Citation Nr: 21007256 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 17-32 356 DATE: February 9, 2021 ORDER Service connection for tinnitus is granted. Service connection for generalized anxiety disorder is granted. Service connection for bilateral hearing loss is denied. Service connection for residuals, right hand and wrist fracture, is denied. Service connection for a left ankle disability is denied. Service connection for a right ankle disability is denied. Service connection for a right shoulder disability is denied. Service connection for scar, hand and palm, is denied. Service connection for a left shoulder disability is denied. REMANDED Service connection for a right knee disability is remanded. Service connection for scar, right knee, is remanded. A compensable initial rating for scar, lower left leg, left thigh, is remanded. FINDINGS OF FACT 1. The Veteran had noise exposure in service; tinnitus has been continuous since that time. 2. A psychiatric disability was incurred in, or is otherwise etiologically related to, military service, including the circumstances of the Veteran’s service as a Navy SEAL. 3. The Veteran does not have decreased hearing acuity which qualifies as a bilateral hearing loss disability for VA purposes. 4. The Veteran was not diagnosed with right hand/wrist, bilateral ankle, or right shoulder disabilities during the pendency of these appeals, nor did he complain of pain productive of functional impairment for any of those claimed conditions. 5. A right hand/palm scar was not caused or aggravated by a service-connected disability. 6. A left shoulder disability was not incurred in, or is otherwise etiologically related to, the Veteran’s active service. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for generalized anxiety disorder have been met. 38 U.S.C. §§ 1106, 1110, 1116, 5107; 38 C.F.R. §§ 3.6, 3.303, 3.307, 3.309. 3. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1131, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for service connection for residuals, right hand and wrist fracture, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 307, 3.309. 5. The criteria for service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 307, 3.309. 6. The criteria for service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 307, 3.309. 7. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 307, 3.309. 8. The criteria for service connection for scar, hand and palm, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 307, 3.309, 3.310. 9. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from May 1976 to May 1980, including foreign service and with additional reserve service. He testified before the undersigned Veterans Law Judge at a March 2020 videoconference hearing. A transcript of this proceeding has been associated with the record. Upon the evidence of record, the psychiatric appeal has been expanded to include all acquired disorders. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Service Connection The Veteran is currently pursuing service connection for multiple disabilities. The Board will limit its analyses to those theories of entitlement as established by the record. Generally, service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may also be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Tinnitus In addition to the criteria set forth above, service connection may also be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) Where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Tinnitus is recognized by VA as a “chronic disease” under 38 C.F.R. § 3.309(a), such that the presumptive provisions of 38 C.F.R. §§ 3.303(b), 3.307, and 3.309 apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). Turning to the instant case, there is competent evidence of a current disability. Notably, the Veteran was diagnosed with recurrent tinnitus during September 2017 VA contract examination. He subsequently testified as to his related symptoms, including recurrent tinnitus, during a April 2020 private examination and the March 2020 Board hearing. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In contrast, the Veteran’s VA treatment records do not document diagnoses or symptoms of tinnitus during the period on appeal. Instead, his examiners repeatedly denied tinnitus during a review of the Veteran’s systems. However, these appear to be cursory notations based upon the Veteran’s current reporting rather than actual examinations conducted by medical professionals. Thus, in interpreting the evidence in the light most favorable to the Veteran, a current diagnosis of tinnitus is found. Next, the Veteran experienced acoustic trauma during active duty. He served as both an operations specialist and combatant swimmer during service. In these capacities, he served as a 60 gunner, meaning he frequently carried and operated machine guns and other weapons without prescribed hearing protection. See March 2020 hearing transcript, p. 19; September 2017 Disability Benefits Questionnaire (DBQ). His testimony on this point is consistent throughout the record, and there is no evidence which tends to contradict his recollections. Accordingly, in-service acoustic trauma is also established. On the question of continuity, the Veteran has repeatedly indicated that his tinnitus onset during service and has continued since that time. See, e.g., March 2020 hearing transcript, p. 19; September 2017 DBQ. While there is an absence of complaints or treatment for tinnitus for many years after service separation, the Board has resolved reasonable doubt in the Veteran’s favor and finds that he had continuous symptoms of tinnitus since service separation, thus meeting the requirements of presumptive service connection under 38 C.F.R. § 3.303(b). In this respect, the Veteran informed his April 2020 private examiner that his tinnitus onset “at least 20 years ago.” This appears to be an off-the-cuff remark meant only to memorialize that the Veteran has demonstrated symptoms for an extended period of time, and does not directly challenge his more precise testimony regarding the onset of his tinnitus. Thus, this notation is insufficient upon which to challenge the credibility of the Veteran’s testimony regarding the in-service onset of his symptoms. Additionally, the Board acknowledges that the September 2017 VA examiner offered a negative nexus opinion in this case. However, the Board does not need to reach the weight assignable to this opinion because service connection is granted on a presumptive basis under 38 C.F.R. § 3.303(b) for the chronic disease of tinnitus (38 C.F.R. § 3.309(a)) based on a finding of continuous symptoms since service. The appeal is hereby granted. Psychiatric Disorder The Veteran has repeatedly been diagnosed with generalized anxiety disorder throughout the period on appeal. See, e.g., July 2015 and April 2019 private assessments; May 2019 DBQ. His related symptoms and the treatment thereof are also frequently noted throughout his VA treatment records. Thus, the first element of direct service connection—a current disability, classified here as generalized anxiety disorder—has been met. Next, the Veteran associates his current disability with the circumstances of his service as a Navy SEAL. Specifically, he has described his participation in multiple covert missions which posed a direct threat to his safety and livelihood, including one such instance when he was almost apprehended. See, e.g., VA Forms 21-0781 dated September 2014 and January 2019; lay statement dated January 2019; March 2020 hearing transcript. The Veteran presents as a competent and credible historian in this regard. Generally, a veteran is competent to report that which he perceives through his senses, including events capable of observation. See Layno, 6 Vet. App. at 469. Moreover, his testimony is largely corroborated by the record, to include multiple buddy statements which confirm his participation in covert assignments during service. See, e.g., buddy statements dated July 2018 and January 2019; see also April 2019 private assessment (noting that the Veteran provided an in-service performance evaluation which was not of record and documented his history of repeated disputes with other servicemembers). His statements are well-documented and consistent throughout the record, and reasonably correspond with the nature of his assignment as a SEAL. Compellingly, there is no evidence of record which tends to directly contradict his testimony on this point. Thus, in affording the Veteran the benefit of the doubt, the second element of direct service connection—an in-service incurrence—has also been met. Finally, the evidence supports the finding of a causal link between the Veteran’s current disability and his military service There are two opinions of record in this respect. First, a July 2015 private examiner reported that the Veteran had a significant history of physical and emotional problems. Per the examiner’s assessment, the “majority of these problems are the result of his military career, and the extreme experiences that were required.” In his discussions with the examiner, the Veteran described a “long military career which resulted in a series of events that have created long-standing emotional scars, emotional lability, and increased [a]nxiety.” In comparing the Veteran’s symptoms with the Millon Clinical Multiaxial Inventory—Third Edition (MCMI-III), he appeared to have experienced in-service events involving physical threat or serious injury and which produced current anxiety, sleep impairment, and avoidance via numbing and detachment. Similar findings were reported by an April 2019 private examiner, who concluded that it was at least as likely as not that the Veteran experienced traumatic events during active duty, and that those events are the cause of his current psychiatric disability. Notably, there “are no other incidents in the record that would account for his persistent condition.” Instead, his current symptoms were attributed to a continuous disability from active duty to the present. In support of these findings, the examiner offered a comprehensive analysis of the Veteran’s personal and military histories and his current symptomatology as evaluated against multiple testing practices. These evaluations are probative evidence in support of this appeal. Both examiners definitively concluded that the Veteran’s currently disability was related to his service, as supported by detailed rationales. Said rationales offered appropriate consideration to the Veteran’s military history and the nature and onset of his current symptoms, and concluded that he was an accurate historian in this respect. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the “factually accurate, fully articulated, sound reasoning for the conclusion”). There is no indication that either examiner was not fully aware of the Veteran’s past medical history or misstated any relevant fact in providing their nexus opinions. Importantly, there are no opinions of record which tend to contradict the positive findings. Upon the above, a nexus is found in this case. Thus, direct service connection for generalized anxiety disorder is hereby granted. Briefly, the Board acknowledges that the Veteran initially sought service connection for posttraumatic stress disorder (PTSD), for which he has been repeatedly diagnosed during the period on appeal. See, e.g., July 2015 and April 2019 private assessments; May 2019 DBQ. However, the regulations relevant to such a claim are distinct and specific, and additional development would be required to further develop such a claim in this case. However, the above evidence is sufficient upon which to grant service connection for a separate psychiatric disorder, and it does not appear that his symptoms may be reliably differentiated. See May 2019 DBQ (reporting that the Veteran experiences anxiety in the absence of PTSD triggers, but that his symptoms also overlap considerably, such that attempting to differentiate between them would require the examiner to resort to mere speculation). Thus, the Board declines to remand this appeal for further development at this time, as a grant is awarded upon the evidence of record and encompasses the full scope of the Veteran’s known symptoms. Bilateral Hearing Loss Turning to the Veteran’s hearing loss appeal, competent evidence of a current disability is not found. Hearing loss is considered a disability for VA purposes when the threshold level in any of the frequencies 500, 1000, 2000, 3000 and 4000 Hertz (Hz) is 40 decibels or greater; when the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores, using the Maryland CNC test, are less than 94 percent. 38 C.F.R. § 3.385. Accordingly, a current hearing loss disability cannot be established absent corresponding test results. Such evidence is not present in this case. Rather, the Veteran underwent VA contract examination in September 2017, which yielded the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 15 25 15 LEFT 10 15 15 25 25 The examiner deemed these results valid for rating purposes. Accompanying speech discrimination scores were reported as 100 percent bilaterally; these results were also deemed appropriate for evaluating the Veteran. He also underwent private examination in April 2020, which yielded the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 15 20 15 15 15 LEFT 15 20 15 15 20 Accompanying speech discrimination scores were reported as 96 percent in the right ear and 100 percent in the left ear. As per the examiner’s notes, speech recognition thresholds were in agreement with puretone averages, which indicated “good reliability” for the Veteran’s test results. These results do not correspond to decreased hearing acuity at a level considered disabling for VA purposes, and there are no additional audiological examinations for consideration in this appeal, to include in VA or private treatment records. Rather, the remaining medical evidence is silent for reports of bilateral hearing loss or the treatment thereof. In the absence of a current disability, the appeal must be denied. In offering this conclusion, the Board does not disregard the Veteran’s contention that he has bilateral hearing loss. Although he is competent to testify as to his observable symptoms such as decreased hearing ability, whether hearing loss is of an extent considered a disability for VA purposes is determined by the application of a mechanical formula. Thus, the Board is precluded from finding that a hearing loss disability exists absent a supporting audiological examination, which is not found. Regarding the adequacy of the referenced examinations, the Veteran has repeatedly challenged the validity of the September 2017 VA examination. See, e.g., October 2017 VA Form 9 (“I dispute the validity of the VA audiology exam of [September 2017]”); March 2020 hearing transcript, p. 20 (noting that the representative disputed “the results and the conclusions” of the VA examination). However, the Veteran and his representative have offered absolutely no basis for such a challenge, which prevents the Board’s capacity to respond to such. Instead, the Board simply notes that its own review of the September 2017 VA examination revealed no inadequacies or deficiencies. Rather, the examination was conducted by an audiologist, who offered test results in direct correlation with VA regulations and repeatedly confirmed the veracity of the results. Accordingly, there is no basis to challenge the September 2017 results, and the examination is considered probative evidence against the appeal. During the March 2020 hearing, the representative also indicated that the Veteran had recently participated in a private audiological evaluation with a Dr. Hunt, but that the examination did not appear to be of record. The April 2020 private evaluation, conducted by a Dr. Hunsaker, was subsequently obtained. It would appear that this represents the private examination to which the representative referred, as the record is otherwise devoid of evidence suggesting examination or treatment by a Dr. Hunt. Thus, the Board does not find good cause to remand this appeal to engage in a fishing expedition for an audiological examination which likely does not exist. See Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992) (“The ‘duty to assist’ is not a license for a ‘fishing expedition’ to determine if there might be some unspecified information which could possibly support a claim”). In the absence of a current hearing loss disability, further inquiry into the in-service or nexus elements is unwarranted, and the Veteran’s claim for service connection for bilateral hearing loss is hereby denied. Right Hand/Wrist, Bilateral Ankles, Right Shoulder, and Hand Scar Disorders As with the bilateral hearing loss claim, the Veteran’s right hand/wrist, bilateral ankles, and right shoulder appeals are denied upon the absence of current disabilities. Critically, VA and private treatment records spanning the period on appeal are completely silent for relevant diagnoses, symptoms, or the treatment thereof, and the Veteran has not identified any outstanding records to be obtained. Further, he has not offered any specific testimony of current disabilities during the period on appeal, to include of relevant diagnoses or treatment. Rather, the Veteran generally argues that he demonstrates current right hand/wrist, bilateral ankle, and right shoulder disorders, as evidenced by chronic pain. See, e.g., April 2016 Notice of Disagreement (NOD); October 2017 VA Form 9 (also reporting that the Veteran has right hand arthritis and has had chronic symptoms of the claimed conditions since various in-service incidents); March 2020 hearing transcript. However, he has never signaled that the reported pain is productive of such functional impairment as to constitute the finding of current disabilities on this basis. See Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). Moreover, the record is otherwise silent for relevant diagnoses or treatment spanning the period on appeal. Accordingly, the competent evidence weighs against the finding of current disabilities with respect to the right hand/wrist, bilateral ankles, and right shoulder appeals; despite the Veteran’s reports of pain, this singular symptom does not cause functional impairment, has not been attributed to any specific diagnoses, and has not required treatment during the period on appeal. Given this finding, the appeals cannot succeed. Such a finding also precludes an award of service connection for a right hand and palm scar, which the Veteran was pursuing on a secondary basis as related to a right hand/wrist disorder. See December 2013 claim (seeking service connection for scars of the right hand and palm). As he is not currently service-connected for a right/hand wrist disorder, and direct service connection for such has been denied herein, the Veteran cannot be awarded service connection for a secondary disorder. 38 C.F.R. § 3.310. As such, the scar appeal is also denied. In offering these conclusions, the Board acknowledges that the claims file contains a May 1980 service treatment record (STR) documenting a prior right wrist/hand condition with no current symptoms. There are no subsequent reports of a similar disorder in the record, to include during the period on appeal. Thus, the May 1980 documentation of a right wrist/hand condition is not sufficiently contemporaneous to the period on appeal as to warrant the finding of a current disability. Rather, the distant notation appears to document a condition with no subsequent sequelae in the following decades. As to the bilateral ankles, the claims file contains a February 2012 VA treatment record reporting “occasional dependent bilateral ankle swelling.” However, this isolated report falls outside of the period on appeal (initiated by a December 2013 claim), and no similar symptomatology is documented during the appeal period. Accordingly, the referenced VA treatment record does not establish a current disability for which service connection is available. Additionally, the Veteran’s private treatment records document a surgical history for the left ankle. This notation appears to have been made in error, as the claims file is otherwise silent for such a history, to include in corresponding treatment records and the Veteran’s own testimony. As one might reasonably expect surgical records to be found or reported in this respect, the absence of such leads the Board to conclude that the private recordation was merely made in error. Accordingly, a current disability is not established on this basis. During the March 2020 hearing, the representative repeatedly solicited testimony about a series of VA examinations which simply did not occur, to include for the claimed right shoulder and scar disorders. Specific testimony was also offered by the representative as to the content of these examination reports. Upon the Board’s review of the claims file, it is evident that the Veteran has not undergone VA examination for the claimed disorders, including of the right shoulder or scars, nor have such examinations been requested at any time. That said, VA examinations are not required for the Veteran’s claimed disabilities. In this case, there is insufficient evidence of a current disability (or of persistent or recurrent symptoms of a disability) to warrant VA examinations. Upon the above, the preponderance of the evidence is against the claims, the benefit-of-the-doubt rule is inapplicable, and the appeals seeking service connection for right hand/wrist, bilateral ankles, right shoulder, and hand scar disorders are hereby denied. Left Shoulder Turning to the left shoulder appeal, the Veteran’s VA treatment records document a left shoulder dislocation in approximately December 2011. Although this incident occurred outside of the period on appeal, treatment records also note ongoing symptoms related thereto, including chronic and radiating pain. The Veteran has also offered competent testimony to this effect. See, e.g., April 2016 NOD; October 2017 VA Form 9. Accordingly, the first element of service connection has been met. However, the Veteran’s STRs are entirely silent for a left shoulder injury or related in-service event. Rather, the December 2011 VA treatment record clearly attributes the Veteran’s left shoulder dislocation to a recent skiing injury. In contrast, the Veteran argues that his left shoulder disorder onset during service and was simply exacerbated by the December 2011 skiing accident. See October 2017 VA Form 9. However, the record simply does not support such a finding. See Kahana v. Shinseki, 24 Vet. App. 428 (2011) (VA may use silence in the service treatment records as evidence contradictory to a veteran’s assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred). The Veteran’s medical records, both in- and post-service, are silent for a left shoulder disorder or related symptoms until the December 2011 incident. Given that the Veteran lacks the expertise to offer a competent opinion as to complex medical matters, to include the etiology of a current disorder, greater probative value is afforded to the medical treatment records in concluding that an in-service injury or event was not incurred. Id.; see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). As such, the second element of direct service connection is not met. Accordingly, further inquiry into the nexus element of service connection is rendered moot. The preponderance of the evidence is against the claim such that the benefit-of-the-doubt rule is not applicable, and the appeal seeking service connection for a left shoulder disorder is denied. With respect to the above denials, the Board acknowledges that the Veteran has not been afforded VA examinations to date. However, such examinations are not warranted absent competent evidence of current disorders with potential relationships to service. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Such evidence is not present in this case, as the competent medical records either fail to establish current disabilities or attribute current symptoms to nonservice-related incidents. Accordingly, examinations are not justified by the record at this time. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). REASONS FOR REMAND Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to the adjudication of the remaining appeals. As to the right knee appeal, negative VA nexus opinions were obtained in May 2015 and June 2015. Since that time, VA has obtained significant evidence relevant to this appeal, to include private treatment records addressing the Veteran’s right knee surgical history and a June 2018 buddy statement indicating that his disability may have onset during service. Accordingly, remand to obtain an addendum opinion, contemplative of this evidence, is warranted. Further, the Veteran attributes his right knee scar to the claimed right knee disorder and related surgery. As such, these issues are inextricably intertwined, and remand of the right knee appeal necessitates remand of the scar claim, as well. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Finally, the Veteran has offered testimony that his service-connected left leg/thigh scar is productive of potentially compensable symptoms, including pain and underlying tissue or muscle damage. See, e.g., March 2020 hearing transcript. He has not yet been afforded a VA examination for this disability, such that the record does not fully evaluate the nature and severity of the Veteran’s symptoms. Such an evaluation is now warranted. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion addressing the questions below.  If the reviewing examiner determines that the opinions requested may not be offered without first examining the Veteran, then consider whether a telehealth interview may be appropriate.  Schedule an in-person examination only if deemed necessary to answer the questions below.   The claims file and a copy of this remand must be made available for review, and the examination report must reflect that review of the claims file occurred.   In particular, the examiner must address the following: (a.) Identify all right knee disorders demonstrated by the Veteran during the pendency of this appeal. If a diagnosis of arthritis is rendered, the examiner must identify whether this condition onset within one year of separation. (b.) Is it at least as likely as not (50 percent probability or more) that a right knee disorder began during a period of active duty service, was caused by service, or is otherwise related to service? The examiner must explicitly discuss the Veteran’s private surgical records; the June 2018 buddy statement; and the Veteran’s testimony regarding the nature of his service, to include the physical demands thereof. In formulating the opinion, the examiner is advised that the term “at least as likely as not” does not mean “within the realm of possibility.”  Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it.  A complete rationale should be provided for all opinions or conclusions expressed.  It should be noted that the Veteran is competent to attest to observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.  2. Schedule the Veteran for a VA examination to assess the current severity of his service-connected left leg/thigh scar. The claims folder must be provided to the examiner in conjunction with the examination. The examiner should offer an assessment of all pertinent symptomatology and findings, to be reported in detail in accordance with Diagnostic Code 7805. The examiner must also identify any manifestations of this scar, to include pain and underlying muscle/tissue damage. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.