Citation Nr: 21067581 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 19-03 276A DATE: November 4, 2021 ORDER Entitlement to a rating of 20 percent for median neuropathy of the right hand is granted. FINDING OF FACT For the entirety of the appeal period, the median neuropathy of the right hand most nearly approximated incomplete paralysis of a moderate severity; however, incomplete paralysis of a severe nature is not shown, as the Veteran has not exhibited symptomatology that was more than sensory in nature. CONCLUSION OF LAW For the entirety of the appeal period, the criteria for a disability rating of 20 percent, but no more, for median neuropathy of the right hand have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8515. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1964 to July 1968. The Board has considered whether a claim for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) has been raised by the Veteran during the pendency of this appeal. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) held that VA must address the issue of entitlement to TDIU in increased-rating claims when the issue of unemployability is either raised expressly or by the record. The Veteran has never contended that he is unable to work as due at least in part to the symptomatology from his median neuropathy of the right hand. Moreover, as will be detailed below, no VA examiner or any other medical professional who has evaluated the severity of the median neuropathy condition has determined that the condition precludes the Veteran from securing and following substantially gainful employment. Accordingly, a claim for TDIU has not been raised by the record. Entitlement to an increased rating for median neuropathy of the right hand The Veteran seeks entitlement to a rating in excess of 10 percent for median neuropathy of the right hand. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. As the claim seeking an increased rating was submitted on January 17, 2017, the relevant period on evaluation extends back up to one year prior to the date of the claim, that is, from January 17, 2016. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007). The 10 percent rating is assigned pursuant to Diagnostic Code 8515, which provides ratings for paralysis, neuritis, and neuralgia of the median nerve. Under Diagnostic Code 8515, incomplete paralysis of the median nerve in the major extremity warrants 10, 30, or 50 percent ratings if it is mild, moderate, or severe, respectively. For the minor extremity, incomplete paralysis of the median nerve warrants 10, 20, or 40 percent ratings if it is mild, moderate, or severe, respectively. A 70 percent rating is warranted for paralysis of the median nerve in the major extremity if the paralysis is complete; the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened, and; pain with trophic disturbances. The same paralysis for the minor extremity warrants a 60 percent rating. 38 C.F.R. § 4.124a, Diagnostic Code 8515. Words such as "severe," "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for a higher disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. In rating diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of 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 should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. During the appeal period, the severity of the median neuropathy of the right hand was evaluated in a February 2017 peripheral nerves examination, during which the Veteran asserted that he had been experiencing symptoms of right hand nerve impairment since an in-service injury when his right hand was crushed. According to the Veteran, his symptomatology had worsened since he was last evaluated by a VA examiner. After confirming that the Veteran's right hand was his dominant one, an in-person evaluation revealed severe right upper extremity pain as well as severe paresthesias and/or dysesthesias. Muscle strength testing revealed reduced right hand grip strength and pinch, while sensory testing confirmed that there was decreased sensation in the right hand. Ultimately, it was the examiner's impression that the Veteran experience incomplete paralysis of the right hand of a mild severity. The examiner also noted that the Veteran's median neuropathy would impact his occupational functioning in the form of reduced grip strength of the right hand. As the examiner reviewed the entire claims file and considered the Veteran's full medical history, the Board finds his opinion to be highly probative of the ultimate determination as to the severity of the condition during the appeal period. Sklar v. Brown, 5 Vet. App.140 (1993). A review of available VA medical records pertaining to the period on appeal reflects that the Veteran reported experiencing right hand pain and stiffness in June 2016. A September 2016 radiographic evaluation revealed multifocal osteoarthritis of the right thumb as well as small broad-based exostosis associated with the little finger proximal phalangeal neck. The Veteran underwent right little finger surgery in January 2017. Outpatient records dated in March and in April 2018 show that the Veteran reported difficulty using his wheelchair due to chronic right hand pain in the center of his palm. Subsequent records show that degenerative joint disease of the right hand has been listed as a continuing problem in the Veteran's VA medical records for the entirety of the appeal period. The predominant symptomatology associated with the condition has been pain focused at the palm of the Veteran's right hand. After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence supports a determination that a 20 percent rating, but no more, is warranted for median neuropathy of the right hand, corresponding to incomplete paralysis of a moderate severity. Specifically, the February 2017 VA examiner found that the Veteran experienced severe right hand pain and severe paresthesias and/or dysesthesias. Although that examiner ultimately determined that the median neuropathy of the right hand was no more than mild in severity, the Board finds that instead for the entirety of the appeal period the Veteran's right hand median neuropathy has approximated moderate incomplete paralysis of the right hand. Specifically, the Board relies on the Veteran's consistent complaints of experiencing significant pain in the palm of his right hand that restricted his ability to use his right hand, especially to help him maneuver around his home via a wheelchair. That being said, there is no indication from the record that the Veteran has experienced any symptomatology that is more than sensory in nature at any time during the appeal period, which would be necessary to warrant a rating in excess of 20 percent. Accordingly, a 20 percent rating, but no more, is warranted for the median neuropathy of the right hand for the entirety of the appeal period, that is, from the date of the claim, January 17, 2017. 38 C.F.R. § 4.124a, Diagnostic Code 8515. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.