PANCREATITIS

Summary

The Veteran, who served in the U.S. Coast Guard from December 2006 to April 2020, appeals the denial of an increased rating for pancreatitis with cholangitis status-post cholecystectomy and for keloid scars of the abdomen status-post cholecystectomy. The Board reviewed the evidence of record at the time of the January 2021 rating decision, including the Veteran's testimony from a November 2024 hearing. For pancreatitis, the Veteran currently has a noncompensable rating. The Board found the Veteran's testimony credible regarding attacks of abdominal pain, establishing at least one recurrent attack of severe abdominal pain in the past year, thus warranting a 10 percent rating. However, the evidence did not support a higher rating as the Veteran did not experience four to seven moderately severe attacks annually. For the abdominal scars, the VA examiner noted two keloid scars measuring 28 sq. cm. that were not described as painful. The Board found the Veteran's testimony credible that the scars are painful, resolving doubt in her favor and granting a 10 percent rating under Diagnostic Code 7804 for one or two painful scars. The Board found that the evidence did not support a rating higher than 10 percent for either condition, and the benefit-of-the-doubt rule did not apply as the evidence weighed against higher ratings.

Rationale

Veteran's testimony regarding abdominal pain attacks found credible; Evidence supports at least one recurrent attack of severe abdominal pain; Evidence does not support four to seven moderately severe attacks annually

Full Decision Text

Citation Nr: A26018487
Decision Date: 03/02/26	Archive Date: 03/02/26

DOCKET NO. 210126-140390
DATE: March 2, 2026

ORDER

Entitlement to an initial 10 percent rating, but no higher, for pancreatitis with cholangitis status-post cholecystectomy is granted.

Entitlement to an initial 10 percent rating, but no higher, for a keloid scars of the abdomen status-post cholecystectomy is granted.

FINDINGS OF FACT

1. Resolving all reasonable doubt in favor of the Veteran, the Veteran's pancreatitis manifested with at least one recurrent attack of typical severe abdominal pain in the past year.

2. Resolving all reasonable doubt in favor of the Veteran, the Veteran's two keloid scars of the abdomen status-post cholecystectomy are painful.

CONCLUSIONS OF LAW

1. The criteria for a 10 percent rating, but no higher, for pancreatitis with cholangitis status-post cholecystectomy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7347.

2. The criteria for a 10 percent rating, but no higher, for two anterior trunk surgical scars have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Coast Guard from December 2006 to April 2020. 

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ).

In a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD) received later that month, the Veteran elected the Hearing option; therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

In November 2024, the Veteran testified before a Veterans Law Judge at a video conference hearing. A transcript of the hearing is of record.

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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

The veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In a claim for a greater original rating after an initial award of service connection, all of the evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). VA must determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a "staged rating." See Fenderson, 12 Vet. App at 119.

Where there is a question as to
 original rating after an initial award of service connection, all of the evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). VA must determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a "staged rating." See Fenderson, 12 Vet. App at 119.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

When all the evidence is assembled, VA is responsible for determining whether the weight of the evidence is in approximate balance. If the positive and negative evidence is evenly or approximately balanced, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

1. Entitlement to an initial 10 percent rating, but no higher, for pancreatitis with cholangitis status-post cholecystectomy is granted.

The Veteran contends that her pancreatitis with cholangitis status-post cholecystectomy is worse than her current rating reflects. 

The Veteran is currently in receipt of a noncompensable rating for pancreatitis with cholangitis status-post cholecystectomy under Diagnostic Code 7347.

Under Diagnostic Code 7347, a 10 percent rating is warranted for pancreatitis with at least one recurrent attack of typical severe abdominal pain in the past year. A 30 percent rating is warranted for moderately severe pancreatitis with at least four to seven typical attacks of abdominal pain per year with good remission between attacks. A 60 percent rating is warranted for pancreatitis with frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks. A 100 percent rating is warranted for pancreatitis with frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea, and severe malnutrition.

Words such as "mild," "moderate," and "severe" are not defined in the rating 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. See 38 C.F.R. § 4.6. Use of terminology such as "severe" by VA examiners and others, although 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 Veteran underwent a VA Gallbladder and Pancreas Conditions examination in July 2020. On examination, diagnoses of pancreatitis with chronic cholangitis, status post cholecystectomy, or removal of the gall bladder.

The VA examiner found there was no need for continuous medication for control of symptoms and there were no observable symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions.

No other pertinent physical findings, complications, signs or symptoms were observed other than scarring, assessed in detail below. No functional impact was noted.

During the Veteran's November 2024 hearing, she testified that she experiences attacks of abdominal pain, describing dealing with these symptoms while working as a teacher as well as an occurrence while she was at the store with her husband that left her doubled over in pain.

Based on the Veteran's credible testimony, the Veteran's pancreatitis was productive of at least one recurrent attack of typical severe abdominal pain in the past year.

A higher 30 percent rating under Diagnostic Code 7347 is not warranted unless the Veteran's pancreatitis is moderately severe with at least four to seven typical attacks of abdominal pain per year with good remission between attacks. Although the Board finds the Veteran's testimony credible regarding instances of attacks of abdominal pain, during the relevant period from May 2020 to January 2021, the evidence does not show that the Veteran had at least four moderately severe attacks in the past year, but rather showed approximately three mild attacks.

Thus, during the appeal period, the Veteran's pancreatitis did not manifest as moderately severe with at least four to seven typical attacks of abdominal pain per year with good remission between attacks. Accordingly, the Veteran's pancreatitis
.

A higher 30 percent rating under Diagnostic Code 7347 is not warranted unless the Veteran's pancreatitis is moderately severe with at least four to seven typical attacks of abdominal pain per year with good remission between attacks. Although the Board finds the Veteran's testimony credible regarding instances of attacks of abdominal pain, during the relevant period from May 2020 to January 2021, the evidence does not show that the Veteran had at least four moderately severe attacks in the past year, but rather showed approximately three mild attacks.

Thus, during the appeal period, the Veteran's pancreatitis did not manifest as moderately severe with at least four to seven typical attacks of abdominal pain per year with good remission between attacks. Accordingly, the Veteran's pancreatitis does not more nearly approximate that criteria corresponding to a 30 percent rating. A higher 30 percent rating is not warranted, therefore, the Veteran's claim for a rating in excess of 10 percent must be denied.  

In summary, there is sufficient evidence to support a rating of 10 percent for the entire period on appeal. However, the most probative evidence of record persuasively weighs against a rating in excess of 10 percent for pancreatitis with cholangitis status-post cholecystectomy; and to that extent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to an initial 10 percent rating, but no higher, for a keloid scars of the abdomen status-post cholecystectomy is granted.

The Veteran's anterior flank surgical scars are assigned a noncompensable rating under Diagnostic Code 7802. 38 C.F.R. § 4.130.

Diagnostic Code 7800 pertains to scars or other disfigurement of the head, face and neck and is not applicable in this case.

Diagnostic Code 7801 is for 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.

Diagnostic Code 7802 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. Area or areas of 144 square inches (929 sq. cm.) or greater warrant a 10 percent rating.

Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id.

Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 are to be evaluated under an appropriate diagnostic code.

Turning to the evidence of record, the Veteran was afforded a VA examination in July 2020. The Veteran reported that she underwent a cholecystectomy in 2013 and an additional procedure related to the Veteran's pancreatitis with cholangitis in 2019. The examiner observed that there were two keloid scars on the Veteran's anterior trunk, measuring 23 cm. in length and 1 cm in width and measuring 2 cm x 2.5 cm that were not described as painful. The total area was 28 sq. cm. The scars were not unstable with frequent loss of covering of skin over the scar nor were the scars due to burns. The scars were not noted to be painful and no functional impact was observed.

However, based on the Veteran's credible testimony that her post-cholecystectomy surgical scars are painful during her November 2024 hearing, the Board resolves all reasonable doubt in the Veteran's favor and finds that the evidence demonstrates that the Veteran's post-cholecystectomy surgical scars have manifested by pain throughout the relevant period. Therefore, the criteria for a 10 percent rating under Diagnostic Code 7804 effective the date of the Veteran's claim based on the presence of one or two painful scars have been met.

Thus, resolving all reasonable doubt in favor of the Veteran, throughout the period on appeal, a 10 percen rating, but no higher, for painful scars as a residual of a cholecystectomy is granted.

In summary, there is sufficient evidence to support a rating of 
-cholecystectomy surgical scars are painful during her November 2024 hearing, the Board resolves all reasonable doubt in the Veteran's favor and finds that the evidence demonstrates that the Veteran's post-cholecystectomy surgical scars have manifested by pain throughout the relevant period. Therefore, the criteria for a 10 percent rating under Diagnostic Code 7804 effective the date of the Veteran's claim based on the presence of one or two painful scars have been met.

Thus, resolving all reasonable doubt in favor of the Veteran, throughout the period on appeal, a 10 percen rating, but no higher, for painful scars as a residual of a cholecystectomy is granted.

In summary, there is sufficient evidence to support a rating of 10 percent for the entire period on appeal. However, the most probative evidence of record persuasively weighs against a rating in excess of 10 percent for the Veteran's abdominal keloid scars; and to that extent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rosenthal, Ariana

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.