Citation Nr: 18155263 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 14-14 282 DATE: December 4, 2018 ORDER 1. Entitlement to a compensable disability rating for left hand fracture with residual left little finger weakness and ulnar neuropathy is denied. REMANDED 2. Entitlement to an initial compensable disability rating for left foot plantar fasciitis with pes planus prior to March 26, 2014, and in excess of 10 percent thereafter, is remanded. FINDING OF FACT The Veteran’s left hand fracture manifested in limited range of motion of only the little finger and did not result in amputation or ankylosis of any fingers. CONCLUSION OF LAW The criteria for a compensable disability rating for left hand fracture with residual left little finger weakness and ulnar neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5230 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 2002 to 2005. In an October 2018 Rating Decision (RD), the Regional Office (RO) granted an increased 10 percent disability rating for the Veteran’s left foot plantar fasciitis with pes planus disability, effective March 26, 2014. As this was not a full grant of the benefits sought on appeal, and the Veteran did not indicate that he agreed with the increased rating, his claim has remained on appeal. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993). In May 2016, the Board remanded the Veteran’s claim for additional development. There was substantial compliance with the Board’s remand directives to decide the increased rating claim for left hand fracture with residual left little finger weakness and ulnar neuropathy on appeal. See Stegall v. West, 11 Vet. App. 268 (1998). The Board finds that further development is needed with respect to the Veteran’s increased rating claim for left foot plantar fasciitis with pes planus. 1. Entitlement to a compensable disability rating for left hand fracture with residual left little finger weakness and ulnar neuropathy. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. See 38 C.F.R. § 4.7 (2017). When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. See id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran. 38 C.F.R. § 4.3. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a) (2012). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran contends that a compensable disability rating is warranted for his left hand fracture with residual little finger weakness and ulnar neuropathy under 38 C.F.R. § 4.71a, DC 5230. Under DC 5230, for limitation of motion of the ring and little finger, a maximum noncompensable rating is assigned for limited ring or little finger motion in either the major (dominant) or minor hand. 38 C.F.R. § 4.71a. During the January 2011 VA examination, the Veteran reported that his left little finger caused spasms and cramps with pain which limited the ability to use his hand at work with grabbing and lifting. The left finger showed hyperextension of DIP 20 degrees and PIP 10 degrees. The examiner noted that the Veteran was unable to perform initial flexion of the finger but able to flex with manual manipulation. There was full range of motion for all five fingers. Pinch test was 0/5 for the left little finger but 5/5 for the remaining four fingers. X-ray imaging of the left hand showed no acute processes with extension noted at the IP joints of the fifth finger. The examiner noted residual little finger PIP and DIP extension and weakness with a moderate functional limitation. There was no ankylosis of the little finger noted on examination. In a February 2017 Disability Benefits Questionnaire (DBQ), the physician noted that the Veteran had ankylosis, specifically DIP of the left pinky finger. He indicated that there was not a gap between the pad of the thumb and fingers, nor finger and proximal transverse crease of the hand on maximal finger flexion. The physician also indicated that the Veteran was able to perform repetitive-use testing with at least three repetitions without additional functional loss or range of motion. Muscle spasms, weakness, and pain below the 5th digit of the left hand was specifically noted. The Veteran had 0/5 hand grip strength in the left hand but did not have muscle atrophy. In the ankylosis section of the DBQ, the physician did not check the box for “no ankylosis” of the left hand nor under little finger. However, the physician checked “no” next to if the MCP and PIP joints were ankylosed. The physician made specific findings that the left thumb, index finger, long finger, and ring finger did not have ankylosis. He noted that ankylosis resulted in limited use of the hand due to spasms, deformity of the finger, and pain. In the September 2018 DBQ, the examiner noted a diagnosis of trigger finger. The Veteran reported pain in the left ulnar side of the hand, weakness, and a decreased grip in the left hand on ulnar side. He indicated that there was not a gap between the pad of the thumb and fingers, nor finger and proximal transverse crease of the hand on maximal finger flexion. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional functional loss or range of motion. Pain limited functional ability with repeated use over a period of time and flare-ups and the inability to flex the little finger of the left hand. The examiner found no ankylosis of the left hand but indicated that the Veteran cannot hold things because he has a weak grip. The examiner noted that the new diagnosis is a correction of the previous diagnosis and although there was a worsening of the Veteran’s symptoms, there is no change to the service-connected diagnosis and no additional diagnosis have been rendered. In a peripheral nerve DBQ, the examiner also indicated that he did not find any sensory changes nor did the Veteran complain of any sensory changes. The examiner found that the Veteran’s left finger weakness / ulnar neuropathy associated with left hand fracture was asymptomatic on examination. The Veteran asserts that private medical records submitted establish that he is unable to flex his left little finger, that the finger is hyperextended, and that he experiences constant swelling in the finger, including in a November 2018 statement from his representative. The examinations discussed above address the Veteran’s contention that he is unable to flex his left little finger and the contention has been fully considered by the Board. Under DC 5230, any limitation of motion of the little finger receives a noncompensable rating. Therefore, any inability to flex the little finger is encompassed by DC 5230 as a noncompensable rating. The Veteran has not asserted and the record does not show amputation, favorable or unfavorable ankylosis, nor limitation of motion of the other fingers of the left hand to warrant a higher rating under DCs 5216-5230, 38 C.F.R. § 4.71a. The February 2017 DBQ physician checked “no” when asked if the MCP and PIP joints of the left little finger were ankylosed but noted that ankylosis resulted in limited use of the hand due to spasms, deformity of the finger, and pain. No ankylosis was noted by the January 2011 examiner and the September 2018 made a specific finding that there was no ankylosis of the left hand. The Board finds that the preponderance of the evidence is against a finding of ankylosis, but in any event, under DC 5227, ankylosis of the little finger receives a noncompensable rating. Under 38 C.F.R. § 4.59, functional loss due to painful motion can be assigned the minimum compensable rating. As DC 5230 has a noncompensable level as the only rating level, there is no minimal compensable rating to be awarded for painful motion. See Sowers v. McDonald, 27 Vet. App. 472 (2016). A noncompensable rating is therefore appropriate for the left hand fracture with residual little finger weakness and ulnar neuropathy. 38 C.F.R. § 4.71a. As the preponderance of the evidence is against the claim for a compensable disability rating for left hand fracture with residual left little finger weakness and ulnar neuropathy, the benefit of the doubt doctrine is not for application, and the Veteran’s claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.   REASONS FOR REMAND 2. Entitlement to an initial compensable disability rating for left foot plantar fasciitis with pes planus prior to March 26, 2014, and in excess of 10 percent thereafter, is remanded. In a July 2014 VA examination report, the examiner noted that since the Veteran’s last VA examination, he had been under the care of a civilian podiatrist, Dr. H., and had several injections and medications with temporary relief. After a review of the claims file, there is no indication that VA attempted to obtain these private medical records and such records have not been associated with the claims file. The omission of potentially relevant records necessitates that the claim must be returned for additional development. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file any additional VA medical evidence that may have come into existence but has not been associated with the record 2. Ask the Veteran to identify any outstanding VA or private treatment records that he wishes VA to obtain, to include private medical records from podiatrist, Dr. H., referenced in the July 2014 VA examination report. After obtaining any necessary authorization forms from the Veteran, obtain any pertinent records identified, and associate them with the claims file. Any negative responses should be in writing and should be associated with the claims file. 3. After completing the above, and any other development deemed necessary, readjudicate the appeal. If any benefit sought remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board. J. GALLAGHER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Cheng, Associate Counsel