Citation Nr: 18159790 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 17-10 051 DATE: December 20, 2018 ORDER The claim of entitlement to service connection for a back disability is denied. The claim of entitlement to service connection for a left foot disability is denied. The claim of entitlement to service connection for sleep apnea is denied. The claim of entitlement to an initial compensable evaluation for residuals of a left ring finger fracture is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record does not reflect the incurrence of a back disability during a period of active duty, active duty for training or inactive duty for training. 2. The preponderance of the evidence of record does not reflect the incurrence of a left foot disability during a period of active duty, active duty for training or inactive duty for training. 3. The preponderance of the evidence of record does not reflect the incurrence of sleep apnea during a period of active duty, active duty for training or inactive duty for training. 4. The Veteran’s residual fracture of the left ring finger is characterized by subjective reports of pain and stiffness, as well as limitation of motion, but not by ankylosis or symptoms analogous to amputation. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 2. The criteria for service connection for a left foot disability are not met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 4. The criteria for an initial compensable disability rating for residual fracture of left hand ring finger have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1-4.14, 4.71a, Diagnostic Code 5230 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Army from May 1983 to August 1983, and with the United States Air Force from September 2001 to June 2002 with additional periods of active duty for training and inactive duty for training with the Reserves. Service Connection Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by service. 38 U.S.C. §§ 1110 (2012). A grant of service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the present disability and the in-service event, injury, or disease. 38 C.F.R. § 3.303; see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Reserve service generally means active duty for training (ADT) and inactive duty for training (IADT). ADT is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). That usually includes two weeks of annual training and/or an initial period of training. IADT includes duty, other than full-time duty, performed for training purposes by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6 (d). That usually indicates weekend drills or training. A veteran is presumed to have been sound upon entry into active service, except as to conditions noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). The presumption of sound condition under 38 U.S.C. § 1111 may apply for any period of ADT or IADT. Initially, the claimant must have had “veteran” status prior to that period of service, which is satisfied if he performed any prior period of active duty service, or, “any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in [the] line of duty.” However, even with “veteran” status, the presumption of soundness does not apply if an entrance examination was not performed contemporaneous to the period of ADT or IADT. “In the absence of such an [entrance] examination, there is no basis from which to determine whether the claimant was in sound condition upon entry into that period of service on which the claim is based.” Smith v. Shinseki, 24 Vet. App. 40 (2010). Similarly, a presumption of aggravation is not applicable to a veteran seeking service connection based on a period of activity duty for training or inactive duty for training. Service connection will only be warranted if the evidence directly shows both that (1) a worsening of the condition occurred during the period of active duty for training and (2) that the worsening was caused by the period of active duty for training. Smith v. Shinseki, 24 Vet. App. 40 (2010) (explaining that the presumption of aggravation only applies with active duty service); Donnellan v. Shinseki, 24 Vet. App. 167, 174 (2010). Certain chronic diseases, which are listed in 38 C.F.R. § 3.309 (a), may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection on a presumptive basis is not warranted for periods of activity duty for training and inactive duty for training. Smith v. Shinseki, 24 Vet. App. 40 (2010); see also Bowers v. Shinseki, 26 Vet. App. 201 (2013). If a disease listed in 38 C.F.R. § 3.309 (a) is shown to be chronic in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. Id. However, if evidence of a chronic condition is noted during service or during the presumptive period, but the chronic condition is not “shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned,” i.e., “when the fact of chronicity in service is not adequately supported,” then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013) (quoting 38 C.F.R. § 3.303 (b)). A claimant “can benefit from continuity of symptomatology to establish service connection in the ultimate sense, but only if [the] chronic disease is one listed in § 3.309(a).” Walker, 708 F.3d at 1337. Service connection may otherwise be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (a). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno, 6 Vet. App. at 465. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.159; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal. 1. The claim of entitlement to service connection for a back disability The Veteran contends that he is entitled to service connection for a back disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of lumbar facet syndrome and degenerative changes of the spine, the preponderance of the evidence is against finding that it began during qualifying service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s medical records reflect a long history of complaints related to low back pain. His active duty service treatment records do not contain such complaints. The Veteran could not specifically identify an onset of symptoms during a period of active duty, active duty for training or inactive duty for training. In his November 2012 claim, he reported the onset of low back pain during a period of non-duty in April 2005. In his June 2014 Notice of Disagreement, he reported that his back disability was the consequence of maintaining Air Force physical fitness standards over a prolonged period of time, but did not report a specific onset during a period of qualifying service. He also submitted a Disability Benefits Questionnaire (DBQ) in November 2014 that reported diagnoses pertaining to his back, but did not provide an etiological opinion for any of those diagnoses. While the Veteran believes his back disability is related to his service, the Board reiterates that the preponderance of the evidence weighs against findings that such a condition occurred during a qualifying period of service. The Veteran is not competent to provide an etiological opinion for his claimed disability, and thus his opinion that his back disability is the result of years of physical fitness training is afforded significantly reduced probative weight. Service connection on a presumptive basis is not warranted for periods of activity duty for training and inactive duty for training. Evidence does not reflect that any of his claimed conditions began during his two periods of active duty service with the Army and Air Force. Furthermore, the presumption of aggravation is inapplicable as there is no direct evidence of a worsening of the condition occurred during the period of active duty for training and that the worsening was caused by the period of active duty for training. As there is no indication that the Veteran has a present disability stemming from a period of qualifying service, an examination is not required for the purposes of adjudication. While the McLendon factors set a low bar to trigger an examination pursuant to VA’s duty to assist, an examination is not required every time a claim is filed. McLendon v. Nicholson, 20 Vet. App. 79 (2006). A VA examination is only required when necessary to decide a claim. Despite the permissive language of VA’s duty to assist, the Court has stated that “[i]f Congress had wanted the Secretary to automatically provide an examination on all possible theories, then section 5103A would not read the way it does.” Robinson v. Peake, 21 Vet. App. 545, 553 (2008). See also Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a claimant’s mere “conclusory generalized statement” that an in-service illness caused his current disability did not trigger VA’s requirement to obtain an examination, and it rejected the theory “that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues”). Here, there is no credible evidence of a present diagnosis related to active duty, active duty for training or inactive duty for training other than the Veteran’s lay statements, which have been afforded significantly diminished probative weight. Therefore, the RO did not err in its duty to assist by failing to provide an examination. Based on the foregoing, the claim of entitlement to service connection for a back disability is denied. The preponderance of the evidence is against the Veteran’s claim; thus, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 2. The claim of entitlement to service connection for a left foot disability The Veteran also contends that he is entitled to service connection for a left foot disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of a left foot neuroma, the preponderance of the evidence is against finding that it began during qualifying service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). The Veteran’s medical records reflect surgery to alleviate pain associated with a left foot neuroma in January 2005. His active duty service treatment records do not contain complaints of left foot pain. The Veteran could not specifically identify an onset of symptoms during a period of active duty, active duty for training or inactive duty for training. In his June 2014 Notice of Disagreement, he reported that his left foot disability was the consequence of maintaining the Air Force physical fitness standards over a prolonged period of time, but did not report a specific onset during a period of qualifying service. While the Veteran believes his left foot disability is related to his service, the Board reiterates that the preponderance of the evidence weighs against findings that such a condition occurred during a qualifying period of service. The Veteran is not competent to provide an etiological opinion for his claimed disability, and thus his opinion that his left foot disability is the result of years of physical fitness training is afforded significantly reduced probative weight. Service connection on a presumptive basis is not warranted for periods of activity duty for training and inactive duty for training. Evidence does not reflect that any of his claimed conditions began during his two periods of active duty service with the Army and Air Force. Furthermore, the presumption of aggravation is inapplicable as there is no direct evidence of a worsening of the condition occurred during the period of active duty for training and that the worsening was caused by the period of active duty for training. As there is no indication that the Veteran has a present disability stemming from a period of qualifying service, an examination is not required for the purposes of adjudication. While the McLendon factors set a low bar to trigger an examination pursuant to VA’s duty to assist, an examination is not required every time a claim is filed. McLendon, 20 Vet. App. at 79. A VA examination is only required when necessary to decide a claim. Despite the permissive language of VA’s duty to assist, the Court has stated that “[i]f Congress had wanted the Secretary to automatically provide an examination on all possible theories, then section 5103A would not read the way it does.” Robinson, 21 Vet. App. at 553. See also Waters, 601 F.3d at 1278-79 (a claimant’s mere “conclusory generalized statement” that an in-service illness caused his current disability did not trigger VA’s requirement to obtain an examination, and it rejected the theory “that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues”). Here, there is no credible evidence of a present diagnosis related to active duty, active duty for training or inactive duty for training other than the Veteran’s lay statements, which have been afforded significantly diminished probative weight. Therefore, the RO did not err in its duty to assist by failing to provide an examination. Based on the foregoing, the claim of entitlement to service connection for a left foot disability is denied. The preponderance of the evidence is against the Veteran’s claim; thus, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Ortiz, 274 F.3d at 1365. 3. The claim of entitlement to service connection for sleep apnea The Veteran also contends that he is entitled to service connection for sleep apnea. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of sleep apnea, the preponderance of the evidence is against finding that it began during qualifying service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). The Veteran’s medical records reflect early indications of sleep apnea in July 2006, but within acceptable numbers. His service treatment records contain subsequent complaints of inadequate sleep, but do not indicate an onset of symptoms during a qualifying period of service. The Veteran could not specifically identify an onset of symptoms during a period of active duty, active duty for training or inactive duty for training. In his November 2012 claim, he reported an onset of sleep apnea generally in May 2006. In his June 2014 Notice of Disagreement, he reported that his sleep apnea was a consequence of ongoing muscle pain and discomfort caused by his abnormal work schedule, but did not report a specific onset during a period of qualifying service. While the Veteran believes his sleep apnea is related to his service, the Board reiterates that the preponderance of the evidence weighs against findings that such a condition occurred during a qualifying period of service. The Veteran is not competent to provide an etiological opinion for his claimed disability, and thus his opinion that his sleep apnea is the result of his abnormal work schedule is afforded significantly reduced probative weight. Service connection on a presumptive basis is not warranted for periods of activity duty for training and inactive duty for training. Evidence does not reflect that any of his claimed conditions began during his two periods of active duty service with the Army and Air Force. Furthermore, the presumption of aggravation is inapplicable as there is no direct evidence of a worsening of the condition occurred during the period of active duty for training and that the worsening was caused by the period of active duty for training. As there is no indication that the Veteran has a present disability stemming from a period of qualifying service, an examination is not required for the purposes of adjudication. While the McLendon factors set a low bar to trigger an examination pursuant to VA’s duty to assist, an examination is not required every time a claim is filed. McLendon, 20 Vet. App. at 79. A VA examination is only required when necessary to decide a claim. Despite the permissive language of VA’s duty to assist, the Court has stated that “[i]f Congress had wanted the Secretary to automatically provide an examination on all possible theories, then section 5103A would not read the way it does.” Robinson, 21 Vet. App. at 553. See also Waters, 601 F.3d at 1278-79 (a claimant’s mere “conclusory generalized statement” that an in-service illness caused his current disability did not trigger VA’s requirement to obtain an examination, and it rejected the theory “that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues”). Here, there is no credible evidence of a present diagnosis related to active duty, active duty for training or inactive duty for training other than the Veteran’s lay statements, which have been afforded significantly diminished probative weight. Therefore, the RO did not err in its duty to assist by failing to provide an examination. Based on the foregoing, the claim of entitlement to service connection for sleep apnea is denied. The preponderance of the evidence is against the Veteran’s claim; thus, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Ortiz, 274 F.3d at 1365. Increased Rating Disability ratings are determined by application of a ratings schedule which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. The degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. However, pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran’s service-connected disability. 38 C.F.R. § 4.14; see Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In a claim for a greater original rating after an initial award of service connection, all of the evidence submitted in support of the Veteran’s claim is to be considered. In initial rating cases, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); 38 C.F.R. § 4.2. VA’s determination of the “present level” of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased rating claim has been pending and, consequently, staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disabilities must be reviewed in relation to their entire history. 38 C.F.R. § 4.1. VA must also interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. VA is also required to evaluate functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person’s ordinary activity. 38 C.F.R. § 4.10. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Functional loss may be due to pain if supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Functional impairment may be due to pain, including during flare-ups, or from repetitive use. Mitchell v. Shinseki, 25 Vet. App. 32, 43-44 (2011). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno, 6 Vet. App. at 465. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.159; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal. 4. The claim of entitlement to an initial compensable evaluation for residuals of a left ring finger fracture The Veteran contends that he is entitled to an initial compensable evaluation for residuals of his left ring finger fracture. Diagnostic Code 5230 provides compensation for limitation of motion of the ring or little finger. 38 C.F.R. § 4.71a. A 0 percent rating is provided for any limitation of motion for both the minor and the major hands. Id. In the February 2014 VA examination, the Veteran reported that he could not completely flex his left ring finger, and experienced stiffness and occasional pain during cold weather. He experienced flare ups, which caused stiffness. There was a gap between thumb pad and fingers of less than 1 inch for the left ring finger. There was no objective evidence of painful motion. There was a less than 1-inch gap between the left ring finger and the proximal transverse crease of the palm with no objective evidence of painful motion. There was no additional loss of range of motion after repetitive use. Functional loss was noted through less movement than normal in the ring finger. The examiner noted that pain could limit functional ability during flare ups or when joint used repeatedly over time, though could not specify any additional loss of range of motion. The Veteran reported difficulty lifting or pulling any objects, and stated that his finger required him to type slowly. The rating schedule intends to represent “the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations.” 38 C.F.R. § 4.1. Under Diagnostic Code 5230, a 0 percent rating “for ‘any limitation of motion’ indicates that there is no reduction in earning capacity..., irrespective of impairment of motion.” Sowers v. McDonald, 27 Vet. App. 472, 480 (2016). Under this code, then, the Veteran cannot recover for any limitation of motion. Unfortunately, the Veteran also cannot be compensated for painful motion under Diagnostic Code 5230. For a painful joint, a veteran can be awarded at least the minimum compensable rating. See 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (applying § 4.59 in non-arthritis contexts). However, a higher rating for pain is not available under Diagnostic Code 5230 because there is no minimal compensable rating. See Sowers, 27 Vet. App. at 480 (“Reading § 4.59 in conjunction with [Diagnostic Code] 5230, [the veteran] is not entitled to a compensable rating under this [code].”). The Board has considered whether an initial disability rating in excess of 0 percent is available under any other diagnostic code pertaining to the fingers. Unfortunately, the evidence does not demonstrate either favorable or unfavorable ankylosis in the left ring finger, and even if favorable or unfavorable ankylosis were found, Diagnostic Code 5227 only provides a single noncompensable (0 percent) rating. While the evidence does not demonstrate that the left ring finger disability has resulted in right or left finger amputation, Diagnostic Code 5155 provides a 10 percent rating for amputation of the ring finger of the major or minor hand without metacarpal resection, at the proximal interphalangeal joint or proximal thereto. A 20 percent rating is assigned for amputation of the little finger of the major or minor hand with metacarpal resection (more than one-half of the bone lost). 38 C.F.R. § 4.71a, Diagnostic Code 5155. The Board finds that the left ring finger pain does not more nearly approximate the disability picture contemplated by amputation without metacarpal resection at the proximal interphalangeal joint or proximal thereto. The evidence also does not show either left ring finger ankylosis or other disability picture analogous to amputation. As such, the Board finds that an initial rating in excess of 0 percent under Diagnostic Code 5155 is not warranted. 38 C.F.R. § 4.71a. For these reasons, the preponderance of the evidence of record does not support an initial compensable rating for the Veteran’s left ring finger disability. Accordingly, the benefit-of-the-doubt rule is not for application, and the claim must be denied. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Fisher, Associate Counsel