Citation Nr: 21064544 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 15-12 072A DATE: October 20, 2021 ORDER Entitlement to a 30 percent rating prior to February 26, 2020 for left fifth finger neuritis associated with left fifth finger traumatic arthritis is granted. FINDING OF FACT Prior to February 26, 2020, the Veteran's left fifth finger neuritis associated with left fifth finger traumatic arthritis was manifested by moderate incomplete paralysis of the ulnar nerve. CONCLUSION OF LAW The criteria for a rating of 30 percent for left fifth finger neuritis associated with left fifth finger traumatic arthritis prior to February 26, 2020, have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.124A (Diagnostic Code 8699-8616). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from February 1979 to February 1982 and July 1983 to November 1984. This matter comes before the Board of Veterans' Appeals (Board) from the July 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at an April 2018 hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. This matter was previously before the Board in October 2020 and the Veteran's claim for entitlement to an increased rating for left fifth finger neuritis was denied. The Veteran appealed this decision to the Court of Veterans Appeals (Court). In July 2021, the Court issued a joint motion for partial remand. Entitlement to a rating in excess of 10 percent prior to February 26, 2020 for left fifth finger neuritis associated with left fifth finger traumatic arthritis The Veteran contends that he is entitled to a rating greater than 10 percent for his left fifth finger neuritis condition prior to February 26, 2020. As noted above, this matter was remanded by the Court in July 2021. The Court found that the Board failed to adequately address the evidence of record and whether a rating in excess of 10 percent for left fifth finger neuritis disability prior to February 26, 2020 was warranted. Paralysis of the ulnar nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8516. Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8616 and 8716. Under these criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Complete paralysis; the "griffin claw" deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; and, flexion of wrist weakened is rated as 60 percent for the major extremity and 50 percent for the minor extremity. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123 Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124. Throughout the record, the Veteran consistently complained and described a decrease in grip strength in his left hand due to complete loss of motion. The Veteran's dominant hand is his left hand. A February 2014 lay statement by the Veteran stated that he has pain all the time in his little finger and constantly experiences loose grip. At the Veteran's March 2015 VA examination, the examiner noted that the Veteran had mild incomplete paralysis of the right ulnar nerve. The examiner stated that the Veteran's left fifth finger condition manifested in mild intermittent pain, mild numbness, and mild paresthesias and/or dysesthesias. The Veteran also had decreased sensation in his left hand/fingers. No trophic changes or muscle atrophy was present. The examiner stated that the Veteran's peripheral nerve condition did not impact his ability to work. At the Veteran's April 2018 Board hearing, he testified that his left fifth finger disability had gotten worse over the last eight years. Additionally, the Veteran reported difficulty gripping when using a screwdriver, mixing things in a bowl, golfing, and typing on a computer. Furthermore, the Veteran testified that he experiences constant pain, to include shooting pain, decreased range of motion, and the inability to use his left fifth finger. At the Veteran's February 2020 VA peripheral nerve examinations, the examiner noted that the Veteran is diagnosed with left ulnar neuritis and documented that the Veteran had moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness. Additionally, the examiner stated that the Veteran's nerve condition impacted his ability to work noting that he missed 2-4 weeks in the previous 12 months due to this condition. The Veteran also reported difficulty holding onto items and that holding the steering wheel made his hand go numb. The February 2020 examiner concluded that the Veteran had moderate incomplete paralysis of the ulnar nerve. Based on the above, the Board finds that the Veteran's disability prior to February 26, 2020 was primarily manifested by impairment of motor functions (difficulty gripping and holding items), sensory disturbance, and constant pain. The Board also finds that the most probative evidence of record is against a finding that the Veteran's disability was manifested by trophic changes, loss of reflexes, muscle atrophy, and complete paralysis. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis prior to February 26, 2020. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is in favor of the Veteran's claim for a rating of 30 percent prior to February 26, 2020. The Board notes that the RO will set an effective date after determining the date on which increase in severity occurred. This preserves the Veteran's right to appeal the effective date awarded by the RO. See DAV v. Secretary of Veterans Affairs, 327 F.3d. 1339 (Fed. Cir. 2003). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mountford, 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.