Citation Nr: 21011115 Decision Date: 02/27/21 Archive Date: 02/27/21 DOCKET NO. 18-43 019 DATE: February 27, 2021 ORDER Entitlement to a rating in excess of 50 percent prior to November 4, 2020 and in excess of 70 percent thereafter for posttraumatic stress disorder (PTSD) is denied. Entitlement to a rating in excess of 10 percent for right ear scar is denied. REMANDED Entitlement to a compensable rating for hearing loss of the right ear is remanded. FINDINGS OF FACT 1. The severity, frequency, and duration of the PTSD symptomology did not more closely approximate an occupational and social impairment with deficiencies in most areas prior to November 4, 2020. 2. Throughout the entire period on appeal, PTSD has not been manifested by total occupational and social impairment. 3. The Veteran’s right ear scar, measuring 7 by 0.2 centimeters, is manifested by pain, itching and irritation. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 50 percent prior to November 4, 2020 for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for a disability rating in excess of 70 percent as November 4, 2020 for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for a disability rating in excess of 10 percent for right ear scar are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1979 to September 1992. In March 2020, the Veteran and his spouse testified at a Board hearing. The transcript is of record. In April 2020, the Board remanded the case for further development, which is completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a “staged” rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The Court since has extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). 1. Entitlement to a rating in excess of 50 percent prior to November 4, 2020 and in excess of 70 percent thereafter for posttraumatic stress disorder The Veteran contends he is entitled to a higher rating for PTSD as he alleges his symptoms are worse and his civilian medical records were not considered. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Review of the medical evidence reveals a November 2013 evaluation from Dr. H.J. the Veteran’s private physician. The Veteran reported working full-time, which he described as stressful sometimes and disclosed frequent frustration and nightmares and that he has had thoughts of suicide with no intent to carry them out. Additionally, he stated that he tried to avoid reminders of his experiences and had a loss of interest in activities along with social isolation. The mental status examination described him as casually dressed with good eye contact and normal speech. His mood and affect were depressed, his thought processes were within normal limits, he was oriented and did not seem paranoid or delusional. He displayed fair insight and judgment but had problems with focus and concentration. He denied any current suicidal or homicidal ideation. In January 2014 the Veteran reported symptoms of anxiety, depression and trouble sleeping with continued difficulties in crowds and with maintaining relationships. He appeared anxious and disheveled and had a blunted affect; however, he was cooperative with normal speech. In August the Veteran complained of irritability and lack of sleep but continued to maintain his job at the post office. He was described as cooperative with normal speech. He displayed no flight of ideas or looseness of association but did have thought blocking, word searching and delayed thought. He denied hallucinations but reported seeing images of moving objects at the edges of his sight and a general discomfort in crowds. He denied any suicidal or homicidal thought. In January 2015 the Veteran underwent his initial PTSD VA examination for compensation and pension purposes. The examiner diagnosed PTSD and depressive disorder and explained that the disorders interact, reinforce and exacerbate each other. The Veteran reported working full-time and being married with one child. The examiner described the Veteran as cooperative, alert and oriented with an anxious mood and congruent affect. He demonstrated good grooming and hygiene with appropriate eye contact and normal speech; however, he became tearful when discussing traumatic events. He denied any current suicidal or homicidal ideations, intent, or plans as well as any history of suicide attempts or psychiatric hospitalizations. The Veteran also denied any hallucinations or delusions and reported being independent in his activities of daily living. The examiner concluded that the mental disorder was productive of occupational and social impairment with occasional decrease in work efficiency. In September 2015 the Veteran underwent an initial psychiatric assessment and reported feeling bad all the time and disliking crowds and people. He stated that his nightmares, which occurred three to four times a week, were starting to affect his way of life. He also described low energy, fair concentration and bad thoughts but denied suicidal or homicidal ideations and denied hallucinations. The mental status examination reported that the Veteran was neat, cooperative and appropriate with normal and calm speech. He had a depressed mood and appropriate affect with normal thought content, memory, insight and judgment. In November the Veteran reported experiencing nightmares and becoming upset when he is reminded of his traumatic experiences. He described increased irritability, anger, hypervigilance and hyperarousal symptoms. Occupationally, he reported full time employment and hobbies such as drag racing and baking cakes. Socially, he remained married to his supportive wife and has one adult child. The Veteran denied suicidal or homicidal ideation. The mental status examination reported that the Veteran’s appearance was neat, and he was cooperative, alert and oriented. He had good eye contact and relevant speech but had an anxious, irritable at times mood, with a full range of affect appropriate to content. There were no signs of psychosis or delusions and his mental focus appeared within normal limits. The March 2016 mental status examination also described the Veteran as cooperative, alert and oriented with a neat appearance. He had good eye contact and displayed a full range of affect appropriate to content. His speech was relevant and goal-directed with no signs of psychosis or delusions. His mental focus appeared grossly within normal limits and he did not report any suicidal or homicidal ideations. In June the Veteran reported doing fine with less frequent nightmares, improved anxiety and no depression. He denied hallucinations and suicidal or homicidal ideations. In October the Veteran stated that he was doing fairly well with less anxiety and no reported nightmares. He explained he has been busy with work and family and denied suicidal and homicidal ideation. The Veteran reported nightmares and flashbacks as well as social isolation and hypervigilance in March 2017. He denied hallucinations and suicidal or homicidal ideation. In June the Veteran described feelings of anxiousness and depression at times with irritability and frustration but denied suicidal or homicidal ideation. He reported not doing too well in September, again describing nightmares and difficulty sleeping but did report an improvement with his anxiety. He expressed that he remained hypervigilant and socially isolated but denied hallucinations and suicidal or homicidal ideation. The Veteran attended a VA examination in September 2017. The examiner diagnosed PTSD and major depressive disorder with symptoms that are able to be differentiated with depressed mood, disturbance in mood and motivation, feeling down or hopeless, appetite disturbance, and little interest or pleasure in doing things attributed to the depressive disorder. Socially, the Veteran has some friends but does not maintain consistent contact with anyone outside his family with most of his time spent going to work and running errands with his wife of 37 years. Occupationally, he has been employed with the local Post Office since 2008 with a current position in management working in vehicle maintenance. The examiner noted the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, disturbances of motivation and mood, suicidal ideation, and impaired impulse control. The examiner observed that the Veteran was casually dressed, easily engaged and oriented to time, place, person and situation. There was no evidence of delusions or hallucinations and his concentration and memory was accurate upon testing. The Veteran’s responses to the BAI PHQ-9 and PCL-5 indicated severe anxiety, depression and trauma related symptoms and the Veteran reported that he forced himself to work out of necessity. The examiner noted that the Veteran’s impairment was more apparent in his limited social interactions outside of work. Additionally, the Veteran displayed additional symptoms such as hyperarousal, nightmares, feelings of detachment, reduced energy level and fearfulness of losing control and dying. The examiner concluded that the mental disorder was productive of occupational and social impairment with occasional decrease in work efficiency. In December 2017 the Veteran reported that he was fair and still employed with no issues. He described symptoms of depressed mood, low energy and poor concentration on most days but denied feelings of hopelessness, worthlessness and denied any suicidal or homicidal ideations and hallucinations. The mental status examination reported that he was appropriately groomed, alert and oriented in all spheres. He was cooperative and pleasant with a euthymic affect and congruent mood. He had coherent, linear thought processes with goal directed thought content. His memory was intact, and his concentration, insight and judgment were good. He had no current suicidal or homicidal ideations. In February 2019 the Veteran had a mental health consultation and was described as alert and oriented with his overall grooming and hygiene within normal limits. He was cooperative and receptive with normal speech and appropriate eye contact. He had relevant and goal-oriented thought processes with a euthymic mood and affect congruent with content. His attention and concentration seemed within normal limits and he did not report any hallucinations, delusions, mania, obsessions or compulsions. Occupationally, he reported working full-time at the Post Office as the lead technician for the past 11 years and at a car dealership for eight years before that. He denied ever being fired from a job, a history of taking medical leave from work or a history of disciplinary actions at work. He stated that he had not had any marked difficulties in performing his occupational tasks, but he thinks the tasks now take him longer. He denied any problems with getting along with coworkers. In November he reported decreased energy and motivation and increased social isolation and irritability. He denied suicidal or homicidal ideation. In January 2020 the Veteran reported continued work at the Post Office but disclosed getting easily irritated with his coworkers and that he was planning on retiring in October and felt it would improve his mood. He described continued nightmares, which disrupted his sleep and feeling somewhat hypervigilant and irritable but explained that he does not act on his feelings. He expressed that he remains less social with a decreased interest in doing things with family but denied suicidal or homicidal ideation and hallucinations. The mental status examination noted that his mood was irritable at time, but he was alert, oriented and had good impulse control and judgment. In March 2020 the Veteran described his mood as ok with a decrease in frequency of nightmares and he denied suicidal or homicidal ideation and hallucinations. In November 2020 the Veteran attended another VA examination via telehealth. The examiner diagnosed PTSD and major depressive disorder. Socially, the Veteran was still married with a good relationship with his son and brother and one close friend, also a Veteran. He reported having a few friends but described himself as selective due to his distrust and discomfort in social settings. Occupationally, he reported retiring in September 2020 and indicated that while he was frequently irritable with coworkers and had difficulty maintaining composure, he had no disciplinary actions. He also disclosed experiencing substantial anxiety in the morning in anticipation of work. The examiner noted the following symptoms: depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, disturbance of motivation and mood, difficulty establishing and maintaining effective work and social relationships and adapting to stressful circumstances, suicidal ideation and intermittent inability to perform activities of daily living. The examiner observed the Veteran was casually dressed and appropriately groomed. He was alert, oriented, cooperative with appropriate eye contact and normal speech. His mood was irritable, and his affect blunted with minimal range. His thought process was organized with no unusual content and no evidence of responding to internal stimuli. The examiner concluded that the mental disorder was productive of occupational and social impairment with deficiencies in most areas. At a medical appointment in November 2020, the treatment notes reported that the Veteran did not have severe depression but did have some anxiety and insomnia. He reported doing fairly well and denied suicidal ideations. The mental status examination described him as alert, oriented to place, person and time with an ok mood, good impulse control and judgment with insight. When making a decision, the Board must consider all the evidence of record, to include lay statements. 38 U.S.C. § § 5107(b), 7104(a); 38 C.F.R. § 3.303(a). At the hearing the Veteran testified that his PTSD symptoms were worsening as he had difficulties with nightmares, concentration and attention. He expressed a preference for social isolation as he does not like being in crowds or attending functions. The Veteran’s spouse reported that his medications keep increasing, he is not sleeping at night and comes home from work irritated. She testified about giving him “breakthrough pills” when family comes over for dinner due to the increased anxiety. The Veteran reported thoughts of hurting himself but denied any intent or plans citing his family. He expressed feelings of frustration, lack of motivation, difficulty with memory, needing reminders for basic hygiene tasks and obsessively checking doors. He disclosed having a few friends that he described as phone friends. The Veteran’s spouse also provided a statement describing his irritability and frustration towards coworkers, depression and anxiety in large crowds. The Board finds that the Veteran and his spouse are competent to provide testimony as to the presence of his observable symptoms. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Prior to November 4, 2020 the Veteran is rated at 50 percent for an occupation and social impairment with reduced reliability and productivity. For the next higher rating of 70 percent, the evidence must establish and occupational and social impairment with deficiencies in most areas due to symptoms such as obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; or inability to establish and maintain effective relationships. The mental status examinations of record consistently described the Veteran as cooperative, pleasant, appropriately groomed with normal thought content with difficulties including, but not limited to, anxiety, nightmares, hypervigilance and irritability. The Board notes that the September 2017 examiner reported reckless behavior and impaired impulse control; however, this is inconsistent with the medical evidence as the Veteran on more than one occasion denied any disciplinary actions at work or legal problems. Additionally, the mental status examinations throughout the appeal frequently reported good insight and judgment and described him as pleasant and cooperative. Thus, overall, the Veteran’s symptoms primarily manifested in anxiety, social avoidance and isolation, fluctuating mood to include frustration and irritability and a sleep impairment due to frequent and vivid nightmares. Both the January 2015 and September 2017 examiners opined after review of the record and in person examination that the Veteran’s symptoms were productive of occupational and social impairment with occasional decreases in work efficiency, which is most consistent with a 30 percent rating. Occupationally, the Veteran maintained full-time employment at the Post Office throughout the appeal period until he retired in September 2020. While he expressed irritability and work-related stress, he denied receiving disciplinary actions or marked difficulties at work and maintained a managerial position. The Veteran’s ability to sustain employment indicates that he was able to function independently, maintain an acceptable level of hygiene and appearance for work purposes, adapt to the stresses of workplace, and establish and maintain a sufficient level of work relationships as he remained employed at the Post Office for at least a decade. Thus, while the Veteran’s symptoms may have caused occupational difficulties the overall severity and frequency of his symptoms are most consistent with an occupational impairment with reduced reliability and productivity. Socially, the Veteran has maintained a relationship with his wife for over thirty years and throughout the period at issue had at least one close friend, who is also a Veteran with PTSD, along with a few other friends. The Board notes, as pointed out by the September 2017 VA examiner, the Veteran’s impairment is more apparent in his limited social interactions outside of work. However, while the Veteran consistently described a dislike for large crowds and social functions, despite these difficulties he was able to spend time with his family, which includes his wife, son and grandchildren; thus, indicating the ability to engage in limited social interactions when necessary. The Board notes that the September 2017 and November 2020 examiners reported suicidal ideation and the Veteran reported a history of suicidal ideations at the November 2013 consultation and testified to suicidal thoughts at the hearing. These reports have been considered; however, the reports of suicidal ideation are inconsistent as the Veteran also denied current suicidal or homicidal thoughts or intention at the November 2013 consultation and denied suicidal or homicidal ideation at a medical appointment the same month as the September 2017 VA examination. Review of the medical records, as described in detail above, reveal consistent denials of suicidal and homicidal ideation prior to November 4, 2020. As such, the Veteran’s reports of suicidal ideation have been considered but due to the lack of frequency and inconsistency of such; a higher rating is not warranted on that basis. As such, when considering the overall severity, frequency, and duration of the Veteran’s symptoms, the Board finds they more closely approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. As of November 4, 2020, the Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 70 percent rating but the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. While the Veteran has difficulties in large crowds and social functions, he maintains a long-term relationship with his supportive wife, engages with his family and grandchildren and has a few friends; thus, the evidence does not establish a total social impairment. The Veteran's employment was affected by his mental disorder but he was not precluded from employment when he choose to work. Again, the Board notes that the Veteran expressed suicidal ideation at the November 2020 VA examination and Board hearing, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran denied any intent, or a plan involving self-harm in existing treatment records and again provided inconsistent reporting as the November 2020 VA examination noted suicidal ideation, but he also denied suicidal ideation at a medical appointment that same month. Thus, his symptoms are appropriately contemplated by the 70 percent criteria which includes suicidal ideation. The Board notes that the Veteran, at times, required additional medication during social functions, the plain language of the criteria for a 10 percent rating under the General Rating Formula for Mental Disorders specifically contemplates the effects of medication. Consequently, Jones v. Shinseki, 26 Vet. App. 56 (2012) does not apply, and the Board’s evaluation of the Veteran’s PTSD may include the ameliorative effects of medication. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016). In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 100 percent rating at any time during the appeal period. The appeal is denied. 2. Entitlement to a rating in excess of 10 percent for right ear scar The Veteran contends he is entitled to a higher rating for his scar as it is painful and causes irritation when he wears glasses. The Veteran’s right ear scar is rated at 10 percent under Diagnostic Code 7804 for painful scar and non-compensable under Diagnostic Code 7800, for burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Codes 7800 and 7804 were 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. Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar with 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 warrants a 30 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement warrants an 80 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7800 list the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at 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; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id. In February 2018 the Veteran underwent an examination for his scar and reported pain that increases when wearing glasses. The examiner noted one mastoidectomy scar on the right ear that was tender to palpation, painful and unstable. The scar was located on the posterior right ear and measured 3.5 by 0.1 centimeters. The examiner reported no elevation, depression, adherence to underlying tissue or missing underlying soft tissue. There was no abnormal pigmentation or texture, no gross distortion, asymmetry facial features or visible or palpable tissue loss. The examiner noted limitation of function due to the inability to wear prescribed eyewear due to pain and irritation. The Veteran attended a VA examination for scars in August 2020 and again reported pain and itching with extended wearing of glasses. The examiner noted that the Veteran has one painful scar of the head that was tender to palpation but not unstable. The scar was located at the posterior helix and measured 7 by 0.2 centimeters. There was no elevation, depression, adherence to underlying tissue or missing underlying soft tissue. There was no abnormal pigmentation or texture, no gross distortion, asymmetry facial features or visible or palpable tissue loss. The scar did not cause limitation of motion or function. Review of the medical records does not reveal complaints or treatments concerning the Veteran’s right ear scar. As such, the Veteran’s right ear scar measuring 7 by 0.2 centimeters is manifested by pain, itching and irritation. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating under Diagnostic Code 7800 as the Veteran does not have at least one characteristic of disfigurement, which are listed above, or the assignment of a rating in excess of 10 percent under Diagnostic Code 7804, as he does not have three or four unstable or painful scars. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s right ear scar is not deep and non-linear and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does do not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7801 and 7802 both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. 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 right ear scar. 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. REASONS FOR REMAND 1. Entitlement to a compensable rating for hearing loss of the right ear The Veteran underwent a VA examination for his hearing loss in November 2020 as he alleged a worsening of symptoms at the Board hearing. The examination report revealed that the puretone thresholds could not be tested as there were no responses for the right ear; however, the examiner noted that there was a positive Stenger at all frequencies tested. At the hearing the Veteran alleged that he is completely deaf in his right ear and that during his last surgery everything on the inside of the ear was removed. As such, a remand is necessary for clarification as to the severity of the Veteran’s right ear hearing loss. The matters are REMANDED for the following action: 1. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records pertaining to his service-connected right ear. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file. If, after making reasonable efforts, the records cannot be obtained, notify the Veteran and his representative and (a) identify the specific records that cannot be obtained; (b) briefly explain the efforts made to obtain those records; and (c) describe any further action to be taken with respect to the claim. The Veteran must then be given an opportunity to respond. 2. Schedule the Veteran for a VA medical examination to determine the current severity of his service-connected hearing loss of the right ear. The electronic claims file must be reviewed in conjunction with the examination. Any appropriate evaluations, studies, and testing deemed necessary by the examiner should be conducted, and the results included in the examination report. The examiner must consider and address the testimony that the Veteran is completely deaf in his right ear and that during his surgery they removed everything in his right ear. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. The examiner should clarify whether any inability to test the Veteran’s hearing is a result of his alleged deafness or a residual effect from his prior ear surgeries. The examiner must also provide an assessment of the Veteran’s functional limitations due to his hearing loss as it may relate to his ability to function in a work setting and to perform work tasks. However, the examiner should refrain from commenting on the Veteran’s employability. A complete rationale should be given for all opinions and conclusions rendered. (Continued on the next page)   If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Prinsen 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.