Citation Nr: 21013177 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 15-44 108 DATE: March 8, 2021 ORDER Entitlement to an increased disability evaluation for eczema, initially rated as 10 percent disabling, is denied. Entitlement to an increased, initial 20 percent disability evaluation for lumbar strain, for the rating period prior to March 6, 2020, is granted. Entitlement to an increased disability evaluation for lumbar strain, rated as 20 percent disabling for the rating period since March 6, 2020, is denied. Entitlement to an increased, 30 percent disability evaluation for inguinal hernia, for the rating period prior to March 6, 2020, is granted. Entitlement to an increased disability evaluation for inguinal hernia, rated as 30 percent disabling for the rating period since March 6, 2020, is denied. Entitlement to an increased disability evaluation for surgical scar, left inguinal hernia, initially rated as noncompensable is denied. Entitlement to service connection for a prostate disorder is denied. Entitlement to service connection for a seizure disorder is denied. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. Entitlement to service connection for mediastinal lymphadenopathy is denied. FINDINGS OF FACT 1. The Veteran’s eczema affects at least 5 percent, but no more than 20 percent, of the entire body and requires near constant topical treatment; there is no use of systematic therapy or immunosuppressive drugs required. 2. For the entire rating period on appeal, the Veteran’s lumbar strain is manifested by pain, with muscle spasm. Forward flexion is limited to no worse than 80 degrees, without ankylosis. 3. For the entire rating period on appeal, the Veteran’s inguinal hernia is manifested by a recurrent and readily reducible hernia, not well supported by a truss. 4. The Veteran’s surgical scar left inguinal hernia is not painful, at least 6 inches square, deep and nonlinear, or unstable; there are no disabling effects due to the scar. 5. The Veteran does not have a prostate disorder. 6. The Veteran’s seizure disorder was not manifest in service and is not attributable to service. 7. The Veteran’s COPD was not manifest in service and is not attributable to service. 8. The Veteran’s mediastinal lymphadenopathy was not manifest in service and is attributable to service. CONCLUSIONS OF LAW 1. The criteria for a disability evaluation in excess of 10 percent for eczema have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.118, Diagnostic Code 7806 (2020). 2. The criteria for a 20 percent disability evaluation, but no higher, for lumbar strain, for the rating period prior to March 6, 2020, have been met. 38 U.S.C. §§ 1155, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235 to 5243 (2020). 3. The criteria for a disability evaluation in excess of 20 percent for lumbar strain have not been met. 38 U.S.C. §§ 1155, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235 to 5243 (2020). 4. The criteria for a 30 percent disability evaluation, but no higher, for inguinal hernia, for the rating period prior to March 6, 2020, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7338 (2020). 5. The criteria for a disability evaluation in excess of 30 percent for inguinal hernia have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7338 (2020). 6. The criteria for a compensable disability rating for surgical scar, left inguinal hernia, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.118, Diagnostic Codes 7801 – 7805 (2020). 7. The criteria for service connection for a prostate disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303 (2020). 8. The criteria for service connection for a seizure disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303 (2020). 9. The criteria for service connection for COPD have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303 (2020). 10. The criteria for service connection for mediastinal lymphadenopathy have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1971 to December 1973. These matters come before the Board of Veterans’ Appeals (Board or BVA) on appeal from February 2013 and May 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Board remanded the Veteran’s case to the Agency of Original Jurisdiction (AOJ) for additional development and due process considerations. A supplemental statement of the case was issued in January 2021. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). The VCAA requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of the evidence that is necessary in substantiating their claims, and provide notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess v. Nicholson, 19 Vet. App. 473, 486 (2006). Neither the Veteran nor his representative has raised any issues with the duty to notify or 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.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In addition, when assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must also consider the extent that the veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. When evaluating musculoskeletal disabilities, VA must consider whether a higher evaluation is warranted, where the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups. See 38 C.F.R. § § 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Nevertheless, pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Moreover, functional impairment must be supported by adequate pathology. Id.; Johnson v. Brown, 9 Vet. App. 7, 10 (1996) (both citing to 38 C.F.R. § 4.40). 1. Entitlement to an increased disability evaluation for eczema, initially rated as 10 percent disabling. The Veteran’s eczema is currently evaluated as 10 percent disabling pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7806. Diagnostic Code 7806 provides a noncompensable disability evaluation for dermatitis or eczema of less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and no more than topical therapy required during the past 12-month period. A 10 percent disability evaluation is assigned for dermatitis or eczema of at least 5 percent of the entire body, but less than 20 percent of the entire body, or at least 5 percent, but less than 20 percent of the exposed affected areas, or intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the prior 12-month period. See 38 C.F.R. § 4.118, Diagnostic Code 7806. For the next higher 30 percent disability evaluation, there must be dermatitis or eczema over 20 to 40 percent of the body or 20 to 40 percent of the exposed areas affected, or systemic therapy, such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the prior 12-month period. For the next higher 60 percent disability evaluation, there must be dermatitis or eczema over more than 40 percent of the entire body, or more than 40 percent of the exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs for the past 12-month period. Id. Following a review of the evidence, the Board finds that the Veteran’s eczema more nearly approximates the criteria for the currently assigned 10 percent disability evaluation under Diagnostic Code 7806 for the entire rating period on appeal. The evidence shows that the Veteran does not have eczema over at least 20 percent of his entire body. Indeed, the medical evidence, including the May 2014 and March 2020 VA examination reports, indicates that the Veteran has eczema over more than 5 percent, but less than 20 percent, of his entire body. The Board acknowledges that the Veteran reports that he experiences dry and itchy skin which he used to treat with a topical lotion. However, there is no evidence that the Veteran treats his eczema with a systemic therapy as required for the regulation. A higher rating is not warranted as he does not have at least 20 percent of his entire body affected, and the Veteran does not require intermittent systemic therapy of corticosteroids or other immunosuppressive drugs to treat his eczema. To the extent that the Veteran previously treated his eczema with lotion, the Board notes that topical treatment is not characteristic of a systemic (oral) corticosteroid as required for a higher rating. Therefore, the Board finds that the preponderance of the evidence is against the assignment of a disability rating in excess of 10 percent for eczema for the entire appeal period. 2. Entitlement to an increased disability evaluation for lumbar strain, initially rated as 10 percent disabling. 3. Entitlement to an increased disability evaluation for lumbar strain, rated as 20 percent disabling for the rating period since March 6, 2020. The Veteran is currently assigned an initial 10 percent disability rating for the rating period prior to March 6, 2020 and a 20 percent disability rating thereafter for his service-connected lumbar strain pursuant to the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5237. See 38 C.F.R. § 4.20. Lumbosacral and cervical spine disabilities are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine (“general rating formula”). 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Intervertebral disc syndrome (IVDS) is rated under the General Rating Formula for Rating Diseases and Injuries of the Spine or the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Formula for Rating IVDS Based on Incapacitating Episodes provides for ratings from 10 to 60 percent based on the frequency and duration of incapacitating episodes, defined in Note 1 as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. The maximum 60 percent schedular rating is warranted for incapacitating episodes having a total duration of at least 6 weeks during the previous 12 months. The Board notes that effective February 7, 2021, the spine regulations were amended to state that Diagnostic Code 5243 governing intervertebral disc syndrome should only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root; and that Diagnostic Code 5242 should apply to all other disc diagnoses. See 85 Fed. Reg. 76462 (Nov. 30, 2020) (effective 2/7/2021). The Board notes that this change does not impact the evaluation in this case as the Veteran does not have any evidence of incapacitating episodes that would warrant a compensable rating under Diagnostic Code 5243. The Notes following the General Rating Formula for Diseases and Injuries of the Spine provide further guidance in rating diseases or injuries of the spine. Note 1 provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note 2 provides that, for VA compensation purposes, the combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. Note 4 provides that range of motion measurements are to be rounded to the nearest five degrees. Note 5 defines unfavorable ankylosis as a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note 6 provides that disability of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. According to the general rating formula, a 10 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees, but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is to be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is to be assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Code 5235 for vertebral fracture or dislocation; 5236 for sacroiliac injury and weakness; 5237 for lumbosacral strain; Diagnostic Code 5238 for spinal stenosis; Diagnostic Code 5239 for spondylolisthesis or segmental instability; Diagnostic Code 5240 for ankylosing spondylitis; Diagnostic Code 5241 for spinal fusion; Diagnostic Code 5242 for degenerative arthritis of the spine; and Diagnostic Code 5243 for intervertebral disc syndrome. The Veteran contends that he is entitled to a higher rating and that his symptoms have been consistent throughout the appeal period. After a review of all the evidence, the Board finds that the Veteran’s disability picture more nearly approximates the criteria for a 20 percent disability evaluation for his service-connected lumbar strain. At the May 2014 VA examination, the Veteran had normal range of motion in all directions; however, the Veteran had pain on motion and tenderness to palpation. There was no muscle spasm, guarding, or atrophy. Strength and reflex testing were normal. There was no evidence of ankylosis. The VA examination report indicated that there was no evidence of functional loss due to pain on motion. The VA examiner stated that the Veteran did not have intervertebral disc syndrome or incapacitating episodes. At the March 2020 VA examination, the Veteran had forward flexion to 85 degrees, extension to 30 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. Upon repetitive motion, he had pain on motion with decreased range of motion; the VA examiner indicated that the Veteran had flexion to 80 degrees. The VA examiner noted that the Veteran’s range of motion which impacts his ability to bend, lift, and to do prolonged sitting, standing, walking. The VA examiner indicated that the Veteran’s functional impairment was due to pain on motion, with weight-bearing. The VA examiner observed pain on motion and tenderness to palpation, as well as muscle spasm resulting in abnormal gait or abnormal spine contour; there was no evidence of muscle atrophy, guarding, or ankylosis. The VA examiner indicated that the Veteran does not have intervertebral disc syndrome or incapacitating episodes. VA treatment records dated throughout the rating period on appeal reflect that the Veteran was treated for back pain and reduced range of motion; however, no measurements were provided. The lay and medical evidence demonstrates that the Veteran’s symptoms do not result in additional functional limitation to a degree that would support a rating in excess of a 20 percent disability rating at any time during the appeal period. The evidence shows that the Veteran experiences forward flexion of the thoracolumbar spine which is better than 30 degrees which is required for a higher rating based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5242. Here, the lay evidence has been considered; however, that evidence when accepted as correct does not establish that he is functionally limited to 30 degrees or less forward flexion. Further, the evidence does not show favorable or unfavorable ankylosis of the entire thoracolumbar spine during the rating period on appeal. Additionally, he does not experience incontinence or bowel complaints as a result of his lumbar strain. The Board has considered whether additional functional impairment due to factors such as pain, weakness and fatigability demonstrate additional limitation of motion or function to warrant a higher rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca at 206-07. The evidence shows no atrophy or decrease in strength. To the extent that the Veteran claims that his pain upon motion is the equivalent of limited motion, the Board finds that the Veteran’s subjective complaints of pain have been contemplated in the current rating assignment, as the current rating is based on the objectively demonstrated reduced motion and impairment, as well as estimated limitation of motion during a flare-up; the projected limitation of motion was based on the Veteran’s report of symptomatology and reports of functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Moreover, the available medical findings do not show that painful motion, limitation of motion on repetitive use testing, or pain or limitation of motion on active motion/passive motion/in weight-bearing/nonweight-bearing resulted in functional loss warranting the assignment of any higher evaluation for the lumbar spine during the entire appeal period. See Correia v. McDonald, 28 Vet. App. 158 (2016). Therefore, the lay and medical evidence demonstrates that the Veteran’s symptoms do not result in additional functional limitation to a degree that would support a rating in excess of a 20 percent disability rating. With respect to a higher evaluation based on incapacitating episodes under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, as noted earlier, the Veteran does not have intervertebral disc syndrome which is productive of incapacitating episodes requiring physician prescribed best rest having a total duration of at least 4 weeks during a 12-month period as contemplated by a higher evaluation. Review of the Veteran’s treatments record also do not reveal any periods of physician prescribed bed rest as a result of his lumbar strain, further there was no evidence of a diagnosis of intervertebral disc syndrome. With consideration of the provisions of Note (1) of the General Rating Formula for Diseases and Injuries of the Spine, the Veteran’s VA examination reports reflect that the Veteran does not experience any lower extremity neurological deficits, it is not for consideration here. As such, the Board finds that the Veteran is entitled to a disability rating of 20 percent, but no higher, for service-connected lumbar strain for the entire rating period on appeal. 4. Entitlement to an increased disability evaluation for inguinal hernia, initially rated as 10 percent disabling. 5. Entitlement to an increased disability evaluation for inguinal hernia, rated as 30 percent disabling for the rating period since March 6, 2020. The Veteran’s service-connected inguinal hernia is rated as 10 percent disabling for the rating period prior to March 6, 2020, and 30 percent disabling thereafter, pursuant to 38 C.F.R. § 4.114, DC 7338. Under DC 7338, a noncompensable evaluation is appropriate if the hernia is small, reducible, or without true hernia protrusion; or where it is not operated, but remediable. A 10 percent evaluation is warranted if a hernia is postoperative recurrent, readily reducible and well supported by truss or belt. A 30 percent evaluation is warranted for a small, postoperative recurrent hernia, or unoperated irremediable hernia that is not well-supported by truss, or not readily reducible. A maximum schedular evaluation of 60 percent is warranted for a large, postoperative recurrent hernia that is not well-supported under ordinary conditions and not readily reducible, when it is considered inoperable. The record shows the Veteran's history of inguinal hernia is longstanding, dating from 1971. The May 2014 VA examination report reflects that the Veteran reported that the Veteran was noted to have an inguinal hernia in 1971 and 1972, which required surgery in 1973 for his hernia; he reported that he continued to have issues since that time. Examination showed a recurrent left inguinal hernia without noticeable protrusion or indication of the need for a supportive belt. No further evaluation was provided. At the more recent, March 2020 VA examination, the Veteran reported experiencing a recurrent hernia. Examination indicated that the Veteran’s recurrent hernia appears operable and remediable. The hernia was described as small and readily reducible, but in need of support; the VA examiner noted that the Veteran’s hernia was not well supported by truss or belt. The VA examiner noted that the Veteran would be functionally impaired by his hernia because he “would likely experience pain when lifting items heavier than 50 pounds.” In reviewing the evidence of record, the Board finds that the Veteran’s symptomatology throughout the appeal period has most closely approximated the criteria associated with a 30 percent evaluation for this disability for the entire rating period on appeal. The Veteran’s hernia is recurrent and productive of pain. However, assignment of a 60 percent evaluation is not appropriate; the record has never suggested the Veteran’s inguinal hernia is inoperable. Thus, the Board finds that entitlement to a 30 percent evaluation, but no higher, is warranted for the entire rating period on appeal. 6. Entitlement to an increased disability evaluation for surgical scar, left inguinal hernia, initially rated as noncompensable. The Veteran’s service-connected surgical scar, left inguinal hernia, is rated as noncompensable pursuant to Diagnostic Code 7805. See 38 C.F.R. § 4.20. Diagnostic Code 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 7800-04 under an appropriate diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7805. Diagnostic Code 7800 provides that the 8 characteristics of disfigurement, for purposes of rating under 38 C.F.R. § 4.118, are the following: scar is 5 or more inches (13 or more centimeters) in length; scar is at least one-quarter inch (0.6 cm.) wide at the widest part; surface contour of scar is elevated or depressed on palpation; scar is adherent to underlying tissue; skin is hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); skin texture is abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); underlying soft tissue is missing in an area exceeding six square inches (39 sq. cm.); and skin is indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Diagnostic Code 7801 provides ratings for scars, other than the head, face, or neck, that are deep or that cause limited motion. Scars in an area or areas exceeding 144 square inches (929 sq. cm.) are rated 40 percent disabling. Note (1) to Diagnostic Code 7801 provides that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801. Diagnostic Code 7802 provides ratings for scars, other than the head, face, or neck, that are superficial or that do not cause limited motion. Superficial scars that do not cause limited motion, in an area or areas of 144 square inches (929 sq. cm.) or greater, are rated 10 percent disabling. Note (1) to Diagnostic Code 7802 provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802. Diagnostic Code 7804 pertains to unstable or painful scars. Five or more scars that are unstable or painful are 30 percent disabling. This is the highest rating available under this Diagnostic Code. 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. 38 C.F.R. § 4.118, Diagnostic Code 7804. After a review of all the evidence, the Board finds that the Veteran’s surgical scar, left inguinal hernia, more closely approximates the criteria for the currently assigned noncompensable disability evaluation for the entire rating period. The Board notes that the medical evidence does not show that his scar is unstable or painful upon examination in May 2014 and March 2020. Moreover, the Veteran has not reported that his scar is painful. At the March 2020 VA hernia examination, the scar measured 4 cm X .2 cm. A higher disability rating is not warranted as the Veteran has only one scar, and the objective clinical evidence of record, namely the May 2014 and March 2020 VA examination reports, shows that the Veteran’s surgical scar, left inguinal hernia does not exceed 6 square inches. Likewise, the scar is superficial, without skin breakdown, keloid formation, inflammation, or edema. Additionally, the scar is not productive of adherence, and the Veteran’s does not cause limitation of motion or disfigurement. Therefore, a higher, compensable rating is not warranted for his surgical scar, left inguinal hernia, under Diagnostic Code 7805. See 38 C.F.R. §§ 4.118, Diagnostic Codes 7801-7805. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § §§ 1110, 1131; 38 C.F.R. § 3.303(a) (2020). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present 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 or aggravated during service—the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. For chronic diseases, if chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § § 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310. At the outset, the Board notes that the Veteran does not allege, and the evidence does not show, that the Veteran was exposed to combat during service. As such, the provisions of 38 U.S.C. § 1154 are not applicable in this case. 7. Entitlement to service connection for a prostate disorder. The Board acknowledges that the Veteran claims that he has prostate disorder related to active duty, including as secondary to his service-connected erectile dysfunction with traumatic varicocele of the left cord. The Board notes that whether service connection is claimed on direct or secondary basis, a necessary element for establishing such a claim is the existence of current disability. In this case, the Veteran must show that he currently has a prostate disorder due to an event, disease, or injury in service. The Board finds that the weight of the evidence is against the existence of a prostate disorder. There is no evidence reflecting that he has been treated for or diagnosed with a prostate disorder. Moreover, although the Veteran reports a prostate disorder during and since service, there is no evidence of any related disability. The Board acknowledges that the Veteran was treated for traumatic varicocele of the left cords, but points out that the only residual was the Veteran’s now service-connected erectile dysfunction. Moreover, the Board observes that the Veteran’s post-service treatment records do not reflect any complaints or treatment related to a prostate disorder. To the contrary, post-service treatment records reflect that the Veteran repeatedly declined a prostate examination, and did not report any related symptomatology; treatment records repeatedly reflect the Veteran’s normal PSA (prostate-specific antigen) levels, but no other findings. In this regard, the Veteran has not provided any medical evidence of treatment, complaints, or diagnoses related to a prostate disorder in the years since his active duty. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has noted that in order for a veteran to qualify for entitlement to compensation under those statutes, he or she must prove existence of a disability, and one that has resulted from a disease or injury that occurred in the line of duty. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). Here, we are faced with multiple denials of related complaints, without any competent evidence of post-service pathology (diagnosis). The Board finds that the preponderance of the evidence is against the claim for service connection of a prostate disorder. 8. Entitlement to service connection for a seizure disorder. 9. Entitlement to service connection for chronic obstructive pulmonary disease (COPD). 10. Entitlement to service connection for mediastinal lymphadenopathy. Based on the evidence of record, the Veteran’s claims of entitlement to service connection for a seizure disorder, COPD, and mediastinal lymphadenopathy are denied. The record shows that the Veteran has been diagnosed with tonic-clonic seizures, COPD, and mediastinal lymphadenopathy. Thus, the Veteran has satisfied the current disability element of service connection. Turning to the issue of an inservice incurrence of these conditions, there are no treatment or complaints related to a seizure disorder, COPD, and mediastinal lymphadenopathy, or within one year after separation. Additionally, there is nothing to suggest that there were characteristic manifestations sufficient to identify a seizure disorder, COPD, and mediastinal lymphadenopathy during service or within one year of separation. The Board acknowledges that the Veteran alleged that an episode of vertigo and functional versus intercostal myalgia during service; however, the January 2019 VHA medical opinion found that these complaints and diagnoses are not indicative of or related to epileptic seizures. 38 C.F.R. § 3.303(b). In this case, there is no evidence of a seizure disorder, COPD, and mediastinal lymphadenopathy during active duty or for many years thereafter. Thus, there is no evidence to satisfy the first element of service connection, in service incurrence. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000) (a Veteran seeking disability benefits must establish the existence of a disability and a connection between such Veteran’s service and the disability). In addition to the lack of an in-service event, injury or disease related to these conditions, the evidence fails to establish a nexus between his current diagnoses and his active service. As noted, there was no diagnosis of tonic-clonic seizures, COPD, or mediastinal lymphadenopathy within one year of separation, so a nexus cannot be presumed for these conditions. Further, the weight of the evidence reflects that the Veteran’s tonic-clonic seizures, COPD, or mediastinal lymphadenopathy are unrelated to his service. None of the post-service treatment records reflect complaints, treatment, or diagnoses of tonic-clonic seizures, COPD, or mediastinal lymphadenopathy prior to 2000, and none of the Veteran’s treating providers associate these disabilities with his service. Significantly, the May 2014, March 2020, and December 2020 VA examiners, as well as the medical expert that provided the January 2019 medical opinion, concluded that the Veteran’s tonic-clonic seizures, COPD, and mediastinal lymphadenopathy are not related to the Veteran’s service. According to the May 2014, January 2019, March 2020, and December 2020 VA medical opinions, the Veteran’s tonic-clonic seizures, COPD, and mediastinal lymphadenopathy are not likely to be related to his service given the extensive passage of time between service and his initial symptoms and diagnoses; the medical opinions also noted that the Veteran did not report any relevant symptomatology or complaints during his service. As previously discussed, the January 2019 VA medical opinion notes that the Veteran’s episode of vertigo and myalgia are not indicative of an epileptic seizure, and are not causally related to the Veteran’s seizure disorder. Furthermore, the March 2020 and December 2020 VA examiners concluded that the Veteran’s tonic-clonic seizures are a residual of a post-service brain abscess which occurred in 2000; the brain abscess was also unrelated to the Veteran’s service. Likewise, the May 2014 and March 2020 VA examiners found that the Veteran’s COPD and mediastinal lymphadenopathy are unrelated to service; the onset of the Veteran’s COPD was too remote to be causally related to any chemical exposures during service. Moreover, the medical evidence indicates that the Veteran’s COPD and mediastinal lymphadenopathy diagnoses were related to a pleural abscess that had onset in 2000; the March 2020 VA examiner noted that the mediastinal lymphadenopathy was resolved without residuals in 2000 and that more recent medical evidence does not demonstrate that the Veteran has COPD. These opinions are accurate based on the record which does not contain evidence of symptoms or treatment during service or continuity of symptoms since service to diagnosis. Thus, the opinions are based on an accurate medical history and provide a rationale to support the findings. The Board has considered the Veteran’s statements regarding nexus. However, the Veteran’s statements are insufficient to establish that the Veteran’s tonic-clonic seizures, COPD, and mediastinal lymphadenopathy are related to his service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran is competent to report observable symptoms such as pain, but he is not competent to determine the cause of these disabilities. Such a determination requires more than mere observation of symptoms, but medical training and knowledge which the Veteran does not have. Further, the Veteran is not competent to diagnose Veteran’s tonic-clonic seizures, COPD, and mediastinal lymphadenopathy. These disabilities require medical testing and training to diagnose. Thus, his lay assertions of a diagnosis and nexus are not competent evidence as to the claims. Reviewing the evidence, the Board finds that the most probative evidence is against the claims of entitlement to service connection for Veteran’s tonic-clonic seizures, COPD, and mediastinal lymphadenopathy. Given that the preponderance of the evidence fails to establish an inservice event, injury or disease related to these conditions and does not provide a competent nexus opinion relating them either to service or a service-connected disability. Absent these two elements of service connection, the claims are denied. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Hallie E. Brokowsky, 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.