Citation Nr: 21011602 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-00 861 DATE: March 2, 2021 ORDER An initial rating in excess of 10 percent for hypertension prior to May 3, 2019, is denied. Subject to the laws and regulations governing the award of VA monetary benefits, a 20 percent rating, but no more, for hypertension from May 3, 2019, is granted. Subject to the laws and regulations governing the award of VA monetary benefits, an initial 30 percent rating, but no more, for left gynecomastia with breast reduction is granted. An initial compensable rating for scar, status post left gynecomastia reduction, is denied. An effective date of September 30, 2019, but no earlier, for a 10 percent rating for a painful scar, status post left gynecomastia reduction, is granted. A rating in excess of 10 percent for a painful scar, status post left gynecomastia reduction, is denied. FINDINGS OF FACT 1. Prior to May 3, 2019, the Veteran’s diastolic blood pressure was predominantly 100 or more but was not predominantly 110 or more, nor was systolic pressure predominantly 200 or more. 2. From May 3, 2019, the Veteran’s systolic pressure was predominantly 200 or more but his diastolic pressure was not predominantly 120 or more. 3. The Veteran’s left gynecomastia reduction surgery constitutes either a wide local excision or a simple mastectomy resulting in significant alteration in size or size and form of his left breast. 4. Throughout the entire appeal period, the Veteran’s left breast scar was linear and did not have other disabling effects. 5. From September 30, 2019, the Veteran’s left breast scar was reported to be painful. 6. From September 30, 2019, the Veteran had only one painful scar and no unstable scars. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for hypertension prior to May 3, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7101. 2. The criteria for a 20 percent rating, but no more, for hypertension from May 3, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.104, DC 7101. 3. The criteria for an initial 30 percent rating, but no more, for left gynecomastia with breast reduction have been met 38 U.S.C. § 1155; 38 C.F.R. §§ 4.10-4.10, 4.21, 4.116, DC 7626. 4. The criteria for an initial compensable rating for scar, status post left gynecomastia reduction, have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.118, DC 7805. 5. The criteria for a 10 percent rating for painful scar, status post left gynecomastia reduction, from September 30, 2019, but no earlier, have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.118, DC 7804. 6. The criteria for a rating in excess of 10 percent for painful scar, status post left gynecomastia reduction, from September 30, 2019, have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from February 1973 to December 1974. These matters were previously before the Board in November 2019 at which time they were remanded for further evidentiary development. Substantial compliance with the remand requests having been accomplished, the Board may proceed to consider the claims. See Stegall v. West, 11 Vet. App. 268 (1998). In a September 2013 rating decision, service connection for hypertension, left gynecomastia with breast reduction, and scar associated with left gynecomastia with breast reduction was granted at noncompensable rates, respectively, effective May 30, 2012. The Veteran timely appealed. In a May 2019 rating decision, the rating for hypertension was increased to 10 percent, effective May 30, 2012. In a September 2020 rating decision, an additional rating for the residual scar from the left gynecomastia with breast reduction was granted at 10 percent, effective December 16, 2019. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Increased Ratings 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. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In every instance where the rating schedule does not provide for a noncompensable evaluation, a noncompensable evaluation shall be assigned where the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 1. Hypertension The Veteran’s hypertension is rated 10 percent disabling under 38 C.F.R. § 4.104, DC 7101, pertaining to hypertension, effective May 30, 2012, the date of his original claim for service connection. As such, the Board will consider the severity of the disability from that date. Under DC 7101, a 10 percent disability rating requires diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or that an individual with a history of diastolic pressure predominantly 100 or more requires continuous medication for control. A 20 percent disability rating requires diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent disability rating requires diastolic pressure predominantly 120 or more. A 60 percent disability rating requires diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104. Turning to the evidence of record, the Veteran underwent a VA examination in August 2013. He stated that his blood pressure was stable at the time. Current medications were noted to be Hydralazine, Labetalol, Amlodipine, and Lisinopril. Three separate blood pressure readings were taken at 150/100. The Veteran reported that he had not taken his blood pressure medications on the day of the examination. He was advised to take them as soon as possible. There was no functional impact from his hypertension noted. Another VA examination was conducted in April 2019. Current medications were noted to be Lisinopril, Carvedilol, Simvastatin, Nifedipine, and aspirin. Three separate blood pressure readings were 146/98, 150/100, and 154/104, with the average being 150/100. There was no functional impact from his hypertension noted. A private Disability Benefits Questionnaire (DBQ) was completed in May 2019 but submitted by the Veteran in January 2020. It demonstrated three separate blood pressure readings of 176/92, 150/83, and 219/103. In an August 2019 VA treatment record, it was noted that the Veteran’s blood pressure was always high, with systolic pressure in the 160s. A September 2019 reading was 210/98. In November 2019, he sought emergency treatment when his blood pressure was 210/100 but it was noted that he had not taken his medication that day. He told clinicians that his home reading was 190/100 and that his systolic pressure ran in the 170s to 200s. Additional readings taken that day were 213/90, 180/88, 180/88, 215/100, 210/100, and 194/93. The Veteran underwent another VA examination in December 2019. Current medications were noted to be Clonidine, Losartan, and Nifedipine. Three separate blood pressure readings were 197/89, 173/88, and 159/76. In December 2019, the Veteran’s treating doctor saw his home blood pressure log and stated that some systolic readings were in the 170s to 200s. At a later appointment that month, his home reading was noted to be 208/97. Late in December 2019, the Veteran passed out following a cerebrovascular accident (CVA) during which his blood pressure was measured at 263/133. As an aside, the Board notes the Veteran has been separately service-connected for residuals of this stroke, rated 100 percent disabling from December 31, 2019, to June 30, 2020, and 10 percent thereafter, effective July 1, 2020. Following the CVA, private clinicians aggressively treated the Veteran’s hypertension, attempting to bring it under control with various medications and dosages. While hospitalized in February 2020, multiple blood pressure readings were taken that reflected systolic pressure in the high 180s. Elevated readings were noted in March 2020 with systolic blood pressure in the 150s to 160s. In April 2020, it was recorded that the Veteran’s blood pressure was trending back up and multiple readings were taken, reflecting varying levels of control. Another VA examination was sought in April 2020 in response to the receipt of the DBQ. It was noted that due to the COVID-19 pandemic, the Veteran could not be examined but would be rescheduled when possible. Subsequent treatment records reflected varying blood pressure levels, from normal readings to systolic readings in the 180s and diastolic pressures below 100. At the outset, the Board finds that a new VA examination is not necessary before the Board may proceed to consider the claim. Although a new examination was sought in April 2020 in response to the DBQ, the DBQ was completed in May 2019. A VA examination was already conducted following the DBQ in December 2019. Further, there are voluminous private and VA treatment records since May 2019 reflecting hundreds of blood pressure readings. As such, the Board has sufficient information regarding the current severity of the hypertension disability to proceed without prejudice to the Veteran. (a.) An initial rating in excess of 10 percent for hypertension prior to May 3, 2019, is denied. Prior to May 3, 2019, the Veteran’s hypertension was frequently elevated with diastolic pressure predominantly 100 or more. At no point was diastolic pressure measured at 110. Further, systolic pressure was not measured at 200. As such, the criteria for a 20 percent rating under 38 C.F.R. § 4.104, DC 7101, were not met prior to May 3, 2019. Accordingly, an initial rating in excess of 10 percent for hypertension prior to May 3, 2019, is not warranted. (b.) A rating of 20 percent, but no more, for hypertension from May 3, 2019, is granted. From May 3, 2019, the Veteran’ systolic pressure was repeatedly measured at 200 or more. Although on several occasions it was noted that he had not taken his blood pressure medication as prescribed in those instances, affording the Veteran the benefit of the doubt, his systolic pressure was predominantly 200 or more, warranting a 20 percent rating under DC 7101. The first recorded reading of a systolic pressure 200 or more was taken on May 3, 2019, as reflected in the private DBQ. Accordingly, a 20 percent rating is warranted as of that date, but no earlier. Subsequently, the Veteran’s blood pressure worsened, eventually skyrocketing to 263/133 and resulting in the CVA. Again, the Veteran’s CVA (stroke) has been separately service-connected, rated 100 percent disabling from December 31, 2019, to June 30, 2020, and 10 percent thereafter, effective July 1, 2020. However, the Board has considered the significance of this incident with respect to the Veteran’s hypertension rating. During emergency treatment, his blood pressure was brought under relative control, with no other readings exceeding diastolic pressure of 100. Although subsequent readings varied, diastolic pressure was predominantly 100 or less and systolic pressure 160 or less. Close monitoring and medication management of the Veteran’s hypertension continue. The Board finds that although one blood pressure reading had diastolic pressure over 130, that does not equate to diastolic pressure predominantly 120 or 130, meriting a higher rating under DC 7101. The Veteran’s diastolic pressure did not exceed 120 or 130 on any other occasion. Again, the results of the 263/133 blood pressure, the CVA and residuals, have been separately service connected and compensated. As such, the Board finds that a rating in excess of 20 percent is not warranted at any point. At the same time, although readings taken since the December 2019 CVA have been greatly reduced, the Veteran continues to have fluctuating blood pressure carefully managed with medication and diet. As such, there is no evidence of sustained improvement such that a lower rating is warranted. Accordingly, resolving the evidence in favor of the Veteran, the Board finds a rating of 20 percent, but no more, for hypertension from May 3, 2019, is warranted. 2. Left gynecomastia with breast reduction The Veteran’s left gynecomastia with breast reduction is in receipt of a noncompensable rating under 38 C.F.R. § 4.116, DC 7626, pertaining to surgery of the breast, effective May 30, 2012, the date of his original claim for service connection. As such, the Board will consider the severity of the disability from that date. Under DC 7626, a noncompensable rating is provided following wide local excision without significant alteration of size or form of one breast. A 30 percent rating is warranted following a simple mastectomy or wide local excision with significant alteration of size or form of one breast, and a 40 percent rating is provided following modified radical mastectomy of one breast. Finally, a 50 percent rating is provided following radical mastectomy of one breast. For VA purposes: (1) Radical mastectomy means removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament; (2) Modified radical mastectomy means removal of the entire breast and axillary lymph nodes (in continuity with the breast), but pectoral muscles are left intact; (3) Simple (or total) mastectomy means removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact; (4) Wide local excision (including partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy) means removal of a portion of the breast tissue. 38 C.F.R. § 4.116, DC 7626, Note. Turning to the evidence of record, the Veteran underwent a VA examination in August 2013. He stated that his left breast caused him pain with soreness that came and went a few times per week. The examiner indicated that the Veteran’s breast surgery was a left wide local excision. The surgery did not result in the loss of 25 percent or more tissue or any other residuals other than the service-connected scar. There was no functional impact from the disability. Another VA examination was conducted in April 2019. The examiner indicated that the Veteran’s breast surgery was a wide local excision which resulted in significant alteration in size of the left breast. The surgery did not result in the loss of 25 percent or more tissue or any other residuals other than the service-connected scar. There was no functional impact from the disability. In a September 2019 Informal Hearing Presentation (IHP), the Veteran’s representative contended that his disability had worsened with pain and other residuals in the left breast. The Veteran underwent another VA examination in December 2019. The examiner noted that he did not take any current mediations and that his condition had stayed the same. She indicated that the Veteran’s breast surgery was a simple mastectomy resulting in significant alteration of form and size of the left breast. The surgery did not result in the loss of 25 percent or more tissue or any other residuals other than the service-connected scar. There was no functional impact from the disability. A VA addendum opinion was obtained in September 2020 to reconcile the differing findings by the previous VA examiners. The clinician listed the findings of the other examiners and noted that following the Veteran’s in-service excision, sutures were removed, and he was considered recovered and fit to return to duty. He noted that there were no additional surgeries to the left breast. As such, he concluded that the various VA examiners had different interpretations of the physical examinations. At the outset, the Board notes that the September 2020 addendum opinion did not state whether there had been a change in the breast surgery residuals throughout the appeal period nor provide a rationale to reconcile the different opinions. However, the Board finds that there is sufficient evidence in the record in order to determine the severity of the disability without further needed development. (a.) An initial rating of 30 percent, but no more, for left gynecomastia with breast reduction is granted. As noted above, the interpretations of the Veteran’s left breast surgery and residuals have varied throughout the record. However, the Board finds that, affording the Veteran the benefit of the doubt, a 30 percent rating is warranted throughout the entire appeal period. The August 2013 examiner found that the surgery was a wide local excision but did not determine whether it resulted in significant alteration of size or form of the left breast. The other examiners indicated that the breast surgery was either a wide local excision or a simple mastectomy resulting in significant alteration in size or size and form. Both interpretations warrant a 30 percent evaluation under 38 C.F.R. § 4.116, DC 7626. Only the Veteran’s left breast was affected by the gynecomastia reduction and at no point has the surgery been characterized as a radical mastectomy or modified radical mastectomy. As such, a rating in excess of 30 percent is not warranted under the criteria of DC 7626. Based on the foregoing, the Board finds that an initial 30 percent rating, but no more, is warranted throughout the appeal period. The Board notes that when providing a 30 percent rating under DC 7626, the claim must be reviewed for entitlement to special monthly compensation (SMC) under 38 C.F.R. § 3.350. See 38 C.F.R. § 4.116. SMC is a special statutory award in addition to awards based on the schedular evaluations provided in VA’s rating schedule. See 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350. In pertinent part, SMC under subsection (k) is payable for loss of 25 percent or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy), or following receipt of radiation treatment of breast tissue. However, all three VA examiners agreed that the Veteran’s left breast gynecomastia surgery did not result in the loss of 25 percent or more tissue in the left breast. As such, entitlement to SMC has not been demonstrated. 3. Scars The Veteran is currently in receipt of two ratings for the residual scar from his left gynecomastia with breast reduction. He has a noncompensable rating under 38 C.F.R. § 4.118, DC 7805, pertaining to other scars, effective May 30, 2012, the date of his original claim for service connection. He is also in receipt of a 10 percent rating under 38 C.F.R. § 4.118, DC 7804, pertaining to painful or unstable scars, effective December 16, 2019. Thus, the Board will consider all manifestations and severity of the scar from May 2012. Scars in general are evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.118, DC 7800-7805. Amendments to the criteria became effective on August 13, 2018, during the pendency of this claim. See 83 Fed. Reg. 32,592 (July 13, 2018). The amendments provide that in such cases the Board should apply the criteria which are more favorable to the Veteran. The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change. However, the old regulations will be considered for the periods both before and after the change was made. See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The Board will first address the regulations in effect prior to August 13, 2018. DC 7800 contemplates scars of the head, face, or neck. As the Veteran’s scars are located in his bilateral lower extremities, rating is not warranted under DC 7800. DC 7801 provides ratings for burn or other scars (not on the head, face, or neck) that are deep and nonlinear. Deep and nonlinear scars involving an area or areas of at least 6 square inches (39 sq. cm) but less than 12 square inches (77 sq. cm.) are rated 10 percent. Scars in an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) are rated 20 percent. Scars in an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) are rated 30 percent. Scars in an area or areas of 144 square inches (929 sq. cm.) or greater are rated 40 percent. Note (1) specifies that a deep scar is one associated with underlying soft tissue damage. Note (2) specifies 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 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 separates 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. DC 7802 provides a maximum 10 percent rating for a burn or other scars that are superficial and nonlinear involving an area of 144 square inches (929 sq. cm) or greater. Note (1) provides that a superficial scar is one not associated with underlying soft tissue damage. Note (2) specifies 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 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 separates 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. DC 7804 provides a 10 percent rating for one or two scars that are unstable or painful, a 20 percent rating for three or four scars that are unstable or painful, and a 30 percent rating for five or more scars that are unstable or painful. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) 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. Note (3) provides that scars evaluated under Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. DC 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under diagnostic codes 7800, 7801, 7802, and 7804 under an appropriate diagnostic code. In every instance where the schedule does not provide a 0 percent rating for a diagnostic code, a 0 percent rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Under the amended criteria which became effective on August 13, 2018, DC 7800 and 7804 were not changed. DC 7801 now provides for burn scars or scars due to other causes, not of the head, face, or neck that are associated with underlying soft tissue damage. The rating criteria for this code remained the same. But Note (1) now reads as follows: For the purposes of DC 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) now reads as follows: A separate evaluation may be assigned for each affected zone 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. Under the amended criteria which became effective on August 13, 2018, DC 7802 now provides for burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. The rating criteria remained the same. But Note (1) now reads: For the purposes of DC 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) now reads: A separate evaluation may be assigned for each affected zone 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 7805 was amended in that the parentheses which noted that linear scars were included was removed. The title now provides for scars, other and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, and 7804. The rating criteria remained the same. Turning to the evidence of record, the Veteran underwent a VA examination in August 2013. He stated that he had a residual scar from his left breast surgery which did not bother him. The examiner indicated that the left breast scar was linear, measuring 10 cm by 2 cm. The scar was not painful or unstable. There was no treatment of and no functional impact from the scar. Another VA examination was conducted in April 2019. The examiner indicated that the Veteran had a scar on his left chest measuring 11 cm by 1 cm. The scar was not painful or unstable. There was no treatment of and no functional impact from the scar. In a September 2019 IHP, the Veteran’s representative stated that the left breast scar was very sensitive. The Veteran underwent another VA examination in December 2019. He reported that his scar experienced aching and tightness. The examiner indicated that he had a scar on his left breast measuring 11 cm by 2 cm. The single scar was painful but not unstable. There was no treatment of and no functional impact from the scar. (a.) An initial compensable rating for scar status post left gynecomastia reduction is denied. Based on the foregoing, the Board finds that a compensable rating for the Veteran’s left breast scar under the criteria of 38 C.F.R. § 4.118, DC 7805, is not warranted at any time during the appeal period under the pre-amended or amended criteria. A noncompensable rating was awarded based on the scar being linear and not having other disabling effects. The scar is not of the head, face, or neck and is not deep and nonlinear or superficial and nonlinear and it does not meet the criteria for a compensable rating under DC 7800, 7801, or 7802. As such, a compensable rating is not warranted at any point during the appeal period under DC 7805. (b.) An effective date of September 30, 2019, but no earlier, for a 10 percent rating for a painful scar, status post left gynecomastia reduction, is granted. The Board finds that the additional 10 percent rating granted for the left breast scar under 38 C.F.R. § 4.118, DC 7804, for a painful scar is warranted from September 30, 2019. Prior to that date, the Veteran denied symptomology in the scar, specifically noting upon examination that it did not bother him. In the IHP of that date, his representative stated that the scar was very sensitive. This is the first indication in the claims file that the scar was painful. As such, an effective date of September 30, 2019, but no earlier, for the 10 percent rating under DC 7804 is warranted. (c.) A rating in excess of 10 percent for a painful scar, status post left gynecomastia reduction, is denied. A rating in excess of 10 percent under DC 7804 is not warranted. The Veteran only has one scar from his left breast gynecomastia reduction surgery. As he does not have three or four scars, the criteria for a higher rating under DC 7804 have not been demonstrated. Accordingly, a rating in excess of 10 percent for a painful scar is not warranted. Neither the Veteran or his representative has raised any other issues, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (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). Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Rachel E. Jensen, 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.