HEARING LOSS

JIMMY L. BARDIN · 2026 · Case ID: A26022041

MIXED

Summary

The Veteran served from September 1966 to October 1969. This case comes before the Board of Veterans' Appeals (Board) following rating decisions from June and July 2025. The Veteran appealed the initial noncompensable rating for bilateral hearing loss and sought increased ratings for several other conditions, including residuals of gunshot wounds to the left shoulder and left index finger, diabetes mellitus type 2 status post TIA, left and right lower extremity sciatic nerve neuropathy, and left knee degenerative arthritis. The Veteran also appealed the denial of service connection for scarring of the trunk and chest, left leg scar, and psoriasis on bilateral legs. Service connection for chloracne and right knee arthritis (secondary to left knee arthritis) was granted. The Board reviewed evidence of record at the time of the AOJ decisions, including a Board hearing held on October 29, 2025. The Board denied increased ratings for most conditions, granting only a 10 percent rating for the left shoulder scar and a 10 percent rating for residuals of the TIA. Service connection for chloracne, right knee arthritis, and bilateral leg psoriasis was granted. Importantly, the Board granted entitlement to TDIU, finding the Veteran's service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation.

Rationale

Audiometric testing showed hearing acuity below compensable levels.; Criteria for compensable rating not met per 38 CFR 4.85, 4.86.

Special Benefit

TDIU

Diagnostic Code

7804

Docket No.

250811-563955

Full Decision Text

Citation Nr: A26022041
Decision Date: 03/11/26 Archive Date: 03/11/26

DOCKET NO. 250811-563955
DATE: March 11, 2026

ORDER

A compensable rating for bilateral hearing loss is denied.

A compensable rating for scarring of the anterior trunk and chest status post gunshot wound is denied.

A rating higher than 30 percent for residuals of gunshot wound left shoulder is denied.

A 10 percent rating, but not more, for left shoulder scar residual of gunshot wound is granted.

A compensable rating for residuals of superficial fragmentation wound, left index finger injury, is denied.

A rating higher than 20 percent for diabetes mellitus type 2 status post trans ischemic attack (TIA) is denied.

A separate 10 percent rating for residuals of a trans ischemic attack (TIA) is granted.

A rating higher than 20 percent for left lower extremity sciatic nerve neuropathy is denied.

A rating higher than 20 percent for right lower extremity sciatic nerve neuropathy is denied.

A 30 percent rating, but not higher, for left knee degenerative arthritis status post total knee replacement is granted.

A 10 percent rating, but not higher, for left knee scar, status post total knee replacement, is granted.

A compensable rating for left leg scar, cyst removal is denied.

Service connection for chloracne is granted.

Service connection for right knee arthritis (claimed as right leg arthritis) is granted.

Service connection for psoriasis, bilateral legs, is granted.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted.

FINDINGS OF FACT

1. The Veteran's bilateral hearing loss has been manifested by hearing acuity of no worse than Level I in the right ear and no worse than Level I in the left ear.

2. The Veteran's scarring of the anterior trunk and chest status post gunshot wound affects a total area less than 144 square inches (929 sq. cm.), is not painful or unstable, is not due to burns or associated with underlying tissue damage, and occasionally tingles during cold weather that is analogous to no more than mild incomplete paralysis of the circumflex and/or long thoracic nerves.

3. The Veteran's 30 percent rating for residuals of gunshot wound left shoulder is the maximum rating available for a muscle injury of the minor shoulder.

4. The Veteran's left shoulder scar, residual of gunshot wound, is associated with underlying tissue damage, is painful, and affects an area no larger than 12 cm2.

5. The Veteran's superficial fragmentation wound, left index finger injury, manifests as a 1 cm2 asymptomatic scar.

6. The Veteran's diabetes mellitus type 2 status post trans ischemic attack (TIA) required only restricted diet and an oral glycemic agent during the period on appeal; he reported no more than mild residuals of his TIA.

7. The Veteran's left and right lower extremity sciatic nerve neuropathy manifest as manifest by sensory disturbance, including numbness, tingling, and decreased sensation, which is analogous to no more than mild incomplete paralysis.

8. The Veteran has undergone a total left knee replacement and is entitled to a minimum 30 percent rating; his left knee degenerative arthritis status post total knee replacement does manifests as severe painful motion or weakness and does not result in residuals that would warrant and intermediate rating between 30 and 60 percent.

9. The Veteran's left knee scar, status post total knee replacement, is painful.

10. The Veteran's left leg scar, cyst removal, affects a total area of 3 cm2, is not painful or unstable, is not due to burns or associated with underlying tissue damage, does not impair function, and has no other disabling effects not considered in the ratings schedule for scars.

11. The Veteran's chloracne is related to his in-service herbicide exposure.

12. The Veteran's right leg arthritis is due to service-connected left leg arthritis.

13. The Veteran's psoriasis, bilateral legs, is related to his in-service toxin exposure.

14. The Veteran's service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation.

CONCLUSIONS OF LAW

1. The criteria for a compensable rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

2. The criteria for a compensable rating for scarring of the anterior trunk and chest status post gunshot wound are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§
exposure.

14. The Veteran's service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation.

CONCLUSIONS OF LAW

1. The criteria for a compensable rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

2. The criteria for a compensable rating for scarring of the anterior trunk and chest status post gunshot wound are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802; 4.124a, Diagnostic Codes 8519-8520.

3. The criteria for a rating higher than 30 percent for residuals of gunshot wound, left shoulder, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.56. 4.73, Diagnostic Code 5302.

4. The criteria for a 10 percent rating, but not more, for left shoulder scar, residual of gunshot wound, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804.

5. The criteria for a compensable rating for residuals of superficial fragmentation wound, left index finger injury, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802.

6. The criteria for a rating higher than 20 percent for diabetes mellitus type 2 status post trans ischemic attack (TIA), are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.119, Diagnostic Code 7913.

7. The criteria for a separate 10 percent rating for residuals of a trans ischemic attack (TIA) are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8007.

8. The criteria for a rating higher than 20 percent for left lower extremity sciatic nerve neuropathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

9. The criteria for a rating higher than 20 percent for right lower extremity sciatic nerve neuropathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

10. The criteria for a 30 percent rating, but not higher, for left knee degenerative arthritis status post total knee replacement are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5055.

11. The criteria for a 10 percent rating, but not more, for left knee scar, status post total knee replacement, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804.

12. The criteria for a compensable rating for left leg scar, cyst removal are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802.

13. The criteria for service connection for chloracne are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

14. The criteria for service connection for right knee arthritis as secondary to service-connected left knee arthritis are met. 38 U
. The criteria for a compensable rating for left leg scar, cyst removal are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802.

13. The criteria for service connection for chloracne are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

14. The criteria for service connection for right knee arthritis as secondary to service-connected left knee arthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

15. The criteria for service connection for psoriasis, bilateral legs, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

16. The criteria for a total disability rating based on individual unemployability due to service-connected disability (TDIU) are met. 38 U.S.C. 1155, 5107; 38 C.F.R. 3.102, 3.340, 3.341, 4.3, 4.16(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1966 to October 1969.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from June 2025 and July 2025 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

In the August 11, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 29, 2025. Therefore, the Board may only consider the evidence of record at the time of the June 2025 and July 2025 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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.

Increased Ratings

1. A compensable rating for bilateral hearing loss

The Veteran was originally granted service connection for bilateral hearing loss in a June 2025 rating decision. At that time, this disability was assigned a noncompensable (0 percent) rating effective June 28, 2024. The Veteran has appealed this initial rating.

Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

A June 20, 2025, VA examination reveals that the Veteran reported difficulty understanding conversations without looking directly at the speaker and paying close attention. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows:

June 20, 2025 HERTZ

1000 2000 3000 4000 Avg CNC

RIGHT 20 25 65 75 46 100%

LEFT 20 30 70 95 54 94%

Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level I in the left ear. Entering the resulting bilateral numeric designation of Level I for both ears to 38 C.F.R. § 4.85, Table VII, equates to a noncompensable (0 percent) disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown.

At the October 2025 hearing, the Veteran testified that he was prescribed hearing aids but did not wear them because they amplified background noise and not conversation. He had difficulty hearing the television, the phone, and conversations. It was easier if he was looking at the speaker. His wife testified that he was unable to hear her scream when she fell in the driveway despite being nearby in the car with the windows and door open.

The November 2025 private evaluation notes that the Veteran could not hear at all without his hearing aids. These hearing aids malfunctioned outdoors, created overwhelming noise interference in restaurants and social situations. He was unable to process multiple sounds simultaneously, understand speech from behind, or hold a conversation while performing any other task. His television volume had to be extremely loud to allow him to follow the dialogue.

Based on the evidence above, a compensable rating for the Veteran's bilateral hearing loss is not warranted.

The Board expressly acknowledges its consideration of the private examiner's statements regarding functional impairment and the lay evidence regarding the functional loss due to the Veteran's hearing loss. The Veteran is competent to report difficulty hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992).

The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017).

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to a compensable rating for hearing loss. As the most probative evidence of record persuasively weighs against a compensable rating, 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. 202
acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017).

2. A compensable rating for scarring of the anterior trunk and chest status post gunshot wound

The Veteran was originally granted service connection for scarring of the anterior trunk and chest status post gunshot wound, in a July 2025 rating decision. At that time, this disability was assigned a noncompensable (0 percent) rating effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's scarring of the anterior trunk and chest status post gunshot wound is rated under Diagnostic Code 7802 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.

The June 2025 scars DBQ described the Veteran's anterior trunk and chest scars as stable and not painful. They were not due to burns. The right anterior chest scar measured 3 cm by 1 cm, the left anterior deltoid pectoral interval scar measured 6 cm by 1 cm, and the right rear flank scar measured 3 cm by 1 cm for a total affected area of 12 cm2. They were not tender to palpation or unstable upon inspection. They did not have underlying soft tissue damage. These scars did not result in limitation of function. There were no other pertinent physical findings, complications, conditions, signs, or symptoms associated with these scars. They did not impact the Veteran's ability to work.

At this October 2025 hearing, the Veteran testified that his chest and back scars were each about three inches long. These scars would occasionally tingle in cold weather.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under Diagnostic Code 7802 because the Veteran's scarring of the anterior trunk and chest status post gunshot wound is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater. The June 2025 scars DBQ found a total affected area of 12 cm2 and measured these scars as 1 cm wide. The Veteran's testimony only addresses the estimated length of the scars without indication of their width. Nevertheless, there is no indication that the total area affected is at least 144 square inches (929 sq. cm.). The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include tingling during cold weather, and these reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran does not assert, and medical treatment records do not show, that the Veteran's scarring of the anterior trunk and chest status post gunshot wound is manifest by an area or areas of 144 square inches (929 sq. cm.) or greater. Therefore, a higher disability rating is not warranted under the current diagnostic code.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's scarring of the anterior trunk and chest is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran's scarring of the anterior trunk and chest is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804 are inapplicable.

Finally, the Board has considered whether the Veteran's report of tingling during cold weather is a compensable other disabling effect not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under Diagnostic Code 7805. As the Veteran is reporting only occasional tingling, this is akin to no more than mild incomplete paralysis of the nearby nerve. The nearby circumflex and long thoracic nerves do not provide compensable ratings for mild incomplete paralysis. Therefore, compensable ratings are not available by analogy under Diagnostic Code 8518 or Diagnostic
scarring of the anterior trunk and chest is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804 are inapplicable.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for scarring of the anterior trunk and chest status post gunshot wound. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th 776.

3. A rating higher than 30 percent for residuals of gunshot wound left shoulder

The Veteran was originally granted service connection for status post gunshot wound left shoulder, in a July 1983 rating decision. At that time, this disability was assigned a 20 percent rating effective March 21, 1983.

The Veteran's Intent to File was received on June 28, 2024, and his current appeal was received March 20, 2025. The July 2025 rating decision increased this rating to 30 percent effective June 28, 2024.

The Veteran's residuals of gunshot wound left shoulder is rated under 38 C.F.R. § 4.73, Diagnostic Code 5302, which pertains to Muscle Group II regarding the extrinsic muscles of the shoulder girdle involved are the pectoralis major II (costosternal); latissimus dorsi and teres major (teres major, although technically an intrinsic muscle, is included with latissimus dorsi); pectoralis minor; and rhomboid. The functions of these muscles include the depression of arm from vertically overhead to hanging at side; downward rotation of scapula; and acting with Group III in forward and backward swing of arm. Under Diagnostic Code 5302, a noncompensable rating is provided for slight muscle disability of either the dominant or non-dominant side of the body. A 20 percent rating requires moderate disability of the minor and major arm. A 20 percent rating and a 30 percent rating are assigned for the minor and major arm, respectively, if impairment of this muscle group is moderately severe. A 30 percent rating and a 40 percent rating are assigned for the minor and major arm, respectively, if impairment of this muscle group is severe.

Under the criteria for rating muscle injuries, disabilities are characterized as slight, moderate, moderately severe, or severe. 38 C.F.R. § 4.56. The cardinal signs and symptoms of muscle disability are loss of power, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement.

The medical evidence of record indicates that the Veteran is right-hand dominant. See e.g., April 2025 shoulder conditions DBQ. As such, the left shoulder is the minor shoulder for VA purposes. Therefore, the current 30 percent rating is the maximum rating available for this disability under Diagnostic Code 5302. As the Veteran is in receipt of the highest schedular rating for impairment of the clavicle or scapula, there is no basis to award a higher rating.

The Board has considered the Veteran's October 2025 hearing testimony that his shoulder responded to the rainy or cold weather with pain "jabbing a bunch of needles in my arm" in the location of his gunshot wound. He occasionally had trouble putting his shirt on. One time, his shoulder gave out at work and he had to drive home and wait until it warmed up to regain feeling. He moved to a warmer climate on his doctor's recommendation. During the winter, he treated the pain with over-the-counter pain patches. The Veteran's symptoms are consistent with the cardinal signs of and symptoms of muscle disability listed above. 38 C.F.R. § 4.56. Therefore, there are no remaining symptoms to be compensated under a separate diagnostic code.

Finally, the Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide a higher disability rating. However, the Board notes that no other diagnostic code
He occasionally had trouble putting his shirt on. One time, his shoulder gave out at work and he had to drive home and wait until it warmed up to regain feeling. He moved to a warmer climate on his doctor's recommendation. During the winter, he treated the pain with over-the-counter pain patches. The Veteran's symptoms are consistent with the cardinal signs of and symptoms of muscle disability listed above. 38 C.F.R. § 4.56. Therefore, there are no remaining symptoms to be compensated under a separate diagnostic code.

Finally, the Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide a higher disability rating. However, the Board notes that no other diagnostic code for muscle groups of the "Shoulder Girdle and Arm" assign a rating higher than 30 percent for the minor shoulder. See 38 C.F.R. § 4.73, Diagnostic Codes 5301 through 5309.

As the Veteran already has the maximum schedular disability rating, the appeal is denied.

4. A compensable rating for left shoulder scar residual of gunshot wound

The Veteran was originally granted service connection for left shoulder scar residual of gunshot wound, in a July 2025 rating decision. At that time, this disability was assigned a noncompensable (0 percent) rating effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's left shoulder scar residual of gunshot wound is rated under Diagnostic Code 7801 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.

The April 2025 scars DBQ described the Veteran's left shoulder scars as stable and not due to burns. The anterior left shoulder scar and posterior left shoulder scar were painful. These scars measured 9 cm by .5 cm (anterior) and 3 cm by .5 cm (posterior) for a total affected area of 6 cm2. Both were tender to palpation. They were not unstable upon inspection and did not have underlying soft tissue damage. These scars did not result in limitation of function. There were no other pertinent physical findings, complications, conditions, signs, or symptoms associated with this scar. They did not impact the Veteran's ability to work.

The June 2025 scars DBQ described the Veteran's left shoulder scar as stable and not painful. It was not due to burns. This scar measured 4 cm by 3 cm for a total affected area of 12 cm2. It was not tender to palpation or unstable upon inspection. It had underlying soft tissue damage. This scar did not result in limitation of function. There were no other pertinent physical findings, complications, conditions, signs, or symptoms associated with this scar. It did not impact the Veteran's ability to work.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable rating under Diagnostic Code 7801 for scars associated with underlying soft tissue damage because the Veteran's left shoulder scar residual of gunshot wound covers an area less than 6 square inches (39 sq. cm.).

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's left shoulder scar residual of gunshot wound is not of the head, face, or neck. It does not cover an area or areas of 144 square inches or greater. Moreover, the evidence of record does not show limitation of function or any other pertinent physical findings, complications, conditions, signs, or symptoms associated with this scar. Therefore, Diagnostic Codes 7800, 7802, and 7805 are inapplicable.

With regard to Diagnostic Code 7804, there is conflicting evidence regarding whether the Veteran's scar is painful. The April 2025 scars DBQ found two painful but not unstable left shoulder scars. The June 2025 scars DBQ did not find any painful scars.

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.

Based on the above, the Board finds that a 10 percent rating for painful scars under Diagnostic Code 7804 is warranted and to this extent the appeal is granted.

5. A compensable rating for
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.

Based on the above, the Board finds that a 10 percent rating for painful scars under Diagnostic Code 7804 is warranted and to this extent the appeal is granted.

5. A compensable rating for residuals of superficial fragmentation wound, left index finger injury

The Veteran was originally granted service connection for superficial fragmentation wound, left index finger injury, in a June 2025 rating decision. At that time, this disability was assigned a 10 percent rating effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's residuals of superficial fragmentation wound, left index finger injury are rated under Diagnostic Code 7802 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.

The June 2025 scars DBQ described the Veteran's left hand scar as stable and not painful. It was not due to burns. This scar measured 1 cm by 1 cm for a total affected area of 1 cm2. It was not tender to palpation or unstable upon inspection. It did not have underlying soft tissue damage. This scar did not result in limitation of function. There were no other pertinent physical findings, complications, conditions, signs, or symptoms associated with this scar. It did not impact the Veteran's ability to work.

At the October 2025 hearing, the Veteran testified that his finger had healed really well and did not bother him much.

Based on the above, the Board finds that the Veteran's superficial fragmentation wound, left index finger injury, manifests as a small (1 cm2) asymptomatic scar.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under Diagnostic Code 7802 because the Veteran's left index finger scar is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's left index finger scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran's left index finger scar is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804 are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under Diagnostic Code 7805.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for superficial fragmentation wound, left index finger injury. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th 776.

6. A rating higher than 20 percent for diabetes mellitus type 2

7. A separate 10 percent rating for residuals of a trans ischemic attack (TIA)

The Veteran was originally granted service connection for diabetes mellitus type 2 in a November 2009 rating decision. At that time, this disability was assigned a 20 percent rating effective January 21, 2009.

In a June 2010 rating decision, this rating was reduced to 10 percent effective September 1, 2010. Then, in an April 2018 rating decision, this rating was increased to 20 percent effective February 21, 2018.

The Veteran's current Intent to File for the current appeal was received June 28, 2024.

In the July 2025 rating decision on appeal, the Veteran's diabetes mellitus was recharacterized as diabetes mellitus type 2 status post trans ischemic attack (TIA) effective June 28, 2024, and the 20 percent rating was continued.

The Veteran's diabetes is currently rated under 38 C.F.R. § 4.119, Diagnostic Code 7913. Diagnostic Code 7913 provides
10 percent effective September 1, 2010. Then, in an April 2018 rating decision, this rating was increased to 20 percent effective February 21, 2018.

The Veteran's current Intent to File for the current appeal was received June 28, 2024.

The Veteran's diabetes is currently rated under 38 C.F.R. § 4.119, Diagnostic Code 7913. Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is warranted when diabetes requires one or more daily injection of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injection of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is warranted when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated.

Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1).

Because Diagnostic Code 7913 contains successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran's favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018).

The question in this appeal is whether the Veteran's diabetes mellitus required one or more daily injections of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. This criterion requires medical evidence. Camacho v. Nicholson, 21 Vet. App. 360, 364-65 (2007).

The April 2025 diabetes mellitus DBQ found diabetes mellitus managed by restricted diet and a prescribed oral hypoglycemic agent. The Veteran visited his diabetic care provider for episodes of ketoacidosis less than twice per month. Likewise, he visited his diabetic care provider for episodes of hypoglycemic reaction less than twice per month. In the twelve-month period, the Veteran had not had any episodes of ketoacidosis or hypoglycemic reaction. He had not had progressive unintentional weight loss and loss of strength attributable to diabetes mellitus. The Veteran had the diabetic complication of diabetic peripheral neuropathy. He also had a skin condition and a stroke (TIA) due to his diabetes mellitus. No other condition was noted to be due to or aggravated by the Veteran's diabetes mellitus. Functionally, the Veteran's diabetes mellitus did not impact his ability to work.

The May 2025 diabetic sensory-motor peripheral neuropathy DBQ diagnosed diabetic peripheral neuropathy of the bilateral feet. The Veteran reported current symptoms of numbness and daily tingling in both feet. His symptoms were noted to be mild numbness and paresthesias/dysesthesias in the bilateral lower extremities. His muscle strength and deep tendon reflexes were normal throughout. He had decreased light touch sensation, positions sense, and vibration sensation in the bilateral lower extremities. He did not have muscle atrophy or trophic changes. Ultimately, this examiner found mild
by the Veteran's diabetes mellitus. Functionally, the Veteran's diabetes mellitus did not impact his ability to work.

The May 2025 diabetic sensory-motor peripheral neuropathy DBQ diagnosed diabetic peripheral neuropathy of the bilateral feet. The Veteran reported current symptoms of numbness and daily tingling in both feet. His symptoms were noted to be mild numbness and paresthesias/dysesthesias in the bilateral lower extremities. His muscle strength and deep tendon reflexes were normal throughout. He had decreased light touch sensation, positions sense, and vibration sensation in the bilateral lower extremities. He did not have muscle atrophy or trophic changes. Ultimately, this examiner found mild incomplete paralysis of the bilateral sciatic nerves. The Veteran did not have any associated scars or other pertinent physical findings, complications, conditions, signs, or symptoms. This disability did not impact the Veteran's ability to work.

The May 2025 central nervous system and neuromuscular diseases DBQ noted a transient ischemic attack in 2024 but reported on current symptoms. The Veteran did not use continuous medication to control this disability. He did not have an infectious condition. He did not report any associated muscle weakness in the upper and/or lower extremities, pharynx and/or larynx and/or swallowing conditions, respiratory conditions, sleep disturbances, bowel incontinence, gastrointestinal symptoms, voiding dysfunction, or recurrent symptomatic urinary tract infections. Neurologic examination found normal speech, gait, strength, and reflexes. There was no associate muscle atrophy. The Veteran did not have an associated neoplasm or metastases. The Veteran did not have any associated scars or other pertinent physical findings, complications, conditions, signs, or symptoms. He did not have any associated depression, cognitive impairment or dementia, or other mental health conditions. The Veteran did not use an assistive device as a normal mode of locomotion. This disability did not result in functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. This disability did not impact the Veteran's ability to work. Ultimately, the examiner found that the Veteran's symptoms had resolved.

At his October 2025 hearing, the Veteran testified that his lone residual from his stroke was a balance issue that prevented him from turning quickly or standing on one foot for any period of time. He treated his diabetes with oral medication and diet. He also reported numbness more than pain in his bilateral lower extremities unless he tried to kneel.

The December 2025 central nervous system and neuromuscular diseases DBQ noted a 2009 Bell's palsy diagnosis and a July 2023 ischemic stroke. The Veteran reported impaired balance and speech since his stroke. This examiner noted mild left sided droop, mild incoherence, and labile emotion. The Veteran did not use continuous medication to control this disability. He did not have an infectious condition. He did not report any associated muscle weakness in the upper and/or lower extremities, pharynx and/or larynx and/or swallowing conditions, respiratory conditions, sleep disturbances, bowel incontinence, gastrointestinal symptoms, voiding dysfunction, or recurrent symptomatic urinary tract infections. Neurologic examination found normal speech, gait, strength, and reflexes. There was no associate muscle atrophy. The Veteran did not have an associated neoplasm or metastases. The Veteran did not have any associated scars. He did not have any associated depression, cognitive impairment or dementia, or other mental health conditions. The Veteran did not use an assistive device as a normal mode of locomotion. This disability did not result in functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. This disability impacted the Veteran's ability to work in that he reported safety concerns with activities due to balance.

Based on the above, the Board finds that the Veteran's diabetes mellitus required only restricted diet and an oral glycemic agent during the period on appeal. The Veteran does not allege and the medical evidence of record does not suggest that regulation of activities was required during the period on appeal.

Accordingly, the evidence of record persuasively weighs against assigning a rating higher than 20 percent during the period on appeal.

With regard to the Veteran's diabetic complications, his left and right lower extremity sciatic nerve neuropathy are addressed separately below. His associated stroke is most analogous to the vascular conditions under Diagnostic Codes 8007 to 8009 (embolism, thrombosis, or hemorrhage of the blood vessels in the brain. Here, his stroke residuals and characterized
the Veteran's diabetes mellitus required only restricted diet and an oral glycemic agent during the period on appeal. The Veteran does not allege and the medical evidence of record does not suggest that regulation of activities was required during the period on appeal.

Accordingly, the evidence of record persuasively weighs against assigning a rating higher than 20 percent during the period on appeal.

With regard to the Veteran's diabetic complications, his left and right lower extremity sciatic nerve neuropathy are addressed separately below. His associated stroke is most analogous to the vascular conditions under Diagnostic Codes 8007 to 8009 (embolism, thrombosis, or hemorrhage of the blood vessels in the brain. Here, his stroke residuals and characterized by no more than mild speech impairment and subjective balance complaints. While insufficient to warrant a compensable rating elsewhere, this is sufficient to trigger the 10 percent minimum under these diagnostic codes. Therefore, the Board finds that a separate 10 percent rating for residuals of a TIA is warranted.

8. A rating higher than 20 percent for left lower extremity sciatic nerve neuropathy

9. A rating higher than 20 percent for right lower extremity sciatic nerve neuropathy

The Veteran was originally granted service connection for left and right lower extremity sciatic nerve neuropathy in a July 2025 rating decision. At that time, these disabilities were each assigned a 20 percent rating effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's left and right lower extremity sciatic nerve neuropathy are rated under Diagnostic Code 8520 for paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R § 4.124a.

The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. As with any regulatory interpretation where the terms are not defined in the regulation, we presume those terms carry their ordinary dictionary meaning. See Moody v. Wilkie, 30 Vet. App. 329, 336 (2018). The Board finds that these terms are unambiguous and, therefore, a plain dictionary meaning is an appropriate definition. Cf. Kisor v. Wilkie, 139 S. Ct. 2400, 2415 (2019); see also 38 C.F.R. § 4.6 (noting, in general, the Board does not evaluate evidence by applying a mechanical formula, but rather conscientiously to the end that its decisions are equitable and just). According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "mild" means gentle in nature or temperate. "Moderate" means limited in scope or effect or average in amount, intensity, quality, or degree. Webster's New World Dictionary (2nd ed. 1999), 1012. "Severe" means very painful or harmful or of a great degree. "Moderately severe" is not defined but would fall in between those two descriptions. Although a medical examiner's use of descriptive terminology such as "mild" is an element of evidence to be considered by the Board, it is not dispositive of an issue. The Board must evaluate all evidence before arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor
trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017).

Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017).

Based on the above, the Board finds that the disability is primarily manifest by sensory disturbance, including numbness, tingling, and decreased sensation. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, trophic changes, loss of reflexes, pain, muscle atrophy, or complete paralysis. Functionally, these disabilities are not shown to impact the Veteran's ability to work. No individual symptom is found to be more severe than mild. Moreover, the combination of symptoms is not shown to result in functional impairment akin to at least moderate incomplete paralysis as required for the next higher rating. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis of the left and right lower extremity sciatic nerve neuropathy.

The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating higher than 20 percent for either left or right lower extremity sciatic nerve neuropathy. As the evidence of record persuasively weighs against a rating higher than 20 percent, 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).

10. A rating higher than 10 percent for left knee degenerative arthritis status post total knee replacement

The Veteran was originally granted service connection for left knee degenerative arthritis status post total knee replacement in a June 2025 rating decision. At that time, this disability was assigned a 10 percent rating effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's left knee disability is currently rated under hyphenated diagnostic code 5003-5260. Hyphenated diagnostic codes are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen.
Fed. Cir. 2021).

10. A rating higher than 10 percent for left knee degenerative arthritis status post total knee replacement

Diagnostic Code 5003 provides rating criteria for degenerative arthritis other than post-traumatic, and Diagnostic Code 5260 provides rating criteria for limitation of flexion of the leg. In this case, VA treatment records and the June 2025 knee conditions DBQ confirm that the Veteran underwent a total left knee replacement in or around June 2017, prior to the appeals period. The rating schedule has a specific diagnostic code for total knee replacements: DC 5055. Therefore, the Diagnostic Code assigned should have been Diagnostic Code 5055. For this reason, the Board is changing the Diagnostic Code for his left knee disability to 5055 to reflect the actual disability. 38 C.F.R. § 4.71a.

Diagnostic Code 5055 provides a minimum 30 percent rating for total knee replacements. 38 C.F.R. § 4.71a; see generally Duran v. McDonough, 36 Vet. App. 230 (2023) (addressing similar language in diagnostic code 8004 for manifestations of Parkinson's). Additionally, a 60 percent rating is assigned when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity. Intermediate degrees (i.e., between a 30 percent and 60 percent rating) of residual weakness, pain or limitation of motion following a total knee replacement are to be rated by analogy under Diagnostic Codes 5256, 5261, or 5262. 38 C.F.R. § 4.71a, Diagnostic Code 5055.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of fl
Vet. App. 1 (2011).

The June 2025 knee and lower leg conditions DBQ notes that the Veteran did not describe current symptoms since the total knee replacement. He did not report flare-ups, functional loss, functional impairment, instability, recurrent subluxation, or frequent effusion. He had full range of motion in the both knees without evidence of pain, crepitus, or localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing without additional loss of function or range of motion after three repetitions. The Veteran was not being examined immediately after repeated use over time and the procured evidence suggested that pain, locking, and stiffness significantly limited his bilateral knee functional ability after repeated use over time. This examiner estimated that this equated to no additional limitation of flexion or extension. The Veteran was not being examined during a flare-up and the procured evidence did not suggest that pain, fatiguability, weakness, lack of endurance, or incoordination significantly limited his left or right knee functional ability during a flare-up. There were no additional factors contributing to disability. He did not have muscle atrophy. He did not have ankylosis of either knee. Neither knee had recurrent subluxation, persistent instability, or patellar instability. There was no history of or current ligament tear or meniscus condition in either knee. There was no history of or current diagnosis of recurrent patellar dislocation, chronic exertional compartment syndrome, shin splints, stress fractures, or any other tibial or fibular impairment. Stability testing was performed bilaterally and no joint instability was shown. The Veteran had undergone total knee replacement surgery on both knees. He had an associated scar, but no other pertinent physical findings, complications, signs, or symptoms. The Veteran did not use an assistive device as a normal mode of locomotion. Functionally, the examiner noted that this disability impacted the Veteran's ability to work but noted that the Veteran denied any significant impairment following his knee replacement.

Based on the above, the Board finds that the Veteran's left knee degenerative arthritis status post total knee replacement warrants the minimum 30 percent rating under Diagnostic Code 5055, but not more. The record does not suggest any chronic residuals following the Veteran's total knee replacement, much less severe painful motion or weakness in the affected extremity as required for a 60 percent rating under Diagnostic Code 5055. There was no finding of ankylosis, so a rating between 30 and 60 percent under DC 5256 is not warranted. Likewise, the Veteran has full range of both flexion and extension, so a rating between 30 and 60 percent under Diagnostic Code 5260 or Diagnostic Code 5261 is not warranted. Finally, there is no evidence of malunion or nonunion of the left tibia and fibula, so a rating between 30 and 60 percent under DC 5262 is not warranted. Therefore, the minimum rating of 30 percent, but no more, is warranted and to that extent the appeal is granted.

The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

The evidence of record does not show joint instability so a rating under DC 5257 is not warranted. Likewise, there is no evidence of a meniscal condition that would warrant a compensable rating under DC 5258 or DC 5259. Finally, the record does not show genu recurvatum;
not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

11. A compensable rating for left knee scar, status post total knee replacement

The Veteran was originally granted service connection for left knee scar in a June 2025 rating decision. At that time, this disability was assigned a noncompensable (0 percent rating) effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's left knee scar is rated under Diagnostic Code 7802 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.

The June 2025 scars DBQ described the Veteran's left knee scar as stable and not painful. It was not due to burns. This scar measured 14 cm by 1 cm for a total affected area of 14 cm2. It was not tender to palpation or unstable upon inspection. It did not have underlying soft tissue damage. This scar did not result in limitation of function. There were no other pertinent physical findings, complications, conditions, signs, or symptoms associated with this scar. It did not impact the Veteran's ability to work.

At his October 2025 hearing, the Veteran testified that his left knee scar was painful when kneeling. It was six inches long.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under Diagnostic Code 7802 because the Veteran's left knee scar is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's left knee scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Therefore, Diagnostic Codes 7800 and 7801 are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under Diagnostic Code 7805.

There is conflicting evidence as to whether this scar is painful. The VA examiner did not find pain on examination but the Veteran reported pain with kneeling at the time of his hearing. The Board will resolve doubt in the Veteran's favor and accept his lay evidence of scar pain. Under Diagnostic Code 7804, a single scar that is unstable or painful warrants a 10 percent rating. Thus, a 10 percent rating (under Diagnostic Code 7804) but no more is granted for the Veteran's left knee scar.

12. A compensable rating for left leg cyst removal scar

The Veteran was originally granted service connection for left leg scar in a June 2025 rating decision. At that time, this disability was assigned a noncompensable (0 percent rating) effective June 28, 2024. The Veteran has appealed this initial rating.

The Veteran's left leg cyst removal scar is rated under Diagnostic Code 7802 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.

The June 2025 scars DBQ described the Veteran's left leg cyst removal scar as stable and not painful. This scar measured 3 cm by 1 cm for a total affected area of 3 cm2. It was not tender to palpation or unstable upon inspection. It did not have underlying soft tissue damage. This scar did not result in limitation of function. There were no other pertinent physical findings, complications, conditions, signs, or symptoms associated with this scar. It did not impact the Veteran's ability to work.

Based on the above, the Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under Diagnostic Code
.R. § 4.118.

Based on the above, the Board finds that the evidence of record persuasively weighs against the assignment of a compensable evaluation under Diagnostic Code 7802 because the Veteran's left leg cyst removal scar is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater even when combined with the left knee scar.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's left leg scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran's left leg scar is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804 are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under Diagnostic Code 7805.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for left leg scar. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th 776.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

1. Service connection for chloracne

As an initial matter, the Board notes that the June 2025 decision found in-service participation in a toxic risk exposure activity (TERA) and presumed exposure to herbicide agents due to service in the Republic of Vietnam.

Chloracne is a disease for which presumptive service connection is provided if such manifested to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to herbicide agents during service. 38 C.F.R. §§ 3.307(a)(6)ii, (d), 3.309(e). Here, however, there is no evidence showing a compensable level of chloracne during the presumptive period

The November 2025 private physician's evaluation diagnosed chloracne and found that it was at least as likely as not aggravated or influenced by the environmental toxic exposures he experienced during military service, including exposure herbicide agents.

Upon review of the record, the Board concludes that the Veteran has a current diagnosis of chloracne that is related to in-service herbicide and toxin exposure. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Accordingly, the Board finds that service connection for chloracne is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Service connection for right knee arthritis

As an initial matter, the Board notes that the June 2025 decision found a current diagnosis of right knee arthritis and in-service participation in a toxic risk exposure activity (TERA).

The November 2025 private examiner opined that it is at least as likely as not due to or the result of the service-connected left knee arthritis. Upon review of the record, the Board concludes that the Veteran has a current diagnosis of right knee arthritis that is related to his service-connected left knee arthritis. Accordingly
, the Board finds that service connection for chloracne is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Service connection for right knee arthritis

As an initial matter, the Board notes that the June 2025 decision found a current diagnosis of right knee arthritis and in-service participation in a toxic risk exposure activity (TERA).

The November 2025 private examiner opined that it is at least as likely as not due to or the result of the service-connected left knee arthritis. Upon review of the record, the Board concludes that the Veteran has a current diagnosis of right knee arthritis that is related to his service-connected left knee arthritis. Accordingly, the Board finds that service connection for right knee arthritis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Service connection for psoriasis, bilateral legs

As an initial matter, the Board notes that the June 2025 decision found a current diagnosis of psoriasis and in-service participation in a toxic risk exposure activity (TERA).

Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim.

The evidence against the claim includes the June 2025 VA examiner's opinion, which was relied on a failure of current medical literature to show causation for psoriasis based on toxic exposures like the Veteran's.

The evidence in favor of the claim includes the November 2025 private physician's opinion, which found that it was at least as likely as not that the Veteran's psoriasis was aggravated or influenced by the environmental toxic exposures he experienced during military service. Although direct epidemiologic studies linking psoriasis specifically to these exposures are not available yet, the mechanistic pathways involving immune dysregulation, hypersensitivity priming, metabolic activation, and redox stress provide a medically reasonable basis for a medical nexus in this case.

Upon review of the record, the Board concludes that the Veteran has a current diagnosis of psoriasis that is related to in-service participation in a TERA. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Accordingly, the Board finds that service connection for psoriasis of the bilateral legs is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

TDIU

The Veteran raised the issue of TDIU at his October 2025 Board hearing so this issue is now before the Board. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). Here, the Veteran is service connected for a left shoulder gunshot wound, diabetes with bilateral lower extremity neuropathy, left knee replacement, anxiety, hearing loss, tinnitus, residuals of a left finger injury, and multiple scars.

The Veteran did not work during this period. Moreover, after his hearing, the Veteran submitted a private physician's opinion, stating that the Veteran has orthopedic, cardiac, metabolic, neurologic, dermatologic, systemic, and psychiatric disabilities. Based on their severity and interaction, this physician found that the cumulative impact of all of the Veteran's service-connected disabilities, is that it is at least as likely as not that he is unable to secure or follow substantially gainful employment. Given the severity and wide-reaching nature of his impairments, the Board finds that the Veteran's combination of disabilities renders him unable to secure or follow a substantially gainful occupation.

Therefore, the Board finds that service-connected disabilities preclude the Veteran from the ability to secure and follow a substantially gainful occupation consistent with the Veteran's education, skills, training, and work history. Accordingly, a TDIU is warranted.

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Houbeck, Bridgid

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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