Citation Nr: 21004262 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 16-35 553 DATE: January 26, 2021 ORDER Entitlement to an initial rating of 10 percent, but not higher, for left ring and little finger impairment is granted. FINDING OF FACT For the entire period on appeal, the Veteran has had left ring and little finger impairment that is related to his in-service injury, and while not ankylosed, the fingers are fixed in flexion. CONCLUSION OF LAW The criteria for an initial rating of 10 percent, but not higher, for a left ring and little finger disability have been met for the entire period on appeal. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.20, 4.71a, Diagnostic Codes 5223, 5230 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from January 1998 to January 2012. This case comes before the Board of Veterans Appeals (Board) on appeal from a November 2014 rating decisions issued by the Department of Veteran Affairs (VA) Regional office (RO). In connection with this appeal, the Veteran testified at a hearing before the undersigned Veteran Law Judge in July 2019. A transcript of that hearing has been associated with the claims file. This case was previously before the Board in October 2019, at which time ir war remanded for additional development. The case has now been returned to the Board for further appellate action. Increased Rating – Left Finger Disability The Veteran has asserted that he should have a higher rating for his left little finger disability as his symptoms are worse than those contemplated by the currently assigned rating. At a November 2014 VA examination, the Veteran reported that he was unable to flex his left little finger fully, and that he experienced weakness in both is left ring and little fingers. He reported that his symptoms impacted his grip strength, which was not an issue with day-to-day use, but did impact his ability to work out with weights. The examiner noted that the Veteran was right-handed. The Veteran denied flare-ups, and described his overall functional impairment to consist of the decreased grip strength described above. Upon physical examination, range of motion (ROM) testing revealed normal flexion of the carpometacarpal (CMC) joint and interphalangeal (IP) joint of the left thumb; normal flexion of the metacarpophalangeal (MCP) joint and proximal interphalangeal (PIP) joint, and flexion distal interphalangeal (DIP) joint to 70 degrees in the left index finger; normal flexion of the MCP and PIP joints, and flexion of the DIP joint to 65 degrees in the left long finger; normal flexion of the MCP and PIP joints, and flexion of the DIP joint to 55 degrees in the left ring finger; and normal flexion of the MCP and PIP joints, and flexion of the DIP joint to 45 degrees in the left little finger. Extension was normal for all joints in the left hand. There was a 3 centimeter (cm) gap between the pad of the left thumb and the left ring finger when attempting to oppose the fingers, and a 4 cm gap between the pad of the left thumb and the left little finger when attempting to oppose the fingers. The Veteran was able to perform repetitive testing, and there was no additional limitation following repetition. There was no evidence of pain in any finger when the joints were used in weight bearing or non-weight bearing. There was no tenderness to palpation of any left hand finger. The Veteran’s functional impairment of the left hand was noted to consist of less movement than normal in multiple fingers, weakened movement in the ring and little fingers, and pain on movement in the little finger. The examiner noted that the Veteran would not be significantly limited by pain, weakness, fatigability, or incoordination during a flare-up or following repeated use over a period of time. Muscle strength testing revealed slightly decreased left hand grip strength, with active movement against some resistance. There was no muscle atrophy. There was no ankylosis in any finger. At an August 2020 VA examination, the Veteran reported that his left hand pain had increased in severity. He reported that he could not make a fist with his left hand, that he experienced numbness and tingling, and that he was unable to carry heavy things. He reported burning, tingling, and numbness in the ring and little fingers of the left hand. He reported that he used specialized rings to hold the left little finger from flailing out, and that he used a neoprene sleeve for compression. The Veteran was noted to be right-handed. He reported that he experienced painful flare-ups on random days and with cold weather and rain. He reported functional impairment of the left hand to consist of an inability to carry things, and difficulty grasping objects with the left hand. Upon physical examination, ROM testing revealed normal extension in all the left fingers. However, flexion was limited in all joints of the left fingers, with the exception of the left little finger that had MCP extension to 10 degrees, and DIP extension to 5 degrees. The Veteran had left index finger MCP joint flexion to 45 degrees, PIP joint flexion to 50 degrees, and DIP joint flexion to 35 degrees; left long finger MCP joint flexion to 45 degrees, PIP joint flexion to 50 degrees, and DIP joint flexion to 35 degrees; left ring finger MCP joint flexion to 45 degrees, PIP joint flexion to 75 degrees, and DIP joint flexion to 0 degrees; left little finger MCP joint flexion to 5 degrees, PIP joint flexion to 0 degrees, and DIP joint flexion to 5 degrees; and left thumb MCP joint flexion to 50 degrees, and IP joint flexion to 45 degrees. There was a 5 cm gap between the pad of the left thumb and the fingers. The examiner noted that the Veteran would be unable to grasp or hold objects with the left hand. There was pain on extension and flexion of the fingers of the left hand, there was pain with use of the left hand, and there was tenderness to palpation of the left ring and little fingers that was moderate in severity and related to the Veteran’s service-connected disability. The Veteran was able to perform repetitive testing, and there was no additional limitation of function following repetition. The examiner noted that the Veteran would be significantly limited by pain, fatigue, and weakness in the left hand following repeated use over a period of time and during a flare-up. The examiner estimated ROM following repeated use over a period of time and during a flare-up to be as follows: left index finger MCP joint flexion to 40 degrees, PIP joint flexion to 45 degrees, and DIP joint flexion to 30 degrees; left long finger MCP joint flexion to 40 degrees, PIP joint flexion to 45 degrees, and DIP joint flexion to 30 degrees; left ring finger MCP joint flexion to 40 degrees, PIP joint flexion to 70 degrees, and DIP joint flexion to 0 degrees; left little finger MCP joint flexion to 5 degrees, PIP joint flexion to 0 degrees, and DIP joint flexion to 5 degrees; and left thumb MCP joint flexion to 45 degrees, and IP joint flexion to 40 degrees. The examiner further estimated that there would be a 6 cm gap between the pad of the left thumb and the fingers. The examiner noted that there was no ankylosis in the joints, but that the left little finger DIP and PIP joints, and the left ring finger PIP joints did not have mobility due to tendon dysfunction and were in full extension. Muscle strength testing revealed decreased left hand grip strength, with active movement against some resistance. There was no muscle atrophy. The examiner noted that the functional impact of the Veteran’s disability was that he was unable to carry or lift objects with his non-dominant hand. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities, to include his left little finger disability. However, a review of the treatment notes of record does not show the Veteran to have symptoms of his disability that are worse than those reported in the VA examination reports of record, to include limitation of motion and functional impairment following repeated use over a period of time or during a flare-up. In this case, the Veteran’s service-connected left finger disability has been rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230, pertaining to disabilities affecting individual digits. However, the Board finds that the Veteran’s left little finger and his left ring finger have been found to be fixed in flexion, and that the impairment has been documented as related to his service-connected disability. As such, the Board finds that the Veteran’s disability of his left hand would be more appropriately considered under 38 C.F.R. § 4.71a, Diagnostic Code 5223, pertaining to disability affecting multiple digits. Therefore, the Board has changed the diagnostic code as appropriate. The Board finds that the Veteran is entitled to an initial 10 percent rating for his left finger disability for the entire period on appeal. In this regard, the Board notes that the Veteran has been found to have impairment in both his left ring finger and his left little finger as a result of his in-service injury. Further, the August 2020 VA examiner noted that while there was no ankylosis in those two fingers, they were essentially fixed in flexion. As such, the Board finds that a 10 percent rating is warranted for the entire period on appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5223. Consideration has been given to assigning a higher rating for the Veteran’s left finger disability. however, there is no indication from the record that the Veteran has impairment in more than two fingers. In this regard, the Board acknowledges that the Veteran has been noted to have decreased flexion in his left thumb, index finger, and long finger. However, the examiner did not specifically indicate that such impairment was the result of the Veteran’s in-service injury, as was stated regarding the left little and ring fingers. As such, the record does not support a finding that the Veteran has service-connected impairment in more than two fingers on his left hand. Therefore, a rating in excess of 10 percent is not warranted. 38 C.F.R. § 4.71a, Diagnostic Codes 5216-5222 (2019). Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). (Continued on the next page)   Further, the Board notes that the Veteran has scarring from his in-service injury and subsequent surgical repair, and has reported neurological impairment in his left hand. However, the Veteran is in receipt of separate compensable ratings for the scarring and the left upper extremity neurological impairment. The ratings assigned for those disabilities have not been appealed to the Board. As such, the Board will not consider them further in this decision. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ivan Franklin 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.