Citation Nr: 21065684 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 05-03 060 DATE: October 27, 2021 ORDER An initial compensable rating prior to July 17, 2018, and in excess of 10 percent thereafter for scars from lacerations to the left middle and ring fingers is denied. A 10 percent rating for residual functional impairment from laceration to the left middle finger, beginning July 17, 2018, is granted. An initial compensable rating for residual functional impairment from laceration of the left ring finger is denied. FINDINGS OF FACT 1. The evidence does not show that the left finger scars were ever unstable or greater than 929 centimeters or painful prior to July 17, 2018. 2. Resolving doubt in the Veteran's favor, the evidence shows limitation of motion and functional impairment from residuals of laceration to the left middle finger beginning July 17, 2018, but not before. 3. The rating criteria do not provide for a compensable rating for functional limitation of the ring finger or a rating in excess of 10 percent for functional limitation of the middle finger. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating prior to July 17, 2018, and in excess of 10 percent thereafter for scars from lacerations to the left middle and ring fingers have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code (DC) 7804. 2. The criteria for a 10 percent rating for residual functional impairment from laceration to the left middle finger have been met beginning July 17,2018, but not before. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, DC 5229. 3. The criteria for an initial compensable rating for residual functional impairment from laceration of the left ring finger have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, DC 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from June 1968 to February 1970. Increased Rating 1. An initial compensable rating prior to July 17, 2018, and in excess of 10 percent thereafter for scars from lacerations to the left middle and ring fingers Diagnostic Code 7804 provides for a 10 percent rating for one or two scars that are unstable or painful and increased ratings based on the number of painful and/or unstable scars. An unstable scar is defined as one where there is frequent loss of covering of skin over the scar. If one or more scars are both unstable and painful, 10 percent should be added to the evaluation that is based on the total number of unstable or painful scars. Diagnostic Code 7802 provides for a 10 percent rating for scars, not of the head, face, or neck, which are not associated with underlying soft tissue damage and are 929 square centimeters or greater in area. 38 C.F.R. § 4.118. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. Previously, under Diagnostic Code 7802, the term "superficial" was used to describe a scar "not associated with underlying soft tissue damage;" the remainder of the criteria were not significantly changed. Diagnostic Code 7804 was not changed by the August 13, 2018, amendments. The Board finds the criteria for a compensable rating for finger laceration scars prior to July 17, 2018, and in excess of 10 percent thereafter have not been met. Prior to July 17, 2018, the evidence does not show the scars were painful. The September 2002 and November 2016 VA examiners indicated the scars were not tender or painful. The Veteran did not report that the scars, themselves, were painful, and VA treatment records do not show complaints or treatment for painful scars during this period. Beginning July 17, 2018, the Veteran receives a 10 percent rating for up to two painful scars. However, there is no evidence that the scars were unstable or at least 929 square centimeters at any time during the claim period. The September 2002, November 2016, January 2020, and December 2020 VA examiners found the scars were not unstable and measured the length of the first scar as 4 centimeters, length of the second as 2-2.5 centimeters, and width of both scars as one centimeter or less. Additionally, the September 2002 and November 2016 examiners described the scars as linear, well-healed, flat, and not adherent to underlying tissue or associated with underlying tissue loss. As such, a higher rating under Diagnostic Code 7804 or rating under Diagnostic Code 7802 is not warranted. The Veteran's scars are not of the head, face, or neck, not deep, and not associated with underlying soft tissue damage; therefore, the other Diagnostic Codes pertaining to scars are not applicable. Functional impairment from the lacerations to the fingers is rated separately and discussed below. Accordingly, the weight of the evidence is against assigning higher ratings for the finger scars. 2. A 10 percent rating for residual functional impairment from laceration to the left middle finger 3. An initial compensable rating for residual functional impact from laceration of the left ring finger Disabilities of the long (middle) finger are rated under Diagnostic Code 5229 based on limitation of motion. A zero, noncompensable rating is assigned when there is a gap between the fingertip and the proximal transverse crease of the palm of less than one inch (2.5 cm), and a 10 percent rating is assigned when the gap between the fingertip and the proximal transverse crease of the palm is one inch or more. The maximum rating for musculoskeletal disability of the long finger is 10 percent. 38 C.F.R. § 4.71a, DC 5229. Diagnostic Code 5230 addresses disabilities of the ring finger and provides for a zero, non-compensable rating regardless of the degree of limitation of motion in that finger. 38 C.F.R. § 4.71a, DC 5230. Therefore, the Veteran cannot receive a compensable rating for residuals of laceration of his ring finger under the rating criteria. After resolving doubt in the Veteran's favor, the Board finds a 10 percent rating for functional impairment in the left middle finger is warranted beginning July 17, 2018, but not before. See 38 C.F.R. § 4.71a, DC 5229. Prior to July 17, 2018, the evidence does not show a compensable level of limitation of motion in the middle finger. The July 2000 examiner recorded normal flexion and extension of all fingers. Similarly, the May 2002 examiner found the Veteran could touch the tips of all fingers to the median transverse fold of the palm. The Veteran reported severe pain in his left middle finger every other day but did not describe any functional limitation from the pain. During the August 2009 examination, the Veteran reported a new onset of pain and swelling in the left middle finger. The examiner recorded normal range of motion in the middle finger without a gap between the fingertip and proximal transverse crease of the hand, no objective evidence of pain with motion, and no additional loss of motion following repetitive use. During the November 2016 examination, the Veteran denied flare-ups and functional impairment in the left middle finger. The examiner recorded normal motion with no gap between the finger and the proximal transverse crease of the hand. Accordingly, the evidence does not show a gap of at least one inch between the left middle fingertip and the proximal transverse crease of the palm prior to July 17, 2018. The Board has considered the effects of pain, swelling, and flare-ups. However, the Veteran reported having very consistent pain in his finger during the May 2002 examination and denied flare-ups during the November 2016 examination. Therefore, the Board finds the measurements of record accurately reflect the effects of pain and other symptoms on his range of motion. Considering the next period, the July 2018 examiner found the Veteran experienced some limited motion in his left middle finger that included one centimeter of gap between the fingertip and the proximal transverse crease of the hand. The Veteran reported pain and flare-ups with cold weather where he would have to avoid using his left hand. The examiner explained that the Veteran had carpal tunnel syndrome in his left hand unrelated to the lacerations of his left ring and middle finger but that the limitations in grip and dexterity were attributable to both conditions and difficult to separate. The examiner explained that the lacerations could produce limited range of motion and resulting limitation of grip and dexterity of the left hand but could have taken years to manifest as the scar tissue progressed over time. Similarly, in a September 2019 opinion, the examiner reiterated that the painful motion and functional loss in the middle and ring fingers is the result of tissue damage within the hand structure, below the scar, from the laceration event. During the January 2020 examination, the Veteran reported flare-ups with cold weather and gripping, and the examiner recorded reduced range of motion of the middle finger with a one-centimeter gap between the finger and the proximal transverse crease of the hand. During the December 2020 examination, the Veteran reported pain, reduced grip strength, and flare-ups with cold weather and gripping with the left hand. The examiner recorded normal range of motion of the middle finger with no gap between the finger and the hand crease. The Board has resolved doubt in the Veteran's favor in regard to flare-ups and functional limitation from residuals of laceration of the left middle finger and finds that a 10 percent rating is warranted from July 17, 2018, the first date of evidence showing limited motion and flare-ups. As noted, 10 percent is the maximum rating for the middle finger. Finally, the evidence shows the Veteran experiences additional symptoms and functional impairment in his left hand that are not part of the disability picture for residuals of left middle and ring finger lacerations. First, the evidence shows that while operating a bread slicer, the Veteran received lacerations on the tips and side of the left middle and ring fingers only without involvement of the rest of the hand. The Board notes that the rating schedule clearly contemplates the effect limited motion in one finger can have on the function and grip of the hand. Indeed, Diagnostic Code 5229 provides for a compensable rating based on whether the long finger can bend to reach the rest of the hand and assist in gripping objects. Therefore, the award of 10 percent considers and compensates for the functional effect the Veteran's left middle finger disability has on his hand function. Moreover, the weight of the evidence is against finding a disability of the whole hand, including osteoarthritis and carpal tunnel syndrome, is part of the Veteran's disability of lacerations of the middle and ring fingers. During the July 2000 and May 2002 examinations, the Veteran reported the onset of numbness and cramps in his hands while working as an installer for a telephone company and subsequently being diagnosed with bilateral carpal tunnel syndrome around 1998, decades after the laceration injury. The May 2002 examiner described the Veteran's severe bilateral carpal tunnel syndrome as an occupational disease. The July 2018 examiner also noted that the carpal tunnel syndrome was unrelated to the finger lacerations. The record shows the Veteran has carpal tunnel syndrome bilaterally, not only in his left hand, which further supports a finding of no connection between the two conditions. Aside from general assertions, the Veteran has not identified or provided evidence to suggest that his carpal tunnel syndrome is part of his finger laceration disability. VA medical experts in January and June 2021 addressed the diagnosis of arthritis in the hands. The experts explained that laceration is a soft tissue injury that does not affect the bone while arthritis is a condition due to the aging process and degeneration of the joint components, and the conditions have separate etiologies. The June 2021 expert explained that because the Veteran has symmetrical, mild arthritis affecting both hands rather than occurring only in the left hand or occurring more dramatically in the left hand, it is more likely due to aging and normal wear and tear than being caused or aggravated by the left finger lacerations. The Board finds these opinions probative as they include detailed rationale that is consistent with the other evidence of record. The Board finds these opinions are not inconsistent with the examiner's opinions in July 2018 and September 2019 as he found that the lacerations of the Veteran's fingers could result in functional limitation that impacted the function of the hand, not that they would cause other, separate conditions of the hand. The Board has compensated the functional impact on the hand from limitation in the left middle finger with a 10 percent rating, but the evidence does not support assignment of ratings other than for the left middle and ring fingers as residuals of the laceration injuries. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.P. Armstrong 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.