Citation Nr: 21013707 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-03 131 DATE: March 10, 2021 ORDER Entitlement to service connection for left shoulder strain is granted. Entitlement to service connection for lumbar strain is granted. Entitlement to service connection for left chondromalacia of patella is granted. Entitlement to service connection for right chondromalacia of patella is granted. Entitlement to a compensable initial rating for left ear hearing loss is denied. Entitlement to an initial rating of 10 percent for left shin paresthesia is granted. Entitlement to a compensable initial rating for chin scar is denied. Entitlement to an initial rating of 20 percent for shin scar is granted. REMANDED Entitlement to an initial rating in excess of 10 percent for traumatic brain injury (TBI) is remanded. Entitlement to an initial rating in excess of 10 percent for headaches is remanded. FINDINGS OF FACT 1. The Veteran’s left shoulder strain began during active service. 2. The Veteran’s lumbar strain began during active service. 3. The Veteran’s left chondromalacia of patella began during active service. 4. The Veteran’s right chondromalacia of patella began during active service. 5. The Veteran’s left ear hearing loss has been manifested by hearing acuity of no worse than Level I in the left ear. 6. The Veteran’s left shin paresthesia is manifest by mild, wholly sensory symptoms of pain, dysesthesias and/or dysesthesias, and numbness. 7. The Veteran’s service-connected chin scar is not manifested in at least one characteristic of disfigurement or visible palpable tissue loss and is not painful or unstable. 8. The Veteran’s service-connected shin scar is both painful and unstable. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left shoulder strain have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for entitlement to service connection for lumbar strain have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for entitlement to service connection for left chondromalacia of patella have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for entitlement to service connection for right chondromalacia of patella have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for entitlement to a compensable initial rating for left ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 6. The criteria for entitlement to an initial rating of 10 percent, and no higher, for left shin paresthesia have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.124a, Diagnostic Code 8524. 7. The criteria for entitlement to a compensable initial rating for chin scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.118, Diagnostic Code 7800. 8. The criteria for entitlement to an initial rating of 20 percent, and no higher, for shin scar have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 2008 to October 2011. The Veteran indicated in his substantive appeal that he wanted a hearing before a member of the Board by live videoconference. VA informed him in May 2019 that he had been scheduled for the requested hearing in June 2019. The Veteran did not appear for that hearing. VA scheduled him for another hearing to be held in January 2021 and informed him of that scheduled hearing in December 2020. The Veteran did not appear for that hearing either, has not provided an explanation as to why he did not appear, and has not requested that another hearing be scheduled. Accordingly, his hearing request is considered withdrawn. 38 C.F.R. § 20.704(d). The Board is cognizant that a claim for entitlement to a total disability rating based on individual unemployability (TDIU), if expressly raised by the Veteran or reasonably raised by the record, is part of the appeal for an increased rating. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran has indicated that the disabilities for which he seeks increased ratings limit his ability to sit, stand, and walk for extended periods and they affect his ability to remember tasks and instructions. He has stated that he quit a job in the past because he was unable to stand for as long as required. However, the Veteran’s statements only indicate that his service-connected disabilities make it difficult to perform work and worklike activities. He has not argued, and the record does not otherwise reflect, that the disabilities at issue on appeal render him unable to secure or follow a substantially gainful occupation. The Board concludes that a claim for entitlement to a TDIU has not been raised as part of the increased rating issues on appeal. Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issue denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Service Connection 1. Entitlement to service connection for a left shoulder disability 2. Entitlement to service connection for a low back disability 3. Entitlement to service connection for a left knee disability 4. Entitlement to service connection for a right knee disability The Veteran seeks entitlement to service connection for disabilities of the left shoulder, lumbar spine, left knee, and right knee. He contends that those disabilities are due to performing strenuous work while wearing heavy equipment during his active service. The Veteran underwent VA examinations for his left shoulder, lumbar spine, and knees in August 2013. Based on an examination of the Veteran and a review of the record, the VA examiner diagnosed the Veteran with left shoulder strain, lumbar strain, and chondromalacia of patella of the bilateral knees. The examiner noted the Veteran’s reports that his left shoulder, low back, and bilateral knee pain developed gradually from wearing heavy gear and that he injured his left shoulder when he slipped and fell on ice in 2010 during his deployment to Afghanistan. The service treatment records are absent for treatment of any left shoulder, low back, or knee condition. However, they do show that in March 2011 the Veteran reported on a post-deployment health assessment that his health was “much worse” than before his deployment and that he had physical health problems that had been “somewhat difficult” in the prior weeks. In that assessment, he specifically endorsed a history of back pain and swollen, stiff, or painful joints during his deployment. Additionally, the Veteran’s DD Form 214 shows that he had a primary specialty of infantryman and that he was awarded the Combat Infantryman Badge for his service in Afghanistan. He has explained that he was stationed in remote outposts in Afghanistan where he only had access to medics and that his treatment was not fully documented. Furthermore, he did not seek treatment for all health issues he experienced during his active service because going to sick call was looked down upon. The Board accepts the Veteran’s statements, the March 2011 post-deployment health assessment, and the August 2013 VA examiner’s findings as probative evidence that the Veteran’s left shoulder strain, lumbar strain, and chondromalacia of patella of the bilateral knees began during his active service and have continued through the present, even though such disabilities are not specifically shown in the service treatment records. There is no probative evidence of record to the contrary. Therefore, the Board concludes that the Veteran’s left shoulder strain, lumbar strain, and chondromalacia of patella of the bilateral knees had their onset during his active service. The criteria for entitlement to service connection for left shoulder strain, lumbar strain, and chondromalacia of patella of the bilateral knees are therefore met, and service connection must be granted. 38 C.F.R. § 3.303(a). Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). 5. Entitlement to a compensable initial rating for left ear hearing loss The Veteran seeks a compensable initial rating for left hearing loss. The applicable rating period is from October 29, 2011, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. In his notice of disagreement, he asserted that his left ear hearing loss is “significant”, that he cannot talk on the telephone using his left ear, that he has extreme difficulty hearing others on his left side, and that he has an especially difficult time hearing when there is background noise. Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII. An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). If impaired hearing is service-connected in only one ear, the law allows for compensation for hearing loss as if both ears were service-connected if the service-connected hearing loss is ratable as at least 10 percent disabling and the non-service-connected hearing loss meets the standard for a hearing loss disability for VA purposes under 38 C.F.R. § 3.385, unless the non-service-connected hearing loss is the result of the Veteran’s willful misconduct. See 38 C.F.R. § 3.383. To determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I, subject to the provisions of 38 C.F.R. § 3.383. 38 C.F.R. § 4.85(f). The Veteran’s Maryland CNC Word List speech recognition scores and pure tone thresholds, in decibels, at an August 2013 VA examination were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 10 10 10 10 10 100% LEFT 25 30 55 45 38.75 92% Applying the results to Table VI, the findings yield a numeric designation of Level I in the left ear. The Veteran’s nonservice-connected right ear hearing does not meet the requirements for consideration under 38 C.F.R. § 3.383 as though it were service connected, and is therefore assigned a numeric designation of I. Entering the resulting bilateral numeric designation of Level I for the right ear and Level I for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a noncompensable disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. The Board notes that the Veteran’s service treatment records include audiometric data for a hearing test conducted in March 2011, which is just prior to the relevant period. However, the testing results do not include speech recognition scores using the Maryland CNC Word List. In addition, there is no indication that speech recognition testing was not appropriate, and the testing results do not show an exceptional pattern of hearing impairment. Therefore, the pure tone thresholds cannot be used on their own to obtain hearing acuity levels under 38 C.F.R. § 4.85, Tables VIA and VII. See 38 C.F.R. §§ 4.85(c), 4.86. As such, the March 2011 audiometric testing results are inadequate for rating purposes and cannot be used to rate the Veteran’s service-connected left ear hearing loss. See 38 C.F.R. §§ 4.85(a) and (c), 4.86. The Board expressly acknowledges its consideration of the lay evidence of record in adjudicating this appeal, including the Veteran’s reports regarding the functional impact of his service-connected left ear hearing loss. The Veteran reported that the left ear hearing loss affects his ability to hear certain sounds and to hear in certain situations and settings. The Veteran is competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran’s main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). Therefore, the preponderance of the evidence is against the appeal for entitlement to a compensable initial rating for left ear hearing loss. In reaching this conclusion, the Board has considered the doctrine of reasonable doubt. However, because the preponderance of the evidence is against the Veteran’s appeal, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to a compensable initial rating for left shin paresthesia The Veteran seeks a compensable initial rating for left shin paresthesia. The applicable rating period is from October 29, 2011, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. The Veteran contends that the left shin paresthesia manifests in pain, numbness, and a pins and needles sensation that limit his ability to participate in sports activities and makes it difficult to stand, walk, or run for extended periods. The Veteran’s left shin paresthesia is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8524, which pertains to paralysis of the internal popliteal nerve. Under Diagnostic Code 8524, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis is rated as 40 percent disabling. Where there is complete paralysis of the internal popliteal nerve, plantar flexion is lost, frank adduction of the foot is impossible, flexion and separation of toes the toes is abolished; no muscle in the sole can move; and in lesions of the nerve high in popliteal fossa, plantar flexion of the foot is lost. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). Turning to the relevant evidence of record, at an August 2013 VA examination, the Veteran reported that he experiences numbness in the left anterior shin. After walking or running for 15 to 20 minutes he experiences numbness and tingling in the left shin area around his service-connected skin scar. The numbness and tingling will spread to the entire left shin area and radiate down the leg, making the leg feel as though it is falling asleep. He is able to continue walking even when such symptoms occur, but will on occasion stop and rest the leg so that the symptoms go away on their own. Based on the Veteran’s reports, the examiner determined that the Veteran’s left shin paresthesia manifests in mild intermittent pain, paresthesias and/or dysesthesias, and numbness. On examination, the Veteran had normal muscle strength, reflexes, and sensation in the left lower extremity. He did not have atrophy or trophic changes attributable to the left shin paresthesia. The nerves affecting the lower extremities, to include the internal popliteal nerve, were normal without complete or incomplete paralysis. Accordingly, the record shows that the Veteran has reported or demonstrated pain and decreased sensation due to the service-connected left shin paresthesia. There is no competent evidence of record showing that the Veteran had complete or incomplete paralysis of the internal popliteal nerve at any time during the rating period. As such, the evidence shows that, throughout the rating period, the left shin paresthesia has manifested in wholly sensory involvement. Accordingly, the rating for the disability may be for the mild or, at most, the moderate degree. See 38 C.F.R. § 4.124a. In that regard, the August 2013 VA examiner characterized the Veteran’s symptoms, to include his intermittent pain, paresthesias and/or dysesthesias, and numbness, as mild in severity. Given the other findings on testing at the VA examination, to include normal muscle strength, normal reflexes, normal sensation, normal nerve testing, no atrophy, and no trophic changes, the Board finds that the condition has manifested throughout the relevant rating period in mild symptoms. See 38 C.F.R. §§ 4.2, 4.6, 4.124. As such, an initial rating of 10 percent, and no higher, is warranted throughout the relevant rating period under Diagnostic Code 8524. The Board has considered all other potentially applicable diagnostic codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different diagnostic code is not warranted. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected left shin paresthesia, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). In summary, throughout the relevant rating period, the Veteran’s left shin paresthesia has manifested in wholly sensory involvement that is, at most, mild in severity. Under Diagnostic Code 8524, mild involvement of the internal popliteal nerve warrants a 10 percent rating. The Board therefore finds that the criteria for entitlement to an initial rating of 10 percent, and no higher, for left shin paresthesia have been met throughout the rating period. To the extent the Veteran seeks an initial rating in excess of 10 percent for left shin paresthesia, the preponderance of the evidence is against the appeal, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 7. Entitlement to a compensable initial rating for chin scar 8. Entitlement to a compensable initial rating for shin scar The Veteran seeks compensable initial ratings for service-connected scars on the chin and left shin. The applicable rating period is from October 29, 2011, the effective date for the award of service connection for those disabilities, through the present. See 38 C.F.R. § 3.400. The Veteran has stated that the service-connected chin scar is very sensitive, gets cut when he shaves, and causes his facial hair to grow unevenly, which makes him feel self-conscious. The service-connected left shin scar is extremely sensitive and painful. The left shin scar will open back up when he bumps into things. He says that the left shin scar is “gross and extremely visible” such that he must cover it up by wearing pants. The Veteran’s chin scar is rated under 38 C.F.R. § 4.118, Diagnostic Code 7800, which pertains to 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 Veteran’s left shin scar is rated under 38 C.F.R. § 4.118, Diagnostic Code 7805, which rates scars based on other effects not considered under Diagnostic Codes 7800, 7801, 7802, or 7804. Also applicable in this case are 38 C.F.R. § 4.118, Diagnostic Codes 7802 and 7804, which pertain scars not of the head, face, or neck, and to scars that are unstable or painful, respectively. VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Codes 7800, 7804, and 7805 were not changed by the August 13, 2018 amendments. 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 (13 or more centimeters) in length; a scar at least one-quarter inch wide (0.6 or more centimeters) 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 6 square inches (39 square centimeters); skin texture abnormal in an area exceeding 6 square inches (39 square centimeters); underlying soft tissue missing in an area exceeding 6 square inches (39 square centimeters); and, skin indurated and inflexible in an area exceeding 6 square inches (39 square centimeters). Id. Prior to August 13, 2018, Diagnostic Code 7802, was for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that were superficial and nonlinear. Under those criteria, a scar with an area or areas of 144 square inches (929 sq. cm.) or greater warrants a 10 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7802 instructed that a superficial scar was one not associated with underlying soft tissue damage. Id. Since August 13, 2018, Diagnostic Code 7802 is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. The rating criteria under Diagnostic Code 7802 did not change. Under Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating. Three or four scars that are unstable or painful warrants a 20 percent rating. Five or more scars that are unstable or painful warrant a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note 2 to Diagnostic Code 7804 instructs 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. Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran’s chin scar because he does not have at least one characteristic of disfigurement or visible or palpable tissue loss, and the scar is neither painful nor unstable. The Veteran has stated that the scar is sensitive and gets cut when he shaves. However, he has not stated that the scar is painful. He has also not indicated that the covering of the skin over the scar is lost. Rather, he only states that it is cut open at times when he shaves. Furthermore, an August 2013 VA examiner indicated that the chin scar is stable and not painful, measures 1 centimeter by 0.3 centimeters (which calculates to an area of 0.3 square centimeters), is hypo-pigmented, and does not manifest in elevation, depression, adherence to underlying tissue, missing underlying soft tissue, distortion of facial features, or limitation of function. Thus, the record does not show that the chin scar manifested in at least one characteristic of disfigurement, visible or palpable tissue loss, or distortion or asymmetry of paired sets of features. Therefore, the criteria for a compensable rating under Diagnostic Codes 7800, 7804, and 7805 for the service-connected chin scar were not met during the relevant period. The Board further finds that the criteria for a rating of 20 percent, and no higher, were met for the service-connected left shin scar throughout the relevant rating period. The Veteran has reported that the scar is painful and will break open when bumped. Although the scar was not painful or unstable at the August 2013 VA examination, the Veteran is considered competent to report that the scar is painful and breaks open at other times. The Board also finds him credible in that regard. Under Diagnostic Code 7804, a single scar that is both painful and unstable warrants a 20 percent rating. The Board has also considered the other diagnostic codes pertaining to scars as they relate to the service-connected chin and left shin scars. However, the Veteran’s left shin scar is not deep and non-linear and is not associated with underlying soft tissue damage. The August 2013 VA examiner indicated that the left shin scar has an area of 4.5 square centimeters. Therefore, although that scar is superficial and not associated with underlying soft tissue damage, it does do not cover an area or areas of 929 square centimeters or greater. Therefore, Diagnostic Codes 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects for either the chin scar or the left shin scar that are not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. The Board acknowledges the Veteran’s reports that his service-connected chin and left shin scars make him feel self-conscious. The rating schedule provides ratings for psychiatric disabilities under 38 C.F.R. § 4.130. However, the record does not show that the Veteran’s reported feelings of self-consciousness has been associated with a diagnosed psychiatric disability such that those feeling would be compensable in the first instance. Therefore, that manifestation does not warrant a referral for extraschedular consideration. See Long v. Wilkie, 2020 U. S. App. Vet. Claims Lexis 2371, 13 (2020). Neither the Veteran nor his representative has raised any other issues with regard to the ratings for the service-connected chin scar and left shin scar, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s appeal for a compensable rating for the service-connected chin scar. However, the criteria for entitlement to an initial rating of 20 percent, and no higher, have been met for the service-connected left shin scar throughout the relevant rating period. To the extent the Veteran seeks a compensable initial rating for the chin scar and an initial rating in excess of 20 percent for the left shin scar, the preponderance of the evidence is against the appeal, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for TBI is remanded. 2. Entitlement to an initial rating in excess of 10 percent for headaches is remanded. In his January 2016 substantive appeal, the Veteran indicated that his TBI-related memory loss and headaches have worsened since he was last examined by VA October 2013. Specifically, he stated that his migranes had become “far more frequent” and render him “incapable of performing the simplest task”. He further stated that his memory loss had been “more pronounced” in that must use notes or would “not recall what I am supposed to be doing from one moment to the next.” The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of TBI and headaches. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected TBI and its residuals, to include memory loss, vertigo, and headaches. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.