Citation Nr: 20021643 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 18-07 932 DATE: March 26, 2020 ORDER Entitlement to a disability rating of 50 percent for the Veteran’s right wrist disability is granted. FINDING OF FACT The Veteran’s right wrist is almost immobile, and his disability is more accurately approximated by unfavorable ankylosis in any degree of plantar flexion, or with ulnar or radial deviation. CONCLUSION OF LAW The criteria for a 50 percent for right wrist disability have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5214, Diagnostic Code 5215 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION In December 2019, the Board remanded this case to the Agency of Original Jurisdiction (AOJ) to associate all outstanding VA records with the claims file, review the Veteran’s most recent VA examination, and issue a Supplemental Statement of the Case (SSOC). Additional VA records were added to the file and a SSOC was issued in January 2020, which reviewed the Veteran’s most recent VA examination. Accordingly, the Board finds there has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability ratings are determined by applying the criteria established in VA’s Schedule for Rating Disabilities, which is based upon the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.20 (2019). When a question arises as to which of two ratings applies under a particular Diagnostic Code, the higher evaluation is assigned if the disability more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2019). Consideration must be given to increased evaluations under other potentially applicable Diagnostic Codes. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the claimant. 38 C.F.R. § 4.3 (2019). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings may be assigned for separate periods of time based on the facts found; this practice is known as staged ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s right wrist disability is currently rated under Diagnostic Code 5215, wrist limitation of motion. 38 C.F.R. § 4.71a (2019). Under this Diagnostic Code a 10 percent rating is warranted for palmar flexion limited in line with the forearm or dorsiflexion less than 15 degrees. This is the maximum schedular rating available under Diagnostic Code 5215. The Board will also consider the other Diagnostic Code for rating disabilities of the wrist. Under Diagnostic Code 5214, ankylosis of the wrist, a 30 percent rating is warranted for favorable ankylosis in 20 to 30 degrees of dorsiflexion of the major arm. A 40 percent rating is warranted with ankylosis in any other position except favorable. A 50 percent rating is warranted for unfavorable ankylosis in any degree of plantar flexion, or with ulnar or radial deviation. When a rating of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable Diagnostic Code, any additional functional loss the Veteran may have sustained by virtue of other factors. Those factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. 38 C.F.R. §§ 4.40, 4.45 (2019); DeLuca v. Brown, 8 Vet. App. 202 (1995). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40 (2019); Johnston v. Brown, 10 Vet. App. 80 (1997). The Veteran’s VA treatment records from April 2015 documented his issues with his right wrist. He reported that he did not have full range of motion in his wrist and used a brace to help with the pain. His May 2015 VA records noted the Veteran experienced sharp pain with flexion and extension. The Veteran received a VA examination in November 2017. He reported daily pain that he rated as 7 out of 10; he described the pain as throbbing and stabbing. The examiner was unable to test the Veteran’s range of motion due to pain. The Veteran stated that his range of motion was negatively impacted by weakness, decreased endurance, and incoordination. He constantly used a brace and was unable to lift anything with his right hand. The Veteran’s most recent VA examination was in April 2018. He continued to report constant daily, aching, and sharp pain. He also continued to wear a brace 95 percent of the time. He experienced flareups with pain reported as 10 out of 10. The Veteran was unable to write his full name or do any tasks with his right hand that required grasping without experiencing a flareup. His range of motion was palmar flexion to 0 degrees, dorsiflexion to 10 degrees, ulnar deviation to 5 degrees, and radial deviation to 5 degrees. He was unable to do repetitive testing because of pain. The examiner noted that the Veteran did not have muscle atrophy or ankylosis; however, the examiner noted that the Veteran had almost no range of motion in his right wrist. He also had pain on passive range of motion testing and non weight bearing testing. The Board acknowledges that the evidence of record does not show that the Veteran has ankylosis. Nevertheless, it is clear from the medical evidence of record the Veteran’s right wrist is limited by painful motion that affects his functional ability. Consequently, in considering the functional limitations due to pain and other factors identified in, 38 C.F.R. §§ 4.40, 4.45, the Board finds that the Veteran’s functional loss from his right wrist disability is more closely described as ankylosis. Thus, the Board will consider whether a disability rating is increased under Diagnostic Code 5214, wrist ankylosis. The Board finds that an increase to 50 percent under Diagnostic 5214 is warranted. The evidence shows that the Veteran’s right wrist is essentially immobile. At the November 2017 VA examination, the Veteran could not move his wrist to engage in any type of range-of-motion testing. Likewise, the April 2018 examiner found that the Veteran had almost no range of motion in his right wrist. As documented in the April 2018 VA examination, he could not write his name or grasp items with his right hand without experiencing a flareup. Consequently, the Board finds that the maximum schedular rating is warranted. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Brunot, 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.