SCARS

Summary

The Veteran, who served in the U.S. Marine Corps from June 2015 to November 2016, appeals the denial of a compensable initial rating for scalp pilar cysts and the denial of an increased rating for PTSD with OCD. The Board denied the claim for scalp pilar cysts, finding that while the Veteran has cysts on her scalp, they do not meet the criteria for disfigurement under Diagnostic Code 7800, nor do they cause functional impairment. The Board acknowledged the Veteran's testimony regarding pain and the recurrence of cysts, finding her statements credible, but noted the cysts were only palpable and did not cause visible scarring or disfigurement. The Board found the evidence weighed against a compensable rating. The claim for an increased rating for PTSD with OCD was remanded due to pre-decisional duty to assist errors. The VA examination in June 2023 noted ongoing treatment from Dr. K.E. and a therapist via Talk Space, but the record only contained records from Dr. K.E. up to October 2021. The Board remanded the case for the AOJ to obtain records of ongoing treatment from Dr. K.E. from November 2021 forward and records from Talk Space.

Rationale

Cysts did not meet criteria for disfigurement under DC 7800; No visible or palpable tissue loss, gross distortion, or asymmetry identified; Cysts did not meet any of the 8 characteristics of disfigurement; No functional impairment identified

Full Decision Text

Citation Nr: A26036051
Decision Date: 04/17/26	Archive Date: 04/17/26

DOCKET NO. 250103-506815
DATE: April 17, 2026

ORDER

Entitlement to an initial 50 percent rating, but no higher, for posttraumatic stress disorder (PTSD) due to military sexual trauma (MST) with obsessive compulsive disorder (OCD) is granted.

Entitlement to a compensable initial rating for scalp pilar cysts is denied.

REMANDED

Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) with obsessive compulsive disorder (OCD) is remanded.

FINDING OF FACT

The Veteran's scalp pilar cysts did not manifest with a characteristic of disfigurement.

CONCLUSION OF LAW

The criteria for a compensable initial rating for scalp pilar cysts have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800, 7819.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the United States Marine Corps from June 2015 to November 2016. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2024 rating decision and a January 2024 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Board acknowledges that the Veteran listed the February 5, 2024, rating decision in the January 3, 2025, VA Form 10182, but will construe the appeal broadly to encompass the later March 18, 2024, rating decision. 

In the January 3, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, with respect to the PTSD issue the Board may only consider the evidence of record at the time of the January 2, 2024 rating decision on appeal and with respect to the scalp pilar cysts issue the Board may only consider the evidence of record at the time of the March 18, 2024 rating decision. With respect to both issues, the Board may also consider any evidence submitted by the Veteran or her representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claim for an increased rating for PTSD with OCD, 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).

The Board notes that the Veteran's VA Form 10182 was signed and dated January 2, 2025, but was not uploaded to the claims file until January 3, 2025, one day after the one-year deadline to file an appeal expired. The Board will waive the timeliness requirement in this case to accept the January 3, 2025 VA Form 10182 as timely but advises the Veteran against such last-minute filings in the future. 

Increased Ratings

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3
 to file an appeal expired. The Board will waive the timeliness requirement in this case to accept the January 3, 2025 VA Form 10182 as timely but advises the Veteran against such last-minute filings in the future. 

Increased Ratings

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007).  

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.

The Board has reviewed all the evidence in the Veteran's record. Although the Board is required to provide reasons and bases supporting its decision, there is no need to discuss each item of evidence in the record. The Board will summarize the pertinent evidence as deemed appropriate, and the Board's analysis will focus specifically on what the evidence of record shows, or does not show, with respect to the claim. See Gonzalez v. West, 218 F.3d 1278, 1380-81 (Fed. Cir. 2000).

1. Entitlement to a compensable initial rating for scalp pilar cysts

The Veteran contends that her scalp pilar cysts should be assigned a compensable rating. 

Her scalp pilar cysts are currently rated as noncompensable under Diagnostic Code 7819-7800. Diagnostic Code 7819 is for benign skin neoplasm. 38 C.F.R. § 4.118. Diagnostic Code 7800 is for burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. 

Diagnostic Code 7819 directs benign skin neoplasms to be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800), scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), or impairment of function. 

Diagnostic Code 7800 provides a 10 percent rating for a skin disorder with one characteristic of disfigurement of the head, face, or neck. A 30 percent rating is provided for a skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement. A 50 percent rating is provided for a skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement. An 80 percent rating is provided for a skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of three or
 or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement. A 50 percent rating is provided for a skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement. An 80 percent rating is provided for a skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with six or more characteristics of disfigurement.

Note (1) specifies that the 8 characteristics of disfigurement are as follows: (1) scar 5 or more inches (13 or more cm) in length; (2) scar at least one-quarter inch (0.6 cm) wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding 6 square inches (39 square cm); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square inches (39 square cm); (7) underlying soft tissue missing in an area exceeding 6 square inches (39 square cm); and (8) skin indurated and inflexible in an area exceeding 6 square inches (39 square cm).

Turning to the evidence, in an April 2, 2025 submission of January 2023 statement, the Veteran stated that she developed cysts in service and in 2018, post-service, she went to the Naval Medical Center Camp Lejeune to have it removed. The medical staff said the cyst was benign and had been removed. The Veteran said the cyst was not removed and most of it was left intact. The Veteran stated that due to the failure to remove the cyst, three more cysts grew around the procedure area in the past five years. It is painful and she is furious that they did not take the time to remove the cyst properly. 

In January 2024, the Veteran was afforded a VA skin conditions examination. The Veteran reported that after treatment in 2018 to remove cysts on her scalp the cysts recurred. She reported that the cysts were firm and painful to the touch. Anything that contacts the areas caused pain and hurt her head around the cysts. The examiner noted the Veteran's January 2019 diagnosis with pilar cysts, scalp. The examiner indicated that the Veteran had not been treated with medication or had any other treatment or procedures for any skin condition in the past 12 months. The examiner noted that the Veteran's pilar cysts covered less than five percent of the total body area and less than five percent of the exposed area. The examiner described the appearance and location of the pilar cysts as follows: "Located on the scalp, top of scalp to the left of midline. The Veteran has normal skin over the cysts. The cysts are found on palpation of the scalp. There are four small lesions, each is a palpable bump, about 0.5 cm diameter, firm to palpation with overlying skin on scalp normal. Normal hair growth. Lesions are located on top left of head/scalp. There is no visible scar from prior removal on scalp." The examiner indicated that the Veteran did not have any skin conditions other than the diagnosed pilar cysts. The examiner indicated that the Veteran's pilar cysts did not impact her ability to work.

In February 2024, the same examiner completed a VA scars/disfigurement examination. The examiner reviewed the Veteran's records and determined that there were no scars or disfigurements related to the Veteran's pilar cysts. The examiner clarified that the cysts were only identified with palpation and on visible examination there was normal skin and hair. There was no scarring or disfigurement identified on examination. There was no impairment identified on examination. On April 2, 2025, the Veteran also submitted March 2024 private treatment records documenting removal of 3 cysts from scalp. 

Based on the above, the Board finds that the evidence of record persuasively weighs against the assignment of a rating in excess of 10 percent under Diagnostic Code 7800 because the Veteran does not have visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features, or; two or
 Veteran's pilar cysts. The examiner clarified that the cysts were only identified with palpation and on visible examination there was normal skin and hair. There was no scarring or disfigurement identified on examination. There was no impairment identified on examination. On April 2, 2025, the Veteran also submitted March 2024 private treatment records documenting removal of 3 cysts from scalp. 

Based on the above, the Board finds that the evidence of record persuasively weighs against the assignment of a rating in excess of 10 percent under Diagnostic Code 7800 because the Veteran does not have visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features, or; two or three characteristics of disfigurement. 

Under Diagnostic Code 7800, a 10 percent rating is warranted for a skin disorder with one characteristic of disfigurement of the head, face, or neck. Unfortunately, the Veteran's cysts do not meet any of the 8 characteristics of disfigurement. Her cysts are not scars, so they do not meet any of the first 4 characteristics of disfigurement. Further, her cysts are not manifested by skin hypo- or hyper-pigmented in an area exceeding 39 square cm; are not a skin texture abnormal in an area exceeding 39 square cm; are not with underlying soft tissue missing in an area exceeding 39 square cm; and are not skin indurated and inflexible in an area exceeding 39 square cm. Thus, a compensable rating under Diagnostic Code 7800 is not warranted.

The Board has also considered the other Diagnostic Codes pertaining to scars. As noted above, Diagnostic Code 7819 directs benign skin neoplasms to be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800), scars (Diagnostic Codes 7801, 7802, 7803, 7804, or 7805), or impairment of function. Here, Diagnostic Codes 7801, 7802, 7803, 7804, and 7805 do not apply because the Veteran's scalp pilar cysts are not scars. See January 2024 VA skin conditions examination; February 2024 VA scar/disfigurement examination. The record also does not indicate any impairment of function due to the Veteran's scalp pilar cysts. 

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 reports of pain in the area of the cysts, and these reports are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran does not assert, and medical records do not show, that the area is manifest by visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features, or; two or three characteristics of disfigurement; or that it otherwise impacts her ability to work or causes functional impairment of earning capacity. 

Accordingly, the probative evidence is not at least in approximate balance and the Veteran's claim for an initial compensable rating for scalp pilar cysts is denied. 

REASONS FOR REMAND

1. Entitlement to an initial rating in excess of 30 percent for PTSD with OCD

The Veteran's PTSD with OCD is currently rated 30 percent under Diagnostic Code 9404-9411 and the General Rating Formula for Mental Disorders. The Veteran contends that she is entitled to an initial rating greater then 30 percent. See January 2025 VA Form 10182. 

Unfortunately, a remand is required to correct pre-decisional duty to assist errors. During the June 2023 VA examination, the Veteran reported that she had been receiving mental health treatment and medication from Dr. K.E. since 2021 and had been seeing a therapist through Talk Space as well. While the record contains a report from Dr. K.E. dated October 2021, it does not contain records of any treatment after October 2021, including after the effective date for the award of service connection-January 9, 2023. The record does not contain evidence that records of ongoing treatment from Dr. K.E. do not exist. Further, the record does not show that the AOJ made reasonable efforts to obtain records of the Veteran's mental health treatment through Talk Space. A remand is required for the AOJ to make reasonable efforts to obtain these records. 

The matters are REMANDED for the following action:

1. Make reasonable efforts to obtain records of the Veteran's ongoing treatment from Dr. K.E. dated from November 2021. During the June 2023 VA examination, the Veteran reported receiving
 contain records of any treatment after October 2021, including after the effective date for the award of service connection-January 9, 2023. The record does not contain evidence that records of ongoing treatment from Dr. K.E. do not exist. Further, the record does not show that the AOJ made reasonable efforts to obtain records of the Veteran's mental health treatment through Talk Space. A remand is required for the AOJ to make reasonable efforts to obtain these records. 

The matters are REMANDED for the following action:

1. Make reasonable efforts to obtain records of the Veteran's ongoing treatment from Dr. K.E. dated from November 2021. During the June 2023 VA examination, the Veteran reported receiving medication and ongoing treatment from Dr. K.E. If records dated from November 2021 forward do not exist, the AOJ should document any such unavailability. 

2. Make reasonable efforts to obtain records of the Veteran's mental health treatment with a therapist at Talk Space, reported during the June 2023 VA examination. 

 

 

Marissa Caylor

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.B.

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.