BVA9507644 DOCKET NO. 91-54 471 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to a compensable evaluation for a scar on the left upper thigh, the donor site of a skin graft. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Jeffrey J. Schueler, Associate Counsel INTRODUCTION The veteran served on active duty from July 1982 to July 1989. The veteran appealed a January 1990 rating decision that had, inter alia, granted service connection for, and assigned a 20 percent evaluation to, a left knee disability, arguing that his disability warranted a 30 percent evaluation. In a June 1993 rating decision, the regional office (RO) granted the veteran's claim for a 30 percent evaluation for his service-connected postoperative repair of ligaments and tendons of the left knee and status post injury with muscle impairment. He was notified of this decision in a July 1993 supplemental statement of the case. Neither the veteran nor his representative have subsequently provided further argument or contentions relative to this issue. The representative, in statements dated in February 1994 and March 1995, has ceased to include the issue as part of the appeal. As such, the sole remaining issue for appellate review is as stated on the title page of this decision. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his scar on the left upper thigh, the donor site of a skin graft, is of such severity as to warrant a compensable evaluation. He maintains that the size and location of the scar site are such that it presents a degree of limitation of function of the left upper thigh in that any walking motion causes his clothes to come in contact with the scar resulting in pain and tenderness. DECISION OF THE BOARD The Board of Veterans' Appeals (Board), in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim of entitlement to a compensable evaluation for a scar on the left upper thigh, the donor site of a skin graft. FINDINGS OF FACT 1. All available relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO insofar as possible. 2. The veteran's scar on the left upper thigh, the donor site of a skin graft, is not shown to be poorly nourished with repeated ulcerations, or tender and painful on objective demonstration, nor is it shown to interfere with the function of the thigh. CONCLUSION OF LAW The criteria for a compensable evaluation for a scar on the left upper thigh, the donor site of a skin graft, are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.10, 4.14, 4.31, 4.40, 4.118, Diagnostic Codes 7803, 7804, 7805 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board initially finds that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, it is not inherently implausible. We also find that the Department of Veterans Affairs (VA) satisfied its statutory obligation to assist the veteran in the development of facts pertinent to the claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159 (1994). In a July 1992 remand, the Board directed as part of its duty to assist that the veteran be scheduled for a VA examination to determine the nature and severity of his left thigh scar disability. An examination was conducted in July 1992. On appellate review, we see no areas in which further development may be fruitful. Historically, the veteran injured his left knee during service in May 1988. He was hospitalized in June 1988 and he underwent a reconstruction of the ligaments. He was again hospitalized in April 1989 for left knee complaints and a skin graft procedure was also performed at that time. A medical board subsequently determined that the veteran was unfit for further duty. Disability evaluations are determined by application of a schedule of ratings based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1994). The inquiry into disability evaluations centers on the ability of the body or system in question to function in daily life with specific reference to employment. 38 C.F.R. § 4.10 (1994). In evaluating claims for increased ratings, we must evaluate the veteran's condition with a critical eye towards the lack of usefulness of the body or system in question to self support. 38 C.F.R. § 4.10 (1994). A disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Weakness is as important as limitation of motion. 38 C.F.R. § 4.40 (1994). If a question arises as to which of two evaluations is to be assigned, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7 (1994). Evidence of record with respect to the left thigh donor site scar disability includes a November 1989 VA examination, wherein an examiner reported a four by six inch left upper anterior thigh donor scar for a skin graft with moderate partial keloid formation. The left knee passively and actively extended normally, however, in flexion it was limited to 90 degrees active and passive flexion. The diagnosis noted was of keloid post surgical left knee donor site skin graft and status post surgical repair of the left knee. The September 1992 VA examination report shows that the veteran stated he had pain that he described as severe in his knees all the time. He also stated that he could not get a job that required standing. Examination revealed that the veteran walked with a distinct limp in favor of the left side, and that the anterior and anteromedial surfaces of the knee were covered by a large skin graft measuring eight by six inches in diameter. The examiner reported that the skin graft was well healed but somewhat adherent to the underlying structures. On the anterior aspect of the left thigh in the upper portion, it was noted that there were two donor sites for the skin grafts, each measuring six by four inches. They were well healed and there was a slight amount of hypertrophy in the scar which the examiner did not think was a true keloid but was merely hypertrophy. The examiner noted that the knee flexed from 0 to 90 degrees. The veteran seeks a compensable evaluation for a scar on the left upper thigh, the donor site of a skin graft. A 10 percent evaluation may be assigned using Diagnostic Code 7803 for poorly nourished superficial scars with repeated ulcerations. A 10 percent evaluation may also be assigned for superficial scars that are tender and painful on objective demonstration under Diagnostic Code 7804. Finally, scars may be rated on limitation of the function of the part affected using Diagnostic Code 7805. 38 C.F.R. § 4.118 (1994). A compensable evaluation under Diagnostic Code 7805 is not warranted under the facts of this case. The veteran is receiving a 30 percent evaluation for service-connected postoperative residuals of the left knee injury. The evaluation of the same disability under various diagnoses is to be avoided. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided. 38 C.F.R. § 4.14 (1994). Therefore, the Board cannot consider knee impairment. Moreover, the medical evidence of record does not show any interference with the function of the knee or hip, or any other function of the thigh, resulting from the scar. The September 1992 VA examination report also showed that the skin graft donor sites, each measuring six by four inches, were well healed and had a slight amount of hypertrophy which the examiner did not think was a true keloid but was merely hypertrophy. The examiner at the November 1989 VA examination reported that the scar had a moderate partial keloid formation, and in a May 1990 private treatment record an examiner reported keloid formation at the left knee from grafting. The clinical evidence, however, does not show an objective determination that the scar itself was "tender and painful," thereby warranting a compensable evaluation under Diagnostic Code 7804. Nor is there any medical evidence to support the veteran's subjective contention that the scar gets tender and painful from clothing rubbing against the scar. Moreover, the clinical evidence demonstrates that the scar is well healed and does not show, nor does the veteran contend, that the scar is "poorly nourished, with repeated ulceration" as required for a compensable evaluation using Diagnostic Code 7803. Since the rating schedule does not provide a zero percent evaluation for Diagnostic Codes 7803, 7804, or 7805, a zero percent evaluation is to be assigned when the requirements for a compensable evaluation are not met. See 38 C.F.R. § 4.31 (1994). Based on the evidence of record and in light of the analysis above, it is the decision of the Board that the preponderance of the evidence is against the claim of entitlement to a compensable evaluation for a scar on the left upper thigh, the donor site of a skin graft. Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, as mandated in Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, we find the evidence discussed above does not suggest the veteran's left thigh scar disability presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1993). The service-connected injury has not required frequent periods of hospitalization, nor does the record demonstrate a marked interference with employment due to the left thigh scar disability. ORDER Entitlement to a compensable evaluation for a scar on the left upper thigh, the donor site of a skin graft is denied. WILLIAM J. REDDY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.