Citation Nr: 21021874 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 08-18 257 DATE: April 14, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to an initial compensable rating prior to December 1, 2017, and in excess of 30 percent thereafter, for status post left inguinal hernia repair is denied. Entitlement to an initial compensable rating for left inguinal hernia scar is denied. REMANDED Entitlement to an initial rating greater than 20 percent for right shoulder degenerative joint disease (DJD) is remanded. Entitlement to an initial compensable rating for right shoulder scar is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s hypertension was not shown during active duty or within a year of separation from a period of active duty, or during a period of ACDUTRA. 2. The preponderance of the evidence is against finding that a left knee disability began during active service, or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that a right knee disability began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that a left shoulder disability began during active service, or is otherwise related to an in-service injury or disease 5. Prior to December 1, 2017, the Veteran’s service-connected left inguinal hernia status post left inguinal hernia repair had not reoccurred. Since December 1, 2017, the Veteran’s service-connected left inguinal hernia status post left inguinal hernia repair is small and postoperatively recurrent. 6. The Veteran’s left inguinal hernia scar is not manifest by any disabling effects not considered under Diagnostic Codes 7800-04. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1111, 1112, 1131, 1137, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.307, 3.309 2. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for an initial compensable rating prior to December 1, 2017, and in excess of 30 percent thereafter, for status post left inguinal hernia repair are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1 -4.16, 4.114, Diagnostic Code 7338. 6. The criteria for a compensable disability rating for left inguinal hernia scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army National Guard from March 1974 to August 1974, and other periods of active duty or training (ACDUTRA) and inactive duty for training (INACDUTRA) from August 1974 to September 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2006, February 2015, and November 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900. 38 U.S.C. § 7107 (a)(2). 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In the context of Reserve or National Guard service, the term “active military, naval, or air service” includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (21), (24); see also 38 C.F.R. § 3.6. Diseases or injuries incurred or aggravated while performing ACDUTRA are eligible for service connection. 38 U.S.C. §§ 101 (24), 106, 1110, 1131. In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled (or died) as a result of a disease or injury incurred or aggravated in the line of duty on Reserve ACDUTRA/INACDUTRA or during Federalized National Guard service. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Finally, a claimant whose claim is based on a period of ACDUTRA or INACDUTRA is not entitled to the presumptions of service connection for chronic diseases (such as arthritis or hypertension, manifesting to a degree of 10 percent within one year following discharge from service). Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Accordingly, the chronic disease presumptive provisions do not apply to periods of ACUDTRA or INACDUTRA in this case. 38 C.F.R. § 3.307. 1. Entitlement to service connection for hypertension The Veteran seeks service connection for hypertension. He asserts that his stress from the struggle to continuously accomplish difficult work is related to his hypertension. The term hypertension means that the diastolic blood pressure is predominantly 90 mm. or greater. The term isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90 mm. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. As an initial matter, the Board finds that the competent evidence of record confirms that the Veteran has hypertension. Treatment notes reflect diagnosis of hypertension. With current disabilities conceded, the question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran’s service treatment records for his period of active duty service from March 1974 to August 1974 do not contain any complaints, treatment, findings or diagnosis consistent with hypertension. At enlistment in October 1973 his blood pressure reading was within normal limits at 120/80. After release from active duty, service treatment records show that in December 1977 blood pressure readings were similarly within normal limits at 120/80. Thereafter, in a Report of Medical History in April 1981 the Veteran endorsed a history of hypertension. An April 1981 annual physical examination reflected blood pressure readings were within normal limits at 118/70. An October 1984 physical examination showed blood pressure readings of 134/92, an August 1992 physical examination reflected blood pressure readings of 134/86, and a January 1995 physical examination reflected blood pressure readings of 150/82. A clinic profile examination in September 1995 revealed elevated blood pressure readings of 170/100. The Veteran was afforded a VA examination in March 2006. The examiner noted a history of hypertension, with diagnosis and treatment starting in 1996. The examiner opined that the Veteran’ s hypertension is not caused by or a result of military service or anything during that period. However, the examiner did not provide a clear explanation for their conclusion. The Veteran was afforded a VA examination in March 2014. The Veteran reported that he was diagnosed with hypertension within the previous 10 to 15 years. He reported that his blood pressure had been controlled with medication. The examiner diagnosed hypertension from 1996. The examiner indicated that a nexus opinion could not be provided without the ACUDTRA or INACDUTRA dates. In November 2014, after additional development, the examiner opined that the it is less likely than not the Veteran’s hypertension is related to or aggravated by any period of ACDUTRA or INACDUTRA during his National Guard service. The examiner explained that review of the medical record showed the Veteran was first noted to have hypertension in August 1995. This did not correspond to any active duty period or the inactive duty training period. The Veteran’s blood pressure was noted to have been fairly well controlled through the years, though the natural history of progression required changes in the Veteran’s blood pressure medications. He concluded that there is no documentation of acceleration of hypertension or malignant hypertension from ACDUTRA or INACDUTRA service. In September 2017, the Board remanded the claim for an addendum opinion based upon additional service dates of the Veteran’s periods of ACDUTRA and INACDUTRA. Pursuant to the Board’s remand, a VA examiner reviewed the claims file and offered an addendum opinion in October 2018. The examiner opined that it is less likely than not the Veteran’s hypertension began in service, was caused by service, or is etiologically related to an injury or event during a period of active duty, ACDUTRA, or INACDUTRA. The examiner explained that the Veteran’s medical record showed the Veteran was first noted to have hypertension in August 1995. Earlier service physical exams done in January 1995 were silent for a diagnosis of hypertension, and the Veteran’s initial medical review in February 1995 noted “Fully fit.” The examiner further noted the Veteran’s blood pressure was noted to have been fairly well controlled through the years. The Veteran’s last active duty period was in September 2003. Thereafter, the Veteran’s hypertension was well controlled with the natural history of progression of hypertension requiring adjustments in his blood pressure medication. In support of his claim, the Veteran submitted a medical opinion by Dr. M.T. dated February 2019. Dr. M.T. diagnosed hypertension, and opined the Veteran’s hypertension is more likely than not connected to service. The Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The VA opinions of record are persuasive and establish to the Board’s satisfaction that the Veteran’s hypertension is not at least as likely as not related to an in-service injury, event, or disease, including as related to stress from periods of ACDUTRA and INACDUTRA. The examiners’ opinions are probative, because they are based on an accurate medical history, review of the Veteran’s periods of service, and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Private practitioner Dr. M.T. opined that the Veteran’s hypertension is at least as likely as not related to an in-service injury, event, or disease. This opinion is, however, less probative, because it is wholly conclusory and does not provide any supporting rationale or explanation. Consequently, the Board gives more probative weight to the October 2018 VA examination opinion. Nieves-Rodriguez; Stefl v. Nicholson, 21 Vet. App. 120 (2007), Prejean v. West, 13 Vet. App. 444 (2000). The Veteran believes his hypertension is proximately due to or the result of or aggravated beyond its natural progression by a service-connected disability. While the Board has considered the Veteran’s general contention that a relationship exists between his current hypertension and his service, he is not competent to provide an opinion on complex medical questions such as the etiology of hypertension as the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the various VA medical opinions. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. Service connection for hypertension is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). 2. Entitlement to service connection for a left knee disability 3. Entitlement to service connection for a right knee disability The Veteran seeks service connection for left and right knee disabilities. He asserts that his knee disabilities are related to physical demands from ACDUTRA or INACDUTRA. He stated that while in the infantry, he had to jump from helicopters and from trucks with a full load. He also reported that he ran fitness test courses with full gear. A March 2007 buddy statement stated that he served with the Veteran and was aware that the Veteran had knee problems. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran’s service treatment records for his period of active duty service from March 1974 to August 1974 do not contain any complaints, treatment, findings or diagnosis consistent with a knee disability. After release from active duty, service treatment records show that in August 1988 the Veteran reported questionable arthritis of the right knee, though he also indicated that a doctor had said ‘no’ in 1986. June 1995 x-ray imaging showed normal knees bilaterally. In June 1995, the Veteran sought treatment for a left knee injury. The Veteran reported severe pain. September 1995 notes indicated that the Veteran injured his left knee falling on a flight of stairs. The Veteran was afforded a VA examination in March 2014. The Veteran reported that over time he had wear and tear of both knees. The examiner diagnosed degenerative joint disease. The examiner indicated that they could not offer an opinion without the ACDUTRA and INACDUTRA dates. In November 2014, after additional development, the VA examiner offered a nexus opinion. The examiner opined that it is less likely than not that the Veteran’s knee conditions are related to or aggravated by any period of ACDUTRA or INACDUTRA during his National Guard service. The examiner explained that there is no documentation or a knee injury or complaint during an ACDUTRA or INACDUTRA training period. The examiner noted that the Veteran first incurred a left knee injury in February 1995, which was not during an ACDUTRA or INACDUTRA period. Thereafter, the record showed that the Veteran was profiled in September 1995, but this period was also not during an ACDUTRA or INACDUTRA period. With respect to the right knee, the VA examiner noted that the Veteran first complained of right knee pain in September 1999. This was not during ACDUTRA or INACDUTRA. January 2001 x-ray imaging of both knees noted moderate degenerative changes of both knees, but this was also not during ACDUTRA or INACDUTRA training periods. The Veteran submitted a favorable medical opinion in support of his claim by Dr. L.J. dated September 2016. The Veteran reported that he had been in the reserve for 29 years. He stated that he jumped out of helicopters and trucks, which caused his eventual bilateral knee condition. Dr. L.J. stated that he could not verify the injuries, but if true then the Veteran’s knee conditions were more likely related to the injuries during his military service. In September 2017, the Board remanded the claims for an addendum opinion. In October 2018, a VA examiner offered an addendum opinion. The examiner opined that it is less likely than not that the Veteran’s knee conditions began in service, was caused by service, or was etiologically related to an injury or event during a period of active duty, ACDUTRA, or INACDUTRA. The examiner explained that there is no documentation of a knee injury or complaint during an ACDUTRA or INACDUTRA period. They noted that the left knee injury in February 1995 was not during an ACDUTRA or INACDUTRA period. Subsequent treatment in June 1995 and September 1999 were also not during a period of ACDUTRA or INACDUTRA. Thus, the examiner concluded it is less likely than not the Veteran’s knee conditions are related to his active or reserve service. The Board concludes that, while the Veteran has a current diagnosis of degenerative joint disease, and evidence shows that he sought treatment for knee pain in February 1995 and September 1999, the preponderance of the evidence weighs against finding that the Veteran’s diagnoses of degenerative joint disease began during service or are otherwise related to an in-service injury, event, or disease. The record contains conflicting medical opinions regarding whether the Veteran’s degenerative joint disease is at least as likely as not related to an in-service injury, event, or disease, including reported wear and tear or knee injuries during a period of ACDUTRA or INACDUTRA. The October 2018 VA examiner opined that it was not. The examiner noted a history of knee injuries or complaints in 1995 and 1999, but after reviewing the record explained that all treatment was outside of the Veteran’s periods of ACDUTRA or INACDUTRA. The VA examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Private practitioner L.J. opined that it was. The rationale was that if the reported knee injuries were true, then it was more likely than not the Veteran’s current knee conditions were related to a period of ACDUTRA or INACDUTRA. This opinion is, however, less probative than the VA examiner’s opinion. There is no indication that A.B. physically examined the Veteran or reviewed pertinent medical evidence in the claims file. Instead, the opinion appears to be based on the Veteran’s self-reported medical history, which is inconsistent with VA treatment records that show the Veteran’s knee conditions arose outside of a period of ACDUTRA or INACDUTRA. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Consequently, the Board gives more probative weight to the 2018 VA examiner’s opinion. The Veteran believes his degenerative joint disease is related to an in-service injury, event, or disease. To the extent the Veteran may be reporting a specific knee injury during a period of ACDUTRA or INACDUTRA, the Board finds that the Veteran’s report of a knee injury in service is not credible. The medical record includes knee pain and a knee injury in February 1995, but, as noted by the VA examiners, the Veteran’s knee injuries are outside a period of ACDUTRA or INACDUTRA. To the extent the Veteran reports general wear and tear caused his knee conditions, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. Service connection for a knee condition is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). 4. Entitlement to service connection for a left shoulder disability The Veteran seeks service connection for a left shoulder disability. At his August 2016 hearing, the Veteran reported that his left shoulder problems began in the 1990’s. He indicated that he believed the physical demands, such as push ups and loading and unloading trucks, caused his shoulder condition. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran’s service treatment records for his period of active duty service from March 1974 to August 1974 do not contain any complaints, treatment, findings or diagnosis related to a left shoulder condition. X-ray imaging of the left shoulder from March 1997 indicated moderate degenerative arthritis. In June 2002, the Veteran reported bilateral shoulder pain. X-ray imaging from October 2005 revealed degenerative changes of the shoulder bilaterally. The Veteran was afforded a VA examination in March 2006. The examiner opined it is as likely as not the Veteran’s current shoulder conditions are related to service. The examiner indicated that even though there is no documentation of a shoulder problem, the Veteran had fairly recently been discharged from service. Therefore, the examiner concluded it is safe to assume the left shoulder arthritis was also service connected. The Veteran was afforded a VA examination in March 2014. The Veteran reported wear and tear of the left shoulder. The examiner diagnosed left shoulder degenerative joint disease. In November 2014, the VA examiner offered an addendum nexus opinion. The examiner opined it is less likely than not the Veteran’s left shoulder disability is related any period of ACDUTRA or INACDUTRA. The examiner explained that the Veteran was first noted to have a left shoulder condition in March 1997, with x-ray imaging indicated moderate degenerative changes. However, the x-ray did not correspond with any period of ACDUTRA or INACDUTRA. Further, the Veteran reported left shoulder pain, assessed as myalgia, in August 1999. However, the examiner again noted that this date did not correspond to any period of ACDUTRA or INACDUTRA. Thus, the examiner concluded that the Veteran’s left shoulder condition is less likely related to his service. The Veteran submitted a private medical opinion in support of his claim by Dr. L.J. from September 2016. Dr. L.J. indicated that they could not verify the left shoulder injury, but if true the left shoulder condition is related to injuries during service. Thus, in an attached disability benefits questionnaire (DBQ), Dr. L.J. related the left shoulder condition to service. Pursuant to a Board remand, in October 2018 a VA examiner offered an addendum opinion. The examiner opined that it is less likely than not the Veteran’s left shoulder disability began in service, was caused by service or aggravated by an injury or event during a period of active duty, ACDUTRA, or INACDUTRA. The examiner explained that the Veteran was first noted to have a left shoulder condition in March 1997, when his x-ray noted moderate degenerative arthritis. However, this x-ray did not correspond to the Veteran’s ACDUTRA or INACDUTRA during his National Guard service. The examiner also noted that the Veteran reported left shoulder pain and was diagnosed with myalgia in August 1999. However, this also did not correspondence to a period of ACDUTRA or INADUTRA. There was no documented event or injury to the left shoulder during active service, to include ACDUTRA or INACDUTRA to cause the Veteran’s left shoulder condition. The Veteran was afforded a VA examination in October 2020. The examiner reviewed prior nexus opinions of record, but did not offer an addendum nexus opinion with respect to the Veteran’s left shoulder condition. The Board concludes that, while the Veteran has a current diagnosis of left shoulder degenerative arthritis, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of left shoulder arthritis began during service or is otherwise related to an in-service injury, event, or disease. The record contains conflicting medical opinions regarding whether the Veteran’s left shoulder disability is at least as likely as not related to an in-service injury, event, or disease, including a left shoulder injury or “wear and tear” during a period of ACDUTRA or INACDUTRA. The October 2018 VA examiner opined that it was not. The examiner noted left shoulder complaints, but explained that the left shoulder complaints were not related to a period of ACDUTRA or INACDUTRA. The VA examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Private practitioner L.J. opined that it was. Dr. L.J. indicated that if the Veteran’s report of a left shoulder injury was true, the condition is more likely related to service. This opinion is, however, less probative than the VA examiner’s opinion. There is no indication that A.B. physically examined the Veteran or reviewed pertinent medical evidence in the claims file. Instead, the opinion appears to be based on the Veteran’s self-reported medical history, which is inconsistent with VA treatment records that show complaints of left shoulder pain outside any period of ACDUTRA or INADUTRA. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Consequently, the Board gives more probative weight to the October 2018 VA examiner’s opinion. The Veteran believes his left shoulder condition is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the October 2018 VA addendum opinion. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. Service connection for a left shoulder condition is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities found in 38 C.F.R. Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as here, the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a staged rating are required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The assignment of staged ratings is also appropriate. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 5. Entitlement to a higher rating for status post left inguinal hernia repair The Veteran seeks entitlement to a higher initial evaluation for left inguinal hernia repair. He reports recurrent right groin pain from his left inguinal hernia repair. The Veteran is currently in receipt of a noncompensable rating for status post left inguinal hernia prior to December 1, 2017, and in receipt of a 30 percent rating thereafter. The Veteran’s left inguinal hernia is rated 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 Veteran was afforded a VA examination in March 2014. The Veteran reported an inguinal hernia during his service in the National Guard. He could not recall the time of the surgery, however. The examiner noted a history of hernia repair in February 2000. No hernia was detected on physical examination. Private treatment records prior to December 2017 are silent with respect to a recurrent hernia. Physical examinations at visits in May 2014, September 2014, December 2014, May 2015, September 2015, and October 2015 indicated inguinal hernia was absent. In December 2017, private treatment records reflect recurrent hernia, without obstruction or gangrene. A follow up visit later in December 2017 found a left inguinal hernia, reducible, small, and tender. The Veteran underwent a laparoscopic repair in December 2017. Surgical findings noted indirect recurrent inguinal hernia. Subsequent treatment records revealed ongoing pain in the right groin. May 2018 and September 2018 clinic visits showed a left inguinal hernia, reducible, small, and tender. In October 2020, the Veteran was afforded a VA examination. The Veteran indicated that he had two hernia surgeries. He denied any hernia at the time, but stated that he has stabbing pain in the left side when he lifts heavy objects or walks fast. The examiner noted a medical history of hernia repair surgeries in February 2000 and December 2017. Physical examination findings indicated no hernia detected. Prior to December 1, 2017, an initial compensable rating under the schedular criteria for left inguinal hernia, status post hernia repair is not warranted. The probative 2014 VA examination showed that there was no recurrence of the repaired left inguinal hernia. Similarly, private treatment records prior to December 2017 failed to show any recurrence of the repaired inguinal hernia. Ultimately, the evidence indicates that prior to December 1, 2017 the Veteran’s left inguinal hernia had not recurred. Given the above, the residuals of the left inguinal hernia do not more nearly approximate the criteria for a higher rating under 38 C.F.R. § 4.114, Diagnostic Code 7338 for this period of time. Since December 1, 2017, a rating in excess of 30 percent under the schedular criteria for inguinal hernia is not warranted. Private treatment records reflect a small recurrent hernia in December 2017, which required laparoscopic repair. At the October 2020 VA examination, no recurrent hernia was noted by the examiner. Ultimately, the evidence indicates that the Veteran has not had a large, postoperative recurrent hernia that is not well-supported under ordinary conditions and not readily reducible, when it is considered inoperable. Given the above, the residuals of the left inguinal hernia do not more nearly approximate the criteria for a higher 60 percent rating under 38 C.F.R. § 4.114, Diagnostic Code 7338. The Board finds that a higher rating for inguinal hernia is not warranted. Pursuant to DC 7338, prior to December 1, 2017, a compensable rating for a postoperative inguinal hernia requires it to be recurrent, readily reducible, and well supported by truss or belt. Since December 1, 2017, a 60 percent rating for the Veteran’s recurrent hernia requires it to be large, recurrent, and not well supported under ordinary conditions and not readily reducible. Such findings are not shown in this case. There is no doubt to be resolved; the assignment of a compensable rating prior to December 1, 2017, and in excess of 30 percent thereafter, pursuant to DC 7338 is not warranted. 6. Entitlement to an initial compensable rating for left inguinal hernia scar The Veteran seeks a compensable rating for left inguinal hernia scar. He contends that he is entitled to a higher rating because his hernia scar is painful. The Veteran’s left inguinal hernia is rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. Effective August 30, 2002, DC 7803 provides a 10 percent rating for superficial scars that are unstable. 38 U.S.C. § 4.118. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note (2) provides that a superficial scar is one not associated with underlying soft tissue damage. Id. Diagnostic Code 7804 provides a 10 percent rating for superficial scars that are painful on examination. 38 U.S.C. § 4.118. Note (1) provides that a superficial scar is one not associated with underlying soft tissue damage. Id. Note (2) provides that a 10 percent evaluation will be assigned for a scar on the tip of a finger or toe even though amputation of the part would not warrant a compensable evaluation. Id. DC 7805 instructs to rate on limitation of function of the part(s) affected. DC 7800 (for scars affecting the head, face, or neck), DC 7801 (for burn scar(s), other than on the head, face, or neck), and DC 7802 (for second degree burn scars) are not applicable in this case. Effective October 23, 2008, DC 7803 was eliminated from the rating criteria. DC 7804 provides compensation for scars that are painful or unstable. 38 C.F.R. § 4.118. A 10 percent rating is provided for one or two scars that are unstable or painful. A 20 percent rating is provided for three or four scars that are unstable or painful. A 30 percent rating is provided for five or more scars that are unstable or painful. Note (1) states 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. Note (2) states that if one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is based on the total number of unstable or painful scars. Id. Note (3) states that scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. Id. The VA most recently 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. 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. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Veteran’s VA and private treatment record do not generally contain pertinent scar findings. The Veteran was afforded a VA examination in March 2014. The examiner briefly noted that the Veteran indicated he was not certain which surgery his hernia scar was related to. However, specific findings pertinent to the surgical scar were not noted In September 2020, the Board remanded the claim for a VA examination. The Veteran was afforded a VA examination for his hernia scar in October 2020. The Veteran reported a history of hernia surgeries. Physical examination revealed a well healed surgical scar located at the left groin. It was noted as 8 cm. x 0.5 cm. No underlying tissue damage was noted. The examiner found that the scar was not painful, or unstable with frequent loss of the skin over the scar. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran’s hernia scar under Diagnostic Code 7805 as there are no other disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04. The Board finds that a compensable rating for the hernia scar is not warranted under the former or current scar rating criteria. The Board has also considered the other Diagnostic Codes pertaining to scars. As indicated, DC 7800 does not provide an avenue for a higher evaluation as in effect at any time during the appeal period, as it only pertains to scars of the head, face, or neck. DCs 7801 and 7802 also do not provide an avenue for a higher evaluation. Prior to October 23, 2008, DCs 7801 and 7802 provided evaluations for third degree and second degree burn scars, respectfully, and the Veteran’s hernia scar is not a burn scar. While the October 23, 2008, amendments allow for evaluation of scars due to other causes than burns, they do not support the assignment of a higher rating because the Veteran’s scars are not deep and nonlinear. Finally, the August 13, 2018, amendments do not support the assignment of a higher rating because the Veteran’s scars are not associated with underlying soft tissue damage measuring at least 6 square inches. DC 7802 criteria prior to October 23, 2008, do not support the assignment of a higher rating because the Veteran’s scars are not of an area of 144 square inches or greater. The October 23, 2008, amendments and the August 13, 2018, amendments do not support the assignment of a higher rating because the Veteran’s scars are neither superficial and nonlinear nor associated with underlying soft tissue damage of an area 144 square inches or greater. DC 7803, as in effect prior to October 23, 2008, does not support the assignment of a higher rating as the evidence of record does not indicate that the Veteran’s hernia scar has been unstable at any time during the appeal period. While October 2020 VA scar examination report found that the Veteran’s hernia scar is not painful or unstable. This finding is consistent with the other competent medical evidence of record noted above. Therefore, the Board finds the competent and probative medical evidence of record establishes that the Veteran’s hernia scars have not been unstable at any time during the applicable appeal period such that a compensable rating under DC 7803 is warranted. The Veteran is not entitled to a higher evaluation under DC 7804 as prior to October 2008, his scars were not found to be superficial, tender, unstable or painful on objective demonstration. Under the revised criteria effective October 2008, objective confirmation of pain is not required. However, the Board notes that the Veteran has not specifically asserted that his hernia scar itself is painful. Rather, at his October 2019 hearing he as reported symptoms of general pain when he tried to pick up his luggage. He also reported that his hernia would swell out during exercise. At his October 2020 examination, the Veteran reported stabbing pain associated with exercise, but did not report painful scars specifically. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include pain after exercising, and his reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However medical records do not show that the Veteran’s hernia scar is manifest by any disabling effects not considered in a rating provided under Diagnostic Codes 7800-04. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating for residual hernia surgical scar. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to an initial rating greater than 20 percent for right shoulder degenerative joint disease (DJD) is remanded. While the record contains contemporaneous VA examinations regarding the Veteran’s right shoulder disability, the examinations do not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The examination does not contain passive range of motion measurements. Specifically, the October 2020 examiner found objective evidence of pain with non-weight bearing, but the examiner did not test passive range of motion or provide range of motion measurements in degrees. Neither is it clear upon review why passive range of motion testing was not performed by the examiner. Thus, a second examination is warranted. 2. Entitlement to an initial compensable rating for right shoulder scar is remanded. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Finally, because a decision on the remanded issue of an increased rating for right shoulder degenerative joint disease could significantly impact a decision on the issues of a compensable rating for a right shoulder scar and entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claims for right shoulder scar and a TDIU is required. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to adress the current severity of his service-connected right shoulder disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) (Continued on the next page)   The examiner should also address the severity of the Veteran’s right shoulder scar in accordance with VA rating criteria. The examiner is also asked to comment on the functional impact that the Veteran’s service-connected disabilities have on his ability to secure or follow a substantially gainful occupation. When addressing the functional impact, the examiner should consider the Veteran’s educational and occupational history but must not consider the Veteran’s age or any non-service connected disabilitites. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Lauritzen, 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.