Citation Nr: 21041650 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 11-27 722 DATE: July 9, 2021 REMANDED Entitlement to an increased rating higher than 10 percent for residuals of pilonidal cyst with coccygeal pain is remanded. REASONS FOR REMAND The Veteran had active duty service from December 1984 to December 1986 and November 1990 to June 1991. This matter comes to the Board of Veterans' Appeals (Board) from a January 2010 Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in May 2017. In September 2017, the Board, in pertinent part, remanded the claim for additional development. However, for the reasons below, the case is remanded again. 1. Entitlement to an increased rating higher than 10 percent for residuals of pilonidal cyst with coccygeal pain is remanded. The Veteran is rated under Diagnostic Code 7804 based on the residual pain caused by the scarring from a surgery to remove a pilonidal cyst in service in 1986. The evidence of record also raises the issue that he might have additional disabling effects involving the lower back/ hip area that are not considered under Diagnostic Code 7804. The Veteran underwent a VA examination in February 2018, which noted that he had significant pain in the coccyx region upon sitting, particularly on hard surfaces and/ or prolonged periods of time such as driving. He reportedly used a donut cushion and also wore a back brace when his (unrelated) back hurt due to sitting on the left hip to avoid pressure to the coccyx. On examination the Veteran had tenderness with light pressure to the lumbosacral area bilaterally and the coccyx. X-ray examination showed moderate right and mild to moderate left sacroiliac joint degenerative changes. The Veteran also testified at the Board hearing in May 2017 that the residual scarring from the pilonidal cyst made his back a little sore. See May 2017 Board hearing transcript, p. 8. Additional examination is warranted to determine whether the Veteran's residual scarring from the pilonidal cyst removal has resulted in other disabling effects in the sacroiliac joint and/ or low back that are not considered under Diagnostic Code 7804, as noted under Diagnostic Code 7805 (scars, other: evaluate any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code.) The February 2018 VA examiner noted that the back was unrelated in parenthesis but there is no further explanation or rationale for this notation; and it is not clear based on the Veteran's complaints and medical evidence of degenerative changes in the sacroiliac joint whether these are related to his shifting to sit on his left hip to avoid pain in the coccyx region. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from January 2021 to present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected residuals of pilonidal cyst with coccygeal pain. 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. Specifically, the examiner should state whether it is at least as likely as not that any functional impairment in the lower back and/ or sacroiliac region, including the degenerative changes in the sacroiliac joint, are a disabling effect from the residuals of pilonidal cyst with coccygeal pain, particularly from sitting on the left hip to avoid pain in the coccyx. A complete rationale for all expressed opinions should be provided by the examiner. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sarah B. Richmond, 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.