Citation Nr: A19002456 Decision Date: 10/31/19 Archive Date: 10/31/19 DOCKET NO. 190501-8547 DATE: October 31, 2019 ORDER Entitlement to a separate compensable rating for degenerative arthritis of the left hand (claimed as traumatic arthropathy of the left hand) is granted. FINDING OF FACT The Veteran’s left-hand arthritis is a separate and distinct disability from his service-connection left finger amputations. CONCLUSION OF LAW The criteria for a separate compensable rating for degenerative arthritis of the left hand (claimed as traumatic arthropathy of the left hand) have been met. 38 C.F.R. § 4.25. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1976 to October 1978. The rating decision on appeal was issued in February 2019. The Veteran timely appealed the February 2019 rating decision to the Board of Veterans’ Appeals (Board) and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ), i.e., by the local regional office (RO). 1. Entitlement to a separate compensable rating for left hand arthritis. The Veteran’s left-hand degenerative arthritis is currently evaluated in combination with his service-connection left finger amputations. The Veteran contends that he is entitled to a separate compensable rating for his left-hand arthritis. Separate disabilities arising from a single disease entity are to be rated separately. 38 C.F.R. § 4.25 (2017); Esteban v. Brown, 6 Vet. App. 259 (1994). The rating of the same disability under different diagnostic codes, known as pyramiding, must be avoided. However, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14 (2017); Esteban v. Brown, 6 Vet. App. 259 (1994). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability ratings are potentially applicable, the higher rating will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). In the current case the Veteran suffered an in-service injury that resulted in amputation of the long and ring fingers on his left hand, as well as the partial amputation of the left little finger. The Veteran has been in receipt of a 20 percent disability rating for the left-hand amputations since 1978. In September 2017 he filed a formal claim for service connection for degenerative arthritis of the left hand. A February 2019 rating decision granted service connection for left hand arthritis and combined the disability with the service-connected left finger amputations and continued the 20 percent rating for the combined disability. However, the Board finds that the left-hand degenerative arthritis, although secondary to the left-hand finger amputations, is a distinct disability that warrants a separate rating. In this regard, pertinent medical evidence of record indicates that the Veteran suffers from left hand decreased muscle strength, abnormal range of motion, functional loss due to abnormal range of motion, pain with use of hands, weakness, fatigability or incoordination that significantly limit functional ability with repeated use over a period of time, left hand deformity, a gap between fingers and proximal transverse crease of the hand on maximal finger flexion. Also, the Veteran reports flare-ups and if he uses his left hand to grip things, it increases the pain and causes his thumb and index fingers to go into muscle spasms, and the he has to pull them apart with my right hand. The record also shows that the left-hand disability functional impact on occupational activities includes, decreased manual dexterity, problems with lifting and carrying, decreased strength, and upper extremity pain and disfigurement. Thus, the disability picture overall shows a physical left-hand deformity and loss of function due to the loss of fingers as well as pain and loss of left-hand function due to arthritis of the left hand. These are two distinct disabilities with varying symptomology. Therefore, the Veteran is entitled to a separate compensable rating for his left-hand arthritis. As such the Veteran’s claim is granted. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Quinn, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.