concludes that no increased or additional ratings are warranted for the Veteran’s left knee disability prior to his left knee replacement and that a higher rating of 60 percent is warranted for the left knee from September 1, 2016. The Veteran requested higher ratings based on pain, mobility and having to take more medication for the condition. An October 2010 VA treatment note showed the Veteran’s knees had reduced range of motion with left worse than the right. A June 2013 VA treatment record showed the Veteran walked using a cane and had swelling of both knees. At an April 2014 VA examination, the Veteran reported worsening bilateral knee pain, instability, and with flare-ups swelling and increased pain. Left knee flexion was to 70 degrees, but painful motion began at 50 degrees. Extension ended at 20 degrees, but painful motion began at 25 degrees. He had severe pain with motion so was unable to perform repetitive use testing but had normal strength. Anterior, posterior, and medial-lateral instability was assessed as 2+ (5-10 millimeters). He used a cane. A November 2014 private treatment note showed the Veteran ambulated with a bilateral antalgic gait with limited range of motion on both sides. He lacked about 20 degrees of full extension on the left side. He underwent total left knee replacement in June 2015. Because the Veteran’s left knee disability did not manifest in severe recurrent subluxation or lateral instability, flexion limited to 30 degrees or less, or extension limited to 45 degrees or more, a higher disability rating is not warranted for the period prior to the Veteran’s knee replacement in June 2015. See 38 C.F.R. § 4.71a., Diagnostic Codes 5257, 5260, and 5261. The Board considered the flare-ups and pain, but the VA clinician opinion found no additional functional limitations with repetitive use. For the period prior to the Veteran’s left knee replacement, an additional disability rating under Diagnostic Codes 5256, 5258, 5259, 5262, 5263 is inappropriate in this case as the Veteran’s left knee disability does not include the pathology required in the criteria for those Diagnostic Codes (ankylosis, dislocated semilunar cartilage, symptomatic removal of semilunar cartilage, malunion or nonunion of tibia or fibula, or genu recurvatum). 38 C.F.R. § 4.71a. The September 2016 VA examination showed the Veteran’s left knee range of motion was 10 to 80 degrees. Due to pain he was unable to perform repetitive use testing. There was no ankylosis and no instability. The VA examiner found that the Veteran’s left knee replacement resulted in chronic residuals consisting of severe painful motion or weakness. At a September 2017 private treatment appointment, the Veteran reported he had done relatively well overall from his left total knee arthroplasty, but had occasional soreness. Extension was to 0 degrees and flexion to 115 or 120 degrees with mild laxity. There was extreme pain on flexion, but full strength. In April 2020, a VA clinician reviewed the record and opined in regards to the left knee there was no basis to offer additional losses of function or motion when it comes to repetitive use or during a flare up. The Board concludes that the evidence is at least in equipoise as to whether it shows that a disability rating of 60 percent is warranted under DC 5055 for the period beginning September 1, 2016. The September 2016 VA examiner found that the Veteran’s June 2015 left knee replacement surgery resulted in chronic residuals consisting of severe painful motion or weakness. The examiner’s opinion was informed by an in-person examination of the Veteran, a review of the Veteran’s medical history and the claims file. This meets the criteria for a higher rating of 60 percent under Diagnostic Code 5055. A higher evaluation is not warranted under this diagnostic code except within one year after implantation of prosthesis. Separate ratings under alternate diagnostic codes are not warranted as DC 5055 contemplates the Veteran’s full left knee symptomatology. Therefore, the disability evaluation of 60 percent is the highest schedular disability rating available for the period beginning September 1, 2016. The Veteran did not provide any specific contentions as to why he should be awarded a compensable disability rating for his residual left knee scar. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran’s left knee scar under Diagnostic Codes 7800 through 7805. The Veteran’s scar is not on the head, face, or neck, but is on his left knee. Moreover, it is not deep and nonlinear and is not associated with underlying soft tissue damage but is superficial. Although it is superficial and not associated with underlying soft tissue damage, it has not been shown to cover an area of 144 square inches or greater (929 sq. cm.). The Veteran’s scar measures 23 cm by 1.5 cm. Therefore, Diagnostic Codes 7800, 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence does not show that there are any other effects not considered under Diagnostic Codes 7801-04 that would be ratable under another applicable Diagnostic Code. Because the preponderance of the evidence is against the claim, the “benefit-of-the-doubt” doctrine is not applicable; and the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to an increased evaluation for right knee disability. The Veteran appealed for a higher rating for his service-connected right knee disability. From April 17, 2014 to October 16, 2017, it was rated at 20 percent under 38 C.F.R. § 4.71a, Diagnostic Code 5257 for instability. Beginning February 27, 2009, it was rated at 10 percent and from April 17, 2014 to June 1, 2015, the Veteran’s left knee was rated at 0 percent under Diagnostic Code 5260 for limitation of flexion. From April 17, 2014 to October 16, 2017 it was rated at 30 percent under Diagnostic Code 5261 for limitation of extension. Following a right total knee replacement on October 16, 2017, the Veteran was in receipt of a 100 percent rating under Diagnostic Code 5055. From September 7, 2016, the Veteran’s right knee scar was rated at 0 percent under Diagnostic Code 7805. Based on the evidence, the Board concludes that no increased or additional ratings are warranted for the Veteran’s right knee disability. In October 2009, the Veteran appealed the August 2009 rating decision that granted service connection. The Veteran requested a higher rating based on pain, mobility and having to take more medication for the condition. At an April 2014 VA examination, the Veteran reported worsening bilateral knee pain, instability, and with flare-ups swelling and increased pain. Right knee flexion was to 80 degrees, but painful motion began at 60 degrees. Extension ended at 10 degrees, but painful motion began at 15 degrees. He has severe pain with motion so was unable to perform repetitive use testing but had normal strength. Anterior and medial-lateral instability was assessed as 2+ (5-10 millimeters). He used a cane. A November 2014 private treatment note showed the Veteran ambulated with a bilateral antalgic gait with limited range of motion on both sides. Pain was worse on the right side. At a September 2016 VA examination, the Veteran reported bilateral knee pain at 10/10. He reported no flare ups, but did state he cannot lay, sit, stand, or walk for prolonged periods of time. His range of motion was abnormal at 0 to 90 degrees. He was unable to perform repetitive use testing due to pain. The Veteran’s right knee did not show ankylosis, but 1+ medial and lateral instability was noted. A September 2017 private treatment examination showed extension was to 0 degrees and flexion to 130 degrees with no ligamentous laxity. The treatment provider stated that the Veteran would benefit from total knee arthroplasty. The Veteran underwent total right knee replacement in October 2017. In April 2020, a VA clinician reviewed the record and in regards to the right knee opined there was no basis to offer additional losses of function or motion when it comes to repetitive use or during a flare up. Because the Veteran’s right knee disability did not manifest in severe recurrent subluxation or lateral instability, flexion limited to 30 degrees or less, or extension limited to 30 degrees or more, a higher disability rating is not warranted for the period prior to August 2014. See 38 C.F.R. § 4.71a., Diagnostic Codes 5257, 5260, and 5262. The Board considered flare-ups and pain, but the opinion found no additional functional limitations with repetitive use. For the period prior to the Veteran’s right knee replacement, an additional disability rating under Diagnostic Codes 5256, 5258, 5259, 5262, 5263 is inappropriate in this case as the Veteran’s right knee disability does not include the pathology required in the criteria for those Diagnostic Codes (ankylosis, dislocated semilunar cartilage, symptomatic removal of semilunar cartilage, malunion or nonunion of tibia or fibula, or genu recurvatum). 38 C.F.R. § 4.71a. The Veteran did not provide any specific contentions as to why he should be awarded a compensable disability rating for his residual right knee scar. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran’s right knee scar under Diagnostic Codes 7800 through 7805. The Veteran’s scar is not on the head, face, or neck, but is on his right knee. Moreover, it is not deep and nonlinear and is not associated with underlying soft tissue damage but is superficial. Although it is superficial and not associated with underlying soft tissue damage, it has not been shown to cover an area of 144 square inches or greater (929 sq. cm.). Therefore, Diagnostic Codes 7800, 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence does not show that there are any other effects not considered under Diagnostic Codes 7801-04 that would be ratable under another applicable Diagnostic Code. As discussed above, the preponderance of the evidence is against awarding any additional or increased ratings this case. The Board has considered whether there is any other basis for granting increased and/or additional ratings but has found none. As the preponderance of the evidence is against assignment of any further increased and/or additional ratings in this case, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (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). M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Sowden, 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.