SCARS OTHER

Summary

The veteran, who served from September 1977 to January 1999, appeals a August 2020 rating decision. The veteran sought an increased evaluation for a service-connected scar from pilonidal cyst removal, but this claim was denied. The Board found the scar should be rated under Diagnostic Code 7804 for painful scars, warranting a 10 percent rating, and that the prior continuation of a noncompensable rating under DC 7802 was error. The Board denied an increased evaluation for the scar. The veteran also sought increased evaluations for intervertebral disc syndrome with lumbar strain, left knee patellofemoral syndrome with osteomalacia, and right knee patellofemoral syndrome with osteomalacia. These claims were remanded because the VA examiner failed to opine on the ameliorative effects of medication, which is a pre-decisional duty-to-assist error. Finally, the claim for a compensable evaluation for service-connected onychomycosis on bilateral toenails was remanded due to an inadequate VA examination that failed to distinguish between the veteran's bilateral feet condition and his service-connected pseudofolliculitis barbae, necessitating a new examination to determine the severity of the toenail condition.

Rationale

Scar is painful; Warranted 10% under DC 7804; Increased evaluation denied

Full Decision Text

Citation Nr: A26027624
Decision Date: 03/26/26	Archive Date: 03/26/26

DOCKET NO. 201216-130603
DATE: March 26, 2026

ORDER

Entitlement to an evaluation in excess of 10 percent for service-connected scar from pilonidal cyst removal is denied.

REMANDED

Entitlement to an evaluation in excess of 20 percent for service-connected intervertebral disc syndrome with lumbar strain is remanded.

Entitlement to an evaluation in excess of 10 percent for service-connected left knee patellofemoral syndrome with osteomalacia is remanded.

Entitlement to an evaluation in excess of 10 percent for service-connected right knee patellofemoral syndrome with osteomalacia is remanded.

Entitlement to a compensable evaluation for service-connected onychomycosis on bilateral toenails (previously rated as tinea pedis of bilateral feet) is remanded.

FINDING OF FACT

The Veteran has a single painful scar associated with pilonidal cyst removal.

CONCLUSION OF LAW

The criteria for entitlement to an evaluation in excess of 10 percent for service-connected scar from pilonidal cyst removal have not been met.   38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7804.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1977 to January 1999.

This matter comes before the Board of Veterans' Appeals (Board) from an August 2020 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) adjudicated under the Appeals Modernization Act (AMA).

In the December 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  In August 2024, the Veteran, through his representative, withdrew the hearing request.  Therefore, the Board may only consider the evidence of record at the time of the August 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302(b).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 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 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. 

However, because the Board is remanding the claims of entitlement to increased evaluations for intervertebral disc syndrome with lumbar strain, left and right knee patellofemoral syndrome with osteomalacia, and onychomycosis on bilateral toenails, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims.  38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an evaluation in excess of 10 percent for service-connected scar from pilonidal cyst removal

The Veteran is seeking an increased evaluation for his service-connected scar from a pilonidal cyst removal.  The Board notes that there appears to be an error in the rating decision on appeal, which simultaneously continued a 10 percent evaluation for painful scar due to pilonidal cyst removal under Diagnostic Code (DC) 7804, and "continued" a separate noncompensable rating for the same scar under DC 7802.  The same scar thus has been afforded two ratings under two different diagnostic codes.  However, the evidence reflects that there is one scar associated with the Veteran's pilonidal cyst removal and it should be rated under DC 7804, which is the DC used for painful scars. 

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4.  The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average
 painful scar due to pilonidal cyst removal under Diagnostic Code (DC) 7804, and "continued" a separate noncompensable rating for the same scar under DC 7802.  The same scar thus has been afforded two ratings under two different diagnostic codes.  However, the evidence reflects that there is one scar associated with the Veteran's pilonidal cyst removal and it should be rated under DC 7804, which is the DC used for painful scars. 

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4.  The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations.  Separate diagnostic codes identify the various disabilities.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusions.  Schafrath v. Derwinski, 1 Vet. App. 589 (1991).  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.  

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided.  38 C.F.R. § 4.14.  The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability.  See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings."  Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

In considering the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others.  Schoolman v. West, 12 Vet. App. 307, 310-11 (1999).  In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence.  Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).  Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so.  Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992).  In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so.  Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  If "the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise) the claimant receives the benefit of the doubt."  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

VA amended the criteria for rating skin disabilities effective August 
7 Vet. App. 429, 433 (1995).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  If "the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise) the claimant receives the benefit of the doubt."  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

VA amended the criteria for rating skin disabilities effective August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise.  Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).  However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.  The present claim for an increased evaluation was submitted in March 2020.  Therefore, the amended criteria is applicable. 

Under 38 C.F.R. § 4.118, Diagnostic Codes 7800 to 7805 pertain to scars.

Diagnostic Code 7801 applies to burn scars or scars due to other causes, that are not of the head, face, or neck, and that are associated with underlying soft tissue damage.  A 10 percent rating is awarded for area(s) of at least 6 squared inches (39 sq. cm.) but less than 12 sq. in. (77 sq. cm.); a 20 percent rating is awarded for area(s) of at least 12 sq. in. (77 sq. cm.) but less than 72 sq. in. (465 sq. cm.); a 30 percent rating is awarded for area(s) of at least 72 sq. in. (465 sq. cm.) but less than 144 sq. in. (929 sq. cm.); a maximum 40 percent rating is awarded for area(s) of 144 sq. in. (929 sq. cm.) or greater.  Id.

Diagnostic Code 7802 applies to burn scars or scars due to other causes, that are not of the head, face, or neck, but that are not associated with underlying soft tissue damage.  Under this diagnostic code, a maximum 10 percent rating is awarded for area(s) of 144 sq. in. (929 sq. cm.) or greater of scars that are not associated with underlying soft tissue damage.  Id.  

Note (1) for each of DC 7801 and 7802 states that for the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk.  

Note (2) for each of DC 7801 and 7802 states that a separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body.  If applicable, then the Board should combine the separate evaluations under § 4.25.  Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code.  

Under Diagnostic Code 7804 (unstable or painful scars), a 10 percent rating is awarded where the area presents with one or two scars that are unstable or painful; 20 percent with three or four; and a maximum 30 percent with five or more.  Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.  Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars.  Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable.  Id.  

Under Diagnostic Code 7805 (scars, other), the Board can evaluate
 scars that are unstable or painful; 20 percent with three or four; and a maximum 30 percent with five or more.  Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.  Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars.  Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable.  Id.  

Under Diagnostic Code 7805 (scars, other), the Board can evaluate any disabling effects not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code.  Id.

The Veteran received a VA examination in July 2020 regarding the severity of his service-connected scar from a pilonidal cyst removal.  The examiner noted one painful scar measuring 7 x 0.6 cm that had no underlying tissue damage and consisted of an approximate total area of 4.2 square centimeters of the posterior trunk.  The scar was not found to be unstable.

The evidence demonstrates that the scar is painful.  Thus, a 10 percent rating is warranted under DC 7804.  The Veteran has not asserted, and records do not show, that his scar from a pilonidal cyst removal is both unstable and painful, or that there are more than two scars that are unstable or painful.  The scar is not of the head, face or neck, is not due to burns, and is not associated with underlying tissue damage.  Therefore, DCs 7800 and 7801 are also inapplicable.

The Board reiterates that there is one scar associated with the pilonidal cyst removal, and it should be rated under DC 7804 which is the DC used for painful scars.  The continuation of the noncompensable rating for the same scar under DC 7802 was error, as the scar is not large enough to warrant a rating under that DC.  That rating and DC should have simply been replaced by the compensable rating under DC 7804 once it was determined the scar was painful. As it stands, the same scar has been afforded two ratings under two different diagnostic codes.

Accordingly, a rating in excess of 10 percent for the scar from a pilonidal cyst removal is denied. 

REASONS FOR REMAND

1. Entitlement to an evaluation in excess of 20 percent for service-connected intervertebral disc syndrome with lumbar strain is remanded.

The Veteran is seeking an evaluation in excess of 20 percent for his service-connected intervertebral disc syndrome with lumbar strain.

The Board notes that under the AMA, remands are generally only permissible to correct pre-decisional duty to assist errors and "for correction of any other error by the AOJ in satisfying a regulatory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim."  38 C.F.R. § 20.802.

In Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), the United States Court of Appeals for Veterans' Claims (Court) held that, when assigning a disability rating, the Board may not consider the ameliorative effects of medication where those effects are not explicitly contemplated by the rating criteria.  Id.  In a recent Court decision, Ingram v. Collins, 38 Vet. App. 130 (2025), the Court held that in accordance with their holding in Jones, where the diagnostic codes do not reference medication, the Board must discount the beneficial medication effects when assigning an evaluation.  

Pursuant to the present appeal, the Veteran received a VA examination in July 2020.  The examiner noted that the Veteran uses Tylenol and bengay to treat pain related to his service-connected back disability.  However, the examiner did not opine as to the ameliorative effects of the prescribed medication.

In this case, the applicable disability rating criteria do not include the use of medication.  38 C.F.R. § 4.79.  Thus, the Board finds that in this instance failure to obtain a VA opinion to discern any ameliorative effects of medication in terms of range of motion gained is a pre-decisional duty-to-assist error requiring remand.  38 C.F.R. § 20.802(a).

2. Entitlement to an evaluation in excess of 10 percent for service-connected left knee patellofemoral syndrome with osteomalacia is remanded.

3. Entitlement to an evaluation in excess of 10 percent for service-connected right knee patellofemoral
 prescribed medication.

In this case, the applicable disability rating criteria do not include the use of medication.  38 C.F.R. § 4.79.  Thus, the Board finds that in this instance failure to obtain a VA opinion to discern any ameliorative effects of medication in terms of range of motion gained is a pre-decisional duty-to-assist error requiring remand.  38 C.F.R. § 20.802(a).

2. Entitlement to an evaluation in excess of 10 percent for service-connected left knee patellofemoral syndrome with osteomalacia is remanded.

3. Entitlement to an evaluation in excess of 10 percent for service-connected right knee patellofemoral syndrome with osteomalacia is remanded.

The Veteran is seeking increased evaluations for his service-connected left and right knee disabilities.

Pursuant to the present appeal, the Veteran received a VA examination in July 2020.  The examiner noted that the Veteran uses motrin and bengay to treat pain related to his service-connected knee disabilities.  However, the examiner did not opine as to the ameliorative effects of the prescribed medication.

In this case, the applicable disability rating criteria do not include the use of medication.  38 C.F.R. § 4.79.  Thus, the Board finds that in this instance failure to obtain a VA opinion to discern any ameliorative effects of medication in terms of range of motion gained is a pre-decisional duty-to-assist error requiring remand.  38 C.F.R. § 20.802(a).

4. Entitlement to a compensable evaluation for service-connected onychomycosis on bilateral toenails (previously rated as tinea pedis of bilateral feet) is remanded.

The Veteran is seeking a compensable evaluation for his service-connected onychomycosis on bilateral toenails.

The Veteran received a VA examination in July 2020 regarding the severity of his service-connected onychomycosis.  In describing the history of the Veteran's condition, the examiner provided descriptions of both the Veteran's bilateral feet condition and his service-connected pseudofolliculitis barbae, but failed to state which descriptions pertained to which condition.  Accordingly, the Board finds the July 2020 examination to be inadequate for determining the severity of the claimed condition and that remand is necessary to obtain a new VA examination specifically addressing the Veteran's claimed bilateral toenail conditions. 

The matters are REMANDED for the following action:

1. Afford the Veteran a VA examination(s) by an examiner(s) of appropriate expertise to determine the severity of the Veteran's intervertebral disc syndrome with lumbar strain and bilateral knee disabilities.  The claims file should be made available for review, and the examination report should reflect that such review occurred. 

Following the review of the record, the examiner should provide an opinion regarding the severity of the Veteran's  intervertebral disc syndrome with lumbar strain and bilateral knee disabilities, specifically discussing his symptoms without the ameliorative effect of medication.

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2. Afford the Veteran an examination by an examiner of appropriate expertise to determine the severity of the Veteran's service-connected onychomycosis on bilateral toenails (previously rated as tinea pedis of bilateral feet).

 

 

T. REYNOLDS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Gorum, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.