Citation Nr: 20022024 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 12-10 678 DATE: March 30, 2020 ORDER Service connection for degenerative joint disease of the cervical spine is denied. Service connection for a right knee disability is denied. A rating in excess of 10 percent for deformity of the metatarsal head of the third toe of the right foot, status post Friedburg fracture is denied. A rating in excess of 10 percent for bilateral arthralgia of the hands, with arthritis of the right hand, prior to March 15, 2018, is denied. A rating in excess of 10 percent for limitation of motion of the right thumb as of March 15, 2018 is denied. A rating in excess of 10 percent for limitation of motion of the right index finger as of March 15, 2018, is denied. A rating in excess of 10 percent for limitation of motion of the right long finger as of March 15, 2018, is denied. A compensable rating for limitation of motion of the right ring finger as of March 15, 2018, is denied. A compensable rating for limitation of motion of the right little finger as of March 15, 2018, is denied. A rating in excess of 10 percent for limitation of motion of the left thumb as of March 15, 2018, is denied. A rating in excess of 10 percent for limitation of motion of the left index finger as of March 15, 2018, is denied. A rating in excess of 10 percent for limitation of motion of the left long finger as of March 15, 2018, is denied. A compensable rating for limitation of motion of the left ring finger is denied. A compensable rating for limitation of motion of the left little finger is denied. REMANDED Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to a total disability rating by reason of individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s degenerative joint disease of the cervical spine was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The Veteran’s degenerative joint disease of the right knee was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. The Veteran’s deformity of the metatarsal head of the third toe of the right foot, status post Friedburg fracture is manifested by no more than moderate symptoms. 4. Prior to March 15, 2018, the Veteran’s bilateral arthralgia of the hands with arthritis of the right hand was manifested by pain and decreased strength on use, without limitation of motion either hand or any of the digits and no demonstration of arthritis of the left hand. 5. As of March 15, 2018, the Veteran’s service-connected right thumb disability has been manifested by painful motion, but has not been manifested by a gap of more than 2 inches (5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers; ankylosis is not demonstrated. 6. As of March 15, 2018, the Veteran’s service-connected right index finger disability has been manifested by painful limitation of motion and a gap of 2.0 cm between the fingertip and the proximal transvers crease of the palm; ankylosis is not demonstrated. 7. As of March 15, 2018, the Veteran’s service-connected right long finger disability has been manifested by painful limitation of motion and a gap of 2.0 cm between the fingertip and the proximal transvers crease of the palm; ankylosis is not demonstrated. 8. As of March 15, 2018, the Veteran’s right ring finger disability has been manifested by pain and limitation of motion, but does not more nearly approximate ankylosis. 9. As of March 15, 2018, the Veteran’s right little finger disability has been manifested by pain and limitation of motion, but does not more nearly approximate ankylosis. 10. As of March 15, 2018, the Veteran’s service-connected left thumb disability has been manifested by painful motion, but has not been manifested by a gap of more than 2 inches (5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers. 11. As of March 15, 2018, the Veteran’s service-connected left index finger disability has been manifested by painful limitation of motion and a gap of 2.0 cm between the fingertip and the proximal transvers crease of the palm; ankylosis is not demonstrated. 12. As of March 15, 2018, the Veteran’s service-connected left long finger disability has been manifested by painful limitation of motion and a gap of 3.0 cm between the fingertip and the proximal transvers crease of the palm; ankylosis is not demonstrated. 13. As of March 15, 2018, the Veteran’s left ring finger disability has been manifested by pain and limitation of motion, but does not more nearly approximate ankylosis. 14. As of March 15, 2018, the Veteran’s left little finger disability has been manifested by pain and limitation of motion, but does not more nearly approximate ankylosis. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative joint disease of the cervical spine have not been met. 38 U.S.C. §§ 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for a rating in excess of 10 percent for deformity of the metatarsal head of the third toe of the right foot, status post Friedburg fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 4. The criteria for a rating in excess of 10 percent for bilateral arthralgia of the hands with arthritis of the right hand prior to March 15, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5099-5010. 5. The criteria for a rating in excess of 10 percent for limitation of motion of the right thumb as of March 15, 2018 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5228. 6. The criteria for a rating in excess of 10 percent for limitation of motion of the right index finger have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5229. 7. The criteria for a rating in excess of 10 percent for limitation of motion of the right long finger as of March 15, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5229. 8. The criteria for a compensable rating for limitation of motion of the right ring finger have not been met as of March 15, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5230. 9. The criteria for a compensable rating for limitation of motion of the right little finger have not been met as of March 15, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5230. 10. The criteria for a rating in excess of 10 percent for limitation of motion of the left thumb as of March 15, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5228. 11. The criteria for a rating in excess of 10 percent for limitation of motion of the left index finger as of March 15, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5229. 12. The criteria for a rating in excess of 10 percent for limitation of motion of the left long finger as of March 15, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5229. 13. The criteria for a compensable rating for limitation of motion of the left ring finger have not been met as of March 15, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5230. 14. The criteria for a compensable rating for limitation of motion of the left little finger have not been met as of March 15, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1976 to November 1980. The case has a long history having originated from a November 2009 rating decision. The case was before the Board in March 2017 at which time issues related to the rating of arthralgia of the hands and right third toe disorder were remanded for further development of the evidence. Additional issues of service connection for left shoulder, right hip and bilateral carpel tunnel syndrome as well as the rating of the Veteran’s bilateral hearing loss were also remanded pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). The Veteran was furnished a Statement of the Case (SOC) regarding the latter four issues, but did not submit a timely appeal as instructed in the Board’s March 2017 remand or by the letter that accompanied the SOC. As such, the issues have not been properly certified for appellate consideration. The March 2017 Board decision also noted that the issues related to service connection for right shoulder, right knee and cervical spine disabilities were found to have not been formally appealed to the Board. The Veteran appealed this matter to the United States Court of Appeals for Veterans Claims (Court) and, in a December 2017 Joint Motion for Remand (JMR) the parties agreed that these matters had been properly appealed so that those matters needed to be addressed by the Board. In a June 2018 decision, the Board remanded those three issues for additional development. In an August 2019 rating decision, the Regional Office (RO) found that, rather than rating the Veteran’s arthralgia of the hands in a single rating, it was more proper to rate each finger individually. As such, effective March 15, 2018 (the date of a VA examination), separate 10 percent ratings were assigned for the thumb, index, and long fingers of each hand and noncompensable ratings were assigned for each ring and little finger. The RO concurrently terminated the single 10 percent rating for bilateral hand arthralgia. The Veteran has continued his appeal as to these ratings. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition, as identified in 38 C.F.R. § 3.309(a), noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as arthritis and diseases of the nervous system such as carpal tunnel syndrome, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In order to prevail on the issue of service connection, there must be medical evidence of current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1990). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1990); 38 C.F.R. § 3.303(a). The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence where appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Service connection for degenerative joint disease of the cervical spine The Veteran contends that service connection should be established for degenerative joint disease of the cervical spine. It is asserted that the Veteran has already been service connected for arthritis of the hands and that, as arthritis is a chronic condition, the later development of arthritis in the cervical spine should establish a relationship with service. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of degenerative disc and joint disease of the cervical spine as evidenced by a July 2008 medical report associated with records received in connection with a claim made by the Veteran with the Social Security Administration (SSA). At that time, it was noted that a July 2007 X-ray study had noted the cervical spine disorder. As noted, arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Review of the record, however, shows that the disability was not demonstrated as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. The Veteran’s service treatment records (STRs) are silent for any complaints or manifestations of a cervical spine disability while he was on active duty and there is no indication of arthritis of the cervical spine noted within one year thereafter. An April 1990 injury report documents that the Veteran had complaints of pain in the neck area after lifting a refrigerator. An October 2006 SSA medical record shows that, while X-ray studies of the shoulders was normal, the shoulder pain that the Veteran was complaining about might be coming from the cervical spine. The Veteran is competent to report experiencing symptoms of arthritis since service, but it is noted that he has not specifically done so in this case. The main contention is that, as the Veteran has been service connected for arthritis of the hands, it follows that cervical spine arthritis should be likewise service connected. The Veteran is not competent to determine that such a relationship exists, as he has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires specialized medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are instead attributable to other causes. The Veteran was examined by VA in September 2019 at which time the VA examiner opined that it was less likely than not that his cervical spine disorder was incurred in or caused by a claimed in-service injury, event or illness. The examiner determined that the symptoms were due to traumatic injury and wear and tear over time. The examiner noted that review of the record showed that the Veteran had documented complaints of neck pain beginning in 1985, five years after separation from service. He was noted to have had neck injuries in 1987 and 1990 and, although heavy lifting and marches with heavy back packs could have been a contributing factor, the medical evidence was more supportive of the arthritis being related to neck injuries in the Veteran’s post-service years. As such, there was no objective evidence in the claims folder showing that the cervical disc disease was related to his time in service and a nexus had not been established. While service connection may still be granted on a direct basis, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s cervical spine disability and an in-service injury, event or disease. 38 U.S.C. § 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. As noted, the September 2019 VA examiner rendered a negative nexus opinion. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for degenerative joint disease of the cervical spine, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for a right knee disability The Veteran contends that service connection should be established for right knee arthritis that is believed to be related to complaints of right knee pain noted while he was on active duty. Alternatively, it is contended that the Veteran has had chronic complaints of right knee pain through the years since service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of right knee arthritis, and evidence shows that he had complaints of right knee pain during service, the preponderance of the evidence weighs against finding that the Veteran’s right knee arthritis began during service or is otherwise related to an in-service injury, event, or disease. Review of the Veteran’s STRs shows that in November 1977, he was treated for complaints of right knee pain after running. Specifically, he treated with heat and an Ace wrap and told not to run over one mile for the next three days. On examination for separation from service, clinical evaluation of the lower extremities (other than the feet) was normal. VA treatment records show the Veteran’s right knee arthritis was not diagnosed until January 2001, years after his separation from service. While the Veteran is competent to report having experienced symptoms of knee pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of knee arthritis. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau 492 F.3d at 1372. Further, two VA examiners in August 2009 and September 2019 have opined that the Veteran’s right knee arthritis is not at least as likely as not related to an in-service injury, event, or disease, including the episode of knee pain during service. Taken together, the VA examiners’ opinions establish that the Veteran’s right knee arthritis is not at least as likely as not related to an in-service injury, event, or disease. The rationale for the August 2009 VA examiner opinion was that although the Veteran was seen in November 1977 for leg pain following a run, the examination at that time was essentially unremarkable for abnormalities. Thus, there was no evidence of a lasting, permanent disability of the knee joint. Additionally, there was no continuity of care documented in the years following service. The examiner noted that the current examination showed no functional abnormality, but there were mild degenerative changes radiographically that were most likely the result of aging. The September 2019 VA examiner also opined that the Veteran’s right knee arthritis was not at least as likely as not related to service. The rationale for that opinion was that the Veteran had an acute condition of the right knee during service documented by one sick call visit in 1977 with no further complaints of right knee pain during service. The earliest knee complaints were in 2001 when there was a notation of an earlier ACL repair. This procedure was not documented in the record and the Veteran denied having had a surgical procedure on the knee. There were no objective findings that this had occurred. The examiner stated that the record showed normal findings in 1977 and a nexus was not established. The VA examiners’ combined opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, there is no competent evidence to the contrary. Although the record also contains a private opinion dated in May 2011 that references the Veteran’s right knee arthritis, which is mentioned along with arthritis of the hands, the opinion deals specifically with his gastrointestinal disorder, which has been service connected and is not part of the present appeal. As such, this opinion has no bearing on the issue of service connection for right knee arthritis. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for arthritis of the right knee, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating 3. Entitlement to a rating in excess of 10 percent for deformity of the metatarsal head of the third toe of the right foot, status post Friedburg fracture The Veteran contends that his right foot disability is more disabling than currently evaluated. Service connection for status post Friedburg fracture of the right foot was granted by rating decision dated in July 1981. The current 10 percent rating was awarded at that time. The Veteran’s claim for TDIU in 2009 was also accepted as a request for an increased rating for his right foot disability. The Veteran’s right great toe fracture residuals is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5284, for other foot injuries. Under Diagnostic Code 5284, a 10 percent rating is warranted for moderate other foot injuries. A 20 percent rating is warranted for moderately severe other foot injuries. A 30 percent rating is warranted for other foot injuries. A Note to Diagnostic Code 5284 instructs that with actual loss of use of the foot rate as a maximum 40 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5284. According to MERRIAM WEBSTER, “moderate” means “tending toward the mean or average amount or dimension”. See www.merriam-webster.com/dictionary/moderate. “Severe” means “of a great degree”. See www.merriam-webster.com/dictionary/severe. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. An examination was conducted by VA in October 2009. At that time, the Veteran related that he was in pain from his foot disorder and took a Percocet tablet every six hours and used a fentanyl patch. The examiner noted, however, that these medications were also utilized for back pain and that the Veteran had undergone back surgery in 1999. The Veteran stated that his foot pain was across the top of the foot. He stated he was able to stand for only 15 to 30 minutes and was unable to walk for more than a few yards. He utilized a cane. Examination of the right foot showed no evidence of painful motion, swelling, tenderness, instability, weakness, or abnormal weight bearing. There were no hammertoes, hallux valgus, or rigidus. There was a scar to the top of the foot in front of the third digit that measured 3 cm by 2cm. The scar was mildly hypopigmented, smooth surfaced, non-tender to palpation and superficial. There was no evidence of pes cavus, malunion or nonunion of the tarsal or metatarsal bones, flat foot, muscle atrophy, or other foot deformity. There was no point tenderness to any part of the right foot. The Veteran had full range of motion of the ankle joint as well as the toes of the foot. There was no instability of the ankle joint. The Veteran walked with a limp but did not use a cane and had strong propulsion. X-ray studies showed a flattened deformity of the metatarsal head of the third toe on the right with similar deformity of the proximal end of the proximal phalanx. The diagnosis was status post Friedburg fracture of the right foot. The examiner noted the Veteran was not currently employed, but indicated the foot disorder did not have an effect on his daily activities. An examination was conducted by VA in March 2018. At that time, the diagnoses were flat foot, diagnosed in 2018, and residual flattened deformity of the metatarsal head of the third doe of the right foot with scar, status post Friedburg fracture. The Veteran reported having soreness of the right foot all the time, which worsened if he walked for a long time. He also reported that cold weather and weight bearing worsened his foot pain; these were described as flare-ups. He noted that he needed to take his shoes off in church due to pain. The Veteran did have flatfoot of the right foot, but there was no pain accentuated on use, pain on manipulation of the feet. He described swelling on use, but no characteristic calluses on the right. He used arch supports for both feet and had extreme tenderness of the plantar surfaces on both feet. There was no marked pronation of the feet, inward bowing of the Achilles tendon or weight bearing that fell over or medial to the great toe. There were mild residuals of the Friedburg fracture of the right foot with metatarsal head flattening of the right third toe. This compromised weight bearing and caused constant pain. Examination, however, showed no pain on physical examination. The Veteran reportedly experienced pain after prolonged use. There was no evidence of pain on passive range of motion or when the joint was used in non-weight bearing. There was pain on weight-bearing on the right. He described pain that limited his time on his foot. Over a period of time or during flare-ups, the Veteran was unable to shift his weight onto his forefoot as the pain increased. There was a scar, but this was not shown to be painful or unstable, or to have a total area equal to or greater than 39 square cm. This was located on the right dorsal foot and measured 3 cm by 1 cm. It was well-healed, linear, nontender, and stable. The Veteran used a cane to assist in normal locomotion. Imaging studies of the foot did not document degenerative or traumatic arthritis. Deformity of the third toe on the right was noted, but the testing was otherwise unremarkable. Functional impact was described as difficulty sustaining prolonged weight bearing to the right foot, but the Veteran could otherwise entertain activities of daily living. The examiner also noted that some degree of pes planus was present bilaterally, which was a new and separate diagnosis from the service-connected flattened deformity of the metatarsal head of the third toe of the right foot with scar, status post Friedburg fracture, which had remained unchanged. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran’s right third toe disability. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain on prolonged walking. However, even considering the Veteran’s lay reports of symptoms and functional loss, the degree of additional limitation reflected by the statements of flare-ups do not result in symptoms more nearly approximating moderately severe other foot injuries. The Veteran’s foot disability was described as mild on examination in 2009 and as unchanged on examination in 2018. The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court’s holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court’s holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. In this case, while the record shows that the Veteran was recently found to have pes planus of both of his feet, there is no indication that this is related to his service-connected right third toe deformity, status post Friedburg fracture. In conclusion, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran’s right toe deformity. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to a rating in excess of 10 percent for bilateral arthralgia of the hands prior to March 15, 2018, Service connection for bilateral arthralgia of the hands was established by rating decision of the RO in July 1981. At that time, a noncompensable rating was assigned as analogous to rheumatoid arthritis under Diagnostic Codes 5099 and 5002. When an unlisted condition is encountered it is permissible to rate it under a closely related disease or injury in which not only the function affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. The rating was increased to 10 percent disabling by rating decision dated in November 2009 when X-ray evidence of arthritis was found in the right hand. The rating was based as analogous to traumatic arthritis under Diagnostic Codes 5099 and 5010. This rating remained in effect until March 15, 2018, when separate ratings were awarded for each of the Veteran’s fingers. Those ratings will be addressed separately. Arthritis due to trauma, substantiated by X-ray findings, shall be rated as degenerative arthritis. 38 C.F.R. § 4.71a, Code 5010. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriated diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, an evaluation of 10 percent is applied for each major joint or group of minor joints affected by limitation of motion. These 10 percent evaluations are combined, not added, under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation will be assigned where there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups. A 20 percent evaluation will be assigned where there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. An examination was conducted by VA in October 2009. At that time, the Veteran described his hand problem during service, but it was noted that he had not had any injury to either hand an no diagnosis of a connective tissue disease such as rheumatoid arthritis. He stated that he had pain in his hands, more in the right than the left. There had been no interference with daily activities due to the hand condition. He stated that he had decreased strength in both hands, but no decrease in hand dexterity and no other symptoms. He described flare-ups in that his hand grip became weak with prolonged holding of an object. Range of motion testing of all fingers and the thumb of both hands was normal without notation of pain. There was no decreased strength on pushing, pulling or twisting. There was no decreased dexterity. The Veteran was able to make a complete fist bilaterally and grip strength was strong. There were no signs of connective tissue disease to the fingers of each hand or each wrist. There was no swelling, redness, limitation in range of motion or warmth. Range of motion was performed by the Veteran and verified on passive flexing and extending the joints of the fingers. X-ray studies of each hand showed minimal degenerative changes seen in the distal interphalangeal joints in the right hand, particularly in the third and fifth digits. Joint spaces in the left hand were relatively intact. The diagnosis was radiographic evidence of minimal degenerative change seen in the right hand, unremarkable in the left hand, with no functional impairments to either hand or fingers of either hand. There were no effects on the Veteran’s usual daily activities. The evidence of record prior to March 15, 2018, shows that the Veteran’s bilateral hand arthralgia was manifested by pain and decreased strength in both hands on use, particularly on the right. On examination in 2009, the Veteran was shown to have minimal arthritis of the right hand only. Based on this X-ray finding, the RO awarded a 10 percent rating as analogous to arthritis of a minor joint group in accordance with the provisions of Diagnostic Code 5003. Significantly, the Veteran had degenerative changes in the right hand only, without any limitation of motion of the hand or fingers. The Board has reviewed all of the evidence and can find no basis for a rating in excess of 10 percent prior to March 15, 2018. There is no evidence of arthritis of any service-connected minor joint group other than the right hand and no limitation of motion that could warrant additional ratings. As the examinations of record show no arthritis other than that demonstrated in the right hand and, most significantly, no limitation of motion of any of the Veteran’s fingers, the Board finds that a preponderance of the evidence is against the Veteran’s appeal for a higher rating for arthralgia of the hands, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Individual digit ratings as of March 15, 2018 An examination was conducted by VA on March 15, 2018. The diagnosis was arthralgia, bilateral hands, with degenerative changes of the right hand. It was noted that the Veteran was right-handed. He reported having flare-ups of the hand, finger and thumb joints in that cold weather caused swelling and pain to worsen. He had functional loss in that he had weak grips and dropped things, small things in particular. Range of motion was abnormal. The Veteran could extend the metacarpal phalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of the right index finger to maximum extension, but flexion of the MCP was to only 40 degrees, flexion of the PIP was to 30 degrees and flexion of the DIP was to 20 degrees. Extension of the right long finger was normal with flexion of the MCP to only 70 degrees, flexion of the PIP to only 10 degrees, and flexion of the DIP to only 10 degrees. Extension of the right ring finger was normal with flexion of the MCP to 30 degrees, flexion of the PIP to 60 degrees and flexion of the DIP to 20 degrees. Extension of the right little finger was normal with flexion at the MCP joint to only 60 degrees, flexion at the PIP joint to only 65 degrees and flexion at the DIP joint to a full 70 degrees. Extension of the thumb was normal with flexion at the MCP joint to be only 30 degrees and flexion at the interphalangeal (IP) joint to only 40 degrees. Range of motion of the left hand was also abnormal with extension of the index finger normal. Flexion of the MCP was to only 30 degrees, flexion of the PIP was to 50 degrees and flexion of the DIP was to 50 degrees. Extension of the left long finger was normal. Flexion of the MCP was to only 40 degrees, flexion of the PIP was to 50 degrees and flexion of the DIP was to 50 degrees. Extension of the left ring finger was normal. Flexion of the MCP was to only 35 degrees, flexion of the PIP was to 40 degrees and flexion of the DIP was to 0 degrees. Extension of the left little finger was normal. Flexion of the MCP was to only 50 degrees, flexion of the PIP was to 30 degrees and flexion of the DIP was to 10 degrees. Extension of the thumb was normal with flexion at the MCP joint to be only 30 degrees and flexion at the IP joint to only 40 degrees. Examination showed that there was a gap between the pad of the thumb and the fingers was 2.5 cm on the right hand and 3.0 cm on the left hand. There was a gap between the fingers and the proximal transverse crease of the hand on maximal finger flexion. The tap of the right hand was 2.0 cm at the index and long fingers and left hand gap was 2.0 cm at the index finger and 3.0 cm at the long finger. Lack of range of motion contributed to functional loss due to pain. Pain was noted on examination of both hands with finger flexion and on use of the hand. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions without additional functional loss or additional loss of range of motion. The Veteran was not examined immediately after repetitive use over time. There was no pain, weakness, fatigability or incoordination that significantly limited functional ability with repeated use over time or with flare-ups for either hand. Additional factors contributing to disability was weakened movement due to muscle or peripheral nerve injury and swelling. Grip strength was 4/5 in each hand. There was no muscle atrophy. There was no ankylosis of either hand. The Veteran used a brace on an occasional basis for support. The remaining effective function of the hands was not so diminished that amputation with prosthesis in place would equally serve the Veteran. X-ray studies showed arthritis in multiple joints of the right hand. The Veteran’s hand disability would have a functional impact in that he would have difficulty performing activities of daily living such as using a washcloth and soap, with any household chores and difficulty gripping and grasping. The Veteran could perform general activities without significant restrictions. Evaluations of ankylosis or limitation of motion of single or multiple digits of the hand are based upon certain criteria most of which are specific for ankylosis of the various joints of the fingers. On examination, however, limitation of motion of the fingers was demonstrated, specifically in flexion, with no demonstration of ankylosis of any of the joints of any of the Veteran’s fingers. Regulations provide that if there is limitation of motion of two or more digits, each digit is to be evaluated separately and the evaluations combined. For limitation of motion of the thumb, with a gap of more than two inches (5.1 cm) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, a 20 percent rating is warranted for either a major or minor extremity. With a gap of one to two inches (2.5 to 5.1 cm), with the thumb pad attempting to oppose the fingers, a 10 percent rating is warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5228. For limitation of motion of the index or long finger, with a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible or; with extension limited by more than 30 degrees, a 10 percent rating is warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5229. For any limitation of motion of the ring or little finger, a noncompensable rating is warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5230. It is noted that neither the Veteran nor his representative has raised a matter related to an extraschedular award for any of the individual ratings of the Veteran’s digits. 5. Entitlement to a rating in excess of 10 percent for limitation of motion of the right thumb as of March 15, 2018 The Veteran maintains that he is entitled to a rating in excess of 10 percent for a right thumb disability, currently rated under Diagnostic Code 5228. As noted, this rating was made effective as of the date of the VA examination on March 15, 2018. At the Veteran’s March 2018 VA examination, he reported consistent pain right thumb. He described flare-ups that involved decreased grip strength on use. Upon physical examination, the examiner noted full extension of the phalangeal joints to 0 degrees, but flexion of the MCP was to only 30 degrees, and maximum flexion of the IP to only 40 degrees. Significantly, there was a gap between the pad of the thumb and the fingers of 2.5 cm. The Veteran was able to perform repetitive-use testing without additional loss of range of motion or function. The Board finds that the initial 10 percent disability rating for the service-connected right thumb disability is appropriate as there is objective evidence of a gap of 1 to 2 inches (2.5 to 5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers. The record clearly indicates that a higher disability rating is not warranted under Diagnostic Code 5228. In order to assign the next-higher 20 percent rating under this diagnostic code, the medical evidence must show a gap of more than 2 inches between the Veteran’s right thumb pad and fingers when attempting to oppose his fingers. As noted above, there is no evidence of such a gap between the Veteran’s right thumb pad and opposing fingers. Therefore, he does not meet the criteria for a higher rating under Diagnostic Code 5228. The Board has given consideration to the Veteran’s complaints of pain affecting his right thumb and notes that in increased rating claims, an appellant’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See e.g., Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010). In this case, however, the Veteran has not actually stated that he has limitation of motion of the thumb causing a gap of more than two inches between the thumb pad and the fingers with the thumb attempting to oppose the fingers. Similarly, a disability rating in excess of 10 percent is not warranted any other applicable diagnostic code. As noted, the Veteran does not have ankylosis of the right thumb, as noted by the March 2018 VA examination. As such, a rating in excess of 10 percent under Diagnostic Code 5224, for ankylosis is not warranted. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for increased rating for limitation of motion of the right thumb as of March 15, 2018, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 6. Entitlement to a rating in excess of 10 percent for limitation of motion of the right index finger as of March 15, 2018 The Veteran seeks entitlement to a rating in excess of 10 percent for a right index finger disability as of March 15, 2018. His service-connected right index finger disability is rated under Diagnostic Code 5229. As noted above, the intent of the Rating Schedule is to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. As such, when rating disabilities of the musculoskeletal system, VA must consider whether a higher rating is warranted to account for functional loss due to pain, weakened movement, excess fatigability, or incoordination. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 202. This is the highest available rating under Diagnostic Code 5229. Ratings in excess of 10 percent are provided by Diagnostic Codes pertaining to ankylosis; however, as noted, there is no evidence that the Veteran has ankylosis of any of the digits of his hands. Hence, the diagnostic codes that provide evaluations in excess of 10 percent for ankylosis of multiple fingers are not for application. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5223. The Board therefore finds that the criteria for a rating in excess of 10 percent as of March 15, 2018, for the service-connected right index finger disability have not been met. 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 appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 7. Entitlement to a rating in excess of 10 percent for limitation of motion of the right long finger as of March 15, 2018, The Veteran seeks entitlement to a rating in excess of 10 percent for a right long finger disability as of March 15, 2018. His service-connected right long finger disability is rated under Diagnostic Code 5229. As noted above, the intent of the Rating Schedule is to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. As such, when rating disabilities of the musculoskeletal system, VA must consider whether a higher rating is warranted to account for functional loss due to pain, weakened movement, excess fatigability, or incoordination. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 202. This is the highest available rating under Diagnostic Code 5229. As with the index finger, ratings in excess of 10 percent are provided by Diagnostic Codes pertaining to ankylosis; however, as noted, there is no evidence that the Veteran has ankylosis of any of the digits of his hands. Hence, the diagnostic codes that provide evaluations in excess of 10 percent for ankylosis of multiple fingers are not for application. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5223. The Board therefore finds that the criteria for a rating in excess of 10 percent as of March 15, 2018, for the service-connected right long finger disability have not been met. 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 appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 8. Entitlement to a compensable rating for limitation of motion of the right ring finger Regarding the Veteran’s right ring finger, no amount of limitation of motion warrants a compensable evaluation. Under Diagnostic Code 5230, a 0 percent rating “for ‘any limitation of motion’ indicates that there is no reduction in earning capacity..., irrespective of impairment of motion.” Sowers v. McDonald, 27 Vet. App. 472, 480 (2016). Under this code, then, the Veteran cannot recover for any limitation of motion. If the Board were to find there is ankylosis of the ring finger of the right hand, a compensable evaluation could be warranted. As noted, however, ankylosis of the Veteran’s fingers has not been found. Under these circumstances, an increased rating is not warranted. 9. Entitlement to a compensable rating for limitation of motion of the right little finger Regarding the Veteran’s right little finger, no amount of limitation of motion warrants a compensable evaluation. Under Diagnostic Code 5230, a 0 percent rating “for ‘any limitation of motion’ indicates that there is no reduction in earning capacity..., irrespective of impairment of motion.” Id. Under this code, then, the Veteran cannot recover for any limitation of motion. If the Board were to find there is ankylosis of the ring finger of the right hand, a compensable evaluation could be warranted. As noted, however, ankylosis of the Veteran’s fingers has not been found. Under these circumstances, an increased rating is not warranted. 10. Entitlement to a rating in excess of 10 percent for limitation of motion of the left thumb as of March 15, 2018, The Veteran maintains that he is entitled to a rating in excess of 10 percent for a left thumb disability, currently rated under Diagnostic Code 5228. As noted, this rating was made effective as of the date of the VA examination on March 15, 2018. At the Veteran’s March 2018 VA examination, he reported consistent pain in the left thumb. He described flare-ups that involved decreased grip strength on use. Upon physical examination, the examiner noted full extension of the phalangeal joints to 0 degrees, but flexion of the MCP was to only 30 degrees, and maximum flexion of the IP to only 40 degrees. Significantly, there was a gap between the pad of the thumb and the fingers of 3.0 cm. The Veteran was able to perform repetitive-use testing without additional loss of range of motion or function. The Board finds that the initial 10 percent disability rating for the service-connected left thumb disability is appropriate as there is objective evidence of a gap of 1 to 2 inches (2.5 to 5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers. The record clearly indicates that a higher disability rating is not warranted under Diagnostic Code 5228. In order to assign the next-higher 20 percent rating under this diagnostic code, the medical evidence must show a gap of more than 2 inches between the Veteran’s left thumb pad and fingers when attempting to oppose his fingers. As noted above, there is no evidence of such a gap between the Veteran’s left thumb pad and opposing fingers. Therefore, he does not meet the criteria for a higher rating under Diagnostic Code 5228. The Board has given consideration to the Veteran’s complaints of pain affecting his left thumb and notes that in increased rating claims, an appellant’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See e.g., Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010). The Board notes, however, that the Veteran has not actually stated that he has limitation of motion of the thumb causing a gap of more than two inches between the thumb pad and the fingers with the thumb attempting to oppose the fingers. Similarly, a disability rating in excess of 10 percent is not warranted any other applicable diagnostic code. As noted, the Veteran does not have ankylosis of the right thumb, as noted by the March 2018 VA examination. As such, a rating in excess of 10 percent under Diagnostic Code 5224, for ankylosis is not warranted. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for increased rating for limitation of motion of the left thumb as of March 15, 2018, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 11. Entitlement to a rating in excess of 10 percent for limitation of motion of the left index finger as of March 15, 2018, The Veteran seeks entitlement to a rating in excess of 10 percent for a left index finger disability as of March 15, 2018. His service-connected left index finger disability is rated under Diagnostic Code 5229. As noted above, the intent of the Rating Schedule is to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. As such, when rating disabilities of the musculoskeletal system, VA must consider whether a higher rating is warranted to account for functional loss due to pain, weakened movement, excess fatigability, or incoordination. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 202. This is the highest available rating under Diagnostic Code 5229. Ratings in excess of 10 percent are provided by Diagnostic Codes pertaining to ankylosis; however, as noted, there is no evidence that the Veteran has ankylosis of any of the digits of his hands. Hence, the diagnostic codes that provide evaluations in excess of 10 percent for ankylosis of multiple fingers are not for application. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5223. The Board therefore finds that the criteria for a rating in excess of 10 percent as of March 15, 2018, for the service-connected left index finger disability have not been met. 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 appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49. 12. Entitlement to a rating in excess of 10 percent for limitation of motion of the left long finger as of March 15, 2018, The Veteran seeks entitlement to a rating in excess of 10 percent for a left long finger disability as of March 15, 2018. His service-connected left long finger disability is also rated under Diagnostic Code 5229. As noted above, the intent of the Rating Schedule is to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. As such, when rating disabilities of the musculoskeletal system, VA must consider whether a higher rating is warranted to account for functional loss due to pain, weakened movement, excess fatigability, or incoordination. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 202. This is the highest available rating under Diagnostic Code 5229. As with the index finger, ratings in excess of 10 percent are provided by Diagnostic Codes pertaining to ankylosis; however, as noted, there is no evidence that the Veteran has ankylosis of any of the digits of his hands. Hence, the diagnostic codes that provide evaluations in excess of 10 percent for ankylosis of multiple fingers are not for application. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5223. The Board therefore finds that the criteria for a rating in excess of 10 percent as of March 15, 2018, for the service-connected right long finger disability have not been met. 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 appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49 13. Entitlement to a compensable rating for limitation of motion of the left ring finger Regarding the Veteran’s right ring finger, no amount of limitation of motion warrants a compensable evaluation. Under Diagnostic Code 5230, a 0 percent rating “for ‘any limitation of motion’ indicates that there is no reduction in earning capacity..., irrespective of impairment of motion.” Sowers 27 Vet. App. at 472. Under this code, then, the Veteran cannot recover for any limitation of motion. If the Board were to find there is ankylosis of the ring finger of the right hand, a compensable evaluation could be warranted. As noted, however, ankylosis of the Veteran’s fingers has not been found. Under these circumstances, an increased rating is not warranted. 14. Entitlement to a compensable rating for limitation of motion of the left little finger Regarding the Veteran’s left little finger, no amount of limitation of motion warrants a compensable evaluation. Under Diagnostic Code 5230, a 0 percent rating “for ‘any limitation of motion’ indicates that there is no reduction in earning capacity..., irrespective of impairment of motion.” Id. Under this code, then, the Veteran cannot recover for any limitation of motion. If the Board were to find there is ankylosis of the ring finger of the right hand, a compensable evaluation could be warranted. As noted, however, ankylosis of the Veteran’s fingers has not been found. Under these circumstances, an increased rating is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for a right shoulder disorder is remanded. This matter was remanded by the Board in June 2018 so that an addendum opinion regarding the right shoulder could be obtained. The Veteran’s claim was referred for such an opinion, but it was determined that the examiner who had conducted the original right shoulder examination in August 2009 was not available. Another examination was to be scheduled, but the claims file does not indicate that this was accomplished. As such, the case must be returned for compliance with the Board’s June 2018 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 2. Entitlement to TDIU is remanded. As the matter of service connection for a right shoulder disorder must be remanded, the issue of entitlement to TDIU must be held in abeyance pending the resolution of the requested development. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right shoulder disorder. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including his asserted heavy lifting in service. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph P. Gervasio 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.