Citation Nr: 21011105 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-16 014 DATE: February 26, 2021 ORDER An increased rating in excess of 10 percent for service-connected residual right foot scar associated with right foot bunionectomy (“right foot residual scar”) is denied. FINDING OF FACT The Veteran has one scar which she has sometimes reported is painful, but no objective evidence of pain has been found on examination. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for right foot residual scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1981 to April 1984. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In March 2019, the Veteran testified before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the claims file. The Board notes that this matter was previously before the Board in July 2019 and October 2020 for further development. The development requested having been completed, the case is now appropriate for appellate review. Board decisions shall be based on the entire record and consideration of all evidence, lay and medical, that is material. 38 U.S.C. § 7104(a); 38 U.S.C. § 5107(b); 38 C.F.R. § 3.303(a). The law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). While the Board must review the entire record, it does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. See Timberlake, supra. In evaluating the evidence in any given appeal, it is the responsibility of the Board to make appropriate determinations of (a) competence; (b) credibility; and (c) weight. Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Medical opinions are deemed competent since they are from medical professionals. 38 C.F.R. § 3.159(a)(1). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). As to the matters adjudicated below, neither the Veteran nor his representative has raised any issues with VA’s duty to notify or VA’s duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. A non-initial rating in excess of 10 percent for service-connected right foot residual scar The Veteran contends that she is entitled to a higher rating for her service-connected right foot residual scar. The Veteran’s service-connected right foot residual scar is rated under Diagnostic Code 7805-7804 for unstable or painful scar. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. See 38 C.F.R. § 4.27. The hyphenated diagnostic codes in this case indicate that the Veteran’s service-connected right foot residual scar was initially assigned a noncompensable rating under Diagnostic Code 7805. Subsequently, the Veteran was assigned a 10 percent disability rating under Diagnostic Code 7804 when combined with another service-connected residual scar. During the entire period on appeal, the Veteran is in receipt of a 10 percent disability rating under Diagnostic Code 7804 for her service-connected right foot residual scar. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7804 was not changed by the August 13, 2018, amendments. Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. At the March 2019 Board hearing, the Veteran testified that the skin of her service-connected right foot residual scar does not flake, but stated it is painful. Hearing Transcript at 13. The Veteran underwent VA examinations in April 2014, August 2018, and November 2019. The April 2014 examiner noted that the Veteran reported pain for her service-connected right foot residual scar, but found that the scar was not unstable. The examiner failed to determine whether the scar was superficial nonlinear or deep nonlinear. The August 2018 examiner determined the Veteran’s service-connected right foot residual scar to be superficial and nonlinear measuring 7 centimeters in length and 0.5 centimeters in width with a combined total affected area of 3.5 square centimeters, and did not result in any functional limitation. The November 2019 examiner noted the Veteran did not report any pain relating to her service-connected right foot residual scar. The November 2019 examiner determined the scar was not unstable, measured 5 centimeters in length by one centimeter in width resulting in a combined total affected area of 5 square centimeters, and did not result in any functional limitation. In addition, the examiner, after thoroughly palpitating the scars during the examination, found there was no evidence of pain. The examiner determined the Veteran’s service-connected right foot residual scar was nonlinear and superficial with no evidence of underlying soft tissue damage. While the Board acknowledges the Veteran’s subjective report of pain, the Veteran’s current 10 percent disability rating compensates her for pain even though there is no objective evidence of pain. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s service-connected right foot residual scar is not of the head, face, or neck, is not deep, is superficial and nonlinear, and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does not cover an area of 929 square centimeters or greater. Therefore, Diagnostic Codes 7800 through 7802, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms of experiencing pain at times, and her reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, she does not assert, and medical records do not show, that the Veteran’s service-connected right foot residual scar is manifested by three or four scars that are unstable or painful to warrant a 20 percent disability rating. The medical records show that the Veteran’s service-connect right foot residual scar consists of only one scar. Thus, there is no evidence to support a 20 percent or higher disability rating. (Continued on the next page)   In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a disability rating in excess of 10 percent for service-connected residual right foot scar associated with right foot bunionectomy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Agarwal, 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.