Citation Nr: 20040137 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 14-02 559 DATE: June 11, 2020 ORDER A 20 percent rating for right ankle disability is granted. REMANDED Entitlement to a compensable rating for service-connected lacerated fifth finger, right hand, status post tendon repair is remanded. FINDING OF FACT The Veteran's right ankle disability is manifested by marked limitation of motion, but the limitation of motion does not amount to ankylosis of the ankle. CONCLUSION OF LAW The criteria for 20 percent disability rating for right ankle disability have not been met. 38 C.F.R. §§ 1154 (a), 1155, 5107(b); 38 C.F.R. § 3.102 , 4.3, 4.7, 4.71a, Diagnostic Codes 5299-5271. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1988 to August 1994. In September 2017, the Board remanded these issues for additional development. Entitlement to a rating in excess of 10 percent for right ankle disability. The Veteran seeks a higher rating for his right ankle disability, citing both pain and limitation of motion of the right ankle as well as right ankle instability. The Veteran’s right ankle disability is currently rated at 10 percent, effective May 11, 2011 under Diagnostic Code 5271. Diagnostic Code 5271 assigns a 10 percent disability rating for moderately limited range of motion of the ankle and a 20 percent disability rating for markedly limited range of motion of the ankle. The words slight, moderate, marked, and severe as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence. 38 C.F.R. § 4.6. Use of terminology such as severe by VA examiners and others, although an element to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Pursuant to VA regulations, normal range of motion for ankle dorsiflexion is 0 to 20 degrees and for plantar flexion is 0 to 45 degrees. See 38 C.F.R. § 4.71a, Plate II. The Board must also consider whether the Veteran is entitled to separate or higher disability ratings under other Diagnostic Codes that relate to the ankle. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270 through 5274. Under Diagnostic Code 5003, degenerative arthritis, established by X-ray findings, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Diagnostic Code 5270 provides the following disability ratings for ankylosis of the ankle: 20 percent for in plantar flexion of less than 30 degrees; 30 percent for in plantar flexion between 30 and 40 degrees or in dorsiflexion between 0 (zero) and 10 degrees; and 40 percent for in plantar flexion at more than 40 degrees, in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion or eversion deformity. See 38 C.F.R. § 4.71a. Diagnostic Code 5272 provides a 10 percent disability rating for subastragalar or tarsal joint ankylosis in good weight-bearing position and a 20 percent disability rating for ankylosis in poor weight-bearing position. See 38 C.F.R. § 4.71a . Diagnostic Code 5273 provides a 10 percent disability rating for moderate deformity resulting from the malunion of the os calcis or astragalus and a 20 percent disability rating for a marked deformity resulting from the malunion of the os calcis or astragalus. Diagnostic Code 5274 provides a 20 percent disability rating for astragalectomy. In considering the applicability of other diagnostic codes, the Board finds that Diagnostic Code 5272, 5273, and 5274 are not applicable in this case, as the evidence does not show that the Veteran has any of those conditions. Analysis The Veteran was afforded a VA examination in January 2012. Because the Board finds that that VA examination is not adequate for rating purposes, it will not be discussed. The Veteran was afforded a VA examination in February 2019. The Veteran's February 2019 VA examination demonstrates that he experiences marked reduction in right ankle range of motion and instability. The Veteran exhibited dorsiflexion to 5 degrees (Normal 0-20 degrees) and to 10 degrees for plantar flexion (Normal 0-45 degrees). The Veteran reports constant right ankle pain that worsens with prolonged ambulation; becomes sharp with some particular movements and increased swelling with prolonged ambulation. The Veteran reported flare-ups described as increased pain with prolonged walking. Additionally, the Veteran’s range of motion contributing to a functional loss is described as impaired ambulation. The examiner noted, the Veteran has pain and weakness that significantly limits his functional ability with repeated use over a period of time. He added, the Veteran reports the loss of range of motion is variable, depending on how strenuously the joint was used. He added, that the Veteran reported, that at its worst, he cannot move his ankle at all due to pain and weakness but there are other times where his range of motion is minimal; therefore, it is impossible to describe in terms of range of motion. The Board finds that a 20 percent rating is warranted for the Veteran’s right ankle disability. However, a rating in excess of 20 percent is not warranted. The Veteran has not claimed, and the evidence does not show, that he experiences right ankle ankylosis, even during flare-ups. Therefore, the Veteran's right ankle is rated under the appropriate Diagnostic Code and 20 percent is the maximum rating allowed under Diagnostic Code 5271. REASONS FOR REMAND Entitlement to a compensable rating for service-connected lacerated fifth finger, right hand, status post tendon repair is remanded. The Veteran asserts that his service-connected lacerated fifth finger, right hand, status post tendon repair is entitled to a compensable rating. See December 2013 Form 9, Appeal to Board of Veterans’ Appeals. In September 2017, the Board remanded this issue for additional development, to include a contemporaneous VA examination. The Veteran was afforded a VA examination in February 2019. The examiner described the Veteran’s functional loss as decreased ability to grip objects. However, the examiner failed to address whether there was a neurological or muscular reason for the Veteran’s decreased ability to grip objects. In addition, it appears that the Veteran’s disability may be affecting his entire right hand, so this issue must be investigated. As such, this issue must be remanded for a VA examination that identifies all manifestations of the Veteran’s service-connected lacerated fifth finger, right hand, status post tendon repair. The matters are REMANDED for the following action: 1. Obtain any outstanding treatment records. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of, the nature, extent and severity of his lacerated fifth finger, right hand, status post tendon repair disability symptoms and the impact of the condition on his ability to work. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible). The VA examination that must identify all manifestations of the Veteran’s service-connected lacerated fifth finger, right hand, status post tendon repair. This must specifically include all orthopedic, muscle and neurological impairment. The VA examiner is asked to acknowledge and discuss the Veteran’s functional impact of his lacerated fifth finger, right hand specifically regarding his difficulty with grasping objects, difficulty with manipulating objects in dominant hand and difficulty carrying objects and address whether the Veteran’s decreased ability to grip is due to a neurologic or muscular reason. This must also include addressing whether the Veteran’s lacerated fifth finger right hand status post tendon repair, impacts his entire right hand. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jacquelynn M. Jordan, 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.