SCAR(S) UNSTABLE OR PAINFUL

STEVEN D. REISS · 2026 · Case ID: 26005022

MIXED

Summary

The veteran, who served in the U.S. Navy from July 2008 to July 2014, appeals the denial of a compensable rating for residuals of left breast gynecomastia removal and an increased rating for a painful scar related to the surgery. The Board granted a 10 percent rating for the painful scar for the period of appeal from July 17, 2014, to March 9, 2023, finding the scar met the criteria for a minimum rating based on the veteran's credible report of continuous pain. However, the Board remanded the issues of entitlement to a compensable rating for the gynecomastia residuals and a rating in excess of 10 percent for the scar. The remand is necessary because the veteran reported additional manifestations of pain and discomfort not fully addressed in prior examinations, and the Board acknowledged the need to consider extraschedular evaluation for the gynecomastia residuals. The Board also noted that the existing 10 percent rating for the scar might be inadequate given the veteran's reported continuous pain. Further development, including obtaining updated treatment records and a new VA examination, is required to properly assess all current symptoms and determine entitlement to a higher rating or extraschedular consideration.

Rationale

Veteran reported continuous pain in the scar; Board found veteran's report fully credible; Met criteria for 10 percent rating under DC 7804

Service Branch

U.S. NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7804

Docket No.

18-00 520

Full Decision Text

Citation Nr: 26005022
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 18-00 520
DATE: April 29, 2026

ORDER

A 10 percent rating for painful scar, anterior trunk related to left breast gynecomastia removal is granted for the period on appeal from July 17, 2014, to March 9, 2023.

REMANDED

A rating in excess of 10 percent for painful scar, anterior trunk related to left breast gynecomastia removal is remanded.

A compensable rating for left breast gynecomastia removal is remanded.

FINDING OF FACT

For the period on appeal from July 17, 2014, to March 9, 2023, scar, anterior trunk related to left breast gynecomastia removal has been painful.

CONCLUSION OF LAW

From July 17, 2014, to March 9, 2023, the criteria for a 10 percent rating for the Veteran's scar, anterior trunk related to left breast gynecomastia removal have been met. 38 U.S.C. §§ 1154(a), 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Navy from July 2008 to July 2014.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that granted service connection for gynecomastia left breast status post surgery and left breast scar status post surgery, assigning a noncompensable rating for each condition, effective July 17, 2014, the day following service separation. In August 2015, the Veteran filed a notice of disagreement (NOD) with the rating for gynecomastia left breast status post-surgery, indicating the percentage evaluation sought was an 'extra schedular evaluation'.

In a December 2022 decision, the Board remanded the matter of entitlement to a compensable rating for residuals of gynecomastia left breast status post-surgery to the agency of original jurisdiction (AOJ) for necessary development, specifically to obtain updated treatment records and VA examination to evaluate all of the current manifestations and severity of the Veteran's residuals of gynecomastia left breast status post-surgery.

In May 2023, the AOJ issued a rating decision granting a separate 10 percent rating for painful scar, anterior trunk as related to the service-connected disability of left breast gynecomastia removal, effective March 10, 2023, noted as the date of VA examination showing the scar was tender.

Also in May 2023, the RO issued a Supplemental Statement of the Case (SSOC) in which it denied a compensable rating for left breast gynecomastia removal, a compensable rating for scar, anterior trunk related to left breast gynecomastia removal prior to March 10, 2023, and a rating greater than 10 percent for painful scar, anterior trunk related to left breast gynecomastia removal from, March 10, 2023.

As the record reflects that the Veteran is working during the appeal period, and there is no suggestion that he is claiming unemployability due to his service-connected issues on appeal, the Board does not find that a claim for total disability rating based on individual unemployability due to service-connected disabilities (TDIU) has been raised in connection with an underlying increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

The Veteran's accredited service representative submitted evidence and argument in July 2024 along with a waiver of AOJ consideration. The representative urges extraschedular consideration is warranted for Veteran's residuals of gynecomastia left breast status-post surgery.

In April 2026, the Veteran's Privacy Act request dated in January 2025 was fulfilled.

Increased rating

Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4.

Where there is a question as to which of two 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.
urges extraschedular consideration is warranted for Veteran's residuals of gynecomastia left breast status-post surgery.

In April 2026, the Veteran's Privacy Act request dated in January 2025 was fulfilled.

Increased rating

Where there is a question as to which of two 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007).

The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. That does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994).

For increased rating claims, an effective date should not be assigned mechanically based on the date of a diagnosis or a VA examination report. Rather, all of the facts should be examined to determine when an increase in a veteran's disability can be ascertained. DeLisio v. Shinseki, 25 Vet. App. 45 (2011); Swain v. McDonald, 27 Vet. App. 219, 224 (2015).

A 10 percent rating for painful scar, anterior trunk related to left breast gynecomastia removal is granted for the period on appeal from July 17, 2014, to March 9, 2023.

The Veteran urges that the scar, anterior trunk related to left breast gynecomastia removal has been painful throughout the appeal period and did not become painful March 10, 2023, at the examination.

When he underwent a VA examination for this condition in March 2023, it was noted to measure 1.7x0.2cm and .34cm2 but was also noted as was approximately 5.0x0.1cm visibly indented "disfigurement" area measuring. It was not associated with underlying soft tissue damage.

In pertinent part, unstable or painful scars are evaluated under Diagnostic Code 7804.

The minimum 10 percent disability rating is warranted for one or two scars that are unstable or painful. A 20 percent disability rating is warranted for three or four scars that are unstable or painful. The maximum 30 percent disability rating is warranted for five or more scars that are unstable or painful. See 38 C.F.R. § 4.118, Diagnostic Code 7804.

The Board notes that the Veteran is certainly competent to report pain. Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007).

In its role as a finder of fact, the Board finds that given Veteran's report of continuous pain in the scar, anterior trunk related to left breast gynecomastia removal area, which the Board judges to be fully credible, the Board finds that the evidence supports a 10 percent disability rating for the Veteran's scar, anterior trunk related to left breast gynecomastia removal under DC 7804 criteria from July 17, 2014, to March 9, 2023.

REASONS FOR REMAND

1. A compensable rating for left breast gynecomastia removal is remanded.

2. A rating in excess of 10 percent for painful scar, anterior trunk related to left breast gynecomastia removal is remanded.

The Board acknowledges the representative's argument that extraschedular consideration is warranted in the rating of the left breast gynecomastia removal and specifically asserting there has been no such consideration despite the fact that the Veteran requested such in the aforementioned 2015 NOD.

Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran's disability picture.
, 2023.

REASONS FOR REMAND

1. A compensable rating for left breast gynecomastia removal is remanded.

2. A rating in excess of 10 percent for painful scar, anterior trunk related to left breast gynecomastia removal is remanded.

Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran's disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008).

The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. at 111.

Importantly, however, the Board notes that in Morgan v. Wilkie, 31 Vet. App. 162 (2019), the Court held, "VA has powerful, ready-made schedular rating tools with which it can better adjudicate claims that include symptoms and effects not contemplated by an applicable diagnostic code." Morgan, 31 Vet. App. at 167. Indeed, the Court stated doing so was necessary to ensure a veteran is appropriately compensated before resorting to § 3.321(b)'s extraschedular provisions. In doing so, the Court held this included secondary service connection. Id; see also Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021); Long v. Wilkie, 33 Vet. App. 167, 174 (2020) (en banc), vacated on other grounds sub nom. Long v. McDonough, 38 F.4th 1063 (Fed. Cir. 2022).

Here, the left breast gynecomastia removal is rated under DC 7628, Benign neoplasms of gynecological system. This DC directs to rate chronic residuals to include scars, lymphedema, disfigurement, and/or other impairment of function under the appropriate diagnostic code(s) within the appropriate body system.

The record reflects that the Veteran has reported there may be manifestations of this condition other than the scar that have yet to be considered. Specifically, he has reported often waking up from sharp pain in his left breast from the surgery he had while in service. See April 2024 VA treatment record. He reported at an April 2024 VA examination that it started as a little ball under his nipple and it was removed. After the healing he still had a ball but it was not as prominent. In 2014-2015 he went to VA and talked to them about the residual pain. They were going to schedule another surgery but he decided not to do the surgery because of the damage from the first one. He stated he cannot sleep on that side due to sharp pain that causes him to wake up.

In light of the Veteran's competent and credible report as to additional manifestations that have not yet been fully addressed on examination, the Board finds that further information is necessary to properly consider, and rate, on a schedular basis, all of the manifestations of the Veteran's service-connected left breast gynecomastia removal and related scarring.

As such, on remand, a medical opinion should be obtained to determine whether there are any compensable left breast gynecomastia removal symptoms the Veteran may have for the period on appeal. Morgan; Bailey; Long. The opinion should address the degree of symptoms, to include symptoms related to the scar currently rated 10 percent, as the Veteran urges that the symptoms are in excess of the current rating for that condition as well.

Additionally, the most recent SSOC in this matter is dated in May 2023 and does not include review of subsequent VA examinations to include the April 2024 examinations and VA treatment records dated to December 2024 in the record. Records of the Veteran's VA treatment are constructively before VA. As such, remand is necessary to obtain updated medical records. See Lang v. Wilkie, 971 F.3d 1348 (Fed. Cir. 2020); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992).

Under the circumstances, the Board finds further that, after updated VA treatment records are requested and any available records are added to the record, examination to assess all current manifestations of these conditions is required. See Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) (an adequate VA medical examination must consider the Veteran's pertinent medical history).

The matters are REMANDED for the following action:

1. Obtain outstanding VA treatment records.

2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge as to the nature, extent and severity of all manifestations of these disabilities, and the impact of the disabilities on his ability to work.

The Veteran should be provided an appropriate amount of time to submit this lay evidence.

3. Obtain VA medical examinations and opinions to determine the current manifestations, nature and severity of the painful scar, anterior trunk related to left breast gynecomastia removal, and also to determine whether he has had any other symptoms that are manifestations of his left breast gynecomastia removal, and to determine the current nature and severity of his left breast gynecomastia removal.

This must specifically include any pain that limits the Veteran's motion of a body part, to specifically include arm pain.

The examiner(s) should provide a full description of the disability to include all manifestations.

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Nancy Rippel

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.

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