Citation Nr: 18143319 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 13-18 168 DATE: October 18, 2018 ORDER A compensable rating for a left ring finger disability is denied. REMANDED Service connection for hypertension is remanded. Entitlement to an increased rating for a low back disability is remanded.   VETERAN’S CONTENTIONS The Veteran is also seeking service connection for hypertension. He contends that his currently diagnosed hypertension had its onset during his active duty service. The Veteran’s low back disability and left ring finger disability are currently rated as 20 percent disabling and noncompensably disabling, respectively. The Veteran contends that these ratings do not accurately reflect the severity of his disabilities. Specifically, he asserts that his back disability has worsened, and that it causes him numbness in his right side and lower right leg daily, as well as pain in his hip. He also asserts that his left ring finger is painful to bend, and that it makes it difficult to grip things. FINDINGS OF FACT Throughout the claim period, the Veteran’s left ring finger disability has been rated under Diagnostic Code 5230, which does not admit of a compensable rating. CONCLUSIONS OF LAW There is no legal basis for a compensable schedular rating for a left ring finger disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from December 1964 to December 1967 and in the Air Force from March 1977 to September 2003. This case is before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. 1. Entitlement to an increased rating for a left ring finger disability The Veteran’s left ring finger disability is rated under Diagnostic Code 5230 of 38 C.F.R. § 4.71a. The complete rating schedule for this disability is as follows: 5230 Ring or little finger, limitation of motion: Any limitation of motion 0 0 The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. 38 C.F.R. § 4.59. A veteran experiencing an “actually” painful joint is entitled to at least the minimum compensable rating per joint under the appropriate DC involved. Petitti v. McDonald, 27 Vet. App. 415, 424 (2015) (citing Mitchell v. Shinseki, U.S. Vet. App. No. 09–2169, Secretary’s Response (Resp.) to April 6, 2011, Order at 1). Where a diagnostic code provides a 0 percent rating for any of level of disability, however, and does not include a note allowing consideration under other DCs, a compensable rating on the basis of painful motion is not assignable. Sowers v. McDonald, 27 Vet. App. 472, 480 (2016). In this case, The Veteran has demonstrated painful motion of the left ring finger. A July 2010 VA examination showed no indication of pain. However, in a May 2011 statement, the Veteran gave competent and credible testimony that heh a hdl om and painful motion, which impacted his ability to grip items. Notwithstanding his painful motion, because the Veteran’s left ring finger disability is rated under Diagnostic Code 5230, there is no legal basis for a compensable rating, either for limitation of motion or painful motion. The law precludes such a compensable rating. Accordingly, the Veteran’s claim for an increased rating must be denied. REASONS FOR REMAND 1. Service connection for hypertension is remanded This issue is remanded for a new VA opinion. To this extent, there is conflicting evidence as to whether the Veteran had blood pressure readings during service warranting a diagnosis of hypertension. Initially, the Veteran underwent a pre-discharge VA examination during service in June 2003. This was approximately three months prior to his service separation. The examiner took blood pressure readings on two different days. On the first day, the readings were 130/100 reclining, 132/102 sitting, and 130/102 standing. On the second day, the blood pressure readings were 160/86, 154/90, 148/96, 6/24/03: 136/86, 128/88, and 134/88. Based on these readings, the examiner diagnosed hypertension. The VA examiner’s diagnosis is inconsistent with the VA criteria for diagnosing hypertension, because readings were not taken two or more times on at least three different days. See 38 C.F.R. § 4.104, diagnostic code 7101. Moreover, after service, there is no diagnosis of hypertension until July 2008, when an assessment of prehypertension was made. Blood pressure medication was then started in March 2009. Finally, a VA examiner in April 2013 opined that the Veteran’s hypertension was less likely than not related to his active duty service. The examiner reasoned that the June 2003 in-service examination had yielded a diagnosis of hypertension, but on the basis of blood pressure readings that did not actually support the diagnosis. The examiner reasoned that the June 2003 in-service examination recorded blood pressure readings across two different days, with the second set of readings yielding an average of 132/87 (systolic/diastolic blood pressure), below VA’s definition of hypertension. Therefore, the April 2013 examiner concluded that the findings of the June 2003 in-service examination did not support the diagnosis of hypertension. This examiner’s opinion appears probative, but falls short because the examiner did not address other blood pressure readings during and after service. For instance, his blood pressure during service was 150/74 in May 2003; 123/85 in August 2003; and, after service, it was 128/82 in April 2004, and 146/78 in April 2007. The first two readings were close in time to the June 2013 VA examination and were elevated. The last two readings were after service and continue to reflect elevated blood pressure. Overall, these readings do not meet VA’s definition of hypertension, but do meet the American Heart Association’s current definition of hypertension. See American Heart Association, Understanding Blood Pressure Readings (Nov. 30, 2017), available at http://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings. Thus, the VA examiner’s failure to address them limits the probative weight assignable to the examiner’s opinion. As such, remand for a new opinion is needed. 2. Entitlement to an increased rating for a low back disability is remanded This issue is remanded for a new VA examination. The Veteran has been afforded one VA examination during the claim period for his low back disability, in June 2010. The examiner noted a diagnosis of diffuse spondylosis with degenerative disc space narrowing, and recorded limitation of the range of motion of the lumbar spine. The examiner noted no objective signs of neurological abnormalities, although the Veteran reported subjective symptoms of paresthesia, numbness, and weakness of the right leg. In his May 2011 notice of disagreement, the Veteran alleged that his low back disability had worsened. He also reported symptoms of numbness in his right side and leg daily, along with pain in his hip. Therefore, before the Board can adjudicate this claim, the Veteran must be afforded a new VA examination to evaluate the current level of his disability. A new examination is also needed for compliance with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) and Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. Next, obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not related to the elevated blood pressure readings during and after service. In doing so, the examiner must explain why the elevated blood pressure reading during and after service, which are diagnostic of hypertension under the American Heart Association’s definition, do or do not support a medical finding that the Veteran’s post-service diagnosis first had its onset during service and continued thereafter. (Continued on the next page)   3. After completing the development outlined in item 1, schedule the Veteran for a VA examination to ascertain the current severity of his low back disability and associated neurological manifestations. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Timmerman, Associate Counsel