Citation Nr: 18142103 Decision Date: 10/15/18 Archive Date: 10/12/18 DOCKET NO. 15-18 456A DATE: October 15, 2018 ORDER Entitlement to service connection for dental trauma to front teeth is denied. Entitlement to a compensable evaluation for fracture, 5th metacarpal, right hand is denied. REMANDED Entitlement to service connection for a right ankle injury is remanded. FINDINGS OF FACT 1. There is no evidence that the Veteran has sustained a loss of teeth as a result of loss of substance of the body of the maxilla or mandible during service due to an in-service trauma or disease. 2. The Veteran’s fracture, 5th metacarpal, right hand, disability has been manifested by, pain, stiffness, swelling, tenderness, limitation of motion, decreased grip strength/dexterity of the right hand. CONCLUSIONS OF LAW 1. The criteria to establish service connection for dental trauma to front teeth have not been met. 38 U.S.C. §§ 1131, 1712, 5107 (2012); 38 C.F.R. §§ 3, 309, 3.311, 3.381, 17.161 (2017). 2. The criteria for a compensable rating for residuals of a right little finger injury are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§, 4.1, 4.2, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5003, 5216-5230 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from August 1976 to April 1986. This matter is before the Board of Veterans’ Appeals (Board) on appeal from February 2015, May 2015, and July 2015, rating decisions of the Los Angeles, California, Department of Veterans Affairs (VA) Regional Office (RO). The Board further notes that a claim for service connection for a dental disability is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). Review of the file reveals, however, that the AOJ (i.e., Veterans Benefits Administration) has only adjudicated the issue of entitlement to service connection for a dental disorder for VA compensation purposes. Thus, the claim for outpatient dental treatment is referred to the AOJ (which, in this case, is Veterans Health Administration) for appropriate action, to include, if appropriate, informing the Veteran and her representative that a claim for benefits must be submitted on the application form prescribed by the Secretary of VA and providing such forms. Service Connection 1. Entitlement to service connection for dental trauma to front teeth The Veteran has asserted that during service he experienced dental trauma to his front teeth. In a July 2015, statement in support, the Veteran reported injuring his tooth while in Texas, when he was riding on a truck and the butt of a fellow soldier’s rifle struck his tooth, chipping it. In a March 2016 statement, he indicated he sustained a trauma while in Panama, and lost a tooth, that resulted in a partial denture. The Veteran’s service treatment records document a partial denture to one tooth. The service treatment records do not document a loss of maxilla or mandible. Even if the Veteran’s tooth loss occurred in service as a result of the events he describes, he does not identify a loss of substance of the maxilla or mandible, and no such loss is reflected in any of the documentary evidence. What the record shows is a partial denture repair of one tooth during service. Replaceable missing teeth are not compensable disabilities. As the evidence does not indicate the Veteran suffered a traumatic injury during service that resulted in loss of substance of his mandible or maxilla, the claim for service connection for loss of teeth, for compensation purposes only, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence weighs against this claim, that doctrine is not applicable. 2. Entitlement to a compensable evaluation for fracture, 5th metacarpal, right hand The Veteran’s residuals of a right 5th finger injury is rated under 38 C.F.R. § 4.71a, DC 5230 as limitation of motion of the ring or little finger. Under DC 5230, a noncompensable rating is warranted for any limitation of motion of the little finger. 38 C.F.R. § 4.71a, DC 5230. Under DC 5227, a noncompensable rating is warranted for either unfavorable or favorable ankylosis of the little finger. 38 C.F.R. § 4.71a, DC 5227. A note to DC 5227 directs that consideration should also be given to whether a rating for amputation is warranted and whether an additional rating is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Id. DC 5156 evaluates amputation of the little finger and provides a 10 percent rating where there is amputation, without metacarpal resection, at the proximal interphalangeal joint or proximal thereto; and a 20 percent rating where there is amputation, with metacarpal resection (more than one-half bone lost). Id. Under 38 C.F.R. § 4.71a, DC 5003, degenerative arthritis, and DC 5010, traumatic arthritis, will be assigned a 10 percent rating where there is X-ray evidence of involvement of 2 or more minor joint groups and a 20 percent rating where there is X-ray evidence of involvement of 2 or more minor joint groups, with occasional incapacitating exacerbations. Under these DCs, arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Note (1) provides that the 10 and 20 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. As noted above, the Veteran is service-connected for the right 5th finger, rated as noncompensable. In April 2015, the Veteran underwent an examination. He was diagnosed with right hand fracture of fifth metacarpal. He complained of pain at the site with prolonged use of the hand, and in cold weather. He denied range of motion changes or limitations in use of the hand. Flare-ups were reported as occurring with prolonged use of the hand, or during cold weather. There was no limitation of motion or evidence of painful motion of any fingers or thumbs. There was no gap between the thumb pad and fingers. There was no gap between any fingertips and the proximal transverse crease of the palm, and there was no limitation of extension, or evidence of painful motion for the index finger or long finger. He could perform repetitive use testing, and there was no additional limitation of motion for any fingers post-test. He had no functional loss or functional impairment of any fingers or thumbs. He had mild tenderness over the 5th metacarpal. Muscle strength testing was normal. There was no ankylosis of the thumb and/or fingers. He has no scars. He does not use any assistive devices. In a March 2016, statement in support, the Veteran stated he experiences cramps and stiffening in his fingers, that causes pain and temporary immobility until the cramp and passes. In April 2016, the Veteran was afforded an examination. He was diagnosed with a fracture of the 4th and 5th metacarpals, healed, of the right hand with a strain. He described flare-ups as being his pinky knuckle will swell and the joint stiffens. Functional impairment included difficulty writing, handling tools, and his hand gets fatigued. Range of motion testing revealed the index finger, long finger, and ring ringer, to have extension of the MCP, PIP, and DIP, to 0 degrees, flexion of MCP was to 90 degrees, PIP to 100, and DIP to 70 degrees. Little finger range of motion was extension of the MCP. PIP, and DIP to 0 degrees, flexion of the MCP to 40 degrees, PIP to 50 degrees, and DIP to 30 degrees. His thumb range of motion measured, MCP and IP, to 0 degrees, and MCP flexion to 100 and IP flexion to 90 degrees. There was a gap between the pad of the thumb and the fingers, of 1 centimeter. There was no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. He had pain on finger flexion, finger extension, and opposition with thumb. There was evidence of pain with use of the hand, and of localized tenderness and moderate pain on palpation of the right 5th finger. He could perform repetitive use testing with at least three repetitions, with no additional functional loss or range of motion after repetitions. He was not examined immediately after repetitive use over time, or during a flare- up. The exam was deemed neither medically consistent or inconsistent with the Veteran’s statements describing functional loss with repetitive use over time, or during a flare up. Pain, fatigue, weakness, limit functional ability with repeated use over a period of time, and during a flare-up. This was not able to be described in terms of range of motion, however the Veteran explained he has difficulty writing, handling tools, and his hand gets fatigued. Muscle strength testing was normal, he had no atrophy, and no evidence of an ankylosis. X-rays were taken that revealed an old healed fracture of the 4th and 5th metacarpal of the right hand. The evidence reflects that the Veteran’s right 5th metacarpal disability is manifested by pain, stiffness, limitation of motion, and decreased dexterity of the right hand. There was limitation of motion associated with the right 5th finger, however, any limitation of motion of the right 5th finger alone warrants a noncompensable rating under DC 5230. The Veteran is already in receipt of the maximum possible rating under DC 5230 based on any limitation of motion of the little finger, by itself (a 0 percent rating). See 38 C.F.R. § 4.71a, DC 5230. The 2016 examiner found the Veteran had a healed fracture of the 4th and 5th metacarpals. He was not diagnosed with arthritis. Under 5003 and 5010, only allows for a rating of 10 percent or higher when there is x-ray evidence of two or major or minor joint groups are affected by arthritis. Here, there is no evidence of two minor joint groups being affected by arthritis. Thus, the Veteran is not entitled to a compensable rating under DCs 5003 or 5010 based on limitation of motion. Such ratings are provided “under the appropriate DC for the specific joint or joints involved.” Because DC 5230 provides a maximum noncompensable rating for limitation of motion, the Veteran is not entitled to a compensable evaluation based on limitation of motion due to arthritis. Nor has there been any evidence of any ankylosis involving the right little finger or any other finger of the right hand related to the service-connected right little finger disability during the claim period. See 38 C.F.R. § 4.71a, DC 5227. In sum, the symptoms of the Veteran’s service-connected residuals of a right 5th finger injury most closely approximate the criteria for a noncompensable rating under the applicable rating criteria. Hence, a higher rating is not warranted and the appeal is denied. REASONS FOR REMAND Entitlement to service connection for a right ankle injury The Veteran has asserted that his right ankle injury originated during service. The Veteran’s service treatment records contain reports of a fall in July 1980, with him complaining of sustained pain in his leg. In a February 2015, statement, the Veteran explained that during service he was participating in a running exercise, and stepped into a ditch causing an injury to his ankle. Later in June 2015, he stated he sprained his ankle during service, went to sick call, and was sent home. He explained he did not pursue treatment or file a claim for an injury to his ankle as he feared it would hinder his ability to move up within the service. In April 2015, the Veteran underwent a VA examination, in which the examiner concluded the claimed condition was less likely than not incurred in or caused by an in-service injury, event, or illness. In a June 2015, private treatment record from Whole Family Health, PC, it noted the Veteran sustained an ankle injury during service. He was suffering from chronic right ankle osteoarthritis. The Veteran has been consistent in his report of falling during service and injuring his ankle. He requested a new examination, as he felt the prior examination was not conducted appropriately. Because the VA examiner made no reference to the Veteran’s contentions regarding his in-service injury and continuity, and there is now medical documentation from a private physician of a chronic condition, a remand is necessary to obtain a new examination. The matter is REMANDED for the following action: 1. Schedule the Veteran for an appropriate examination for his right ankle. The claims file should be made available. Following a review of the claims file, the reviewing examiner shoulder provide an opinion for the following questions: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s right ankle osteoarthritis, claimed as right ankle injury, is related to his service? The examiner is asked to address the Veteran’s contentions regarding continuity of symptomatology, as well as the June 2015 entry detailing a chronic ankle condition that originated during service. The examiner is asked to provide a complete rationale for all opinions. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Skiouris, Associate Counsel