Citation Nr: 18154108
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 14-13 093
DATE:	November 29, 2018
ORDER
An increased rating for facial trauma, status post multiple surgeries with residual effects of neuropathy in the upper lip and nose (facial trauma) in excess of 10 percent from August 3, 2011 to March 30, 2016, and an increased (compensable) rating from March 30, 2016 forward is denied.
FINDINGS OF FACT
1. For the rating period on appeal from August 3, 2011 to March 30, 2016, the facial trauma has been manifested by moderate incomplete paralysis of the seventh cranial nerve, that does not more nearly approximate symptoms of complete or severe incomplete paralysis of the seventh cranial nerve.
2. For the rating period on appeal from March 30, 2016 forward, the facial trauma has not manifested in symptoms that more nearly approximate moderate or severe incomplete paralysis or complete paralysis of the seventh cranial nerve. 
CONCLUSION OF LAW
The criteria for an increased rating for facial trauma in excess of 10 percent from August 3, 2011 to March 30, 2016, and an increased (compensable) rating from March 30, 2016 forward, have not been met or more nearly approximated.  38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326, 4.3, 4.7, 4.10, 4.21, 4.124a, Diagnostic Code 8207 (2017).
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran, who is the appellant, served on active duty from April 2004 to November 2005.
This appeal is before the Board of Veterans’ Appeals (Board) from a July 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California.
In November 2015, the Board granted an increased rating for facial scars, denied increased ratings for impairment of smell and injury to the right mandible, and remanded increased ratings for facial trauma neuropathy and deviated septum with instruction to obtain relevant records and provide adequate VA examinations.  The appropriate records were obtained, and the Veteran underwent VA examinations in March 2016.  In January 2018, the Board granted an increased rating for a deviated septum and remanded the remaining issue on appeal with instruction to obtain an addendum opinion from the VA examiner.  Such an opinion was obtained in March 2018.  The Board is therefore satisfied that the instructions in its remands of November 2015 and January 2018 have been satisfactorily complied with.  See Stegall v. West, 11 Vet. App. 268 (1998).  As the issues regarding increased ratings for facial scars, impairment of smell, injury to the right mandible, and deviated septum have been fully adjudicated by the Board, such symptoms of facial trauma are outside the scope of this decision.
An increased rating for facial trauma neuropathy
Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4.  38 U.S.C. § 1155.  It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances.  38 C.F.R. § 4.21. 
Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case.  When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.  38 C.F.R. § 4.3.
The Veteran is in receipt of a 10 percent disability rating under Diagnostic Code 8207 for the service-connected facial trauma neuropathy from August 3, 2011 to March 30, 2016, and a noncompensable (0 percent) rating from March 30, 2016 forward.  38 C.F.R. § 4.124a.  Diagnostic Code 8207, for impairment of the seventh (facial) cranial nerve, provides for a 10 percent disability rating for moderate incomplete paralysis of the seventh cranial nerve.  A 20 percent disability rating is assigned for severe incomplete paralysis, and a 30 percent disability rating is assigned for complete paralysis.  38 C.F.R. § 4.124a.  Severity is dependent upon relative loss of innervation of the facial muscles.  See 38 C.F.R. § 4.124a.
After review of the lay and medical evidence of record, the Board finds the weight of the evidence is against finding that the Veteran’s facial trauma more nearly approximated complete or severe incomplete paralysis of the seventh cranial nerve for the period from August 3, 2011 to March 30, 2016, so as to warrant an increased rating for that period.
An August 2011 VA treatment record reflects a neurological examination of the Veteran revealed findings that all cranial nerves were intact except for the seventh cranial nerve, which the VA provider observed caused an asymmetrical smile.  The August 2011 VA provider also noted that sensation was intact to light touch throughout the face.  The VA provider assessed that the service-connected facial trauma resulted in paralysis of the seventh cranial nerve, but did not note the severity of the assessed paralysis.  In a March 2018 VA addendum opinion, the VA examiner reviewed the Veteran’s medical history and the August 2011 VA treatment record and determined that at the time of the August 2011 treatment, the Veteran’s facial trauma that resulted in paralysis of the seventh cranial nerve was at most, moderate, but that such symptoms were no longer evident when the Veteran was examined again in March 2018 as further discussed below.  VA treatment records throughout the rating period from August 3, 2011 to March 30, 2016 do not indicate any findings that the facial trauma resulted in symptoms that more nearly approximate complete or severe incomplete paralysis of the seventh cranial nerve.
Based on the foregoing, the Board finds that the weight of the lay and medical evidence of record demonstrates that, for the rating period from August 3, 2011 to March 30, 2016, the Veteran’s facial trauma has not more nearly approximated the criteria for an increased rating under Diagnostic Code 8207 for symptoms of complete or severe incomplete paralysis of the seventh cranial nerve; therefore, a disability rating in excess of 10 percent is not warranted under Diagnostic Code 8207 for the facial trauma.  38 C.F.R. §§ 4.3, 4.7.  
The Board further finds that the weight of the evidence is against finding that the Veteran’s facial trauma more nearly approximates complete paralysis or moderate or severe incomplete paralysis for the rating period from March 30, 2016 forward, so as to warrant an increased (compensable) rating for the period from March 30, 2016.
The Veteran underwent another VA examination in March 2016, the examination report for which reflects no current diagnosis for a cranial nerve impairment.  During the March 2016 VA examination, the Veteran reported that he currently does not experience any symptoms of numbness, tingling, or pain around his face.  Furthermore, the Veteran stated that he did not believe that he has any problems with his facial muscles or any abnormal asymmetry in the face.  Upon examination, the March 2016 VA examiner noted normal findings of the seventh cranial nerve.  The VA examiner also acknowledged the abnormal findings noted in the August 2011 VA treatment record, but explained that at the time of the March 2016 VA examination, which was several years after the August 2011 VA treatment, the seventh cranial nerve was found to be within normal limits, in addition to the Veteran’s denial of any current symptoms.  VA treatment records throughout the rating period from March 2016 forward similarly do not indicate that the facial trauma has resulted in symptoms that more nearly approximate moderate or severe incomplete paralysis or complete paralysis of the seventh cranial nerve.
Based on the above evidence, the Board finds that the weight of the lay and medical evidence of record does not demonstrate that the facial trauma has more nearly approximated moderate or severe incomplete paralysis or complete paralysis of the seventh cranial nerve.  Accordingly, an increased (compensable) disability rating for the facial trauma for the rating period from March 30, 2016 forward is not warranted under Diagnostic Code 8207.  38 C.F.R. §§ 4.3, 4.7.  
 
J. GALLAGHER
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Choi, Associate Counsel 

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