Citation Nr: 18150164 Decision Date: 11/15/18 Archive Date: 11/14/18 DOCKET NO. 15-03 847 DATE: November 15, 2018 ORDER Entitlement to service connection for carpal tunnel syndrome of the bilateral hands is dismissed. Entitlement to service connection for unspecified trauma/stressor-related disorder is granted. Entitlement to service connection for coronary artery disease is denied. Entitlement to service connection for diabetes mellitus, type II, with peripheral neuropathy of the bilateral lower extremities is denied. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities is denied. Entitlement to a compensable initial rating for healed fracture of the right fifth metacarpal with mild palmer angulation is denied. Entitlement to a compensable initial rating for laceration scar on the left thumb is denied. REMANDED Entitlement to service connection for an acquired psychiatric disability other than an unspecified trauma/stressor-related disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran withdrew the issue of entitlement to service connection for carpal tunnel syndrome of the bilateral hands on the record at an April 2018 Board hearing. 2. The probative evidence indicates that the Veteran’s diagnosed unspecified trauma/stressor-related disorder is etiologically related to his active service. 3. Exposure to herbicide agents may not be presumed based on the locations and nature of the Veteran’s active service; and there is no probative evidence showing that he was actually exposed to herbicide agents during his active service. 4. There is no probative evidence of record linking the Veteran’s current coronary artery disease to his active service. 5. There is no probative evidence of record linking the Veteran’s diabetes mellitus, type II, with peripheral neuropathy of the bilateral lower extremities to his active service. 6. There is no probative evidence of record linking the Veteran’s peripheral neuropathy of the bilateral upper extremities to his active service. 7. Throughout the rating period on appeal, the Veteran’s healed fracture of the right fifth metacarpal with mild palmer angulation has been manifested by pain; the Veteran is already in receipt of the maximum schedular rating available for limitation of motion of the right fifth metacarpal; the finger has not been amputated; and the symptoms are not productive of loss of use of the hand. 8. Throughout the relevant rating period, the Veteran’s laceration scar on the left thumb has been superficial and linear, has not been unstable or painful, has had an area of less than 929 square centimeters; and has not had any other disabling effects. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the issue of entitlement to service connection for carpal tunnel syndrome of the bilateral hands have been satisfied. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.202, 20.204. 2. The criteria for entitlement to service connection for an unspecified trauma/stressor-related disorder have been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for coronary artery disease have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for diabetes mellitus, type II, with peripheral neuropathy of the bilateral lower extremities have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for peripheral neuropathy of the bilateral upper extremities have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for entitlement to a compensable initial rating for healed fracture of the right fifth metacarpal with mild palmer angulation have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5230. 7. The criteria for entitlement to a compensable initial rating for laceration scar on the left thumb have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.118, Diagnostic Codes 7802, 7804, and 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1970 to October 1973 and from October 1974 to April 1975. In April 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge via video conference. A transcript of the hearing is associated with the record. In an October 2018 statement, the Veteran’s representative waived initial consideration by the Agency of Original Jurisdiction (AOJ) of all evidence added to the record since the most recent statements of the case in this appeal. Accordingly, the Board may proceed with appellate consideration and accepts the additional evidence for inclusion in the record on appeal. See 38 C.F.R. § 20.1304(c). Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). In that regard, the Board notes that the development directed in the Remand section below pertains to the issues remanded herein, and there is no indication that evidence developed as part of those actions may be relevant to the issues decided herein. The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues decided herein. The Veteran should not assume that evidence that is not explicitly discussed herein has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Withdrawn Issue The Board may dismiss any appeal that does not allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. A substantive appeal may be withdrawn on the record at a hearing before the Board. 38 C.F.R. §§ 20.202, 20.204(b). At the April 2018 Board hearing, prior to promulgation of a decision in this case, the Veteran requested withdrawal of the issue of entitlement to service connection for carpal tunnel syndrome of the bilateral hands. Accordingly, there remain no allegations of error of fact or law for appellate consideration with respect to that issue. The Board consequently does not have jurisdiction to review the issue, and the issue is dismissed. Service Connection Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection for a disability, the Veteran must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition, certain diseases may be presumed to have been incurred in service where a Veteran was exposed to herbicide agents, such as Agent Orange, while on active service, even when there is no evidence of such exposure during the period of service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Veterans who served in the Republic of Vietnam during the Vietnam Era are presumed to have been exposed to herbicide agents. 38 C.F.R. § 3.307(a)(6)(iii). In addition, an individual who performed service in the Air Force or Air Force Reserve under circumstances in which the individual concerned regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent. 38 C.F.R. § 3.307(a)(6)(v). Generally, the regulation applies where an enumerated disease becomes manifest to a compensable degree at any time after active service. 38 C.F.R. § 3.307(a)(6)(ii). Coronary artery disease and diabetes mellitus, type II, are included in the list of enumerated diseases. The presumptive regulations, however, do not preclude a claimant from establishing service connection with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). 1. Entitlement to service connection for unspecified trauma/stressor-related disorder The Veteran seeks entitlement to service connection for an acquired psychiatric disability. He contends that the condition is related to traumatic experiences that he had during his second period of active service. Specifically, he states that he began having panic attacks once his ship set sail and he could no longer see land. Although he was given medications for the panic attacks, he could not adjust to life aboard the ship. The executive officer of the ship forced him to monitor the rear of the ship at night without his medications and without a functioning means of communication. The Veteran had extreme anxiety during that night, and was discharged shortly thereafter. He testified at the April 2018 Board hearing that the experience changed his life. He still has nightmares about the experience, has panic attacks, and has rage issues. The Board concludes that the Veteran has a current diagnosis of unspecified trauma/stressor-related disorder that is related to his reported in-service experiences. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Specifically, the Veteran’s service treatment records reflect that the Veteran underwent a suitability evaluation in February 1975 due to his complaints of marked anxiety, especially aggravated when at sea, since beginning service aboard a ship. He was assessed with anxiety disorder. Later in February 1975, the Veteran had another psychiatric consultation where he again reported extreme anxiety over being at sea and difficulties adjusting to service in the Navy. He said that he could not tolerate the isolation, restriction, confinement, and living and working conditions aboard the ship, and felt that he would lose control while out to sea and hurt himself or somebody else. While at sea he would freeze up and be unable to work or concentrate on his duties. The attending physician diagnosed the Veteran with immature personality with inadequate features and noted that the Veteran would probably incur disciplinary problems and perform in an unsatisfactory manner if he were to remain on active duty. Thus, the service treatment records show that the Veteran was treated for an anxiety disorder related to being on a ship, and that the Veteran’s anxiety prevented him from performing his duties in a satisfactory manner. The service treatment records are generally consistent with the Veteran’s assertions that he had panic attacks while on a ship, and that he had difficulties with the executive officer due to his anxiety. An October 2015 VA psychology note shows that the Veteran has a current diagnosis of an unspecified trauma/stressor-related disorder, and includes a statement from the Veteran’s psychiatric treatment provider indicating that being forced to stand watch on an external deck in rough weather for a prolonged period “seems to have played havoc with the [Veteran’s] fear of being swept overboard” and “served to exacerbate the severity of his anxiety disorder.” The physician concluded, “In my view, this series of events caused him to develop a Trauma/Stressor-related Disorder Unspecified.” The Board finds the physician’s statement to be probative evidence that the Veteran’s currently diagnosed unspecified trauma/stressor-related disorder is related to his in-service experiences. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (the thoroughness and detail of a medical opinion is a factor in assessing the probative value of the opinion). There is no competent medical evidence of record that weighs against the physician’s probative October 2015 statement. Accordingly, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s unspecified trauma/stressor-related disorder is related to his active service. The benefit of the doubt is resolved in the Veteran’s favor, and the Board therefore concludes that entitlement to service connection for the unspecified trauma/stressor-related disorder must be granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for diabetes mellitus, type II; peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities; and coronary artery disease The Veteran seeks entitlement to service connection for diabetes mellitus, type II; peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities; and coronary artery disease. He contends that the conditions are due to exposure to herbicide agents while he was serving in Okinawa, Japan. He asserts that he was exposed to the herbicide agents directly and through contact with gas canisters he removed from vehicles returning from Vietnam. In support of his contentions, he has submitted internet-based articles regarding the storage and use of herbicide agents in Okinawa during the Vietnam War and an article discussing a prior Board decision that granted a veteran entitlement to service connection based on actual exposure to herbicide agents while serving in Okinawa. The medical evidence of record confirms that the Veteran has current diagnoses of coronary artery disease and diabetes mellitus, type II. They also show that he has been diagnosed with peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities associated with the diabetes mellitus, type II. The Veteran’s service personnel records confirm that he served in Okinawa from April 1972 to October 1973. However, the Board concludes that the claims must be denied because there is no probative evidence demonstrating that the Veteran served in the Republic of Vietnam; that exposure to herbicide agents may be presumed based on contact with C-123 aircraft; that the Veteran was actually exposed to herbicides during active service; or that the Veteran’s coronary artery disease; diabetes mellitus, type II; and/or peripheral neuropathy are otherwise medically attributable to his active service on any other basis. Specifically, as noted above, there is a rebuttable presumption of exposure to herbicides where a Veteran served in the Republic of Vietnam during the Vietnam Era or had certain types of exposure to C-123 aircraft. In this case, the Veteran has not contended, and the record does not show, that he served in the Republic of Vietnam. The relevant statutes and regulations do not provide for presumption of exposure to herbicide agents based on service in Okinawa. The Veteran also has not contended that performed service in the Air Force or Air Force Reserve or that he had the type of contact with C-123 aircraft described in 38 C.F.R. § 3.307(a)(6)(v). The relevant statutes and regulations do not provide for presumption of exposure to herbicide agents based on contact with equipment other than C-123 aircraft. Therefore, exposure to herbicide agents based on contact with gas canisters he removed from vehicles returning from Vietnam may not be presumed. In short, there is no basis in the present case for presuming exposure to herbicide agents. As such, the evidence must show that the Veteran was actually exposed to herbicide agents for service connection to be granted on a presumptive basis as due to exposure to herbicide agents. With regard to the Veteran’s contentions that he was exposed to herbicide agents while serving in Okinawa, Japan, in February 2012, the AOJ made a Personal Information Exchange System (PIES) request for any documents showing exposure to herbicide agents. A response received later in February 2012 states, “No records of exposure to herbicides”, and, “all available requested records <>“. A May 2009 memorandum from the Department of the Army’s U.S. Army & Joint Services Records Research Center (JSRRC) states that no evidence has been found that indicates Navy or Coast Guard ships transported tactical herbicides from the United States to the Republic of Vietnam or that ships operating off the coast of Vietnam used, stored, tested, or transported tactical herbicides. Additionally, the JSRRC cannot document or verify that any veteran was exposed to tactical herbicides based on equipment that was used in Vietnam. In July 2013, the Compensation Service indicated that the Department of Defense (DOD) has provided a list of locations outside Vietnam and the Korean Demilitarized Zone where tactical herbicides, such as Agent Orange, were used, tested, or stored. The Compensation Service noted that the list does not contain names of individuals involved with the tactical herbicides, and does not reference routine base maintenance activities, such as range management, brush clearing, and weed killing. It further notes that such activities were accomplished with commercial herbicides on all military bases worldwide, and that commercial herbicides do not fall under the regulations governing tactical herbicides at 38 C.F.R. § 3.307(a)(6)(i). Furthermore, use of Agent Orange was terminated in 1971 and all remaining stores of the herbicide agent were incinerated at sea. Therefore, Compensation Service could provide no evidence to support the Veteran’s claim that he was exposed to herbicide agents in Okinawa. A November 2014 memorandum indicates that the AOJ coordinated with the National Archives and Records Administration to attempt to locate records that would document the Veteran’s claimed exposure to herbicide agents, to include while loading and unloading supplies used in Vietnam. However, such records could not be located. The available records also did not document the spraying, testing, transporting, storage, or use of Agent Orange or other tactical herbicides in Okinawa. The Board has conducted its own review of the Veteran’s service records, and concludes that they do not contain evidence of actual in-service exposure to herbicide agents. Thus, the Veteran’s claimed exposure to herbicides in Okinawa, Japan, was not verified through a review of the evidence of record, a PIES request, a request to Compensation Service, and a request to JSRRC. The Board acknowledges the internet-based articles the Veteran submitted in support of his assertion that he was exposed to herbicide agents in Okinawa. The articles argue that Agent Orange was used and stored in Okinawa and describe a prior Board decision for another veteran in which the Board granted service connection based on exposure to herbicides in Okinawa. However, the Board notes that each decision by the Board is necessarily based on review of the evidence of record in a particular claims file and has no precedential value toward adjudication of appeals by other claimants, even those who may appear to be similarly situated. See 38 C.F.R. § 20.1303. Furthermore, the present appeal can be distinguished from the earlier cases before the Board because the record in the present case contains evidence against the presence of herbicides on Okinawa that is based on research of pertinent government records that was not cited in the prior Board decision, and that may not have even been available to the Board at the time those decision was made. Moreover, the articles arguing that Agent Orange, dioxins, and/or other herbicide agents were present in Okinawa are general in nature and do not show that the Veteran himself was actually exposed to herbicide agents. For these reasons, the Board places no probative value on the internet-based articles. Based on the above, the Board finds there is no probative evidence supporting a finding that the Veteran was exposed to herbicide agents during his active service. The Veteran is competent to report on what he observed, but the Board places greater probative value on the actual research conducted by the service department, based on historical documents, which indicates that tactical herbicides were not present in Okinawa during the Veteran’s period of active service. Rather, only commercial herbicides were used in Okinawa, and such chemicals do not fall under the regulations governing tactical herbicides at 38 C.F.R. § 3.307(a)(6)(i). The Veteran’s reports of what he observed do not confirm the presence of tactical herbicides such that the Board may find that he was actually exposed to such herbicide agents. In addition, the Veteran’s reports that he handled gas canisters returning from Vietnam also does not confirm that he was actually exposed to herbicide agents. As such, the Veteran’s assertion that he was exposed to herbicide agents is based on supposition, and is contrary to other evidence of record. The probative evidence of record, which is based on review of actual government records, weighs against the Veteran’s suppositions. Finally, the Veteran’s service treatment records are absent for evidence of in-service treatment for a heart condition, diabetes mellitus, or peripheral neuropathy. In addition, there is no competent evidence of record linking the Veteran’s current coronary artery disease, diabetes mellitus, or peripheral neuropathy to his active service on a direct basis. Therefore, the record does not show that the Veteran’s coronary artery disease; diabetes mellitus, type II; and/or peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities had their onset during his active service or are otherwise etiologically related to his active service on a direct basis. See Combee, 34 F.3d at 1043. In summary, there is no competent, probative evidence of record linking the Veteran’s current coronary artery disease; diabetes mellitus, type II; and/or peripheral neuropathy of the bilateral upper extremities or bilateral lower extremities to his active service, to include the claimed exposure to herbicide agents. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claims for entitlement to service connection for coronary artery disease; diabetes mellitus, type II; and peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities. Because the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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. Where there is a question as to which of two 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. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). 3. Entitlement to a compensable initial rating for healed fracture of the right fifth metacarpal with mild palmer angulation The Veteran seeks entitlement to a compensable initial rating for healed fracture of the right fifth metacarpal with mild palmer angulation. The Veteran has contended that the condition is productive of hand pain and that that the condition has led to a loss of use of the hand. The Veteran’s healed fracture of the right fifth metacarpal with mild palmer angulation is rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230. Under Diagnostic Code 5230, a noncompensable rating is assigned for any limitation of motion in the little finger or ring finger. The medical treatment records show that the Veteran has reported bilateral hand pain, but do not contain information pertinent to rating the Veteran’s healed fracture of the right fifth metacarpal with mild palmer angulation under the relevant rating criteria. The Veteran underwent VA hand and finger conditions examination in November 2010. The Veteran reported that the pain in his right fifth metacarpal had increased since the original in-service injury. He had no history of hospitalization or surgeries related to the condition. He treated the pain with acetaminophen. He reported decreased strength and dexterity, as well as stiffness in the right hand. On examination, the Veteran had reduced range of motion in the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the right little finger. He had pain and weakness in the finger after the first range-of-motion movement, and additionally had fatigue, lack of endurance, and incoordination in the finger after the fifth range-of-motion movement. The Veteran had a flattened knuckle on the fifth metacarpal phalangeal joint of the right hand. The examiner noted that the Veteran’s inability to fully flex the fifth finger on the right hand affects the full flexion of his fourth finger on that hand. The Veteran underwent another VA hand and finger conditions examination in May 2013. On examination, the Veteran had a gap of less than 1 inch between his thumb pad and the ring and little fingers of the right hand. He showed no objective evidence of painful motion during range-of-motion testing. He did not have any additional limitation of motion following repetitive-use testing. He had functional loss in the right little finger due to less movement than normal, incoordination, pain, and deformity. However, the examiner opined that the Veteran would not have any additional functional loss on repeated use of the finger over time. The Veteran had normal grip strength in the right hand. The examiner opined that the functioning of the Veteran’s right little finger was not so diminished that amputation with prosthesis would equally serve him. The examiner further opined that the Veteran’s right little finger condition would not impact his ability to work. The Veteran underwent a further VA hand and finger conditions examination in June 2014. At the examination, the Veteran reported intermittent pain in his right fifth metacarpal joint when he sleeps, bumps the hand, or is in cold weather. He stated that he does not have a good grip in his right hand, but is unsure why. When the pain occurs, it rates at a severity of 9 out of 10, is sharp, and lasts 10 seconds. The pain occurs a few times daily. He also reported that his right hand tingles. On examination, the Veteran had a gap of less than 1 inch between his thumb pad and the ring and little fingers of the right hand on flexion, but showed no objective evidence of painful motion. He did not have any additional limitation of motion following repetitive-use testing. He had normal grip strength in the right hand. The examiner opined that the functioning of the Veteran’s right little finger was not so diminished that amputation with prosthesis would equally serve him. The examiner noted the Veteran’s report that his hands hurt more now that he is older, that he can ride his motorcycle for only 20 minutes before his entire hand goes numb, and that he does not ride the motorcycle now due to his leg problems. However, the examiner opined that the Veteran’s tingling pain of the bilateral hands is the Veteran’s main hand issue and is likely as not related to his diabetes and not localized to the prior fracture area. Upon review of the record, the Board finds that the preponderance of the evidence shows that a compensable initial rating is not warranted for the Veteran’s healed fracture of the right fifth metacarpal with mild palmer angulation. Specifically, under the applicable diagnostic criteria, any limitation of motion of the little finger of either hand is noncompensable. 38 C.F.R. § 4.71a, Diagnostic Code 5230. Additionally, although 38 C.F.R. § 4.59 and Burton v. Shinseki, 25 Vet. App. 1 (2011), provide that actually painful, unstable, or mal-aligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint, there is no compensable rating for limitation of motion of the little finger; thus, an increased rating cannot be awarded on that basis. Furthermore, the Board has considered the November 2010 VA examiner’s finding that the Veteran’s inability to fully flex the fifth finger on the right hand affects the full flexion of his fourth finger on that hand, but concludes that even if the limited range of motion of the right fourth finger is considered in rating the service-connected right fifth finger disability, a compensable rating is not warranted because any limitation of motion of the right fourth finger also warrants a noncompensable rating under Diagnostic Code 5230. Review of the schedular criteria also does not indicate that there is another Diagnostic Code more analogous to the service-connected disability, and no medical examiner or evidence of record has suggested a level of impairment akin to amputation or loss of use of the right fifth metacarpal. See 38 C.F.R. § 4.71a, DC 5156. The Board has also considered the Veteran’s reports of tingling pain and numbness of the bilateral hands. However, the Veteran is not considered competent to attribute those symptoms to the service-connected disability of the right little finger. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The competent medical evidence of record, to include the June 2014 VA examiner’s statements, attribute those symptoms to the Veteran’s nonservice-connected diabetes mellitus, type II, and its associated peripheral neuropathy. Therefore, the Veteran’s tingling pain and numbness of the bilateral hands is not for consideration in rating the service-connected right little finger disability. See Mittleider v. West, 11 Vet. App. 181 (1998). Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected healed fracture of the right fifth metacarpal with mild palmer angulation, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). The Board therefore finds that the criteria for entitlement to a compensable initial rating for the Veteran’s healed fracture of the right fifth metacarpal with mild palmer angulation have not been met at any time during the rating period. Accordingly, there is no basis for staged rating of the Veteran’s healed fracture of the right fifth metacarpal with mild palmer angulation pursuant to Fenderson, 12 Vet. App. at 126-27. As the preponderance of the evidence is against the assignment of a compensable initial rating, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 4. Entitlement to a compensable initial rating for laceration scar on the left thumb The Veteran seeks entitlement to a compensable initial rating for laceration scar on the left thumb. He has not presented any specific arguments as to why he believes a compensable initial rating is warranted. The record indicates that the Veteran’s left thumb scar is superficial and linear. Scars not of the head, face, or neck that are superficial and linear are rated under 38 C.F.R. § 4.118, Diagnostic Codes 7802, 7804, and through 7805. Under Diagnostic Code 7802, a 10 percent rating is warranted for a scar that is superficial, linear, and has an area or areas of 929 square centimeters or greater. Under Diagnostic Code 7804, a 10 percent rating is warranted for one or two scars that are unstable or painful. Higher ratings, up to a maximum 30 percent, are warranted for additional scars that are unstable or painful. If one or more scars are both unstable and painful, 10 percent is to be added to the rating that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (2). Diagnostic Code 7805 provides that any disabling effects not considered in a rating provided under diagnostic codes 7800 through 7804 should be rated under an appropriate diagnostic code. The Veteran underwent VA scars examination in November 2010. At the examination, the Veteran reported that he was not currently receiving treatment for the service-connected left thumb scar and had no current symptoms associated with the scar. On examination, the scar was slightly concave to the hand and very faintly visible. The scar measured 2.1 centimeters in length and less than 2 millimeters in width. The scar was not painful, was not associated with skin breakdown, and did not involve the underlying soft tissue. The scar did not cause limitation of motion or other limitation in function. The Veteran underwent another VA scars examination in May 2013. On examination, the service-connected left thumb scar measured 2 centimeters in length and 1 millimeter in width. The scar was superficial and was not painful or unstable. The examiner noted that the Veteran could not bend his left thumb at the interphalangeal joint, but that the reduced range of motion was due to tendon damage and not due to the scar. The examiner determined that the Veteran’s laceration scar on the left thumb did not impact his ability to work. The Veteran underwent a further VA scars examination in June 2014. At the examination, the Veteran reported that the left thumb tendon was damaged during a fight and was surgically repaired, but that the left thumb still does not function correctly. He reported that following the initial treatment of the left thumb laceration with stitches, he had received no further treatment for the left thumb scar. He reported current symptoms of pain in the left thumb if he hits it or is trying to carry something for any length of time. However, that pain is inside the thumb, and is not related to the service-connected left thumb scar. On examination, the scar was linear and 2 centimeters in length. The scar was superficial and was not painful or unstable. The examiner determined that the Veteran’s laceration scar on the left thumb did not impact his ability to work. Accordingly, throughout the relevant rating period, the Veteran’s service-connected laceration scar on the left thumb has been superficial and linear, not painful or unstable, and had an area of less than 929 square centimeters. Therefore, the Board finds that the criteria for entitlement to a compensable initial rating for the service-connected laceration scar on the left thumb under 38 C.F.R. § 4.118, Diagnostic Codes 7802 and 7804, have not been met at any time during the appeal period. The record also does not show that the Veteran’s laceration scar on the left thumb has any functional effects not considered under Diagnostic Codes 7802 and 7804. The Veteran’s pain and loss of motion in the left thumb have been attributed to his left thumb tendon injury and not to the left thumb scar. Therefore, the criteria for entitlement to a compensable initial rating under 38 C.F.R. § 4.118, Diagnostic Codes 7805 have also not been met any time during the appeal period. See Mittleider, 11 Vet. App. 181. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected laceration scar on the left thumb, nor have any other such issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. The Board therefore finds that the criteria for entitlement to a compensable initial rating for the Veteran’s laceration scar on the left thumb have not been met at any time during the rating period. Accordingly, there is no basis for staged rating of the Veteran’s laceration scar on the left thumb pursuant to Fenderson, 12 Vet. App. at 126-27. As the preponderance of the evidence is against the assignment of a compensable initial rating, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disability other than an unspecified trauma/stressor-related disorder; and entitlement to a TDIU are remanded. At the April 2018 Board hearing, the Veteran’s representative indicated that the Veteran had recently received further mental health treatment at a VA facility in Coralville, Iowa, but that records for that treatment were “still being scanned in” at that time. The records reportedly include a diagnosis of PTSD. No further VA treatment records have been associated with the record since the Board hearing. Efforts must be made to obtain the potentially relevant VA treatment records referenced at the April 2018 Board hearing. Additionally, in June 2014 a VA initial PTSD examiner diagnosed the Veteran with obsessive-compulsive disorder-tic related, agoraphobia without panic attacks, and depressive disorder. The examiner provided an opinion that the Veteran’s symptoms do not rise to the level of PTSD, but did not provide an opinion as to whether the diagnosed psychiatric disabilities other than PTSD may be related to his active service. An August 2014 addendum statement from the June 2014 VA examiner also did not provide this information. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for an acquired psychiatric disability other than an unspecified trauma/stressor-related disorder because no VA examiner has opined whether such disabilities are related to the Veteran’s active service, to include the reported in-service stressful events and the psychiatric symptoms documented in the Veteran’s service treatment records. The matters are REMANDED for the following action: 1. Obtain the Veteran’s outstanding VA treatment records, to include from a VA facility in Coralville, Iowa. 2. Obtain an addendum opinion from an appropriate clinician regarding whether any of the Veteran’s diagnosed acquired psychiatric disabilities other than an unspecified trauma/stressor-related disorder are at least as likely as not (50 percent probability or greater) related to his active service, to include the reported in-service stressful events and the psychiatric symptoms documented in the Veteran’s service treatment records. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. J. Anthony, Counsel