Citation Nr: 20006037 Decision Date: 01/28/20 Archive Date: 01/24/20 DOCKET NO. 15-00 643 DATE: January 28, 2020 ORDER A rating in excess of 10 percent for the right wrist is denied. FINDING OF FACT The Veteran is in receipt of the highest rating available under the appropriate rating code for his right wrist disability, and the weight of the probative, competent evidence does not show ankylosis of the wrist or its equivalent. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for a right wrist disability have not been met for any portion of the appeal period. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5214, 5215. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1972 to December 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2017, the Veteran testified before the undersigned at a videoconference hearing. A transcript of that hearing has been associated with the virtual file and reviewed. Subsequently, the Board remanded this matter in April 2018 for additional development, to include VA treatment records and a new examination. As additional records have been added to the file and the Veteran underwent a VA examination in June 2019, the Board finds there has been substantial compliance with its prior remand directives. Entitlement to a rating in excess of 10 percent for the right wrist Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). The Veteran is rated at 10 percent disabling for residuals of his right wrist disability under DC 5215 throughout the period on appeal – from the Veteran’s filing for increased compensation in February 2013. 38 C.F.R. § 4.71a. Disabilities of the wrists are rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5214 (ankylosis) and 5215 (limitation of motion). A distinction is made between major (dominant) and minor (non-dominant) musculoskeletal groups for evaluation purposes. 38 C.F.R. § 4.69. In this case, the record reflects that the Veteran’s right hand is his dominant extremity, to include as noted upon VA examination in November 2013 and June 2019. Under the regulatory provision of DC 5215, a rating of 10 is warranted where limitation of motion is less than 15 degrees of dorsiflexion; or when palmar flexion is limited in line with forearm. The 10 percent rating is the maximum allowable under this Diagnostic Code. Normal range of motion of the wrist includes dorsiflexion (extension) from zero to 70 degrees, palmar flexion from zero to 80 degrees, ulnar deviation from zero to 45 degrees, and radial deviation from zero to 20 degrees. See 38 C.F.R. § 4.71a, Plate I. Under Diagnostic Code 5214, a 30 percent evaluation is provided for favorable ankylosis in 20 to 30 degrees dorsiflexion; a 40 percent evaluation is provided for ankylosis in any position except favorable, and; a 50 percent evaluation is provided for unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation. 38 C.F.R. § 4.71a, Diagnostic Code 5214. Extremely unfavorable ankylosis will be rated as loss of use of hands under 38 C.F.R. § 4.71a, Diagnostic Code 5125. 38 C.F.R. § 4.71a, Diagnostic Code 5214, Note. At the February 2017 Board hearing, the Veteran reported daily swelling and pain that limited some of his daily activities. He also reported that he constantly wore a brace. After review of the competent and probative evidence, the Board finds that a rating in excess of 10 percent for the right wrist disability is not warranted. The Veteran is already in receipt of the highest available schedular rating under the applicable rating code, as such consideration of functional loss is unnecessary. See 38 C.F.R. § 4.71a, DC 5215; see also Johnston v. Brown, 10 Vet. App. 80, 85 (1995) (concluding that remand was not appropriate for a functional loss assessment where the veteran was in receipt of the maximum schedular rating for limitation of motion of the wrist). Thus, for an increased rating under the other code that evaluates the wrist, evidence of ankylosis is required but the record does not reflect this nor is there the equivalent of ankylosis per the findings noted on the examinations. In support of this finding, a December 2013 VA examination was negative for ankylosis. The Board notes that the June 2019 VA examiner notes less movement than normal due to ankylosis, but then documented that there was no ankylosis of the right wrist. In looking at this examination report in total, it does not support a finding of ankylosis as the Veteran was able to perform range of motion testing, such as 0 to 25 degrees palmar flexion and 0 to 30 degrees of dorsiflexion, that demonstrated his ability to have some range of motion in his right wrist. The Veteran’s medical records show limited range of motion with pain in his wrist in March 2017. Moreover, both the 2013 and 2019 VA examinations both showed no ankylosis. The December 2013 VA examination revealed the right wrist had palmar flexion of 35 degrees and dorsiflexion of 25 degrees. There was pain on motion and additional limitation upon repetition, but it did not contribute to functional loss. The June 2019 VA examination revealed palmar flexion of 25 degrees; dorsiflexion of 30 degrees; ulnar deviation of 25 degrees; and radial deviation of 5 degrees. The pain contributed to some functional loss. He did not have pain with weight-bearing, and he did not have localized tenderness or pain on palpation, and did not have crepitus. He was able to perform three times repetitive use testing with no additional loss of function or range of motion. Regarding evaluation of the wrist after repetitive use after time, the examiner reported that pain, fatigue, weakness, and lack of endurance did not limit functional ability. However, he did have functional loss during flare-ups. He had 4/5 muscle strength indicating active movement against some resistance. He had no atrophy an arthritis was documented. He also testified before the Board in February 2017, and while he has difficulties with activities of daily living, at no point did he assert that he had no range of motion in his right wrist. Based on the foregoing, the Board places no weight on the notation of ankylosis of the right wrist. This one notation is heavily outweighed by the other competent evidence of record as just described. As such, the probative, competent evidence weighs against a rating higher than 10 percent for the Veteran’s right wrist disability based on favorable or unfavorable ankylosis. 38 C.F.R. §§ 4.3, 4.7. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Cruz, 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.