Citation Nr: 22013201 Decision Date: 03/08/22 Archive Date: 03/08/22 DOCKET NO. 17-06 187 DATE: March 8, 2022 ORDER Entitlement to service connection for excessive sweating is denied. Entitlement to service connection for bronchitis is denied. Entitlement to service connection for an enlarged lymph nodes in groin is denied. Entitlement to service connection for anemia is denied. Entitlement to service connection for lung disability to include hypersensitive lung disease is denied. Entitlement to service connection for internal scarring is denied. Entitlement to service connection for a right foot scar due to ulcer is denied Entitlement to service connection for balance issues is granted. Entitlement to service connection for chronic fatigue is granted. Entitlement to service connection for hyperkalemia is granted. Entitlement to service connection for arteriovenous fistula is granted. Entitlement to service connection for bilateral foot onychomycosis is granted. Entitlement to service connection for bilateral foot osteomyelitis is granted. Entitlement to service connection for bilateral foot ulcers is granted. Entitlement to service connection for rhabdomyolysis of the kidney is denied. Entitlement to service connection for residuals of a bacterial infection is denied. Entitlement to service connection for a bilateral hand disability is denied. Entitlement to an increased rating in excess of 40 percent for a chronic duodenal ulcer with vagotomy bilateral Jaboulay, pyloroplasty and gastrostomy is denied. Entitlement to an increased rating in excess of 10 percent for a post-operative surgical scar due to chronic duodenal ulcer is denied. Entitlement to compensable rating for a superficial non-linear scar residual post-operative due to chronic doudenal ulcer is denied. Entitlement to a total disability rating due to individual unemployability is dismissed. FINDINGS OF FACT 1. The Veteran did not have a disability for VA purposes for excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung disability, internal scarring, and right foot scar during the course of the appeal period. 2. The Veteran's balance disability, chronic fatigue, hyperkalemia, arteriovenous fistula, bilateral foot onychomycosis, and bilateral osteomyelitis are at least as likely as not caused by his service-connected diabetes. 3. The Veteran's bilateral foot ulcers are related to his service-connected diabetes. 4. The Veteran's rhabdomyolysis of the kidney is not related to the Veteran's service-connected disabilities. 5. The Veteran's bacterial infections is duplicative for the claim for osteomyelitis which has been granted. 6. The Veteran's bilateral hand disability is not related to his service-connected disabilities or his active duty service. 7. Throughout the appeal period, the Veteran's digestive system disabilities were manifested by symptoms of abdominal pain which occurs at least monthly which is pronounced, periodic, and unrelieved by standard ulcer therapy; alongside episodes of recurrent nausea, which occurs 4 or more times a year and last at less than a day. 8. The Veteran had one painful superficial post-operative surgical scar due to chronic duodenal ulcer no scars were classified as deep or with underlying soft tissue damage. 9. The Veteran's second superficial residual post-operative due to chronic doudenal ulcer was not classified as painful or unstable. 10. The Veteran has been granted a 100 percent schedular rating for the entirety of the appeal period. 11. The Veteran has been granted entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114(s) for the entirety of the appeal period. CONCLUSIONS OF LAW 1. The criteria to establish service connection for excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung disability, internal scarring, and right foot scar have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 2. The criteria to establish service connection for balance disability, chronic fatigue, hyperkalemia, arteriovenous fistula, bilateral foot onychomycosis, and bilateral osteomyelitis have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 3. The criteria for service connection for rhabdomyolysis have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 4. The criteria for service connection for bacterial infections have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 5. The criteria for service connection for bilateral hand disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 6. The criteria for service connection for bilateral foot ulcers have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 7. The criteria for entitlement to an evaluation for digestive system disabilities, in excess of 40 percent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code (DC) 7305. 8. The criteria for a rating in excess of 10 percent for residuals of a surgical scar due to abdominal surgery have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code (DC) 7804. 9. The criteria for a compensable rating for the superficial non-linear scar, residual of abdominal surgery have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code (DC) 7802. 10. Entitlement to a TDIU is moot. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from October 1968 to September 1972. The Veteran died in September 2018. As an initial matter, the Board again expresses its sympathy to the Appellant for the loss of her husband and recognizes the years of excellent service he provided to the country during his service in the United States Air Force. I. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). "To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service'-the so-called 'nexus' requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. See 38 C.F.R. § 3.310 (b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 1. Entitlement to service connection for excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung disability, internal scarring, and right foot scar. Service connection may only be granted for a current disability. When a claimed condition is not shown, there may be no grant of service connection. Congress specifically limited entitlement for service-connected disease or injury to cases where the incident resulted in a disability. In the absence of proof of a present disability there can be no valid claim. 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992); Brammer v. Derwinski, 3 Vet. App. 223 (1992). While the Board acknowledges the Appellant's contentions that the Veteran complained of excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung condition, and internal scarring and right foot scar; there is no medical disability identified in review of the Veteran's medical evidence or by the March 2021 VA examiner which can be service connected. No diagnosis was made in examination and likewise VA treatment records do not support the contention that either the Veteran was provided a diagnosis for these disabilities or that these symptoms constituted a disability. Lay evidence can be competent and sufficient to establish a diagnosis when (1) a layperson is competent to identify the medical condition (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), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, in the present case, while a lay person may be competent to report symptoms, they are not competent to diagnose a disability or establish a disability related to excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung disability, or internal scarring. A diagnosis of these disabilities requires greater medical knowledge and testing than the Appellant has shown to possess. Accordingly, the Veteran is not competent to establish diagnosis for these disabilities. In the absence of evidence of a current disability, there is no valid claim of service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied when a claimant has a disability at any time during the pendency of a claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). The record does not demonstrate that the Veteran had excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung condition, internal scarring, and right foot scar disabilities at any time during the appeal period. The threshold element of a service connection claim (a current disability) has not been met; therefore, service connection for excessive sweating, bronchitis, enlarged lymph nodes, anemia, lung disability, or internal scarring disability must be denied. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, the evidence is persuasively against these claims for service connection and they are denied. 2. Entitlement to service connection balance issues, chronic fatigue, hyperkalemia, arteriovenous fistula, bilateral foot onychomycosis, and bilateral foot osteomyelitis. The Veteran contended that his balance issues, chronic fatigue, hyperkalemia, arteriovenous fistula, foot onychomycosis and foot osteomyelitis were secondary to his diabetes mellitus. The March 2021 VA examination establishes current disabilities related to balance issues, chronic fatigue, hyperkalemia, arteriovenous fistula, bilateral foot onychomycosis, and bilateral foot osteomyelitis. Further, the Veteran is service connected for diabetes mellitus. Nor is there is a dispute that these disabilities were caused by his diabetes as noted again in the March 2021 VA examination. The March 2021 VA examination report ultimately found that the Veteran's diabetes caused his balance disability, chronic fatigue, hyperkalemia, arteriovenous fistula, bilateral foot onychomycosis, and bilateral osteomyelitis. As such, the record supports the claims, and all the elements of service connection on a secondary basis are met. Consequently, service connection for the Veteran's balance disability, chronic fatigue, hyperkalemia, arteriovenous fistula, bilateral foot onychomycosis, and bilateral osteomyelitis is granted. 3. Entitlement to service connection for bilateral foot ulcers. The Veteran and Appellant contend that the Veteran's foot ulcers are related to his diabetes. At the onset, the Board notes that the Veteran was diagnosed with diabetic foot ulcers in a July 2015 private treatment note. Thus, a current disability is documented in the claims file. Moreover, the Veteran is service connected for diabetes as noted in a January 2021 Board decision. Turning to a nexus between the Veteran's bilateral foot ulcers and his diabetes, the Board notes that the July 2015 clinician was treating the Veteran when he found that that the ulcers were caused by the Veteran's diabetes, and he concluded this after a review of the Veteran's history. Thus, the Board recognizes the unique position the July 2015 clinician is in to provide an opinion because of his relationship to the Veteran and his disease, and as such, his opinion on etiology carries significant weight. Considering the foregoing, the Board finds that service connection for a bilateral foot disability is warranted. Considering the foregoing, the Board finds that all the elements of service connection on a secondary basis have been met, and service connection for bilateral foot ulcers is granted. 4. Entitlement to service connection for rhabdomyolysis of the kidney. The Veteran and the appellant contend that the Veteran's rhabdomyolysis of the kidney is due to his diabetes. At the onset, the Board notes that there is no dispute that the Veteran had a diagnosis of rhabdomyolysis as noted in a December 2012 VA treatment record. However, with regard to nexus, in the same December 2012 treatment note the etiology of the rhabdomyolysis was found to be related to medication for his cholesterol. Furthermore, the March 2021 VA examiner, upon review of the claims file, found that the Veteran's rhabdomyolysis was short-lived and resolved upon adjustment of his cholesterol medication. The Board finds that the medical evidence and the VA examiner's opinion is highly probative on the matter. The examiner provided a reasoned rationale which is supported by the claims file as a whole. The Board notes that the Veteran is not service connection for his cholesterol. The Board acknowledges the Veteran's and the Appellant's opinions that his rhabdomyolysis was due to his diabetes, however, these statements regarding the cause of his rhabdomyolysis are lay statements that purport to provide a nexus opinion. The Board finds these statements are not competent for this purpose. Although it is error to categorically reject a lay person as competent to provide a nexus opinion, not all questions of nexus are subject to non-expert opinion. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Whether a layperson is competent to provide a nexus opinion depends on the facts of the particular case. In Davidson, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) drew from its earlier decision in Jandreau v. Nicholson to explain its holding. Id. In that earlier decision, the Federal Circuit stated as follows: "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Federal Circuit provided an example, stating that a layperson would be competent to identify a simple condition such as a broken leg, but not competent to provide evidence as to a more complex medical question such as a form of cancer. Id. at n.4. Also of note is that the Veterans Court has explained that non-expert witnesses are competent to report that which they have observed with their own senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Taking Davidson, Jandreau, and Layno together, leads the Board to the conclusion that the complexity of the question and whether a nexus opinion could be rendered based on personal observation are factors in determining whether a non-expert nexus opinion or diagnosis is competent evidence. In the instant case, the question of the cause of the Veteran's rhabdomyolysis is not something that can be determined by mere observation. Nor is this question simple. While the Veteran and Appellant are competent to report observable symptoms, the question of the cause of those symptoms in this case is not an observable fact. It requires clinical testing to assess and diagnose the underlying condition and training to make the appropriate interpretations and conclusions about what the testing demonstrates in conjunction with the symptoms reported to determine the cause. Therefore, the Board finds that the lay statements as to how his rhabdomyolysis was caused are not competent evidence as to a nexus. As such, the most probative evidence of record is the December 2012 medical record and the medical opinion from March 2021 which found that there was no relationship between the Veteran's rhabdomyolysis and his service-connected diabetes, and as such, the persuasive evidence is against the claim and service connection for rhabdomyolysis is not warranted. 5. Entitlement to service connection for residuals of a bacterial infection. The Board finds that the matter of residuals of a bacterial infection has been addressed above with the grant of bilateral foot osteomyelitis. The Board notes that in the Appellant's July 2020 hearing she clarified that the Veteran's bacterial infection claim was the claim for bilateral foot osteomyelitis. Specifically, the undersigned Veterans Law Judge asked whether "...the bacterial infection that that you were talking about? The osteomyelitis?" and the Appellant answered "Yes." Given that the osteomyelitis was granted above, there is no longer any claim on appeal related to bacterial infections and the claim is denied. Entitlement to service connection for a bilateral hand disability. The Veteran and Appellant assert that his bilateral hand disability was incurred in service. In the alternative, the Appellant asserts that this condition is due to his service-connected bilateral upper extremity neuropathy. At the onset, the Board notes that there is no dispute that the Veteran was diagnosed with osteoarthritis of his bilateral hands as noted in a March 2021 VA examination. Thus, a current disability has been established. In considering direct service-connection and turning to the issue of an inservice event, injury or disease related to the hands, there is no evidence in the service treatment records regarding complaints, treatment or injury to the Veteran's hands. Thus, this element of direct service connection is not met, and service connection on a direct basis is not warranted. Turning to secondary service connection, the Board notes that the Veteran is service-connected for bilateral upper extremity neuropathy. However, there is no competent evidence of a nexus between the Veteran's bilateral upper extremity neuropathy and his bilateral hand arthritis. The only nexus opinion of record from the VA examiner who found that there was no clinical evidence to relate the Veteran's service connected neuropathy to his bilateral hand osteoarthritis. Upon review of the evidence, the Board finds that the VA examiner opinion is probative as it is based on review of the file and provided a rationale based on medical principles. To the extent that the Appellant's statement could be construed as attempting to provide a nexus between the service-connected upper extremity neuropathy and the bilateral hand arthritis, the Board finds that she is not competent to provide such a nexus. The issue of the etiology of arthritis is complex and beyond the knowledge of a lay person. Such a determination requires medical knowledge and training which the Appellant does not possess. Thus, the Board finds that the persuasive evidence is against the claim, and service connection for bilateral hand arthritis is denied. II. Increased Ratings Generally Disability ratings are determined by comparing a veteran's present symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.7. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1 ; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary in order to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A. Increased Rating - Criteria for Disabilities of Duodenal Ulcer Diagnostic Code 7305 provides ratings for duodenal ulcer. Mild duodenal ulcer, with recurring symptoms once or twice yearly, is rated 10 percent disabling. Moderate duodenal ulcer, with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration; or with continuous moderate manifestations, is rated 20 percent disabling. Moderately severe duodenal ulcer, with less than severe disability, but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year, is rated 40 percent disabling. Severe duodenal ulcer, with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health, is rated 60 percent disabling. 38 C.F.R. § 4.114. The terms "mild," "moderate," and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The use of terminology such as "moderate" or "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board notes, for reference and illustrative purposes, that the definitions for "mild" includes not very severe. WEBSTER'S II NEW COLLEGE DICTIONARY at 694 (1995). In addition, a synonym for "mild" is "slight" and definitions for "slight" includes small in size, degree, or amount. Id at 1038. The definitions for "moderate" includes of average or medium quantity, quality, or extent. Id. at 704. Finally, definitions for "severe" includes extremely intense. Id. at 1012. It is also noted that the term "moderately severe" includes impairment that is considered more than "moderate" but not to the extent as to be considered "severe." 6. Entitlement to an increased rating in excess of 40 percent for a chronic duodenal ulcer with vagotomy bilateral Jaboulay, pyloroplasty and gastrostomy is denied. The Veteran's chronic duodenal ulcer with vagotomy bilateral Jaboulay, pyloroplasty and gastrostomy is rated as 40 percent under 38 C.F.R. § 4.114, Diagnostic Code 7305. Turning to the record, the Veteran was afforded a VA examination in September 2013. The examiner confirmed the Veteran's diagnoses of Vagotomy with pyloroplasty or gastroenterostomy. The examiner reported abdominal pain which occurs at least monthly, pronounced, periodic, and unrelieved by standard ulcer therapy. He also reported recurrent nausea, which occurs 4 or more times a year and last at less than a day. The Appellant provided testimony in January 2021 documenting the day to day difficulties the Veteran experienced as a symptoms of this surgery. However, the symptoms of pain she described are compensated under the 40 percent rating as noted in the rating criteria. Moreover, the testimony did not describe symptoms which the Board finds would be persuasively functionally equivalent of the necessary criteria of the next higher evaluation of recurrent hematemesis, periodic vomiting, with recurrent hematemesis or melena with manifestation of anemia and weight loss. Based on the evidence, the Board concludes that a rating in excess of 40 percent is not warranted for the Veteran's service-connected digestive system disabilities. Specifically, the Board finds that although the record indicates abdominal pain unrelieved by standard ulcer therapy, it does not reflect that the Veteran's service-connected digestive system disabilities were manifested by periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health pursuant to 38 C.F.R. § 4.114, DC 7305. Accordingly, a rating greater than 40 percent for a chronic duodenal ulcer with vagotomy bilateral Jaboulay, pyloroplasty and gastrostomy is denied. B. Increased Rating - Criteria for Scars The Board notes that on July 13, 2018, VA published a final rule amending its regulations on skin disabilities. 83 Fed. Reg. 32592 (July 13, 2018). The effective date of the final rule is August 13, 2018. However, for this final rule, VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. As the Veteran filed his initial increased rating claim for his lumbar spine disability before the August 13, 2018 effective date, the Board will consider whether either the old or new rating criteria is more favorable to the Veteran. The pre-amended DC 7801 provided disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, DC 7801 (2017). In contrast, the amended DC 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801. Both the old and new criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square cm) but less than 12 square inches (77 square cm). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square cm) but less than 72 square inches (456 square cm). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square cm) but less than 144 square inches (929 square cm). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square cm) or greater. 38 C.F.R. § 4.118, DC 7801. Note (1) to the pre-amended DC 7801 stated that a deep scar is one associated with underlying soft tissue damage. Prior to August 13, 2018, DC 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, DC 7802. The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7802. Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square cm) or greater. Under both the old and new rating criteria, DC 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating for is assigned for one or two such scars. A 20 percent rating is warranted for three to four such scars, and a 30 percent disability rating is assigned for five or more scars. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC, when applicable. 38 C.F.R. § 4.118, DC 7804. Under the old rating criteria, DC 7805 provided that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, DC 7805. The Board notes that this DC is largely unchanged under the new amendments apart from the replacement of the phrase "(including linear scars)" with "and other effects of scars evaluated under DCs 7800, 7801, 7802, or 7804." 38 C.F.R. § 4.118, DC 7805. 7. Entitlement to an increased rating in excess of 10 percent for a post-operative surgical scar due to chronic duodenal ulcer is denied. The evidence to evaluate the Veteran's scar is limited to a September 2013 VA examination, the VA examiner in this examination noted the surgical scar was painful but not unstable (with frequent loss of covering of skin over the scar) and was not due to burns. The scar was described as superficial and non-linear; its total area was 40 cm2. Based on the evidence above, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran's painful surgical scar. DCs 7801 and 7802 are not applicable under either the old or new criteria, as the Veteran's painful surgical scar is not described as deep or associated with underlying soft tissue damages and do not cover 144 square inches. Further, as noted 10 percent is the maximum available rating under DC 7802. A rating in excess of 10 percent is also not warranted under either the old or new criteria under DC 7804, as the Veteran did not have at least five scars that were unstable or painful as required for a higher rating. The September 2013 VA examiners indicated that the Veteran had only one scar that was painful but not unstable. Accordingly, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran's painful surgical scar. Entitlement to compensable rating for a superficial non-linear scar residual post-operative due to chronic doudenal ulcer is denied. The evidence to address the superficial non-linear scar is considerably limited as this scar is only passingly noted in the September 2013 VA examination. The VA examiner noted the Veteran had scars from two previous surgeries of his abdomen. While the examiner noted two surgeries with associated scars he documented only one painful scar. This scar is addressed above. Instead, the examiner provided that the other scar was not painful or unstable, and was not caused by burns. The Board finds that a compensable rating is not warranted for the Veteran's superficial non-linear scar. DC 7801 is not applicable under either the old or new criteria, as the Veteran's scar was not described as deep or associated with underlying soft tissue damage. Nor is a compensable or higher rating warranted under either the old or new criteria under DC 7802, as 10 percent requires that the scars cover 144 square inches, which the Veteran's scars do not. A compensable rating is also not warranted under either the old or new criteria under DC 7804, as the Veteran did not have any scars that were unstable or painful as is required for a compensable rating. Thus, a compensable rating for a superficial non-linear scar residual post-operative due to chronic doudenal ulcer is denied. 8. Entitlement to a total disability rating due to individual unemployability is dismissed. The Veteran's claim for a total disability rating arose from an increased rating claim filed in June 2012. The Board notes that previous claim for a total disability rating was filed in March 2005, but was denied by the VA regional office and never appealed to the Board. As such, the Board finds that no actionable prior formal or informal claim appears to be of record. Furthermore, the Veteran has been awarded a 100 percent scheduler rating for the entirety of the appeal period back to September 2, 2010. Thus, to the extent that the Veteran already has a total disability rating for the entire appeal period, the Veteran's claim for TDIU is moot. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990) (The United States Court of Appeals for Veterans Claims (Court) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled.). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent scheduler rating was awarded for the same period). However, the Board notes that the presence of a 100 percent disability rating does not necessarily render the issue of TDIU moot. In Bradley v. Peake, 22 Vet. App. 280, 293 (2008), the Court held that a TDIU satisfies the total (100 percent) rating requirement if the TDIU evaluation was, or can be, predicated upon a single disability and there exists additional disability or disabilities independently ratable at 60 percent or more, for purposes of entitlement to SMC for a housebound rating. In other words, 38 U.S.C. § 1114(s) for housebound benefits does not limit "a service-connected disability rated as total" to only a schedular rating of 100 percent. Id. A TDIU rating based on a single disability is permitted to satisfy the statutory requirement of a total rating. Id. In the present case, the Veteran has been awarded SMC based on 38 U.S.C. § 1114(s) since September 2, 2010. Thus, for the entirety of the appeal period the Veteran is already in receipt of SMC. Thus, there are no additional benefits available to the Veteran based on TDIU. Accordingly, the TDIU claim is moot. GAYLE E. STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Acosta, J. 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.