Citation Nr: 21067710 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 15-44 972 DATE: November 5, 2021 ORDER An initial 10 percent rating for left wrist ganglion cyst is granted. An initial rating higher than 10 percent for De Quervain's tendonitis of the left wrist is denied. An initial rating higher than 10 percent for De Quervain's tendonitis of the right wrist is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, throughout the appeal period, the Veteran's left wrist ganglion cyst has been described as painful. 2. Throughout the appeal period the Veteran's De Quervain's tendonitis of the left wrist manifested as painful movement. 3. Throughout the appeal period, the Veteran's De Quervain's tendonitis of the right wrist manifested as painful movement. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 10 percent for left wrist ganglion cyst have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7819-5015. 2. The criteria for an initial rating higher than 10 percent for De Quervain's tendonitis of the left wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Code 5215-5024. 3. The criteria for an initial rating higher than 10 percent for De Quervain's tendonitis of the right wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Code 5215-5024. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Navy from May 1994 to May 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2020, the Board remanded this matter for further development. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Whereas here, the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the effective date of the grant of service connection and consideration of the appropriateness of the assignment of different ratings for different periods of time, based on the facts found is required. Fenderson v. West, 12 Vet. App. 119 (1999). Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Left Wrist Ganglion Cyst The Veteran contends that a compensable rating is warranted for her left wrist ganglion cyst. For the following reasons the Board agrees and finds that a 10 percent rating is warranted. The Veteran's left wrist ganglion cyst is assigned a noncompensable rating under diagnostic codes (DC) 7819-5015. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. §§ 4.20, 4.27. DC 7819 pertains to benign skin neoplasms which are to be rated as disfigurements of the head, face, or neck (DC 7800), scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment of function. DC 5015 pertains to bones, new growths of, benign. Disabilities under DC 5015 are to be rated on limitation of motion of affected parts, as arthritis, degenerative. The Board notes that the regulations pertaining to musculoskeletal disabilities were revised effective February 7, 2021. Claims such as this pending prior to the effective date will be considered under both old and new rating criteria from that date, and whichever criteria is more favorable to the Veteran will be applied from this date. In this matter, the amendments to DC 5015 removes the reference to gout, which does not affect the Veteran's appeal. The Board also notes that during the pendency of this appeal, the regulations pertaining to skin disabilities were amended, effective August 13, 2018. 83 Fed. Reg. 32,592 (July 13, 2018), revised, 83 Fed. Reg. 38,663 (Aug. 7, 2018). However, DC 7819 was not changed in the amended regulations. The Veteran's cyst is located on her left wrist. As such, DC 7800 is not applicable as that relates to scars of the head, face, or neck. DC 7801 relates to scars not of the head, face, or neck. A 10 percent rating is assigned for scars of areas at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). DC 7804 relates to unstable or painful scars. A 10 percent rating is assigned for one or two scars that are unstable or painful. Note (1) for DC 7804 describes an unstable scar as one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) for DC 7804 provides that if one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is based on the total number of unstable or painful scars. In September 2013, the Veteran underwent a VA examination for her left wrist ganglion cyst. At this examination she described the cyst as painful to the touch. The cyst measured as approximately 1 x 1 cm in size. The Board finds the above evidence to support the assignment of a 10 percent rating. A disability under DC 7819 is to be rated under the disability codes for scars. DC 7804 allows for a minimum 10 percent rating for a painful or unstable scar. At her examination the Veteran stated that her cyst is painful to the touch. The Veteran has also consistently stated that she has pain in her left wrist. The Veteran is competent to report observable symptoms such as pain. As such, a 10 percent rating is appropriate. A rating higher than 10 percent cannot be assigned. The Veteran's cyst was not described as unstable, foreclosing a 20 percent rating under Note (2) of DC 7804. The cyst is also not at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) for a 20 percent rating using DC 7801. A higher rating based on limited motion under DC 5015 cannot be awarded as the Veteran is already compensated for limited motion of the left wrist under her service-connected left wrist De Quervain's tendonitis, and another rating based on limited motion of the wrist would violate the rule against pyramiding. As such, a rating higher than 10 percent is not warranted. The Board finds the evidence to be in equipoise as to whether the Veteran's left wrist ganglion cyst has been painful throughout the appeal period. When the evidence is in equipoise, reasonable doubt is resolved in the Veteran's favor. Accordingly, an initial rating of 10 percent for left wrist ganglion cyst is granted. Left Wrist De Quervain's Tendonitis Right Wrist De Quervain's Tendonitis The Veteran contends that a higher rating is warranted for her bilateral wrist De Quervain's tendonitis. For the following reasons, the Board disagrees and finds that a higher rating is not warranted. The Veteran's wrists are rated 10 percent disabling under DC 5215-5024. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. §§ 4.20, 4.27. The Board notes that the regulations pertaining to musculoskeletal disabilities were revised effective February 7, 2021. Claims such as this pending prior to the effective date will be considered under both old and new rating criteria from that date, and whichever criteria is more favorable to the Veteran will be applied from this date. However, the amendments did not change the rating criteria for DC 5215 and DC 5024 and as such do not affect the appeal before the Board. DC 5024 address tenosynovitis and is to be rated on limitation of motion of the affected part. DC 5215 addresses limited motion of the wrist. A maximum 10 percent rating is assigned for dorsiflexion less than 15 degrees in the major or minor extremity or palmar flexion limited in line with forearm in the major or minor extremity. The rating schedule under DC 5215 contemplates only one evaluation for limited motion of the wrist, regardless of the number of planes in which the wrist's motion is limited. See Yonek v. Shinseki, 722 F.3d 1355, 1359 (Fed. Cir. 2013). The Board notes that 10 percent is the maximum rating available based on limited motion of the wrist. The Veteran would need to exhibit ankylosis in order to obtain a higher rating. At her VA examinations in October 2015 and July 2020, no ankylosis was found in either wrists. The Board notes that the Veteran did not participate in range of motion testing of dorsiflexion at either of her VA examinations. The July 2020 VA examiner explained in a September 2020 addendum that they could not determine baseline range of motion without resorting to speculation due to the Veteran declining to perform range of motion testing. However, as a higher rating requires ankylosis, which the evidence does not support, the Board finds that the examination is adequate for rating purposes. The claims file does include private treatment records that measure range of motion for the Veteran's wrists. Though these records include flexion measurements, it is unclear if this is dorsiflexion or palmar flexion. Furthermore, the treatment records do not include any findings of ankylosis. Accordingly, these records do not support a higher rating. VA must in some circumstances consider functional impairment in addition to limitation of motion due to factors such as pain, weakness, premature or excess fatigability, and incoordination. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45. However, this rule does not apply where, as here, the Veteran is receiving the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis. See Johnston v. Brown, 10 Vet. App. 80, 8485 (1997). The Board acknowledges the Veteran's contention that she is entitled to a higher rating due to pain, but the Veteran is already receiving the maximum rating based on limited motion. She has not shown that she has the medical knowledge or expertise to diagnose herself with ankylosis of the wrists. (Continued on the next page) For the foregoing reasons, the preponderance of the evidence is against awarding a rating higher than 10 percent for the De Quervain's tendonitis in both her wrists. In denying such a rating, the Board finds the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Chandeck, 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.