Citation Nr: 21064441 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 20-04 459 DATE: October 20, 2021 ORDER Entitlement to revision of an August 1967 rating decision that assigned a noncompensable rating under diagnostic code 7805 for residuals of a gunshot wound to the right arm with scar based on clear and unmistakable error (CUE) is denied. Entitlement to a 30 percent rating, but no higher, for residuals of a gunshot wound to muscle group V of the right arm is granted. FINDINGS OF FACT 1. The Veteran's claim for service connection for residuals of a gunshot wound to the right arm was granted in an August 1967 rating decision, which assigned a noncompensable rating under diagnostic code 7805. The decision became final because he did not submit a notice of disagreement or new and material evidence within the appeal period. 2. The correct facts, as known at the time, were before the adjudicators in August 1967 and the statutory and regulatory provisions extant at the time were correctly applied. 3. The Veteran's dominant hand was his right hand. 4. Throughout the period on appeal, the injury to muscle group V in the Veteran's right arm was manifested by moderately severe symptoms. CONCLUSIONS OF LAW 1. The criteria for revision of an August 1967 rating decision that assigned a noncompensable rating under diagnostic code 7805 for residuals of a gunshot wound to the right arm based on CUE have not been met. 38 U.S.C. § 5109A; 38 C.F.R. §§ 3.104, 3.105(a). 2. The criteria for a 30 percent rating, but no higher, for residuals of a gunshot wound to muscle group V of the right arm have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.1 4.3, 4.7, 4.71a, 4.73, Diagnostic Code 5305. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1953 to June 1967 and received a Purple Heart. Unfortunately, the Veteran died during the pendency of his appeal; his surviving spouse has been approved to serve as the substitute claimant. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). Clear and Unmistakable Error Generally, the appellant argues that revision of an August 1967 rating decision is warranted because the adjudicator erroneously assigned a noncompensable rating for residuals of gunshot wound to the right arm under diagnostic code 5305. The appellant's representative argues that the RO failed to apply the provisions of the then-extant version of 38 C.F.R. §. 4.56(c), and that, but for this error, a 30 percent evaluation would have been assigned. A previous RO determination that is final and binding will be accepted as correct in the absence of CUE. Where evidence establishes such error, the prior decision will be reversed or amended. 38 C.F.R. § 3.105(a). Here, after he was notified of the August 1967 rating action, the Veteran did not file a timely notice of disagreement challenging this determination, nor did he submit new evidence and material evidence within one year of its promulgation. Thus, the August 1967 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 3.156(b), 20.302, 20.1103. Once a decision becomes final, it may only be revised by a showing of CUE. 38 C.F.R. §§ 3.104, 3.105. CUE is a very specific and rare kind of "error." It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. Simply to claim CUE on the basis that previous adjudications had improperly weighed and evaluated the evidence can never rise to the stringent definition of CUE. Similarly, neither can broad-brush allegations of "failure to follow the regulations" or "failure to give due process," or any other general, nonspecific claim of "error." Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993). In addition, failure to address a specific regulatory provision involves harmless error unless the outcome would have been manifestly different. Id. at 44. Where evidence establishes CUE, the prior decision will be reversed or amended. 38 C.F.R. § 3.105(a). For the purpose of authorizing benefits, the rating or other adjudicatory decision which constitutes a reversal of a prior decision on the grounds of CUE has the same effect as if the corrected decision had been made on the date of the reversed decision. Id. CUE is established when the following conditions are met: (1) either (a) the correct facts in the record were not before the adjudicator, or (b) the statutory or regulatory provisions in existence at the time were incorrectly applied; (2) the alleged error must be "undebatable," not merely "a disagreement as to how the facts were weighed or evaluated"; and (3) the commission of the alleged error must have "manifestly changed the outcome" of the decision being attacked on the basis of CUE at the time that decision was rendered. Evans v. McDonald, 27 Vet. App. 180, 185 (2014), aff'd, 642 F. App'x 982 (Fed. Cir. 2016); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14 (1992). The error must be of a type that is outcome-determinative, and subsequently developed evidence may not be considered in determining whether an error existed in the prior decision. See Porter v. Brown, 5 Vet. App. 233, 235-36 (1993); Glover v. West, 185 F.3d 1328 (Fed. Cir. 1999). A manifest change in the outcome of an adjudication means that, absent the alleged CUE, the benefit sought would have been granted at the outset. King v. Shinseki, 26 Vet. App. 433, 441 (2014). The standard is not whether it is reasonable to conclude that the outcome would have been different. Id. at 442. The benefit-of-the-doubt doctrine is not for application in claims of CUE. Andrews v. Principi, 18 Vet. App. 177, 186 (2004) (citing Russell, 3 Vet. App. at 313) (it is well established that the benefit-of-the-doubt doctrine can never be applicable in assessing a CUE motion because the nature of such a motion is that it involves more than a disagreement as to how the facts were weighed or evaluated). As a threshold matter, the Board finds that the arguments advanced by the Veteran allege CUE with the requisite specificity. See Simmons v. Principi, 17 Vet. App. 104 (2003). At the outset, the Board will review the relevant evidence and legal framework that existed at the time of the August 1967 rating decision. The evidence indicates that the Veteran was shot while serving in combat in Vietnam in May 1966. He sustained multiple gunshot wounds, including injuries to his neck, left shoulder, right lower extremity, and right elbow. Hospital records from this period reflect that he was initially treated at a field hospital on May 2, 1966, where his wounds were debrided, but then transferred by air to a hospital at Clark Air Force Base on May 5, 1966. Subsequently, he was transferred to Tripler Army Hospital on May 9, 1966. Records indicate that on the same day, a .30 caliber brass gunshot missile was extracted from the depth of his right elbow wound, which was debrided and partially sutured. Notes reflect that the missile did not appear to violate his elbow joint. X-rays of the right arm were negative. Other records indicate that on May 12, 1966, he underwent surgery, during which his right elbow wound was debrided, irrigated, and closed. On May 18, 1966, he was transferred to Walter Reed Medical Center, where his right arm was noted to be in good condition on May 21, 1966. However, he continued to undergo extensive additional treatment and surgeries for his other injuries. An undated narrative summary reiterates that the Veteran sustained wounds on the left side of his neck, left shoulder, right arm, right elbow, right knee, and right foot, and indicates that he had been treated at various hospitals, most recently at Walter Reed. Physical examination reflected a well-developed male in moderate distress, although this appeared to be related to complaints of pain in his right leg. He had a well-healed wound of the right posteromedial distal arm; x-ray results do not discuss any findings with respect to the right arm. The record indicates that following convalescent leave in August 1966, he received extensive treatment for his right lower extremity injuries. With respect to his present condition, the report stated that he had a well-healed J-shaped scar along the medial aspect of his right arm extending from approximately the mid-third to the antecubital fossa region. There was no loss of function or range of motion of the right elbow or any neurological deficit in the right arm. Due to his left shoulder injury, however, he was unable to carry heavy objects in his left hand and had to pre-position his left arm in order to use it. The ultimate diagnosis with respect to the right arm was a gunshot wound the right arm, without artery, nervy, or bone involvement, that had been treated and healed. In light of his other injuries, it was recommended that the Veteran be presented to the physical evaluation board for consideration of separation from service. An accompanying March 1967 medical board examination reflected that the right arm had a J-shaped scar over the medial aspect of the left elbow. Physical evaluation board proceedings took place at Walter Reed in April 1967. The diagnoses listed in the summary of the proceedings include humerus impairment of muscle groups III and IV on the left, ankylosis of the right knee, and nonunion of the tarsal or metatarsal bones on the right. The right elbow was not discussed. In medical board proceedings dated May 13, 1967, the injuries listed included a gunshot wound to the right arm without artery, nerve or bone involved that had been treated and healed. The brief summary of his injuries listed stiffness in the right knee and loss of use of the left shoulder, but no symptoms involving the right elbow. The Veteran was discharged from service in June 1967. Subsequently, he filed a claim for compensation for various injuries. At his August 1967 VA examination, the VA examiner noted that he had received gunshot wounds to the left neck, left shoulder, left arm, right arm, right knee, and right foot. His present complaints were that his back would ache and that his left arm would feel numb when left hanging. He also indicated that his right foot and ankle continuously ached. During the psychological portion of the VA examination, the Veteran reported that he could not participate in sports or "do the same things he did before," such as carrying heavy packages. On observation, he had some functional limitation of the left upper extremity and ankylosis of the right knee, but no limitations were noted concerning the right arm. A different portion of the VA examination report indicates that the Veteran was being evaluated for multiple gunshot wounds to the right knee, right foot, right arm, left shoulder, left neck, and for low back strain and an inguinal hernia. He sustained the wounds while in combat in Vietnam in May 1966 and was treated at Walter Reed, where he remained until he was medically discharged from service. His present complaints included the aches in his low back, numbness in his left arm, and aches in his right foot and ankle. After performing a physical examination, the examiner noted that there was a scar on the medial aspect of the right elbow, but that he could extend the elbow to 180 degrees and flex it to 145 degrees. Pronation was from 0 to 80 degrees and supination was from 0 to 85 degrees. The VA examiner rendered various diagnoses, including residuals of a gunshot wound to the left neck, residuals of a gunshot wound and comminuted fracture of the left shoulder with total loss of motion and use of the left arm, residual of a gunshot wound to the right arm, with no limitation of motion at the elbow, chronic lumbosacral strain, residuals of a gunshot wound to the right knee with total loss of motion, residuals of a gunshot wound to the right foot with total loss of motion of the toes, and residuals of a left inguinal hernioplasty. X-ray imaging done during the VA examination revealed a left clavicle with an old, well-healed fracture at midshaft with arching superiorly. The left arm showed a complete disorganization of the third of the left humeral shaft with irregular margins, coarsening and sclerosis of the trabeculae, a medial angulation, and absence of the head and neck. The x-ray of the right arm, conversely, was negative for any findings. The August 1967 rating decision noted that the Veteran was hospitalized in 1966 for injuries sustained in sniper fire in Vietnam and that he was wounded on the left side of the neck, left shoulder, right arm, right elbow, right knee, and right foot. His wounds were closed and debrided while hospitalized. The rating board discussed the scar over the medial aspect of his right elbow, but also indicated that he had normal extension and flexion. Ultimately, the RO assigned a noncompensable rating under diagnostic code 7805 for the residuals of the gunshot wound to the right arm with a scar to the right elbow. No separate rating was awarded for a muscle injury in the right arm caused by a gunshot wound. At the time of the August 1967 rating decision, 38 C.F.R. § 4.50 (1967) recognized that shrapnel, shell fragments, and high velocity bullets could inflict massive damage upon the muscles with permanent residuals. The principal symptoms of disabilities from such muscle injuries were weakness, undue fatigue-pain, and uncertainty or incoordination of movement, with physical factors like intermuscular fusing and binding, and welding together of fascial planes and aponeurotic sheaths. Then, as now, 38 C.F.R. § 4.56 pertained to rating injuries of the muscles. The then-applicable schedule for rating musculoskeletal disabilities provided the following guidelines: Factors to be Considered in the Evaluation of Disabilities Residual to Healed Wounds Involving Muscle Groups Due to Gunshot or Other Trauma (a) Slight (insignificant) disability of muscles. Type of Injury. Simple wound of muscle without debridement infection or effects of laceration. History and complaint. Service department record wound of slight severity or relatively brief treatment and return to duty. Healing with good functional results. No consistent complaint of cardinal symptoms of muscle injury or painful residual. Objective findings. Minimum scar; slight, if any, evidence of fascial defect or atrophy or of impaired tonus. No significant impairment of function and no retained metallic fragments. (b) Moderate Disability of Muscles. Type of injury. Through and through or deep penetrating would of relatively short track by single bullet or small shell or shrapnel fragment are to be considered as of at least moderate degree. Absence of explosive effect of high velocity missile and of residuals of debridement or of prolonged infection. History and complaint. Service department record or other sufficient evidence of hospitalization in service for treatment of wound. Record in the file of consistent complaint on record from first examination forward, of one or more of the cardinal symptoms of muscle wounds particularly fatigue and fatigue-pain after moderate use, affecting the particular functions controlled by injured muscles. Objective findings. Entrance and (if present) exit scars linear or relatively small, and so situated as to indicate relatively short track of missile through muscle tissue; signs of moderate loss of deep fascia or muscle substance or impairment of muscle tonus, and of definite weakness or fatigue in comparative tests. (In such tests the rule that with strong efforts, antagonistic muscles relax is to be applied to insure validity of tests.) (c) Moderately Severe Disability of Muscles. Type of injury. Through and through or deep penetrating wound by high velocity missile of small size or large missile of low velocity, with debridement or with prolonged infection or with sloughing of soft parts, intermuscular cicatrization. History and complaint. Service department record or other sufficient evidence showing hospitalization for prolonged period in service for treatment of wound of severe grade. Record in the file of consistent complaint of cardinal symptoms of muscle wounds. Evidence of unemployability because of inability to keep up to production standards is to be considered, if present. Objective findings. Entrance and (if present) exit scars relatively large and so situated as to indicate track of missile through important muscle groups. Indications on palpation of moderate loss of deep fascia, or moderate loss of muscle substance or moderate loss of normal firm resistance of muscles compared with sound side. Tests of strength and endurance of muscle groups involved (compared with sound side) give positive evidence of marked or moderately severe loss. (d) Severe Disability of Muscles. Type of injury. Through and through or deep penetrating wound due to high velocity missile, or large or multiple low velocity missiles, or explosive effect of high velocity missile, or shattering bone fracture, with extensive debridement or prolonged infection and sloughing of soft parts, intermuscular binding and cicatrization. History and complaint. As under moderately severe above, in aggravated form. Objective findings. Extensive ragged, depressed, and adherent scars of skin so situated as to indicated wide damage to muscle groups in track of missile. X-ray may show minute multiple scattered foreign bodies indicating spread of intermuscular trauma and explosive effect or of muscle substance. Palpation shows moderate or extensive loss of deep fascia or of muscle substance. Soft or flabby muscles in wound area. Muscles do not swell and harden normally in contraction. Tests of strength or endurance compared with the sound side or of coordinated movements show positive evidence of severe impairment of function. In electrical tests, reaction of degeneration is not present but a diminished excitability to Faradism compared with the sound side may be present. Visible or measured atrophy may or may not be present. Adaptive contraction of opposing group of muscles, if present indicates severity. Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone without true skin covering, in an area where bone is normally protected by muscle, indicates the severe type. Atrophy of muscle groups not included in the track of the missile, particularly of the trapezius and serratus in wounds in the shoulder girdle (traumatic muscular dystrophy), and induration and atrophy of an entire muscle following simple piercing by a projectile (progressive sclerosing myositis), may be included in the severe group in there is sufficient evidence of severe disability. See 38 C.F.R. § 4.56 (1967). Then, as now, diagnostic code 5305 governed injuries to muscle group V, the flexor muscles of the elbow. For the major arm, a noncompensable rating was warranted for slight muscle injuries, while a 10 percent rating was warranted for a moderate muscle injury, a 30 percent rating for a moderately severe muscle injury, and a 40 percent rating for a severe muscle injury. 38 C.F.R. § 4.73, Diagnostic Code 5305 (1967). The Board acknowledges that the Veteran's service treatment records clearly reflect treatment for a gunshot wound to the right elbow, that his wounds were debrided after being hospitalized for his injuries, and that there was a period of prolonged hospitalization and convalescence following his injuries. Nonetheless, it cannot be said that the incorrect facts were before the RO at the time of the rating decision; in fact, the RO indicated that it had reviewed his service treatment records in its rating decision. Moreover, various evidence, such as the May 1967 medical board proceedings and his August 1967 VA examination, indicates that the Veteran had a scar on his medial right elbow that was the residual of a healed gunshot wound. Significantly, he had normal range of motion in the right elbow at the VA examination. This evidence is essentially devoid of any findings indicating that there was a current muscle injury in the right arm. To that end, the records then available were absent for reports of symptoms of even an insignificant muscle injury to the right arm, such as loss of deep fascia or muscle substance, loss of normal firm resistance of the muscles, loss of muscle strength or endurance, soft or flabby muscles in the relevant areas, or muscles swelling or hardening abnormally. Additionally, the then-available evidence reflected no signs of moderate loss of deep fascia or muscle substance or impairment of muscle tonus, or of definite weakness or fatigue in comparative tests. It also cannot be said that the RO misapplied the then-extant law in a way that manifestly changed the outcome of the decision. Ultimately, the most recent evidence before the RO in August 1967 did not clearly and unmistakably reflect that the Veteran had any residual muscle injuries due to the gunshot wound to his right arm at the time the rating decision was promulgated. The Board has carefully considered the appellant's representative's arguments regarding the language of 38 C.F.R. § 4.56 as it pertains to gunshot wounds. The then-applicable rating criteria indeed provided that deep and penetrating gunshot wounds were to be considered of at least a moderate degree of disabling. This assumes, however, that there is in fact evidence of a muscle disability in the first place. This is evident from the name of the regulation, "Factors to be Considered in the Evaluation of Disabilities Residual to Healed Wounds Involving Muscle Groups Due to Gunshot or Other Trauma," which explicitly states that disabilities must be present residual to healed wounds involving a muscle group (emphasis added). In this regard, it was simply not clear or obvious that the Veteran had a current muscle disability due to the residuals of the healed gunshot wound to the right arm at the time of the August 1967 rating decision. For instance, although his service treatment records reflect that his right arm wound was debrided in May 1966, later records describe the right arm as healed without any sequelae other than a J-shaped scar. Moreover, service treatment records do not reflect that he complained of the cardinal signs or symptoms of muscle injuries, including weakness, fatigue-pain, uncertainty of movement, loss of power, lowered threshold of fatigue, or impairment of coordination in the right arm. Although he did indeed undergo a prolonged period of hospitalization and convalescence following his May 1966 injuries, the records indicate that this treatment was predominantly related to problems caused by injuries to his left shoulder and right lower extremity, as opposed to problems with the muscle groups in his right arm following his gunshot wound. Furthermore, although the Veteran complained at his August 1967 VA examination that he could no longer carry heavy objects, it appears that this is related to his left shoulder injury. To that end, he endorsed numbness and pain in his left shoulder, but he did not report numbness or pain with respect to the right arm. Essentially, the only residual of the gunshot wound to his right arm that was evident at the time of the August 1967 VA examination was the scar on his elbow. This residual is addressed by diagnostic code 7805, which applies to scars other than disfiguring scars of the head, face, or neck, scars from second- or third-degree burns, superficial, poorly nourished scars with repeated ulceration, or superficial, tender and painful scars. In turn, the then-extant version of diagnostic code 7805 in 38 C.F.R. § 4.118 directed for other scars to be rated based on limitation of function of the part affected. As set forth above, it was not clear and obvious from the evidence then before the adjudicator that the Veteran had experienced any functional limitations in his right arm. Ultimately, even if the RO failed to consider the applicability of 38 C.F.R. § 4.56 in assigning disability ratings in its August 1967 rating decision, there was a legitimate question as to whether the Veteran actually had a muscle injury sufficient to warrant a separate rating for a residual muscle injury of a healed gunshot wound in the right arm. As such, it cannot be said that reasonable minds would all agree that he should have been awarded a separate rating for moderate injuries to muscle group V in the right arm, let alone the 30 percent rating for a moderately severe muscle injury that the appellant's representative has argued was appropriate. Additionally, at the time of the August 1967 rating action, the rating board was permitted to rely on its own medical judgment to support its conclusions. Hime v. McDonald, 28 Vet. App. 1, 7 (2016) (finding that a rating panel was not prohibited from relying upon its own medical judgement to support its conclusion where the rating panel included a medical member); cf. Colvin v. Derwinski, 1 Vet. App. 171 (1991) (holding that the rating board cannot substitute its own medical judgment for that of medical professionals). The Board notes that it was regular practice of the VA in 1967 to have three-member rating panels, and that on the rating board, one of the members "will be a medical doctor" (i.e. the medical member). See VA Adjudication Procedure Manual, M21-1, para. 45.01(b) (October 16, 1970). As can be seen on the face of the August 1967 rating decision, a medical member of the rating board participated in making the determination and, as a signatory to the determination, affirmed his agreement with the finding that [ultimate finding of RO, e.x. the Veteran's psychiatric disorder was not incurred in service or related to his service-connected disability]. MacKlem v. Shinseki, 24 Vet. App. 63, 70 (2010) (affirmed No. 2011-7034 (Fed. Cir. Jan. 11, 2012)); Bowyer v. Brown, 7 Vet. App. 549, 552-53 (1995) (holding that the VA's position was substantially justified in a pre-Colvin decision relying on its own medical judgment). "[T]he presence of the medical member on the [rating board], pre-Colvin, allowed the [b]oard to assess the probative value of medical opinions in a way that it now cannot, through the exercise of its own medical expertise and judgment." Hime, 28 Vet. App. at 8. Thus, to the extent the August 1967 determination is alleged to be contrary to the medical evidence of record, the Board finds that the rating board apparently relied upon the medical judgment of the medical member, among other things, in deciding the claim. While the Veteran may not agree with the rating board's determination, this is not a basis for finding CUE. After a careful review of the evidence of record then before the adjudicator in August 1967, the Board finds that the rating board correctly applied pertinent law and regulations in considering the evidence. At the time of the decision, the evidence did not clearly and unmistakably establish that the residuals of the gunshot wound to the Veteran's right arm warranted an additional rating under the diagnostic code for muscle group V. To the extent that there is a disagreement as to how the RO weighed or interpreted evidence, such a contention is not a sufficient basis to overturn a prior final decision. Indeed, it is "the prerogative of the factfinder . . . to interpret the evidence and draw reasonable inferences from it." Evans, 27 Vet. App. at 187. As such, the Board finds that the RO decision did not contain clear and unmistakable error to the extent that it did not assign a separate rating under diagnostic code 5305 for injuries to muscle group V of the right arm. The August 1967 adjudicator did not ignore facts or law; it committed no undebatable error that would have provided a manifestly different result. Accordingly, the Board finds that revision of the August 1967 rating decision based on CUE is not warranted. Increased Rating The appellant also argues that an increased rating is warranted for the Veteran's current right arm disability, which was evaluated at 10 percent disabling under diagnostic code 5305 prior to his death. Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Where, as here, entitlement to service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each piece of evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). As set forth above, muscle disabilities are evaluated according to the type of injury, history and complaint, and objective findings under 38 C.F.R. § 4.56. A moderate muscle disability is a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without the explosive effect of a high velocity missile, residuals of debridement, or prolonged infection. A history consistent with a moderate muscle disability would include complaints of one or more of the cardinal signs and symptoms, involving loss of power, weakness, fatigue-pain, impairment of coordination and uncertainty of movement, but particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings of a moderate muscle disability include entrance and (if present) exit scars, small or linear, indicative of short track of missile through muscle tissue, some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to sound side. 38 C.F.R. § 4.56(d)(2). A moderately severe muscle disability is a through and through or deep penetrating wound by a small high velocity missile or a large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history consistent with this type of injury should include hospitalization for a prolonged period of treatment of the wound, with a record of cardinal symptoms consisting of loss of power, weakness, lowered threshold of fatigue, pain, impairment of coordination and uncertainty of movement, and, if present, evidence of inability to keep up with work requirements. Objective findings would include entrance and (if present) exit scars indicating a track of a missile through one or more muscle groups. Objective findings would also include indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). A severe muscle disability results from through and through or deep penetrating wound due to high-velocity missile, or large multiple low-velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. History and complaints are like those required for a moderately severe disability, but worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings include ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; tests of strength, endurance or coordinated movements compared with corresponding muscles of the uninjured side indicate severe impairment of function; X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to a long bone; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing muscle group; atrophy of muscle groups not in the track of the missile; and induration or atrophy of an entire muscle group. 38 C.F.R. § 4.56(d)(4). In applying these ratings, a through and through injury with muscle damage shall be evaluated as no less than a moderate muscle injury to the group of muscles damaged. 38 C.F.R. § 4.56(b). An open comminuted fracture with muscle or tendon damage will be rated as a severe injury of the muscle group involved unless, for locations such as the wrist or over the tibia, evidence establishes that the muscle damage is minimal. 38 C.F.R. § 4.56(a). The words "slight," "moderate" 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 the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence 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. As it did in 1967, diagnostic code 5305 pertains to muscle group V and is defined as including the flexor muscles of the elbow, including the biceps, brachialis, and brachioradialis. The function of these muscle groups is listed as elbow supination (long head of biceps as stabilizer of the shoulder joint), and flexion of the elbow. A 10 percent rating is assigned for a moderate injury, while a 30 percent rating is available for a moderately severe injury to the major extremity. A maximum 40 percent rating is assigned for severe impairment of the major extremity. Findings from a December 2018 muscle injuries VA examination reflect that the Veteran had suffered from a penetrating muscle injury in 1966. Since that time, he had reported recurrent right shoulder pain, recurrent right elbow pain, limited right shoulder range of motion, and limited right elbow range of motion, with gradual worsening over time. The injury was to muscle group V, and it had caused some loss of muscle substance. Regarding the cardinal signs and symptoms of muscle disability, the Veteran had loss of power, weakness, fatigue-pain, and lowered threshold for fatigue that were consistent at a more severe level, while impairment of coordination and uncertainty of movement were occasional. Muscle strength testing on elbow flexion was normal and no muscle atrophy was present. The functional impact of his injury was that he did not tolerate excessive, repetitive, or prolonged activity of the right elbow or shoulder, or heavy lifting or raising his hand. Separate VA examinations were performed concerning the Veteran's shoulder and arm and elbow and forearm. Regarding the Veteran's shoulder and arm, range of motion testing indicated that right shoulder flexion was to 119 degrees, while abduction was to 112 degrees. External rotation was to 49 degrees, while internal rotation was to 71 degrees. Pain was noted on range of motion testing. With respect to the elbow and forearm, flexion was to 150 degrees and extension was to 0 degrees, while forearm supination and pronation were from 0 to 90. The VA examiner noted that the Veteran reported flare-ups of the shoulder or arm and elbow or forearm (similar to the functional loss that was described during his muscle injuries examination), but the examiner did not describe the functional loss caused by pain, fatigue, weakness, lack of endurance, or incoordination in terms of range of motion. No ankylosis was present on either examination. Pain was noted on weight-bearing and non-weight-bearing, as well as on passive and active motion, and the left elbow and shoulder joints were tested. Having reviewed the evidence regarding the residuals of the Veteran's right arm gunshot wound, the Board finds that a 30 percent rating under diagnostic code 5305 for a moderately severe muscle injury is appropriate from September 13, 2018 (i.e., the date of the Veteran's claim for an increased rating). To that end, the Board notes that the December 2018 VA examination for muscle injuries indicated that he reported more frequent, severe symptoms, such as loss of power, weakness, fatigue-pain, and lowered threshold for fatigue, as well as some occasional symptoms, such as impairment of coordination and uncertainty of movement. Taken in the light most favorable to the Veteran, the Board finds that a 30 percent rating under diagnostic code 5305 is warranted to reflect these moderately severe symptoms. A 40 percent rating, however, is not warranted, as the Veteran's disability was not characterized by objective findings consistent with a severe muscle injury, such as severe impairment on muscle strength tests, diminished muscle excitability, or atrophy of an entire muscle group. The Board has also considered whether 38 C.F.R. § 4.71a provides for a higher evaluation under other diagnostic codes available for evaluating disabilities of the elbow. See, e.g., Butts v. Brown, 5 Vet. App. 532, 538 (1993) (the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case"); Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992) (one diagnostic code may be more appropriate than another based on such factors as the Veteran's relevant medical history, his current diagnosis, and demonstrated symptomatology). However, the evidence does not indicate that ankylosis of the elbow or its functional equivalent was present. As such, diagnostic code 5205, for ankylosis of the elbow, is not applicable. Additionally, the record does not indicate that the Veteran had a flail joint (diagnostic code 5209), nonunion of the radius and ulna with a flail false joint (diagnostic code 5210), impairment of the ulna (diagnostic code 5211), impairment of the radius (diagnostic code 5212), or impairment of supination or pronation (diagnostic code 5213). Moreover, the record does not indicate that the Veteran's right forearm flexion was limited to 55 degrees or that his right forearm extension was limited to 100 degrees, even when considering additional loss of function during flare-ups. As such, ratings in excess of 30 percent under diagnostic codes 5206 and 5207 are not available. Likewise, a higher rating is not available under the diagnostic codes available in 38 C.F.R. § 4.71a for rating limitation of motion in the shoulder. To that end, even when considering potential additional limitation of motion during flare-ups, the evidence did not indicate that the Veteran had ankylosis of the scapulohumeral articulation or its functional equivalent, limitation of flexion and/or abduction of the arm to 25 degrees from the side, or impairment of the humerus. As such, ratings in excess of 30 percent are not available under diagnostic codes 5200, 5201, or 5202. Accordingly, a 30 percent rating, but no higher, under diagnostic code 5305 is appropriate throughout the period on appeal. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rademacher, 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.