Citation Nr: 21000342 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-26 759 DATE: January 5, 2021 ORDER A rating in excess of 10 percent for a right wrist disability prior to March 14, 2018, is denied. FINDING OF FACT Prior to March 14, 2018, the Veteran’s right wrist disability was manifested by painful motion but not also by ankylosis. CONCLUSION OF LAW The criteria are not met for a rating in excess of 10 percent rating for the right wrist disability prior to March 14, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 3.400, 4.1-4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5214-5024.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from January 2009 to June 2011. Right Wrist Disability (Tenosynovitis) Ratings for service-connected disabilities are determined by comparing the veteran’s symptoms with criteria listed in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based, as far as practically can be determined, on average impairment in earning capacity. Separate DCs identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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. All reasonable doubt material to the determination is resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The Board will consider entitlement to “staged” ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s right wrist disability is rated under hyphenated DC 5214-5024. For the period since March 14, 2018, his appeal already has been withdrawn and dismissed. DC 5214 concerns ankylosis of the wrist. Full wrist motion is to 70 degrees on dorsiflexion (extension), to 80 degrees on palmar flexion, to 45 degrees on ulnar deviation, and to 20 degrees on radial deviation. 38 C.F.R. § 4.71, Plate I. Although the Veteran has been assigned a rating at least partly under DC 5214, which, as mentioned, contemplates ankylosis of the wrist, ankylosis has not been shown in any of the records relevant to this appeal. Ankylosis is stiffening or fixation of the joint as the result of a disease process, with fibrous or bony union across the joint. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999); Lewis v. Derwinski, 3 Vet. App. 259 (1992) [citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)]. Rather, the Veteran has been assigned the existing 10 percent rating based upon painful motion of this wrist with consequent limitation of motion – as directed by the other assigned code, DC 5024. He has been able to flex and extend this wrist. A disability analogous to ankylosis has not been shown. Therefore, a higher rating pursuant to DC 5214 is not possible. DC 5024, which contemplates tenosynovitis, directs the disability be rated according to limitation of motion, as degenerative arthritis, so under DC 5003. DC 5003, in turn, instructs the rater to evaluate the disability under the DC governing the range of motion of the affected joint – which, here, since the wrist, requires considering DC 5215. A 10 percent rating is for assignment under 38 C.F.R. § 4.71a, DC 5215, when motion in either the dominant or non-dominant hand is limited to palmar flexion being in line with the forearm or less than 15 degrees of dorsiflexion. A 10 percent rating is the only assignable rating under DC 5215. The Board resultantly finds that a rating in excess of 10 percent for this right wrist disability is not warranted since a 10 percent rating is the highest available rating under the DC that contemplates limitation of motion of the wrist, absent indication of ankylosis. It also is not shown this disability is so exceptional or unusual as to, in turn, warrant extra-schedular consideration under 38 C.F.R. § 3.321(b)(1). See Thun v. Peake, 22 Vet. App. 111 (2008), aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). While the Veteran did suffer from difficulty with right hand grip during the appeal period, such as holding a frying pain or gallon of milk, and experienced tingling and numbness of his right wrist, he is already in receipt of a separate unappealed rating based upon these neurological manifestations of his right wrist. Therefore, those symptoms and consequent impairment are not currently before the Board for consideration, as this appeal pertains instead to his musculoskeletal symptoms. Specifically, he has a separate 20 percent rating for right hand numbness associated with the tenosynovitis for this time period at issue. With regard to the Veteran’s right wrist disability on appeal, the VA examinations of record, including the most recent 2020 VA examination for comparison purposes, do not demonstrate that he suffers from an additional musculoskeletal disability of the finger joints that would lead to a separate rating. Rather, he reported wrist pain, and has reported neurological pain, which interferes with his ability to grasp objects. These symptoms are already accounted for by the current ratings. The Board finds that there has been substantial compliance with the previous remand directives, in that the most recent VA examination and treatment records show no indication of loss of motion of the finger joints. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Accordingly, as the Veteran is currently in receipt of a 10 percent rating that contemplates his right wrist pain and limitation of motion, as well as a rating for neurological deficits of the right arm (to include the right hand/fingers), the Board finds that an increased rating or separate rating is not warranted. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Erdheim 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.