Citation Nr: 21025223 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-21 137 DATE: April 27, 2021 ORDER Prior to October 3, 2018, a disability rating of 20 percent, but not higher, for the service-connected right elbow limitation of flexion residuals of a right forearm shell fragment wound, is granted. Since October 3, 2018, a disability rating higher than 20 percent for the service-connected right elbow limitation of flexion residuals of a right forearm shell fragment wound is denied. Prior to October 3, 2018, a disability rating of 20 percent, but not higher, for the service-connected right elbow limitation of pronation residuals of a right forearm shell fragment wound is granted. Since October 3, 2018, a disability rating of 20 percent, but not higher, for the service-connected right elbow limitation of pronation residuals of a right forearm shell fragment wound is granted. For the entire period, a disability rating of 30 percent, but not higher, for the service-connected muscle residuals of a right forearm shell fragment wound is granted. Prior October 3, 2018, a disability rating of 10 percent, but not higher, for the service-connected right hip limitation of extension residuals of a right hip and pretibial area shell fragment wound is granted. Since October 3, 2018, a disability rating higher than 10 percent for the service-connected right hip limitation of extension residuals of a right hip and pretibial area shell fragment wound is denied. Prior to October 3, 2018, a disability rating of 40 percent, but not higher, for the service-connected right hip limitation of flexion residuals of a right hip and pretibial area shell fragment wound, is granted. Since October 3, 2018, a disability rating of 40 percent, but not higher, for the service-connected right hip limitation of flexion residuals of a right hip and pretibial area shell fragment wound is granted. Prior to October 3, 2018, a disability rating of 20 percent, but not higher, for the service-connected right hip limitation of abduction residuals of a right hip and pretibial area shell fragment wound is granted. Since October 3, 2018, a disability rating higher than 20 percent for the service-connected right hip limitation of abduction residuals of a right hip and pretibial area shell fragment wound is denied. Prior to October 3, 2018, a disability rating higher than 10 percent for the service-connected muscle residuals of a right hip and pretibial area shell fragment wound is denied. Since October 3, 2018, a disability rating of 10 percent, but not higher, for the service-connected muscle residuals of a right hip and pretibial area shell fragment wound is granted. Prior to October 3, 2018, a rating of 20 percent, but not higher, for the service-connected right upper extremity scar residuals of a shell fragment wound is granted. Since October 3, 2018, a disability rating of 20 percent, but not higher, for the service-connected right upper extremity scar residuals of a shell fragment wound is granted. Prior to October 3, 2018, a disability rating of 10 percent, but not higher, for the service-connected right lower extremity scar residuals of a shell fragment wound is granted. Since October 3, 2018, a disability rating of 10 percent, but not higher, for the service-connected right lower extremity scar residuals of a shell fragment wound is granted. Prior to October 3, 2018, a disability rating of 10 percent, but not higher, for the service-connected left upper extremity scar residuals of a shell fragment wound is granted. Since October 3, 2018, a disability rating of 10 percent, but not higher, for the service-connected left upper extremity scar residuals of a shell fragment wound is granted. Entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) prior to August 29, 2018, is granted. Entitlement to special monthly compensation at the housebound rate is granted. FINDINGS OF FACT 1. Prior to and since October 3, 2018, the service-connected right elbow limitation of flexion residuals of a right forearm shell fragment wound was manifested by flexion limited to 85 degrees, with limitation to 75 degrees after repeated use over a period of time. 2. Prior to and since October 3, 2018, the service-connected right elbow limitation of pronation residuals of a right forearm shell fragment wound is manifested by limitation of pronation approximating motion lost beyond the last quarter of the arc. 3. For the entire period, the service-connected muscle residuals of a right forearm shell fragment wound is manifested by moderately severe impairment. 4. Prior to and since October 3, 2018, the service-connected right hip limitation of extension residuals of a right hip and pretibial area shell fragment wound is assigned the maximum rating. 5. Prior to and since October 3, 2018, the service-connected right hip limitation of flexion residuals of a right hip and pretibial area shell fragment wound was manifested by symptoms that more nearly approximate flexion limited to 10 degrees. 6. Prior to and since October 3, 2018, the service-connected right hip limitation of abduction residuals of a right hip and pretibial area shell fragment wound was manifested by motion lost beyond 10 degrees. 7. Prior to and since October 3, 2018, the service-connected muscle residuals of a right hip and pretibial area shell fragment wound was manifested by moderate impairment. 8. Prior to and since October 3, 2018, the service-connected right upper extremity scar residuals of a shell fragment wound is manifested by three painful scars. 9. Prior to and since October 3, 2018, the service-connected right lower extremity scar residuals of a shell fragment wound is manifested by one or two painful scars. 10. Prior to and since October 3, 2018, the service-connected left upper extremity scar residuals of a shell fragment wound is manifested by one or two painful scars. 11. Prior to August 29, 2018, the service-connected disabilities rendered the Veteran unable to secure or follow a substantially gainful occupation. 12. The Veteran has a single service-connected disability rated as 100 percent and additional service-connected disability or disabilities independently ratable at 60 percent or more, separate, and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. CONCLUSIONS OF LAW 1. Prior to October 3, 2018, the criteria for a rating of 20 percent for the service-connected right elbow limitation of flexion residuals of a right forearm shell fragment wound were met; the criteria for a rating higher than 20 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5206 (2021). 2. Since October 3, 2018, the criteria for a rating higher than 20 percent for the service-connected right elbow limitation of flexion residuals of a right forearm shell fragment wound are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5206 (2021). 3. Prior to October 3, 2018, the criteria for a rating higher than 20 percent for the service-connected right elbow limitation of pronation residuals of a right forearm shell fragment wound were met; the criteria for a rating higher than 20 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5213 (2021). 4. Since October 3, 2018, the criteria for a rating higher than 20 percent for the service-connected right elbow limitation of pronation residuals of a right forearm shell fragment wound are met; the criteria for a rating higher than 20 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5213 (2021). 5. For the entire period, the criteria for a rating of 30 percent for the service-connected muscle residuals of a right forearm shell fragment wound are met; the criteria for a rating higher than 30 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.55, 4.56, 4.73, Diagnostic Code 5307 (2021). 6. Prior to October 3, 2018, the criteria for a rating of 10 percent for the service-connected right hip limitation of extension residuals of a right hip and pretibial area shell fragment wound are met; the criteria for a rating higher than 10 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251, 4.73, Diagnostic Code 5314 (2021). 7. Since October 3, 2018, the criteria for a rating higher than 10 percent for the service-connected right hip limitation of extension residuals of a right hip and pretibial area shell fragment wound are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251, 4.73, Diagnostic Code 5314 (2021). 8. Prior to October 3, 2018, the criteria for a rating of 40 percent for the service-connected right hip limitation of flexion residuals of a right hip and pretibial area shell fragment wound were met; the criteria for a rating higher than 40 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252 (2021). 9. Since October 3, 2018, the criteria for a rating of 40 percent for the service-connected right hip limitation of flexion residuals of a right hip and pretibial area shell fragment wound are met; the criteria for a rating higher than 40 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252 (2021). 10. Prior to October 3, 2018, the criteria for a rating of 20 percent, for the service-connected right hip limitation of abduction residuals of a right hip and pretibial area shell fragment wound were met; the criteria for a rating higher than 20 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253 (2021). 11. Since October 3, 2018, the criteria for a rating higher than 20 percent for the service-connected right hip limitation of abduction residuals of a right hip and pretibial area shell fragment wound are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253 (2021). 12. Prior to October 3, 2018, the criteria for a rating higher than 10 percent for the service-connected muscle residuals of a right hip and pretibial area shell fragment wound were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.55, 4.56, 4.73, Diagnostic Code 5214 (2021). 13. Since, October 3, 2018, the criteria for a rating higher than 10 percent for the service-connected muscle residuals of a right hip and pretibial area shell fragment wound are met; the criteria for a rating higher than 10 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.55, 4.56, 4.73, Diagnostic Code 5214 (2021). 14. Prior to October 3, 2018, the criteria for a rating 20 percent for the service-connected right upper extremity scar residuals of a shell fragment wound were met; the criteria for a rating higher than 20 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.118, Diagnostic Code 7801-7005 (2021). 15. Since October 3, 2018, the criteria for a rating 20 percent for the service-connected right upper extremity scar residuals of a shell fragment wound are met; the criteria for a rating higher than 20 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.118, Diagnostic Code 7801-7005 (2021). 16. Prior to October 3, 2018, the criteria for a rating of 10 percent for the service-connected right lower extremity scar residuals of a shell fragment wound were met; the criteria for a rating higher than 10 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.118, Diagnostic Code 7801-7005 (2021). 17. Since October 3, 2018, the criteria for a rating of 10 percent for the service-connected right lower extremity scar residuals of a shell fragment wound are met; the criteria for a rating higher than 10 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.118, Diagnostic Code 7801-7005 (2021). 18. Prior to October 3, 2018, the criteria for a rating of 10 percent for the service-connected left upper extremity scar residuals of a shell fragment wound were met; the criteria for a rating higher than 10 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.118, Diagnostic Code 7801-7005 (2021). 19. Since October 3, 2018, the criteria for a rating of 10 percent for the service-connected left upper extremity scar residuals of a shell fragment wound are met; the criteria for a rating higher than 10 percent are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.118, Diagnostic Code 7801-7005 (2021). 20. Prior to August 29, 2018, the criteria for entitlement to TDIU were met. 38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.15, 4.16 (2021). 21. The criteria for entitlement to SMC at the housebound rate are met. 38 U.S.C. §§ 1114, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.352, 4.2, 4.3, 4.6, 4.10 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a veteran (the Veteran) who had active duty service from June 1965 to July 1967. He was awarded the Combat Infantryman Badge, the Purple Heart, and the Bronze Star Medal with “V” Device for heroism in combat. This appeal comes before the Board of Veterans’ Appeals (Board) from an August 2018 Order of the United States Court of Appeals for Veterans’ Claims (Veterans Court). The appeal originated from an October 2007 rating decision of the RO in Detroit, Michigan. In January 2015, the Veteran presented testimony at a Board hearing, chaired via videoconference by a Veterans Law Judge who is no longer at the Board and accepted such hearing in lieu of an in-person hearing before a Member of the Board. See 38 C.F.R. § 20.700(e). At the Board hearing, the Veteran was informed of the basis for the RO’s denial of his claims and he was informed of the information and evidence necessary to substantiate each claim. 38 C.F.R. § 3.103. A transcript of the hearing is associated with the claims file. The Veteran was offered a new hearing by the Veterans Law Judge who would decide his case, but he declined. In March 2017, the Board denied increased ratings for service-connected shell fragment wounds of the right hip and forearm. The Veteran appealed the denial of higher ratings for shell fragment wound residuals to the Veterans Court. In a memorandum decision dated in August 2018, the Veterans Court vacated the Board’s decision and remanded the shell fragment wound ratings to the Board for additional development. In March 2017, the Board also remanded a claim of entitlement to a disability rating in excess of 30 percent for the service-connected psychiatric disability to afford the Veteran a Board hearing. The hearing was provided on that issue in May 2017. In a January 2018 decision, the Board granted an increased rating of 70 percent and denied a rating of 100 percent for the service-connected psychiatric disability. The decision was implemented in an October 2018 rating decision. The Veteran apparently appealed the January 2018 Board decision. However, he then moved the Veterans Court to dismiss the appeal, which was granted in October 2018. In January 2018, the Board also remanded the issue of TDIU entitlement for additional evidentiary development. In a March 2019 rating decision, TDIU was granted, effective August 29, 2018, corresponding to the date of receipt of a VA Form 21-8940 (Veterans Application for Increased Compensation Based on Unemployability). Prior Board and Veterans Court Decisions The Board essentially addressed two shell fragment claims in March 2017. These were a 10 percent rating for the right forearm, and a 10 percent rating for the right hip. The Veterans Court instructed the Board to address whether there were other muscle groups involved with the right forearm that might support additional ratings. As regards the right leg shell fragment wounds, the Veterans Court instructed the Board to consider a muscle group injury affecting the right lower extremity, and whether he is entitled to separate compensable evaluations for painful scars. In addition, the Veterans Court instructed the Board to make attempts to obtain the Veteran's in-service inpatient records from the 85th Evacuation Hospital pertaining to the veteran’s 1966 hospitalizations or explain why a search for such records is not necessary in this case. Subsequently, and prior to the Board’s July 2019 remand, the Agency of Original Jurisdiction (AOJ) granted service connection for musculoskeletal disabilities of the right hip and right arm, and scar residuals of the right hip, right arm, and left arm. In March 2019, the AOJ assigned a rating of 30 percent under Diagnostic Code 5252 (limited flexion), assigned a rating of 20 percent under Diagnostic Code 5253 (limited abduction), assigned a rating of 10 percent under Diagnostic Code 5251 (limited extension), assigned a rating of 10 percent under Diagnostic Code 5314 (muscle injury), and assigned a rating of 0 percent under Diagnostic Code 7802 (scar). The AOJ also assigned a rating of 20 percent under Diagnostic Code 5206 (limited flexion), a rating of 10 percent under Diagnostic Code 5307 (muscle injury), and ratings of 0 percent under Diagnostic Code 5213 (pronation) and 7802 (scar). In addition, the AOJ assigned a rating of 0 percent for left arm scarring under Diagnostic Code 7802. Each additional rating was made effective October 3, 2018. As noted in the July 2019 remand, these actions addressed most of the concerns of the Veterans Court. The Board also instructed the AOJ to attempted to obtain the Veteran's inpatient records from his in-service hospitalization. The AOJ made this attempt, but received a response from the National Personnel Records Center (NPRC) that no records were available. The AOJ also obtained a supplemental opinion regarding the extent of the Veteran's right forearm muscle impairment. That opinion essentially found no muscle impairment. The Board will address the expanded claims in two sections below: musculoskeletal residuals, and scar residuals. Increased Ratings—Law and Regulations Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). The rating must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); 38 C.F.R. § 3.159(a)(2). After the evidence has been assembled, it is the Board’s responsibility to evaluate the entire record. 38 U.S.C. § 7104(a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3. A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996); Gilbert at 54. 1. Entitlement to an increased disability rating for the service-connected right elbow limitation of flexion residuals of a right forearm shell fragment wound, currently rated 0 percent prior to October 3, 2018, and 20 percent since October 3, 2018. 2. Entitlement to a compensable rating for the service-connected right elbow limitation of pronation residuals of a right forearm shell fragment wound. 3. Entitlement to a rating higher than 10 percent for the service-connected muscle residuals of a right forearm shell fragment wound. 4. Entitlement to an increased disability rating for the service-connected right hip limitation of flexion residuals of a right hip and pretibial area shell fragment wound, currently rated 0 percent prior to October 3, 2018, and 30 percent since October 3, 2018. 5. Entitlement to a rating higher than 20 percent for the service-connected right hip limitation of abduction residuals of a right hip and pretibial area shell fragment wound. 6. Entitlement to a rating higher than 10 percent for the service-connected right hip limitation of extension and muscle residuals of a right hip and pretibial area shell fragment wound. All issues on appeal arise from a claim of entitlement to service connection for shell fragment wound residuals received at VA on October 11, 2007. In the January 2009 rating decision service connection was granted for “residuals of sfw, right forearm” and “residuals sfw, right hip and pretibial area.” The effective date was October 11, 2007. However, when the AOJ expanded those claims to include musculoskeletal impairment, it assigned the effective date of October 3, 2018, which is the date of a VA examination which elaborated on the extent of the Veteran's shell fragment wound residuals. Under Diagnostic Code 5251, thigh extension is rated at 10 percent with extension limited to 5 degrees. Under Diagnostic Code 5252, thigh flexion is rated at 40 percent with flexion limited to 10 degrees; 30 percent with flexion limited to 20 degrees; 20 percent with flexion limited to 30 degrees; and 10 percent with flexion limited to 45 degrees. Under Diagnostic Code 5253, thigh abduction is rated at 20 percent with motion lost beyond 10 degrees; 10 percent with loss of ability to cross legs; and 10 percent with loss of ability to toe-out more than 15 degrees. Under Diagnostic Code 5206, limited flexion of elbow is rated at 50 percent for the major extremity (40 percent minor) with flexion limited to 45 degrees; 40 percent for the major extremity (30 percent minor) with flexion limited to 55 degrees; 30 percent for the major extremity (20 percent minor) with flexion limited to 70 degrees; 20 percent for either extremity with flexion limited to 90 degrees; 10 percent for either extremity with flexion limited to 100 degrees; and 0 percent with flexion limited to 110 degrees. Under Diagnostic Code 5213, bone fusion is rated at 40 percent for the major extremity (30 percent minor) with the hand fixed in supination or hyperpronation; 30 percent for the major extremity (20 percent minor) with the hand fixed in full pronation; 20 percent for either extremity with the hand fixed near the middle of the arc or moderate pronation. Limitation of pronation is rated at 30 percent for the major extremity (20 percent minor) with motion lost beyond middle of arc; 20 percent for either extremity with motion lost beyond last quarter of arc, the hand does not approach full pronation. Limitation of supination is rated at 10 percent for either extremity when limited to 30 degrees or less. Under Diagnostic Code 5307, impairment of the forearm muscle; flexion of wrist and fingers; muscles arising from internal condyle of humerus; flexors of the carpus and long flexors of fingers and thumb; pronator is assigned a rating of 40 percent for the major extremity (30 percent minor) with severe impairment; a rating of 30 percent for the major extremity (20 percent minor) with moderately-severe impairment; a rating of 10 percent for either extremity with moderate impairment; and a rating of 0 percent with slight impairment. Under Diagnostic Code 5314, impairment of the knee muscle; extension of knee (2, 3, 4, 5); simultaneous flexion of hip and flexion of knee (1); tension of fascia lata and iliotibial (Maissiat’s) band, acting with XVII (1) in postural support of body (6); acting with hamstrings in synchronizing hip and knee (1, 2). Anterior thigh group: (1) Sartorius; (2) rectus femoris; (3) vastus externus; (4) vastus intermedius; (5) vastus internus; (6) tensor vaginae femoris is assigned a rating of 40 percent if severe; 30 percent if moderately-severe; 10 percent if moderate; and 0 percent if slight. A July 9, 2007, VA Hand and Plastic Consult reveals the Veteran's complaint of right forearm and hand pain, mainly at night and after heavy use. The Veteran wears a brace at night. Examination demonstrated some weakness with grip and wrist extension. The assessment was “Unsure of etiology of neurologic dysfunction.” An EMG was recommended (Record 11/12/2015 at 571). An August 29, 2007, Needle EMG revealed normal motor and sensory conduction studies of the right median and ulnar nerves. The testing was incomplete because the Veteran was intolerant to needle EMG (Record 11/12/2015 at 56). At a VA examination in December 2008 the Veteran was noted to have suffered shrapnel injury to the right forearm and right leg. The Veteran’s denied any significant pain in the right forearm or leg. He also denied numbness, tingling, or burning of the upper or lower extremities. The Veteran ambulated with no assistive devices. The Veteran reported some aching pain in the right hip when he lies on the right hip while in bed. The Veteran only uses over-the-counter pain medication in relation to any chronic pain that he is having. There was no instability of the right hip and no flare-ups of pain. Physical examination reveals that there was an entrance and an exit wound over the medial and lateral aspects of the volar surface of the forearm. There was no evidence of edema of the forearm. There was a 3-centimeter long scar with mild hyperpigmentation of the scar, no visible depression of the scar, no keloid formation, no tenderness at the scar, and no definite muscle loss noted. In the right arm, grip-to-pinch thumb abduction opposition was symmetric. There is no visible muscle atrophy, fasciculations, or tremors. Sensation was intact to light touch, vibration, and proprioception, and monofilament touch in the bilateral hands at this. Range of motion of right shoulder is within the normal range with forward flexion from 0-170 degrees, abduction from 0-180 degrees, external and internal rotation from 0-90 degrees. There was a 1.4 centimeter scar over the anterior lateral aspect of the right hip. The scar was superficial, nontender, with no depression of the scar, and no keloid formation. The scar was mildly hyperpigmented. There no depression of the scar and no palpable underlying muscle loss. There was also a 5 centimeter scar over the right pretibial area. There was no evidence of muscle atrophy, fasciculations, or tremors noted in the right lower extremity. Sensation was intact to light touch, pinprick, vibration, and proprioception in the right lower extremity. Posterior tibial and dorsalis pedis pulses were intact and symmetric in the bilateral feet. Range of motion of the right hip was normal with extension of 30 degrees, abduction of 40 degrees, adduction of 25 degrees, external rotation of 55 degrees, and internal rotation 30 degrees. The examiner assessed the Veteran with multiple shrapnel injuries with well-healed scars of the right forearm and entrance and exit wound right hip and right pretibial area. The examiner concluded that there was no evidence of significant neuromuscular residuals from the scarring. Range of motion was full, with no significant restrictions of any range of motion of any joints. There was no additional restriction of joint motion due to pain, fatigue, weakness, or lack of endurance on repetitive use of any of the joints listed. Finally, the examiner indicated that there was no functional impairment of daily occupational activities (Record 12/08/2008). At a February 2010 VA examination, the Veteran was noted to have sustained multiple shrapnel injuries with two well healed scars of the right forearm and entrance and exit wound of the right hip and right pretibial area. The Veteran reported pain and weakness of the right arm. The examiner noted that the initial injury to the forearm was a through and through injury. The Veteran reported pain in the hip. The examiner noted that the initial injuries to the right lower extremity were not through and through. Physical examination reveals that the Veteran had abnormal muscle function in terms of comfort, endurance, and strength sufficient to perform activities of daily living. Specifically, the examiner noted that the Veteran’s overall function was four out of five on the right grip and extension of the fingers. The examiner reported that none of the scars associated with the shrapnel injuries were painful or tender to the touch or adherent to underlying skin. The scar of the right lateral upper thigh measured 3 centimeters in diameter. The scar of the right forearm included entry and exit wounds. The entry wound scar measured 3 centimeters in diameter and the exit wound scar measured 3 centimeters by 1.5 centimeters. The scar of the right tibia measured 4 centimeters by 1 centimeter. There was no motion of any joint limited by muscle disease or injury. The right and left forearm were 30 centimeters in diameter and the right and left calf were 34 centimeters in diameter. An August 2007 electromyography (EMG) was normal. Sensory testing of the right upper and lower extremities was normal. Detailed reflex examination was normal. The examiner diagnosed the Veteran with a through and through right forearm shell fragment injury with no sensory or motor deficit and subjective weakness of the grip of the right hand. The examiner indicated that the Veteran’s right forearm injury resulted in significant effects on the Veteran’s occupational functioning due to problems with lifting and carrying. The examiner also diagnosed the Veteran with superficial shell fragment wounds of the right hip and right lateral mid-calf both with residuals of healed stable scars. There was no evidence of any muscular or neurological deficit. The examiner concluded that the residuals of a shell fragment wound of the right lower extremities did not result in any significant effects on his occupational functioning. The examiner noted that the Veteran worked at GM as an order selector until he retired in 2006 due to age or duration of work (Record 02/05/2010). At a January 2014 video conference hearing, the Veteran testified that his grip was weakened in his right hand. He reported a through and through injury to the right forearm with entry and exit scars and one long scar on his hip. He noted right hip pain when he lies in his bed. He indicated that his disabilities had worsened since the 2010 VA examination. He noted that he had increased numbness, weakness, and pain (Record 01/07/2015). At an August 2015 VA examination, the Veteran reported pain and occasional throbbing in the right forearm. He also endorsed some right leg pain when he walks. He reported the use of Acetaminophen. The examiner noted that the Veteran is right hand dominant. The examiner reported that the Veteran has an injury to muscle group VII on the right side but noted that there was no injury to any other muscle group. The examiner noted that there was minimal scaring and entrance and exit scars were small or linear indicating short track of missile through muscle tissue and one or more muscle groups. The examiner also reported some impairment of muscle tonus. The examiner indicated that there was occasional weakness on the right side, muscle group VII and the wounds were reported to be mild/slight. Muscle strength testing of muscle group VII and group XIV was normal. There was no muscle atrophy. The Veteran was able to walk on his heels with a cane in his right hand (noted to be used for left leg pain) without “much difficulty.” The right hand grip was reported to be weak at times. The Veteran had a good grip on his cane with the right hand. Neurovascular status was intact in both the right upper and right lower extremities with no focal deficits noted. X-rays of the right leg revealed no radiopaque foreign body and the osseous and soft tissues were unremarkable. X-rays of the right forearm revealed a tiny bony projection from the medial aspect of the midshaft of the radius and mild degenerative changes of the elbow joint with no other bony abnormalities. The examiner concluded that the Veteran’s disabilities did not impact his ability to work or keep up with work requirements. The examiner noted that the Veteran retired from GM in 2007 after 30 years working on the assembly line and as an inspector (Record 08/24/2015). A VA examination of the muscles in November 2018 reveals the Veteran is right-hand dominant. There was a muscle injury to Group V, Group VII, and Group VIII on the right upper extremity, and Group XII on the right lower extremity. Entrance and exit scars were small or linear, indicating short track of missile through muscle tissue. Entrance and exit scars indicated track of missile through one or more muscle groups. There was no evidence of fascial defects associated with muscle injury. There was some impairment of muscle tonus. There was consistent loss of power, weakness, lowered threshold of fatigue, and fatigue pain. Muscle strength was reduced on the right upper extremity and right lower extremity (Record 11/07/2018). A VA examination of the right hip in November 2018 reveals right hip flares result in weakness/limp in his right hip/leg. There are no flare-ups on the left hip. When he uses his right leg/hip or walks/stands for long periods of time, his right leg gets weak causing him to limp. Flexion was from 0 to 20 degrees; adduction was from 0 to 10 degrees; extension was from 0 to 5 degrees; external rotation was from 0 to 10 degrees; abduction was from 0 to 10 degrees. Internal Rotation was from 0 to 10 degrees. The Veteran was unable to cross his leg. The decreased range of motion contributes to decreased mobility and therefore functional loss. No pain was noted on the examination. The unaffected left hip had higher range of motion than the right hip. After 3 repetitions, flexion was reduced to 15 degrees, and the other excursions were reduced to 5 degrees. These reduced figures were estimated to also represent range of motion with repeated use over a period of time and during flares. Functional loss was less movement than normal and weakened movement. Strength was reduced as compared to the left hip. There was no atrophy. A goniometer was used for all joint range of motion measurements. There was no evidence of pain on passive range of motion testing of the right hip. There was no evidence of pain on non-weight bearing testing of the right hip (Record 11/07/2018). A VA examination of the right elbow and forearm in November 2018 reveals that the condition has stayed the same with occasional pain in his scars. He wears on occasion a right arm brace to rest his arm. Weakness was reported. No flares were reported. Flexion was to 85 degrees; extension was to 0 degrees; supination was to 80 degrees; and pronation was to 70 degrees. Decreased range of motion contributes to functional loss. No pain was noted. Range of motion of the unaffected arm was normal. After 3 repetitions, flexion and extension remained the same, but supination was reduced to 75 degrees, and pronation to 65 degrees. After repetitive use over a period of time, flexion was estimated to be 75 degrees; extension was 0 degrees; supination was 70 degrees and pronation was 60 degrees. The examiner could not estimate range of motion with a flare due to patient lack of effort. However, the Veteran reported that he does not have flares. Muscle strength was reduced as compared to the unaffected arm. There was no atrophy. There was no impact of the condition on the Veteran’s ability to work. A goniometer was used for all joint range of motion measurements. There was no evidence of pain on passive range of motion testing of the right elbow. There was no evidence of pain on non-weight bearing testing of the right elbow (Record 11/07/2018). A February 2020 addendum opinion addressed the finding from the November 2008 VA muscles examination that there was no injury to Muscle Group IX, and considering the July 9, 2007, Hand and Plastic Surgery Consult finding weakness with grip, as well as the Veteran’s hearing testimony that he has difficulty grasping. The examiner opined that there is no injury to Muscle Group IX associated with the service-connected shell fragment wound. The rationale was that Muscle Group IX involves the intrinsic muscles of the hand, including muscles in the thenar and hypothenar eminence, lumbricales, dorsal and palmar interossei, and not in the forearm. The forearm injury is associated with the service-connected shell fragment wound. This is represented by the two right forearm scars. There is no clinical injury to the right hand structures as per this review of the service treatment records or post military service medical records (Record 02/21/2020). After a review of all of the evidence, the Board finds that the Veteran’s shell fragment wounds have existed throughout the period of the claim and since his original injury in service. There is no indication that his residuals increased on the day of the October 2018 VA examinations. Rather, those examinations represent the point at which the proper extent of the residuals was medically identified. Accordingly, the Board finds that the effective date for the additional residuals granted in March 2019 and July 2020 should be the date of the claim currently on appeal, which is October 11, 2007. This affects the current effective dates for ratings under Diagnostic Code 5206 (elbow flexion), 5213 (elbow pronation/supination), 5251 (hip extension), 5252 (hip flexion), 5253 (hip abduction), and scar residuals. The Board also finds that the rating for muscle residuals under Diagnostic Code 5314 should not have been terminated in favor of a rating for limited extension of the hip. There is no medical basis for terminating the muscle injury rating as the Veteran has reported decreased muscle strength, which has been noted on examination. See November 2018 VA examination of the right hip. Regarding flexion of the right elbow under Diagnostic Code 5206, the currently assigned rating is 20 percent, reflecting flexion limited to 90 degrees, but not limited to 70 degrees. The November 2018 VA examination revealed that flexion was limited to 85 degrees; and that, even after repeated use over a period of time, flexion was still possible to 75 degrees. Thus, the criteria for a higher rating of 30 percent (flexion limited to 70 degrees) are not met, and are not more nearly approximated than are the criteria for the current rating of 20 percent. However, consistent with the Board’s finding above, for the entire appeal period prior to October 3, 2018, the criteria for a rating of 20 percent are met. Regarding pronation/supination of the right elbow under Diagnostic Code 5213, the currently assigned rating is 0 percent, both prior to and since October 3, 2018. To warrant a compensable rating for limitation of supination, motion must be limited to 30 degrees or less. The November 2018 examination reveals that, even with repetitive use over a period of time, supination was possible to 70 degrees. To warrant a compensable rating for limitation of pronation, motion must be lost beyond the last quarter of the arc. Normal pronation is from 0 to 80 degrees. See 38 C.F.R. § 4.71a, Plate I. Therefore, the first three quarters of the arc would be from 0 to 60 degrees, with the last 20 degrees of pronation being lost. The November 2018 VA examination reveals that, after repetitive use over a period of time, pronation is limited to 60 degrees. Therefore, the Board finds that, for the entire period on appeal, the criteria for a rating of 20 percent are more nearly approximated than are those for the currently assigned noncompensable rating. Note the Board’s finding that the period on appeal stems from the October 11, 2007, claim. The next higher rating of 30 percent require motion lost beyond the middle of the arc (40 degree), which is not shown. Regarding the service connected muscle injury of the right forearm under Diagnostic Code 5307, the evidence is in conflict regarding whether there is any muscle injury of the right forearm. The July 2007 treatment record reflects complaints of muscle pain and weakness. However, subsequent testing revealed normal nerve and muscle function. The December 2008 VA examination revealed normal sensation. The February 2010 VA examination revealed no sensory or motor deficits. The August 2015 VA examination revealed only a Group VII injury, with muscle tonus impairment, but no impact on the Veteran's ability to work. The November 2018 VA examination revealed injury to muscle Groups V, VII, and VII, with loss of power and weakness, as well as pain. The current rating of 10 percent under Diagnostic Code 5307 reflects moderate impairment. In order to warrant the next higher rating of 30 percent, the evidence would have to show a history of through-and-through or deep open penetrating wound by a small high velocity missile or a large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. For moderately severe impairment, there should be a history of hospitalization for a prolonged period for treatment of the wound, with a record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating track of missile through one or more muscle groups; and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). Here, while the evidence is not consistent with loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side, the evidence does substantiate positive evidence of impairment of strength, and damage to one or more muscle groups. With resolution of all reasonable doubt in the Veteran's favor, the Board accepts the finding in November 2018 that the injury affects three muscle groups. Accordingly, the Board finds that a rating of 30 percent for moderately severe impairment is warranted for the entire period. Unlike the other residuals, service connection is currently established under Diagnostic Code 5307 from the date of the October 11, 2007, claim. Accordingly, the Board does not make separate findings for the periods prior to and since the October 3, 2018, examinations. The next higher rating of 40 percent under Diagnostic Code 5307 requires through-and-through or deep penetrating wounds due to high velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding, and scarring. To show severe impairment, there should be a history of hospitalization for a prolonged period for treatment of the wound, with consistent complaints of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings should include ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track; palpable loss of deep fascia or muscle substance, or soft flabby muscles in wound area; and abnormal muscle swelling and hardening in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. 38 C.F.R. § 4.56(d)(4). Here, there does not appear to be a history of prolonged hospital treatment of the upper extremity wound. Service treatment records reveal that the Veteran was treated for an abdominal wound, but a July 1966 Clinical Note reveals, with that exception, examination was within normal limits. Moreover, the evidence does not substantiate ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track, palpable loss of deep fascia or muscle substance, soft flabby muscles the in wound area, or abnormal muscle swelling and hardening in contraction. There is also no X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of missile; adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electro-diagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile; or induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56(d)(4). Accordingly, a rating for severe muscle injury under Diagnostic Code 5307 is not warranted. Regarding impaired extension of the right thigh under Diagnostic Code 5251, a 10 percent rating is the maximum rating available. Accordingly, an increased rating is not warranted since October 3, 2018. However, the rating of 10 percent is warranted prior to October 3, 2018. Regarding flexion of the right thigh under Diagnostic Code 5252, a rating of 30 percent is currently assigned. This represents flexion limited to 20 degrees. While this rating was based on the results of the November 2018 examination, after 3 repetitions, flexion was reduced to 15 degrees. In light of this evidence, the Board finds that the criteria for a 40 percent rating (limitation to 10 degrees) are more nearly approximated than are the criteria for the current 30 percent rating. The 40 percent rating is the maximum rating available for limitation of flexion of the thigh/hip. Accordingly, no higher rating is warranted. However, the rating of 40 percent is also warranted for the period prior to October 3, 2018. Regarding abduction of the thigh under Diagnostic Code 5253, a rating of 20 percent is currently assigned. This is the maximum rating available for limitation of abduction. Accordingly, an increased rating is not warranted. However, for the period prior to October 3, 2018, a rating of 20 percent is warranted. The Board notes that, while a rating for muscle impairment of the right hip was originally assigned, the rating was changed to limited extension, effective October 3, 2018. The rating remained at 10 percent prior to and since the change. Based on findings in November 2018 that functional loss included weakened movement, and that strength was reduced as compared to the left hip, the Board finds that a rating of 10 percent is still warranted under Diagnostic Code 5314, for the period since October 3, 2018, in addition to the rating for limited extension. However, a rating consistent with moderately severe impairment is not warranted as the evidence does not substantiate a history of hospitalization for a prolonged period for treatment of the wound, with a record of consistent complaints of cardinal signs and symptoms of muscle disability at that time, and as the objective evidence does not substantiate indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. 38 C.F.R. § 4.56(d)(3). As the Board has granted several increased ratings, the Board notes that the amputation value for the right upper extremity at the elbow level is 80 percent. The currently assigned combined rating for the right upper extremity is 60 percent. Therefore, this value is not exceeded. The amputation value for the right lower extremity at the hip level is 90 percent. The currently assigned combined rating for the right lower extremity is 70 percent. See 38 C.F.R. § 4.68. Therefore, this value is not exceeded. In addition to the medical evidence, the Board has considered the Veteran's hearing testimony and written arguments, as well as the holdings of the Veterans Court. The Board finds that the assigned ratings represent the extent of musculoskeletal disability resulting from the service-connected right forearm and right hip and pretibial area injuries, and that no higher or additional ratings are warranted. To the extent the Veteran is seeking any higher or additional ratings than have been granted here, a preponderance of the evidence is against the claims and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 371 (2017) (the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 7. Entitlement to a compensable rating for the service-connected right upper extremity scar residuals of a shell fragment wound. 8. Entitlement to a compensable rating for the service-connected right lower extremity scar residuals of a shell fragment wound. 9. Entitlement to a compensable rating for the service-connected left upper extremity scar residuals of a shell fragment wound. The Veteran is currently rated at 0 percent for each of his scars under Diagnostic Code 7802. Diagnostic Code 7800 applies to scars of the head, face, and neck, which are not at issue here. Diagnostic Code 7801 is used to rate burn scars or scars due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. However, in order to warrant the minim compensable rating, the scars must be of an area or areas of at least 6 square inches (39 sq. centimeters). Diagnostic Code 7802 is used to rate burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. However, that code requires coverage of an area or areas of 144 square inches (929 sq. centimeters) or greater. Under Diagnostic Code 7804 Scars that are unstable or painful warrant a rating of 30 percent where there are five or more scars that are unstable or painful; a rating of 20 percent requires three or four scars that are unstable or painful; a rating of 10 percent requires one or two scars that are unstable or painful. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. The December 2008 VA examination reveals a 3 centimeter long scar on the right forearm, with mild hyperpigmentation of the scar, no visible depression of the scar, no keloid formation, no tenderness at the scar. There was a 1.4 centimeters scar over the anterior lateral aspect of the right hip. The scar was superficial, nontender, with no depression of the scar, and no keloid formation. The scar was mildly hyperpigmented. There no depression of the scar and no palpable underlying muscle loss. There was also a 5 centimeter scar over the right pretibial area. (Record 12/08/2008). The February 2010 VA examination reveals two well healed scars of the right forearm and entrance and exit wound of the right hip and right pretibial area. The examiner reported that none of the scars associated with the shrapnel injuries were painful or tender to the touch or adherent to underlying skin. The scar of the right lateral upper thigh measured 3 centimeters in diameter. The scar of the right forearm included entry and exit wounds. The entry wound scar measured 3 centimeters in diameter and the exit wound scar measured 3 centimeters by 1.5 centimeters. The scar of the right tibia measured 4 centimeters by 1 centimeter. There was no motion of any joint limited by muscle disease or injury. The right and left forearm were 30 centimeters in diameter and the right and left calf were 34 centimeters in diameter (Record 02/05/2010). A VA scars examination in November 2018 reveals diagnoses of a scar of the right hip and pretibial, and a scar of the right forearm. The two scars were described as painful. The scar of the right arm measured 4 in by 0.5 centimeters and was unstable with underlying soft tissue damage. The left upper extremity was not affected. The scar of the right lower extremity was 4 by 0.5 centimeters (Record 11/07/2018). A VA examination of scars in April 2019 reveals a linear scar of the right elbow (2.5 by 0.2 centimeters); a linear anterior right forearm scar (3 by 0.5 centimeters); and, a linear posterior right forearm scar (3.5 by 2 centimeters). The examination also identified right hip and tibia scars (2 by 2 centimeters and 2.5 by 1.5 centimeters), and a left elbow scar (8 by 0.1 centimeters). The scars were described as not painful and not unstable. None of the scars involved underlying tissue damage. None of the scars resulted in limitation of function or other complications.(Record 04/17/2019). After a review of all of the evidence, the Board finds that a rating of 10 percent is warranted for the scars of the right hip and left upper extremity, and that a rating of 20 percent is warranted for the scars of the right upper extremity. As with the descriptions of the Veteran's muscle injuries, the evidence regarding his scars is inconsistent. This is not only true of his statements, but of the findings on examination. Each examiner has provided a different description of the scar, including location and features. The Board finds that there is no description of the Veteran's scarring that would warrant a compensable rating under Diagnostic Codes 7801 or 7802, as these require large areas of coverage. There is no question of involvement of the head, face, or neck for purposes of Diagnostic Code 7800. The effects of function contemplated by Diagnostic Code 7805 are already separately rated as impairment of joint and muscle function. However, the Veteran has described his scars as painful to the November 2018 VA examiner. To the extent he has been inconsistent in his descriptions, the Board will resolve all reasonable doubt in favor of the claims. According to the findings on examination in April 2019, there are three scars on the right upper extremity. As there are three scars of the right upper extremity, a rating of 20 percent is for assignment under Diagnostic Code 7804. As there are one or two scars on the right lower extremity and left upper extremity, each should be awarded a 10 percent rating. As these scars are presumed to have been present for the entire period on appeal, the ratings apply to the periods before and prior to October 3, 2018. To the extent the Veteran is seeking any higher or additional ratings than have been granted here, a preponderance of the evidence is against the claims and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. 366, 371. TDIU—Law and Regulations It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340(a)(1), 4.15. A claim for a total disability rating based upon individual unemployability presupposes that the rating for the service-connected disability is less than 100 percent, and only asks for TDIU because of subjective factors that the objective rating does not consider. Vettese v. Brown, 7 Vet. App. 31, 34-35 (1994). In evaluating a veteran’s employability, consideration may be given to his level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The term substantially gainful occupation is not specifically defined for purposes of the regulations governing TDIU. However, marginal employment is not considered substantially gainful employment. Marginal employment includes situations in which an individual’s annual income does not exceed the poverty threshold for one person. Employment may be marginal even when the individual’s earned income exceeds the poverty threshold if such individual is employed in a protected environment such as a family business or sheltered workshop. 38 C.F.R. § 4.16(a). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). In Hatlestad v. Derwinski, 1 Vet. App. 164 (1991), the Veterans Court referred to apparent conflicts in the regulations pertaining to individual unemployability benefits. Specifically, the Court indicated there was a need to discuss whether the standard delineated in the controlling regulations was an “objective” one based on the average industrial impairment or a “subjective” one based upon the veteran’s actual industrial impairment. In a pertinent precedent decision, the VA General Counsel opined that the controlling VA regulations generally provide that veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as the result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria include a subjective standard. It was also determined that “unemployability” is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGCPREC 75-91. 10. Entitlement to TDIU prior to August 29, 2018. 11. Entitlement to special monthly compensation. In addition to the disabilities discussed in this decision, service connection is in effect for a mental disability, rated at 70 percent since October 11, 2007, and for a shell fragment wound of the abdomen, rated at 0 percent since October 11, 2007. The combined disability rating is currently 90 percent since October 3, 2018. However, the Board’s actions above will result in a combined total rating of 100 percent for the entire period on appeal. A rating of total disability based on individual unemployability based on a single disability satisfies the statutory requirement of a “total rating.” See Bradley v. Peake, 22 Vet. App. 280 (2008). Therefore, the issue of TDIU entitlement remains on appeal. The Veteran reported in his VA Form 21-8940 (Veterans Application for Increased Compensation Based on Unemployability) that he has a job history working in a parts department for a car dealer. He has a high school education and he became too disabled to work in October 2006, prior to the date of the claims addressed herein. The Board notes that TDIU has already been granted at the AOJ level. The effective date of August 29, 2018, appears to be based solely on the date of receipt of the VA Form 21-8940. While this form provides important information for adjudicating the issue of TDIU entitlement, it is not the claim on appeal regarding that issue. Rather, TDIU is a component of the rating issues addressed in this decision. Those claims all arise from a service connection claim received at VA on October 11, 2007. Accordingly that is the date of claim for TDIU. As discussed above with respect to the ratings assigned to the service-connected shell fragment wound residuals, the Veteran's condition has not changed significantly during the period on appeal. The applicable effective date statute and regulations provide that the proper effective date for TDIU is the earliest date as of which it is factually ascertainable that an increase in disability had occurred if a claim is received within one year from such date. 38 C.F.R. § 3.400(o). In this case, the Board finds that there was no increase in disability during the period of the claim. Rather, the current level of disability has existed throughout the period. As such, the Board concludes that TDIU is warranted for the period prior to August 29, 2018. The Board further finds that the service-connected shell fragment wound residuals, arising from the same injury, are sufficient to support TDIU independent of his other service-connected disabilities. These shell fragment wound residuals combine to a rating of 90 percent. In light of the separately service-connected mental disability, rated at 70 percent, the Veteran has a single disability rated at 100 percent (TDIU) and additional service-connected disability or disabilities independently ratable at 60 percent or more, separate, and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily system. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i)(1). Therefore, the Board also finds that Special Monthly Compensation at the Housebound rate is warranted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Cramp 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.