Citation Nr: 20006913 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 15-39 937 DATE: January 28, 2020 ORDER An initial rating in excess of 10 percent rating for residuals of multiple fractures of the left thumb is denied. FINDINGS OF FACT 1. The Veteran served on active duty from May 1977 to May 1981. 2. The left thumb disability is manifested by objective complaints of painful motion; subjective findings reveal no gap between the thumb pad and fingers or ankylosis. CONCLUSION OF LAW The criteria for an initial rating in excess of 10 percent for residuals of multiple fractures of the left thumb have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Codes (DCs) 5228-5003 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran is in receipt of a 10 percent rating for limitation of the left thumb and degenerative arthritis pursuant to DC 5228-5003. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. Under the limitation of thumb motion provisions of DC 5228, a 20 percent rating is warranted if there is a gap of more than two inches (in.) (5.1 centimeters (cm.)) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Under DC 5003, degenerative arthritis is rated as 20 percent with X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. Turning to the evidence, a review of the record shows no evidence of left thumb ankylosis, nor has the Veteran claimed ankylosis. Ankylosis is defined as a fixation of the joint. As such, the medical evidence does not support a higher rating under DC 5224. In a September 2014 VA examination, the Veteran reported that he experienced pain in the left thumb and left hand, which was aggravated by cold/wet weather. He was left-hand dominant. He did not report any flare-ups. The examiner reported no limitation of motion of the left thumb, no gap between the thumb pad and the fingers, and no limitation of motion or evidence of painful motion for the left ring finger. The was gap between the finger and proximal transverse crease of the hand on maximal finger flexion. The gap was less than 1 in. (2.5 cm). There was no objective evidence of localized tenderness or pain on palpation of the left thumb joint or associated soft tissue. The Veteran was able to perform repetitive-use testing with at least three repetitions, and there was no additional functional loss or range of motion afterwards. The left-hand grip was measured at 5/5. He did not have muscle atrophy or ankylosis. The examiner noted that imaging studies showed degenerative changes of the left thumb but otherwise unremarkable findings. On a June 2019 Disability Benefit Questionnaire (DBQ), the Veteran endorsed flare-ups which were described as increased pain and stiffness. Range of motion testing of the left hand showed overall normal ranges with the exceptions of ring finger flexion to 70 degrees MCP, 70 degrees PIP, and 60 degrees DIP. The examiner noted no gap between the thumb pad and the fingers. The examiner found during flare-ups the Veteran’s symptoms of pain and fatigability would increase but no further range of motion loss. There was no objective evidence of pain on non-weight bearing and no additional limitation of motion on passive range of motion testing. The diagnoses were left thumb strain and osteoarthritis of the proximal and distal interphalangeal joints. VA clinical records show complaints of pain. swelling, difficulty with grip, and decreased range of motion. Additionally, a January 2015 VA treatment note reported that the Veteran had significant osteoarthritis in the metacarpal carpal joint of the left hand and the June 2019 X-ray diagnosis of osteoarthritis of the proximal and distal interphalangeal joints. Based on the above, a higher rating is not warranted. As noted, the left thumb disability is not manifested by a gap of more than 2 in. (5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers as is required for a higher initial 20 percent rating under DC 5228. Nor is there X-ray evidence of the involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, as is required for a higher initial 20 percent rating under DC 5003. Although the September 2014 DBQ examiner noted on physical examination a gap between the Veteran’s left thumb and ring finger on his left hand, the gap was less than 1 in. (2.5 cm). Additionally, the June 2019 DBQ examiner specifically found no gap between the left thumb and any of the fingers of the left hand on physical examination. Moreover, a June 2019 X-rays of the left hand only showed osteoarthritis of the interphalangeal joints related to osteoarthritis of the proximal and distal interphalangeal joints. Even considering increased pain and stiffness during a flare-up, the evidence does not show a gap of more than 2 in. (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, as required for a higher rating. The Board has considered the Veteran’s lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his left thumb disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s left thumb [identify disability] has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiners have the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not   required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Grzeczkowicz 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.