Citation Nr: A25035119 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 231207-398215 DATE: April 16, 2025 ORDER For the initial rating period on appeal from January 23, 2023, a higher (compensable) initial disability rating for the service-connected gynecomastia is denied. FINDING OF FACT For the initial rating period on appeal from January 23, 2023, the service-connected gynecomastia did not more nearly approximate chronic residuals of benign neoplasms of the breast or other injuries of the breast that caused impairment of function due to scars, lymphedema, or mastectomy or wide local excision with significant alteration of size or form of the breasts. CONCLUSION OF LAW For the initial rating period on appeal from January 23, 2023, the criteria for a higher (compensable) initial disability rating for the service-connected gynecomastia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.20, 4.116, Diagnostic Code 7699-7631. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from April 2013 to March 2014, and from March 2018 to April 2019. The instant case is on appeal from a July 2023 Department of Veterans Affairs (VA) Regional Office (RO) rating decision that granted service connection for gynecomastia and established a noncompensable (0 percent) disability rating, effective January 23, 2023. The Veteran appeals for a higher (compensable) initial disability rating. See December 2023 Notice of Disagreement. The modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the December 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket; therefore, the Board may only consider the evidence of record at the time of the July 2023 VA RO rating decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the July 2023 VA RO rating decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. On January 30, 2024, a representative submitted a motion to withdraw as representative. In a February 2025 letter, the Board granted the motion to withdraw and copied the Veteran on the letter. Subsequently, in another February 2025 letter, the Board wrote to the Veteran and informed that he had 30 days to designate a new representative, if he wanted one, or that he would be considered pro se. As the Veteran did not reply to the February 2025 letter, the Veteran is considered pro se for purposes of this appeal. From January 23, 2023, a Compensable Initial Disability Rating for Gynecomastia is Denied. The Veteran appeals for a higher (compensable) initial disability rating for the service-connected gynecomastia, contending that the gynecomastia caused pain and should be rated higher because of the pain that it causes. See December 2023 Notice of Disagreement. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. § Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Gynecomastia is not explicitly listed in the Rating Schedule. As such, the first task before the Board is to determine what Diagnostic Code should be considered for a rating by analogy. The VA RO has assigned Diagnostic Code 7631, based on benign neoplasms of the breast and other injuries of the breast. The Board finds that Diagnostic Code 7631 is the most appropriate Diagnostic Code for rating by analogy, as Diagnostic Code 7631 corresponds to a closely related disease or injury (as gynecomastia is a disability of the breast), has closely analogous symptomatology (tenderness and pain), and has the same anatomical localization (the breast). See 38 C.F.R. § 4.20. Under Diagnostic Code 7631, the disability is based on chronic residuals according to impairment of function due to scars, lymphedema, or disfigurement. Diagnostic Code 7631 lists examples of limitation of arm, shoulder, and wrist motion, or loss of grip strength, or loss of sensation, or residuals from harvesting of muscles for reconstructive purposes. Alternatively, Diagnostic Code 7631 permits rating under Diagnostic Code 7626; however, as Diagnostic Code 7626 pertains to surgery of the breast following a mastectomy and, during the rating period on appeal, the Veteran did not have any surgery of either breast, the Board finds that a rating by analogy to Diagnostic Code 7631 is not appropriate. Rather, the question is whether there is impairment of function. Notably, subsequently to the filing of the Notice of Disagreement, the Veteran had surgery (bilateral gynecomastia reduction with glandular excision). After the surgery, the Veteran applied for an increased disability rating. The noncompen-sable disability rating was continued for gynecomastia, but the VA RO also granted service connection and assigned disability ratings for residual scars. The surgery and resultant scars are not a part of the initial disability rating. After a review of the lay and medical evidence of record, the Board finds that the evidence persuasively weighs against finding that a higher (compensable) initial disability rating is warranted for the service-connected gynecomastia. In a March 2023 VA treatment record, the medical provider noted there was palpable tender gynecomastia on both sides, which was described as palpable lumps surrounding the areolas bilaterally. The Veteran was working as a police officer, with no noted functional deficits. In a May 2023 VA treatment record, the medical provider documented that the Veteran had been having breast enlargement and breast pain on an intermittent basis since 2013. The Veteran reported that sometimes he noticed enlargement of both breasts and that at other points it was one of the breasts alone. The Veteran reported no discharge, and the breasts were positive for gynecomastia on examination. There were no reported functional deficits. At a July 2023 VA examination, the VA examiner wrote, based on records review, that the diagnosis of gynecomastia started in 2013, with the symptoms of tenderness to the right breast on palpation. The symptoms as of the examination were intermittent right and left breast enlargement and tenderness on palpation. There was no treatment at any point, and there was no impact on an ability to perform occupational functioning or ordinary activities. The July 2023 VA examiner additionally referenced an August 2013 mammogram that documented that the only symptom was the Veteran being aware of the presence of the gynecomastia. There was no inhibition in the ability to perform his job or wear his body armor while deployed. Because the symptoms were not limiting the ability to perform the job tasks and the Veteran wanted to return to duty as soon as possible, all interventions were deferred. Because the symptoms of the gynecomastia at the VA examination were listed as being similar to those of the initial onset, the Board finds that the lack of impairment in functioning that was reported as of the August 2013 mammogram provides some evidence as to the symptoms and functional impairment of the disability during the rating period on appeal. Additionally, the findings are supported by the July 2023 VA examiner's assessment that the gynecomastia caused no impact on an ability to perform occupational functioning or ordinary activities. For these reasons, the Board finds that the criteria for a higher (compensable) initial disability rating for the service-connected gynecomastia from January 23, 2023, have not been met. The criteria for a rating under Diagnostic Code 7631 can be met in multiple ways, but the focus of the rating is on the chronic residuals rated according to impairment of function. In this case, the evidence persuasively weighs against a finding that there is impairment in the ability to function, such as the listed examples of limitation of arm, shoulder, and wrist motion, or loss of grip strength. The evidence shows that the Veteran has been employed as a police officer, and the July 2023 VA examiner assessed no occupational or functional impairment. Diagnostic Code 7631 considers impairment of function as related to scars, but there are no scars during the rating period on appeal. Diagnostic Code 7631 also considers impairment of function as related to lymphedema and disfigurement, but the evidence does not show functional impairment due to either. Finally, Diagnostic Code 7631 contemplates a rating by analogy to Diagnostic Code 7626, which would be for surgery. As noted above, there was no surgery until after submission of the Notice of Disagreement and, therefore, the rating decision on appeal. The Board acknowledges that a rating by analogy does not require all symptoms to be present; however, it does require that some symptoms are present. In this case, the rating code, Diagnostic Code 7631, is based on impairment in function and the evidence has not demonstrated compensable impairment in function. The Board acknowledges the Veteran's contention that the disability should be rated higher based on pain, and the Board notes that tenderness has been a part of this disability; however, none of the potential rating criteria rate gynecomastia based simply on the description of pain that is not impairing to a compensable degree. For these reasons, the Board finds that, for the initial rating period on appeal from January 23, 2023, the evidence persuasively weighs against a finding that a higher (compensable) disability rating for the service-connected gynecomastia is warranted; accordingly, the Board must deny the appeal. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Smith, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.