Citation Nr: 20075052 Decision Date: 11/24/20 Archive Date: 11/24/20 DOCKET NO. 18-28 474 DATE: November 24, 2020 ORDER Entitlement to an initial rating in excess of 10 percent for a right wrist condition (formerly residuals of a right wrist fracture with pain and limited range of motion) is denied. FINDING OF FACT The evidence of record reflects that the Veteran’s right wrist condition has manifested with pain and limited motion, but not ankylosis. CONCLUSION OF LAW The criteria for entitlement to an initial rating in excess of 10 percent for a right wrist condition have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5215 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Marine Corps from January 1964 to January 1968. This matter is before the Board of Veterans’ Appeals (Board) on appeal from the January 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) granting service connection for residuals of a right wrist condition with pain and limitation of motion with an evaluation of 10 percent disabling. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 7107(a)(2); 38 C.F.R. § 20.900(c). Increased rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Entitlement to an initial rating in excess of 10 percent for a right wrist condition (formerly residuals of a right wrist fracture) The Veteran asserts that a rating in excess of 10 percent is warranted for his right wrist condition. Additionally, the Veteran asserts that during the January 2018 VA compensation and pension (C&P) examination, the examiner failed to conduct all of the necessary range of motion testing, specifically failed to conduct repetitive use testing. See Appellate Brief, October 2020. A review of the January 2018 C&P examination report reflects that the Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. The report requires that documentation of range of motion if there is additional loss of function or range of motion after three repetitions. The examiner indicated that the Veteran was not being examined immediately after repetitive use over time, but the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Additionally, the examiner noted that the Veteran experienced limited functional ability with repeated use over a period of time resulting in pain which could not be described in terms of range of motion. Based on the above, the Board finds that all necessary testing was conducted and results properly documented. The Veteran’s right wrist condition is currently rated as 10 percent disabling under Diagnostic Code 5215 (DC 5215). Under DC 5215 a maximum 10 percent rating is available when there is dorsiflexion of the wrist to less than 15 degrees or when palmar flexion of the wrist is limited in line with the forearm, regardless of whether the disability is on the major arm or the minor arm. See 38 C.F.R. § 4.71a, DC 5215. Separate 10 percent ratings may not be assigned under DC 5215 for both limitation of dorsiflexion and limitation of palmar flexion. See Cullen v. Shinseki, 24 Vet. App. 74, 84 (2010) (holding that within a particular diagnostic code, a claimant is not entitled to more than one disability rating for a single disability unless the regulation expressly provides otherwise). Therefore, the Veteran is currently in receipt of the highest available rating under DC 5215 and the highest available schedular rating for a wrist disability on the basis of limited motion for the right wrist. As such, the Board finds that a rating in excess of 10 percent for the service-connected right wrist disability is not warranted under DC 5215. Ratings in excess of 10 percent are available under 38 C.F.R. § 4.71a, DC 5214, when there is favorable or unfavorable ankylosis of the wrist. However, the Board finds that the evidence of record does not reflect that the Veteran had favorable or unfavorable ankylosis of the right wrist at any point during the relevant rating period. The medical treatment records do not show a finding or diagnosis of ankylosis of the right wrist. The January 2018 VA examination does not indicate that the Veteran had ankylosis of the right wrist. Furthermore, the Veteran has not contended that he has ankylosis of the right wrist. As such, the Board concludes that the evidence of record does not show that the criteria for entitlement to a higher disability rating under DC 5214 based on ankylosis of the right wrist were met at any time during the relevant rating period. The Board, therefore, finds that the criteria for a rating in excess of 10 percent for the Veteran’s service-connected right wrist condition have not been met at any time during the rating period. As the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Ver. App. 49 (1990). M. Mills Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Camille NeSmith, 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.