Citation Nr: 20005628 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 10-49 679 DATE: January 23, 2020 ORDER Entitlement to an evaluation in excess of 10 percent disabling for service-connected right wrist extension tendinitis is denied. FINDING OF FACT At no point during the period on appeal did the Veteran’s right wrist disability manifest symptoms comparable to ankylosis. CONCLUSION OF LAW The criteria for an evaluation in excess of 10 percent disabling for service-connected right wrist extension tendinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5215. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1997 to October 1997, from February 1999 to June 1999, and from October 2003 through October 2004. This appeal comes to the Board of Veterans’ Appeals (Board) from a December 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is of record. In April 2018, the Board remanded this issue in order to obtain updated medical records and an updated medical evaluation. The requested actions having been completed to the extent possible, and the claim having been readjudicated by the Regional Office (RO) in a March 2019 Supplemental Statement of the Case (SSOC), the matter has properly been returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998). The Board has thoroughly reviewed all the evidence in the Veteran’s VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable an appellant to understand the precise basis for the Board’s decision, as well as to facilitate review by the Court. 38 U.S.C. § 7104(d)(1); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See id. 38 C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating of ten percent for a particular joint. However, the current 10 percent rating is the highest schedular evaluation allowed by law for limitation of motion of the wrist. To warrant a higher disability rating for a wrist disability under 38 C.F.R. § 4.71a, DC 5215, the evidence must show various specified forms and degrees of ankylosis, i.e., fixation or the absence of movement of a joint. Dorland's Illustrated Medical Dictionary 94 (31st ed. 2007). For a higher, 20 percent rating under DC 5215 for the Veteran’s right wrist disability (his “major” or dominant wrist), the evidence must show favorable ankylosis in 20º to 30º of dorsiflexion. Id. Plate I under 38 C.F.R. § 4.71 provides a standardized description of ankylosis and joint motion measurement of the wrist. The Veteran contends that his wrist condition has worsened, and he suffers from moderately severe pain and swelling on a daily basis and experiences increased trouble with gripping and flexing his wrist. The Veteran’s service-connected right wrist extension tendinitis is currently evaluated as 10 percent disabling for painful motion under DC 5214. This is the highest rating available under that DC. To warrant an increased rating, the evidence would have to reflect the Veteran’s right wrist disability manifested as favorable ankylosis in 20 to 30 degrees of dorsiflexion or symptoms comparable to such a finding. After a complete review of the record in conjunction with the applicable laws and regulations, the Board finds that entitlement to an increased rating greater than 10 percent for a service-connected right wrist disability is not warranted. The Veteran was afforded a VA examination to re-evaluate his right wrist disability in March 2019. He reported daily right wrist pain and swelling that flares-up on prolonged typing, as well as difficulty gripping objects. The Veteran also reported intermittent episodes of difficulty in making a fist with the right hand and intermittent episodes of weakness when flexing the right wrist. Range of motion testing reflected the following results: dorsiflexion from zero to 40 degrees; palmar flexion from zero to 55 degrees; radial deviation from zero to 15 degrees; and ulnar deviation from zero to 35 degrees. Pain was noted during range of motion for dorsiflexion, ulnar deviation, and radial deviation. Additionally, pain with weight bearing, and moderate tenderness and swelling on right wrist extensor (dorsal) were noted. The Veteran could perform repetitive use testing without any evidence of additional limitation of motion. Although the Veteran’s wrist was not examined after repetitive use over time, the examiner was able to estimate additional functional loss caused by pain and weakness in terms of degrees. Those estimations were as follows: dorsiflexion from zero to 30 degrees; palmar flexion from zero to 50 degrees; radial deviation from zero to 10 degrees; and ulnar deviation from zero to 30 degrees. The Veteran’s wrist was not examined during a flare-up, but the examiner noted that the examination was medically consistent with the Veteran’s statements describing functional loss during flare ups, and that pain, weakness, fatigability, or incoordination did significantly limit his functional ability during flare ups. Muscle strength testing results were as follows: flexion rate strength 5/5; and extension rate strength 3/5. The examiner found the reduction in strength was entirely due to the claimed condition in the diagnosis section. Further, the examiner identified no evidence of ankylosis. After review of the record and test results, the examiner opined the Veteran’s daily right wrist pain (5-6/10, pain scale) and swelling that flares-up with more right wrist pain and right wrist swelling on prolonged typing with right wrist with difficulty on gripping objects with right wrist for long [periods] are due to his service-connected right wrist extension tendonitis, but that the Veteran's statement that "sometimes he also has intermittent episodes of difficulty to make fist with right wrist and intermittent episodes of weakness to flex the right wrist," are not due to his to his service-connected right wrist extension tendonitis, but are due to Veteran's more recently diagnosed right carpal tunnel syndrome. See CAPRI March 2017. The prior VA examination was done in 2011. His complaints at that time were similar to those he raised during the 2018 VA examination. Range of motion measurements with active motion was dorsiflexion 0 to 50 degrees, palmar flexion 0 to 35 degrees, radial deviation 0 to 20 degrees, and ulnar deviation 0 to 20 degrees. There was objective evidence of pain with active motion of the right wrist. The examiner also provided range of motion findings for the left wrist, which showed more ability to move that wrist in all planes, other than radial deviation, which was the same as the right wrist. There were no additional limitations after three repetitions of range of motion. The examiner noted the effect on employment would include decreased mobility, strength and manual dexterity, problems with lifting and carrying, weakness or fatigue. Although the Veteran’s VA records reflect ongoing complaints of wrist pain, there is no evidence of any ankylosis or comparable symptoms. During his January 2018 Board hearing, the Veteran testified that he needed to use his left wrist more to compensate for pain in his right wrist, and that was affecting his left wrist, but he did not report any symptoms of ankylosis such as immobility of the joint. The record contains no evidence that the Veteran’s right wrist disability manifested as favorable ankylosis in 20 to 30 degrees of dorsiflexion or symptoms comparable to such a finding. The March 2019 VA examination found no evidence of ankylosis. The normal ranges of motion of the wrist are: radial deviation from zero to 20 degrees; ulnar deviation from zero to 45 degrees; dorsiflexion from zero to 70 degrees; and palmar flexion from zero to 80. The VA examinations have shown the Veteran’s palmar flexion was limited by 45 degrees (2011 exam), dorsiflexion limited by at most 40 degrees (2018 exam, finding with flare-ups), ulnar deviation was limited by at most 25 degrees (2011 exam), and radial deviation was limited by at most 10 degrees (2018 exam, finding with flare-ups). The Board cannot find these minor reductions in range of motion for the identified planes more nearly approximate ankylosis nor can the Board assign a higher rating based on symptoms a medical professional concludes are caused by a diagnosis unrelated to the service-connected disability. In forming this decision, the Board has considered the Veteran’s complaints of pain in the right wrist. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45 (2017), pertaining to functional impairment. These provisions are not applicable where, as in this case, the maximum rating for limitation of motion has been awarded. Johnston v. Brown, 10 Vet. App. 80, 85 (1997); 38 C.F.R. § 4.59. The Board notes that in adjudicating a claim, the competence and credibility of the lay statements must be considered. See Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Board acknowledges that the Veteran is competent to give evidence about what he experiences. For example, he is competent to report that he experiences symptoms such as pain, and he is credible in this regard. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Veteran’s competent and credible belief that his disability is worse than the assigned disability rating, is outweighed by the competent and credible medical examination that evaluated the true extent and cause of impairment based on objective data coupled with the Veteran’s lay complaints. For these reasons, greater evidentiary weight is placed on the physical examination findings than the lay statements. In summary, the Veteran’s right wrist disability results in painful motion that more nearly approximates the criteria corresponding to the currently assessed compensable 10 percent rating. The preponderance of the evidence is against a rating in excess of 10 percent, even after all reasonable doubt is resolved in favor of the Veteran. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mireya Martinez 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.