Citation Nr: 18150602 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 14-35 265A DATE: November 15, 2018 ORDER Entitlement to rating in excess of 10 percent for left elbow injury residuals with traumatic arthritis is denied. FINDING OF FACT The veteran’s service-connected left elbow injury residuals with traumatic arthritis is manifested by mildly limited flexion and extension of the minor forearm, and the hand is not fixed in supination or hyperpronation. CONCLUSION OF LAW The criteria for entitlement to a disability evaluation in excess of 10 percent for the veteran’s service-connected left elbow injury residuals with traumatic arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.7 and Diagnostic Codes 5003, 5010, 5205-5213. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1972 to July 1977. This appeal comes before the Boards of Veterans’ Appeals (Board) from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. This case was last before the Board in May 2017, at which time the Veteran’s claim regarding left elbow injury residuals was remanded for additional development including an examination evaluating all neurological and muscle symptomatology attributable to the Veteran’s left elbow injury residuals. In a subsequent September 2018 rating decision, the RO granted a 20 percent rating for left ulnar neuropathy and 20 percent rating for right elbow strain both as secondary to the service-connected left elbow injury. These matters are not presently on appeal, as the Veteran has not submitted a Notice of Disagreement with these grants. The RO also remanded the claim of entitlement to an increased evaluation for bilateral pes planus for the issuance of a Statement of the Case; however, in May 2018, the RO granted a 50 percent evaluation for this disability as of July 27, 2010, representing a full grant of the benefit sought on appeal and removing this issue from appellate status. Entitlement to an increased rating for left elbow injury residuals with traumatic arthritis Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Separate diagnostic codes (DC) identify various disabilities. Id. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional DC to identify the basis for the rating. 38 C.F.R. § 4.27. Any doubt regarding the extent of the disability is resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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 considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. Peyton v. Derwinski, 1 Vet. App. 282 (1991). The Veteran’s left elbow injury has been evaluated by the RO under the hyphenated DC 5209-5010. The Veteran contends that his service-connected left elbow injury residuals with traumatic arthritis are worse than contemplated by the currently assigned 10 percent disability rating. After a review of the evidence, the Board finds that a rating in excess of the currently assigned 10 percent rating is not warranted. Under DC 5010, traumatic arthritis is rated as degenerative arthritis. A minimum compensable evaluation of 10 percent is available for degenerative arthritis under 38 C.F.R. § 4.71a, DC 5003, when limitation of motion of the specific joint involved is noncompensable under the appropriate DCs for each such major joint affected by limitation of motion. The highest evaluation of 20 percent is warranted when there is X-ray evidence of involvement of two or more major joints with occasional incapacitating exacerbations. Disabilities of the elbow are addressed by DCs 5205 through 5213. Id. Ratings for upper extremity disabilities depend on whether the extremity is major (dominant) or minor (non-dominant). Only one extremity may be considered major. 38 C.F.R. § 4.69. The Veteran is right-handed, and therefore his left elbow is a minor extremity. DC 5205 evaluates ankylosis of the elbow, complete limitation of motion so the elbow is frozen in place. Id. DC 5206 evaluates limitation of forearm flexion. A noncompensable rating is warranted for flexion in the minor extremity limited to 110 degrees; 10 percent for flexion limited to 100 degrees; 20 percent for flexion limited to 90 degrees. Id. DC 5207 evaluates limitation of forearm extension. A 10 percent rating is assigned for extension the minor extremity limited to 45 degrees; 20 percent for extension limited to 75 degrees. Id. DC 5208 evaluates the combined limitation of forearm flexion and extension with a 20 percent rating assigned when flexion is limited to 100 degrees and extension is limited to 45 degrees. Id. DC 5209 evaluates other impairments of the elbow. Joint fracture, with marked cubitus varus or cubitus valgus deformity or with ununited fracture of head of radius, is rated 20 percent disabling for the minor side; flail joint of the elbow is rated 50 percent disabling. Id. DC 5210 evaluates nonunion of the radius and ulna with flail false joint warranting a 40 percent rating in the minor extremity. Id. DC 5211 evaluates impairment of the ulna of the arm. A 10 percent rating is warranted with malunion and bad alignment; 20 percent is warranted for both nonunion in lower half or nonunion in upper half with false movement without loss of bone substance or deformity; 30 percent is warranted with nonunion in upper half with false movement with loss of bone substance (1 inch (2.5 cm.) or more) and marked deformity. Id. DC 5212 evaluates impairment of the radius with malunion. A 10 percent rating is warranted with bad alignment; 20 percent for both nonunion in upper half or without loss of bone substance or deformity; 30 percent is warranted with loss of bone substance (1 inch (2.5 cm.) or more) and marked deformity. Id. DC 5213 evaluates impairment of supination and pronation of the forearm. Supination limited to 30 degrees or less is rated 10 percent; limited pronation with motion lost beyond the last quarter of arc, so the hand does not approach full pronation or limitation of pronation with motion lost beyond the middle of arc are both rated 20 percent for the minor side. Id. Normal flexion of the elbow is 0 to 145 degrees, normal forearm pronation is 0 to 80 degrees, and normal forearm supination is 0 to 80 degrees. Id., Plate I. In this matter, the Veteran underwent VA examinations to evaluate his left elbow disability in March 2012 and January 2017. The examination report from March 2012 reveled no range of motion limitations. The January 2017 examination report revealed the Veteran’s left forearm flexion was limited to 100 degrees. A 20 percent rating is warranted when forearm flexion is limited to 90 degrees. Pain was noted to result in functional loss, although this was not articulated in terms of degrees. Therefore, nothing in the report supported an increase in the Veteran’s disability rating in excess of 10 percent. The Veteran subsequently reported to a VA examination in May 2018 to evaluate his left elbow disability. The left elbow’s flexion was from 15 to 125 degrees; extension was from 125 degrees to 15 degrees; supination was from 0 to 60 degrees; pronation was from 0 to 65 degrees; all movement was noted with pain. The Veteran reported no tenderness to the posterior left elbow with palpation. The report noted no crepitus; no muscle atrophy; and no ankylosis, even though the Veteran’s left elbow range of motion is noted as less than normal. In addition, the examiner noted that the results are medically consistent with the Veteran’s description of functional loss during a flare up. During this evaluation, the examiner diagnosed right arm strain based on overuse as the Veteran attempted to guard the left elbow. The Veteran underwent another VA examination for his elbow disability residuals in June 2018. The examiner confirmed no left bicep muscle atrophy but diagnosed left ulnar neuropathy. In this case, DC 5205 is not applicable based on the absence of ankylosis. Based on the May 2018 examination range of motion results, DCs 5206-5608 and 5213 would result in a noncompensable rating or are not applicable. DCs 5210-5212 do not apply as no issues have been diagnosed regarding the Veteran’s left ulna or radius. DC 5209 is implicated by the Veteran’s elbow impairment, but there is no diagnosis for flail joint or joint fracture. The Veteran has been assigned a 10 percent rating for degenerative arthritis because of mildly limited motion and pain shown upon motion. Neither warrants an even higher evaluation. Accordingly, the Board finds that the preponderance of evidence is against a rating in excess of 10 percent for the Veteran’s left elbow injury residuals with traumatic arthritis, and there is no reasonable doubt to be resolved. Gilbert v. Derwinski, 1 Vet. App. 49, 52 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Banks, Associate Counsel