Citation Nr: 21022825 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 14-39 551 DATE: April 19, 2021 ORDER An initial disability rating of 10 percent for scars on the bilateral upper extremities, and the anterior and posterior trunk (“body scarring”), residuals of chloracne, is granted. FINDINGS OF FACT 1. For the entire initial rating period on appeal from August 20, 2007, the body scarring has manifested as superficial acne affecting a total area of 1,266.5 square centimeters (cm2). 2. For the entire initial rating period on appeal from August 20, 2007, the body scarring has not manifested as underlying tissue damage, painful or unstable scars, limitation of motion, or additional disabling effects, did not cover least 20 percent of the entire body or the exposed areas affected, and has not required systemic therapy. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, for the entire initial rating period on appeal from August 20, 2007, the criteria for a disability rating of 10 percent, but no higher, for the body scarring have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code 7802. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Army during the Vietnam Era from February 1968 to February 1970. In this case the Veteran contends that he is entitled to a disability rating in excess of 0 percent for the service-connected body scarring. In August 2007, the Veteran applied for service connection for chloracne due to Agent Orange exposure. In January 2012, service connection for chloracne was granted, with an effective date of August 20, 2007, with an initial disability rating of 0 percent. In May 2012, the chloracne was reevaluated as two disabilities: scarring of the head, face or neck (rated 0 percent disabling) and scarring of the bilateral upper extremities and anterior and posterior trunk (rated 0 percent disabling). In August 2012, the rating for facial scarring was increased to 10 percent disabling, and the rating for body scarring was continued at 0 percent disabling. In September 2012, the Veteran filed a notice of disagreement with the initial rating percentages assigned in the January 2012 rating decision. In July 2014 during the appeal, a 30 percent rating for facial scarring was granted. In March 2018, the Board issued a remand order for the body scarring issue, and found that to be the only issue on appeal before the Board at that time. Review of the record reflects that the March 2018 remand directives have been adequately satisfied. See Stegall v. West, 11 Vet. App. 268, 271 (1998). This Board decision adjudicates the issue of initial rating for body scarring. Initial Rating for Body Scarring For the entire initial rating period on appeal from August 20, 2007, the Veteran is in receipt of a 0 percent disability rating for body scarring based on superficial acne. The Veteran was examined by VA in June 2019. During the examination, the Veteran reported that the scars of the body are not painful or tender. The examiner noted that none of the scars are unstable, nor is there any underlying tissue damage. The examiner noted that the scars do not impact the Veteran’s ability to work. The examiner estimated the total area of the scars on the upper left and right extremities and the anterior and posterior trunk to be 1,266.5 cm2. The Veteran was previously examined by VA in November 2017. The examiner noted that the Veteran had superficial acne, as opposed to deep acne and inflamed pus-filled cysts. The examiner noted that the chloracne covered an area of approximately 2,184 cm2. The Veteran was also examined in June 2012 by VA. The examiner noted that the scars are not painful, nor are they unstable. The examiner approximated the total area of scarring as 9 percent of the total skin area. The examiner noted that none of the scars were more than 5 inches in length, and none were more than 4 inches wide at the widest point. None of the evidence of records indicates that the scarring resulted in limitation of motion, additional disabling effects, or covered least 20 percent of the entire body or the exposed areas affected. In October 2014, the Veteran reported that his chloracne gets infected, and that his scars are painful and contain pus. He also reports receiving treatment from a Dr. Richard Gibbs for these symptoms. In the October 2014 statement, the Veteran did not specify whether he was referring to the chloracne of the face or of the body. Private treatment records from Dr. Gibbs show treatment for pus-filled cysts on the Veteran’s face, but do not include any mention of treatment of the upper extremities or trunk. Additionally, the Veteran’s statements that his scars are painful are contradicted by his reports during multiple VA examinations that the scars are not painful. Accordingly, the Board finds that the body scarring, as opposed to the facial scarring, were not painful or infected. The record shows no reports of treatment of chloracne of the trunk and upper extremities with any systemic therapy, such as corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs. The record does contain evidence of the prescription and usage of topical therapy, but which was not systemic in nature. Accordingly, the Board finds that the Veteran’s chloracne of the upper extremities and the trunk is manifested by no underlying tissue damage, a total affected area of 1,266.5 cm2 or more, no painful or unstable scars, no required systemic therapy, no limitation of motion or additional disabling effects, and superficial acne. Further, the scarring did not cover least 20 percent of the entire body or the exposed areas affected. The Board notes that during the pendency of this appeal the applicable rating criteria for skin disorders was amended on multiple occasions. Relevant to the instant decision, under the regulations in effect prior to October 23, 2008, Diagnostic Code 7802 provided a 10 percent rating was assigned for scars, other than the head, face, or neck, that were superficial and that did not cause limited motion provided the scar involved an area or areas of 144 square inches (929 sq. cm.) or greater. 38 C.F.R. § 4.118 (2008). During the period from October 23, 2008 through August 12, 2018, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear in an area or areas of 144 square inches (929 sq. cm.) or greater were assigned a 10 percent rating. Note (1) indicated that a superficial scar was one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (2018). Effective August 13, 2018, under DC 7802, a 10 percent disability rating is warranted where there is scarring, not of the head, face or neck, and not associated with underlying soft tissue damage, with an area of 929 cm2 or greater. 38 C.F.R. § 4.118, Diagnostic Code 7802 (2020). 10 percent is the highest possible rating under DC 7802. Higher ratings under 7828 and 7829 in excess of 10 percent, throughout the entire rating period on appeal, require deep acne in the axilla of the arm, the anogenital region, the skin folds of the breasts, between digits, or on the face and neck. As discussed above, the Veteran is already in receipt of a 30 percent rating for chloracne of the face and neck, and the record does not show acne in the axilla of the arm, the anogenital region, the skin folds of the breasts, or between digits, nor any deep acne of any kind, and so are not warranted. Consideration for rating under DC 7801 or 7804 at a 10 percent rating is moot, as a 10 percent rating has been granted under 7802. A higher rating under DC 7801 is not warranted, as a 20 percent rating under DC 7801 requires underlying soft tissue damage or limitation of motion depending on the rating period, neither of which are present here. Similarly, a higher rating under DC 7804 is not warranted, as a 20 percent rating under these diagnostic codes requires unstable or painful scars, neither of which are present here. Further, as the evidence of record does not support that the Veteran has any additional disabling effects due to the service-connected bodily scarring, a higher or separate compensable disability rating under DC 7805, under any iteration, is not warranted. Additionally, as the evidence does not reflect that the bodily scarring required systemic therapy or covered at least 20 percent of the entire body or the exposed areas affected, a disability rating in excess of 10 percent is not warranted under Diagnostic Code 7806, in any iteration throughout the initial rating period on appeal. Because the evidence shows superficial acne with no underlying tissue damage, a total affected area of 1,266.5 cm2 to 2,184 cm2, which is less than 20 percent of the total bodily area or exposed areas, no painful or unstable scars, no limitation of motion or other disabling effects, and no required systemic therapy, the body scarring most resembles a 10 percent rating under DC 7802 of scarring with an area of 929 cm2 or more. As noted above, this is the highest rating available under DC 7802. For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds that, for the entire initial rating period on appeal from August 20, 2007, the criteria for an increased disability rating of 10 percent, and no higher, for body scarring are met. 38 C.F.R. §§ 4.3, 4.7. Extraschedular Claim Not Raised The Board finds that neither the Veteran nor the record has raised a claim for extraschedular rating under 38 C.F.R. § 3.321(b) for any period for the increased rating issue on appeal. See Thun v. Peake, 22 Vet. App. 111 (2008); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016), citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff’d, 226 Fed. Appx. 1004 (Fed. Cir. 2007) (holding that when 38 C.F.R. § 3.321(b)(1) is not “specifically sought by the claimant nor reasonably raised by the facts found by the Board, the Board is not required to discuss whether referral is warranted”). E. BLOWERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Charles Plambeck 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.