Citation Nr: 21010364 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 17-65 299 DATE: February 24, 2021 ORDER A 20 percent rating for pilonidal cyst with residual scars is granted, subject to the rules and regulations governing payment of monetary awards. FINDING OF FACT The Veteran’s pilonidal cyst with residual scars manifested with one or two painful and unstable scars during the entire appeal period. CONCLUSION OF LAW The criteria for a 20 percent rating for pilonidal cyst with residual scars are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Codes 7804, 7819. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1986 to September 2006. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in February 2020. A transcript of the hearing is of record. A 10 percent rating for pilonidal cyst with residual scars is granted. The Veteran contends he is entitled to a 10 percent rating for his service-connected pilonidal cyst with residual scars. Generally, disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide used in the evaluation of disabilities encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. A Veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board acknowledges that with respect to a claim for an increased rating for an already service-connected disability, a Veteran may experience multiple distinct degrees of disability that might result in different levels of compensation. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The Veteran’s pilonidal cyst with residual scars has been assigned a noncompensable rating under hyphenated Diagnostic Code 7805-7819. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. The second diagnostic code provides further detail regarding the origins of the unlisted disability, the bodily functions affected, the symptomatology, and anatomical location. Thus, the diagnostic code following the hyphen is the diagnostic code by which the disability is evaluated by analogy. VA amended the criteria for rating skin disabilities effective August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. 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 Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Diagnostic Code 7819 did not undergo revisions and instructs that benign skin neoplasms should be evaluated as disfigurement of the head, face, or neck (Diagnostic Code 7800), scars (Diagnostic Codes 7801, 7802, 7804, or 7805), or based on impairment of function. Diagnostic Code 7805 did not undergo substantive revisions and instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800 to 7804 be evaluated under an appropriate Diagnostic Code. Diagnostic Codes 7800 and 7801 are not applicable here because the Veteran’s scars are not on the head, face, or neck. Prior to August 13, 2018, Diagnostic Code 7802, was for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that were superficial and nonlinear. Under these criteria, a scar with an area or areas of 144 square inches (929 sq. cm.) or greater warrants a 10 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7802 instructed that a superficial scar was one not associated with underlying soft tissue damage. Note 1 instructed that if multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion of the trunk or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separate the anterior and posterior portions of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck. Id. Since August 13, 2018, Diagnostic Code 7802 is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Note 1 provides that 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 provides that a separate evaluation may be assigned for each affected zone of the body 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 diagnostic code. DC 7802 was otherwise unchanged by the August 13, 2018, amendments. Under Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating. Three or four scars that are unstable or painful warrant a 20 percent rating. Five or more scars that are unstable or painful warrant a 30 percent rating. 38 C.F.R. § 4.118. Note (1) to Diagnostic Code 7804 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) to Diagnostic Code 7804 provides that 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. Diagnostic Code 7804 was not changed by the August 13, 2018, amendments. Turning to the evidence in this case, the record reflects that the Veteran underwent a VA Skin examination in November 2016. During the examination, the Veteran reported having the cyst lanced. He also indicated that the cyst can spontaneously drain and that he experiences intermittent pain when the cyst grows. The examiner noted that the cyst did not cause scarring or disfigurement of the head, face, or neck; that there was no evidence of neoplasms, and no systemic manifestations. The examiner also noted that the cyst was located near the top of the rectum and measured about 0.5 cm across and 3 mm raised. December 2016 VA treatment records note the presence of a small non-tender pilonidal cyst at the cleft of the buttocks which had become intermittently symptomatic since the Veteran was age 25. It was noted that treatment options, including surgical removal, were discussed with the Veteran and that he declined. Additionally, a March 2017 record notes a pilonidal cyst without abscess as an active problem. On his February 2017 Notice of Disagreement, the Veteran reported an unstable scar that never heals due to his pilonidal cyst. In September 2017, the Veteran underwent additional VA examinations. During the VA Skin examination, the examiner noted that a review of the Veteran’s medical records indicated that the Veteran’s cyst had been lanced. The examiner also noted that the Veteran denied any further treatment for his cyst. The Veteran reported experiencing symptoms intermittently for years but indicated that, over the past two years, he had been experiencing symptoms constantly. He reported that he currently self-treats the cyst, noting that the cyst can “erupt” on its own or he will drain it. He also reported pain with sitting when the cyst increases in size and intermittent pruritis. The examiner noted there was no scarring or disfigurement on the head, face, or neck; no neoplasms; and no systemic manifestations. The examiner also indicated that the cyst was located on the left upper top of the rectum, measured 0.7 cm by 0.5 cm, was non-tender and non-fluctuant, and appeared to have recently been drained. There was no evidence of secondary infection, edema, erythema, or drainage. On the September 2017 VA Scars examination, two scars (both diagnosed in 1995) were noted. The first was a healed superficial residual scar measuring 0.1 cm by 0.1 cm. The second was a healed superficial scar measuring 3 mm in diameter. The examiner noted that the scars were well-healed without residuals and that there was no evidence of unstable scarring, erythema, edema, tenderness, or drainage of either scar. The examiner also indicated that the scars were not painful, unstable, or due to burns. On physical examination for scars on the trunk and extremities, the examiner noted the presence of a linear scar proximal to the anus that was 0.3 cm long and a superficial non-linear scar proximal to the anus that measured 0.1 cm by 1 cm. The superficial non-linear scar covered an approximate total area of 0.1 cms squared. There were no deep non-linear scars. The examiner noted that the scars did not result in limitation of function. On his December 2017 VA Form 9, the Veteran reported that his scars were unstable and did not heal. During the February 2020 Board hearing, the Veteran testified that his pilonidal cyst with residual scars condition was active. He reported self-treatment, noting two treatment options which include dealing with pain while waiting for the cyst to pop on its own or draining the cyst himself. He also reported that the pilonidal cyst with residual scars is painful and unstable, that he experiences itchy and dry skin, and that he experiences difficulties sitting because of the cyst. He reported frequently having to pop the cyst, and that when it starts draining, it stays open and will drain, but that sometimes he has to assist it. He indicated that it never heals and that it is always active. The Board notes that the Veteran is competent to report the readily observable symptoms of his cyst and scars, to include bleeding and pain. Layno v. Brown, 6 Vet. App. 465 (1994); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Further, the Board finds the Veteran’s testimony to be credible. Thus, the Board assigns a high degree of probative weight to these lay statements. After review of the evidence of record and resolving reasonable doubt in the Veteran’s favor, the Board concludes the Veteran’s pilonidal cyst with residual scars manifests by one or two painful and unstable scars, as reflected by the Veteran’s testimony during the February 2020 Board hearing. The Board acknowledges that the Veteran’s scars were not shown to be unstable or painful upon examination. However, as noted, the Board places a high degree of probative value on the Veteran’s credible lay testimony regarding the readily observable manifestations of his condition. The symptoms the Veteran describes regarding an active cyst that frequently requires popping and draining most nearly approximate an unstable scar where there is frequent loss of covering of the skin over the scar. The Veteran’s testimony also reflects the cyst can be painful, particularly when sitting. As such, the Board concludes that pursuant to the provisions of Diagnostic Code 7819, the Veteran’s pilonidal cyst with residual scars is most appropriately rated under Diagnostic Code 7804 for unstable or painful scars. Accordingly, as the record reflects that the Veteran has one or two scars that are both unstable and painful, the Board finds that a 20 percent rating, but no higher, is warranted throughout the appeal period under Diagnostic Code 7804 and Note (2), which provides for a 10 percent rating for one or two scars that are unstable or painful and the addition of 10 percent if one or more scars is both unstable and painful. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Jiggetts 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.