Citation Nr: 21066905 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 15-25 181 DATE: November 2, 2021 ORDER Entitlement to a disability rating higher than 40 percent for residuals, fracture, left scaphoid navicular bone with traumatic arthritis is denied. Entitlement to a disability rating higher than 20 percent for limitation of motion, left index finger and left thumb with decreased grip, is denied. Entitlement to a disability rating higher than 10 percent for right wrist de Quervain's disease is denied. REMANDED A claim of entitlement to an extraschedular rating for residuals, fracture, left scaphoid navicular with traumatic arthritis is remanded. A claim of entitlement to an extraschedular rating for limitation of motion, left index finger and left thumb with decreased grip, is remanded. A claim of entitlement to an extraschedular rating for right wrist de Quervain's disease is remanded. The claim of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran is receiving the maximum schedular disability rating for residuals of fracture to the left scaphoid navicular bone with traumatic arthritis. 2. The Veteran is receiving the maximum schedular disability rating for limitation of motion, left index finger and left thumb with decreased grip. 3. The Veteran is receiving the maximum schedular disability rating for limitation of motion caused by right wrist De Quervain's disease. CONCLUSIONS OF LAW 1. The criteria for an increased schedular rating for left wrist disability are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 2. The criteria for an increased schedular rating for left index finger and thumb disability are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 3. The criteria for an increased schedular rating for right wrist disability are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1970 to December 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2013 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified in a hearing before the Board. A transcript of the hearing is included in the electronic claims file and has been reviewed. In June 2019, the Board remanded the claims on appeal for additional development. The case is again before the Board for appellate review. Increased rating The Veteran has been service connected for left wrist disability since 1980, left index finger and thumb disability since 1995, and right wrist disability since 2007. In October 2012, he filed claims of entitlement to increased ratings or the disorders. At the time of the claims, the RO rated left wrist disability 40 percent disabling, left index finger and thumb disability 20 percent disabling, and right wrist disability 10 percent disabling. In the May 2013 rating decision on appeal, the RO denied the claims. The question before the Board is whether higher ratings have been warranted since October 2011, one year prior to the date of claim. See 38 C.F.R. § 3.400(o). Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The disorders at issue here are rated under DCs 5214, 5215, and 5223 of 38 C.F.R. § 4.71a. The left wrist disorder is rated under DC 5214. This provision addresses ankylosis and authorizes a maximum 50 percent rating for the major extremity and a maximum 40 percent rating for the minor extremity. The Veteran is right-hand dominant. For his left wrist disability, he has been receiving the maximum 40 percent rating under this DC throughout the appeal period. The left finger/thumb disorder is rated under DC 5223. This DC addresses ankylosis and authorizes a maximum 30 percent rating for the major extremity and a maximum 20 percent rating for the minor extremity. The Veteran is right-hand dominant, so he has been receiving the maximum 20 percent rating under this DC throughout the appeal period. The right wrist disorder is rated under DC 5215. This provision addresses limitation of motion and authorizes a maximum rating of 10 percent for either extremity. As the Veteran has been receiving 10 percent for right wrist limitation of motion during the appeal period, he has been receiving the maximum rating under this provision. As such, a schedular increased rating cannot be awarded here. REASONS FOR REMAND A referral for extraschedular rating is warranted. Based on the medical evidence and the Veteran's testimony before the Board, inquiry into whether an extraschedular rating is warranted should be conducted. During the Board hearing, the Veteran stated that chronic pain and diminished grip interfered with daily activities such as driving and lifting objects. His representative asserted during the hearing that the Veteran should receive an extraschedular rating for the combined effect of his right and left upper extremity problems. Medical evidence indicates severe disability. A December 2019 VA report notes significant hand grip impairment with muscle strength of 3/5 in the right hand and 1/5 in the left hand. The examiner found that the weakness impacted the ability to perform any type of occupational task. The December 2020 VA report notes significantly reduced strength in each wrist, jerking when evaluating for painful motion, and "extremely unfavorable" left wrist ankylosis. The January 2021 examiner emphasized that the Veteran had no range of motion in the left wrist. The medical and lay evidence raises the question of whether application of the regular schedular standards is impractical because the combined upper extremity disability is so exceptional or unusual. 38 C.F.R. § 3.321 (b)(1). The claim of entitlement to a TDIU must also be remanded because it is intertwined with the question of whether an extraschedular rating is warranted. See Smith v. Gober, 236 F.3d. 1370 (Fed. Cir. 2001). The matters are REMANDED for the following action: 1. Refer the claims of entitlement to an extraschedular rating for left wrist disability, left index finger and thumb disability, and right wrist disability to the VA Under Secretary for Benefits or the Director of Compensation Service. 2. Then adjudicate the claims of entitlement to extraschedular ratings and to a TDIU. If warranted, return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.