Citation Nr: 21009392 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 10-29 187 DATE: February 22, 2021 ORDER Entitlement to a compensable evaluation for right hand laceration is denied. Entitlement to an increased evaluation in excess of 10 percent for painful motion of the right index finger, long finger and thumb is denied. Entitlement to a compensable evaluation for painful motion of the ring finger, right hand, is denied. Entitlement to a compensable evaluation for painful motion of the little finger, right hand, is denied. FINDINGS OF FACT 1. The area coverage of the Veteran’s right-hand laceration does not total 39 square centimeters or more and there is no pain, instability, or other disabling effect or functional impairment. 2. The Veteran’s painful motion of the right index finger, long finger and thumb are manifested by painful limitation of motion, but with no evidence of ankylosis, even when considering any additional functional loss. 3. The Veteran’s painful motion of the ring finger, right hand, is manifested by pain, stiffness, numbness, diminished grip and limitation of motion. 4. The Veteran is in receipt of the maximum schedular rating for limitation of motion of the right ring finger. 5. The Veteran’s painful motion of the little finger, right hand, is manifested by pain, stiffness, numbness, diminished grip and limitation of motion. 6. The Veteran is in receipt of the maximum schedular rating for limitation of motion of the right little finger. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for the service-connected right-hand laceration, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.118, Diagnostic Code 7805. 2. The criteria for an increased evaluation in excess of 10 percent for painful motion of the right index finger, long finger and thumb, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5228 3. The criteria for a compensable evaluation for painful motion of the ring finger, right hand, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5230. 4. The criteria for a compensable evaluation for painful motion of the little finger, right hand, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in active duty service with the Army from March 1987 to January 1993. This matter is on appeal from a November 2005 rating decision. The Veteran was afforded a March 2006 hearing, and another hearing in July 2012 held by the undersigned Judge. The transcripts of the hearings have been associated with the claims record. In a November 2018 Board decision, the Board denied entitlement to a compensable evaluation for a right-hand laceration. The Veteran appealed his denial to the Court of Appeals for Veterans Claims (CAVC or the Court). The Court, in November 2019, vacated and remanded the issue back to the Board for further development and adjudication. The Board remanded this appeal in December 2005, January 2013, and May 2020 for further development. The Board notes that the January 2013 Board decision and May 2020 Board decision remanded the issue to determine whether there were underlying disabilities related to the Veteran’s right-hand laceration. During the pendency of the appeal, a November 2020 rating decision granted service connection for painful motion of the right index finger, long finger and thumb; painful motion of the right ring finger; and painful motion of the right little finger. As service connection was granted in relation to the Veteran’s right-hand laceration, the Board finds the issue of entitlement to increased ratings for these issues are part and parcel of the Veteran’s appeal for an increased evaluation for his right-hand laceration and therefore before the Board. As such, the Board has recharacterized the issues on appeal as entitlement to a compensable evaluation for right-hand laceration; entitlement to an increased evaluation in excess of 10 percent for painful motion of the right index finger, long finger, and thumb; a compensable evaluation for painful motion of the right ring finger; and a compensable evaluation for painful motion of the right little finger. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. The evaluation of a service-connected disorder requires a review of a veteran’s entire medical history regarding that disorder. 38 U.S.C. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, 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. Evidence to be considered in an appeal from an initial disability rating was not limited to that reflecting the then current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. Fenderson, 12 Vet. App. at 126-27 ; Hart v. Mansfield, 21 Vet. App. 505 (2007). Such separate disability ratings are known as staged ratings. If two disability evaluations are potentially applicable, 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. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran’s service-connected disability. 38 C.F.R. § 4.14 (2017); see Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be “staged.” Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings). Where entitlement to compensation has already been established, as is the case here, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Right-hand laceration The Veteran is currently service connected for a right-hand laceration with a noncompensable rating under Diagnostic Code 7805. In evaluating skin and scar residuals, the Board notes that during the appeal period, changes were made to certain Diagnostic Codes under 38 C.F.R. § 4.118. Effective August 13, 2018, VA amended its regulations governing skin disabilities. VA’s intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). As the Veteran filed his claim before the August 13, 2018 effective date, the Board will consider whether either the old or new rating criteria is more favorable to the Veteran. Under the old rating criteria, Diagnostic Code 7805 provided that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase “(including linear scars)” with “and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804.” 38 C.F.R. § 4.118, Diagnostic Code 7805 (August 13, 2018). Diagnostic Code 7800 (which was unchanged by the 2018 amendments), contemplates scars of the head, face, or neck. 38 C.F.R. § 4.118, Diagnostic Code 7800. Under Diagnostic Code 7800, for disfigurement of the head, face, or neck, a 10 percent disability rating is warranted for scarring with one characteristic of disfigurement. A 30 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or two or three of the characteristics of disfigurement. A 50 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or four or five characteristics of disfigurement. An 80 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or six or more characteristics of disfigurement. 38 C.F.R. § 4.118. The eight characteristics of disfigurement for the purposes of rating under 38 C.F.R. § 4.118 are: scar of 5 in. or more (13 or more centimeters (cm.)) in length; scar at least 1/4 in. (0.6 cm.) wide at its widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding 6 sq. in. (39 sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 sq. in. (39 sq. cm.); underlying soft tissue missing in an area exceeding 6 sq. in. (39 sq. cm.); and skin indurated and inflexible in an area exceeding 6 sq. in. (39 sq. cm.). Id. , Note (1). The pre-amended Diagnostic Code 7801 provided disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, Diagnostic Code 7801 (2017). In contrast, the amended Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801 (August 13, 2018). Both the old and new criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic 7801. Note (1) to the pre-amended Diagnostic Code 7801 stated that a deep scar is one associated with underlying soft tissue damage. Prior to August 13, 2018, Diagnostic Code 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, Diagnostic 7802 (2017). The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (August 13, 2018). Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater. Under both the old and new rating criteria, Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, Diagnostic 7804. In every instance where the schedule does not provide a 0 percent rating for a diagnostic code, a 0 percent rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Veteran was afforded a January 2003 VA examination. The Veteran stated that while in service he slipped and his right hand hit the edge of his toolbox, resulting in a laceration to his palm. The Veteran reported that his scar had no pain, swelling, stiffness or difficulty in flexing or extending the fingers. Upon physical examination, the examiner found two small lacerations on the distal palmar crease proximal to the middle and ring finger. The scar near the middle finger was measured to be one-half inch in length and the scar near the ring finger was measured to be one-eighth inch in length. The examiner found that scars were not painful, tender, or numb with no other abnormal findings. The Veteran demonstrated full range of motion in his fingers. In a March 2003 addendum, the VA examiner reviewed the January 2003 findings and conclude the Veteran had two healed scars that were not symptomatic. In a December 2004 statement, the Veteran stated that the scars in the palm of his hand sometimes caused him “discomforting cramps with use.” Review of the medical treatment record shows in March 2005 the Veteran presented with pain in his right wrist for the past 2 days; pain and tenderness were found on the Veteran’s medial ulnar prominence with swelling around the posterior aspect of his right hand. At the March 2006 hearing, the Veteran testified that he had a 4-inch scar on his right hand and stated having soreness in his wrist with cramps. The Veteran was unsure of he had any problems with his scar and stated “not really I say. The Veteran noted feeling a little ache when moving his fingers and “at times I can’t feel”; the Veteran stated that he had no other swelling apart from his wrist and noted that he could pick up 10 pounds. The Veteran was afforded a June 2006 VA examination. The Veteran reported suffering from lacerations of the right hand with symptoms of cramps occurring sometimes. The Veteran reported no functional impairment. The Veteran was afforded a December 2008 VA examination. The Veteran reported no symptoms or functional impairment related to his scar. Upon physical examination, the examiner found a well-healed “very hard to see” scar at the base of the right index finger that measured 2 cm by 0.3 cm with no tenderness, disfigurement, inflammation or limitation of motion. The examiner noted the Veteran’s subjective reports of soreness at times. In a May 2009 notice of disagreement (NOD), the Veteran stated that he had swelling in his right wrist at times while using his hand for pushing or carrying objects. The Veteran was afforded a February 2012 VA examination. The Veteran reported no problems, pain or tenderness with his scar since it healed from his initial injury inservice. Upon physical examination, the examiner found a well-healed, non-tender scar on the Veteran’s right palm near the MP joint of his index finger measure at 2.5 cm by 0.3 cm. The examiner found the scar was not painful or unstable with no limitation of function. At the Veteran’s July 2012 hearing, the Veteran stated that he had symptoms of cramping, swelling and soreness in his right wrist as a result from overuse and lifting. The Veteran stated that the pain was not in his scar and it did not hurt. The Veteran was afforded a March 2016 VA examination. Upon physical examination the examiner found a linear scar between the index and middle finger measuring at 3 cm by 0.2 cm. The examiner found the scar was not painful or unstable and did not result in functional limitation or impairment. The Veteran was afforded an October 2020 VA examination. Upon physical examination the examiner found a persistent albeit faint scar on the Veteran’s right palm that measured 3 cm by 0.1 cm. The examiner found the scar to have stayed the same and was not painful or tender and did not result in functional impairment. After review of the evidence of record, the Board finds that the preponderance of the evidence is against a compensable rating for the Veteran’s service-connected right-hand laceration. As noted above, the Veteran’s right-hand laceration, is currently rated as noncompensable under Diagnostic Code 7805, which provides that other scars (including linear scars), not otherwise rated under Diagnostic Code 7800-04, in addition to the other effects of scars which are otherwise rated under Diagnostic Codes 7800-04, are also to be rated based on any disabling effects not provided for by Diagnostic Code 7800-04. Id., Diagnostic Code 7805. Diagnostic Code 7801 provides that scars other than on the head, face, or neck that are deep, nonlinear, and cover an area of at least 6 square inches (39 square (sq.) centimeters (cm.)) warrant a compensable evaluation. Id., Diagnostic Code 7801. A deep scar is one associated with underlying soft tissue damage. Id. As documented in the VA examinations discussed above, there is no evidence that the Veteran’s right-hand laceration covers an area of at least 6 square inches, or that they are deep. Hence, Diagnostic Code 7801 is not for application. Diagnostic Code 7802 provides that scars, other than on the head, face, or neck, that are superficial and nonlinear, and cover an area of at least 144 square inches (929 sq. cm.) warrant a compensable evaluation. Id, Diagnostic Code 7802. A superficial scar is one not associated with underlying soft tissue damage. Id. In this case, the Veteran’s scar does not cover a surface area of 144 square inches (929 sq. cm) or greater; therefore, a compensable rating is not available under Diagnostic Code 7802. Diagnostic Code 7804 contemplates scars that are unstable or painful. Id, Diagnostic Code 7804. A 10 percent disability rating is assigned for one or two scars that are unstable or painful. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id., Note 1. If one or more scars are both unstable and painful, an additional 10 percent is to be added to the evaluation based on the total number of unstable or painful scars. Id., Note 2. As noted in the VA examinations discussed above, the Veteran’s scar was not found to be unstable or painful; therefore, a compensable rating is not warranted under Diagnostic Code 7804. As to Diagnostic Code 7805, no scar has not been found to result in limitation of function. There have been no other pertinent physical findings, complications, signs and/or symptoms associated with any scar (regardless of location) and the scar have been found to have no impact on the Veteran’s ability to work. In sum, a compensable rating is not warranted at any point during the rating period on appeal for The Veteran’s right-hand laceration. As the preponderance of the evidence is against a higher compensable rating, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 53. Painful motion of the right index finger, long finger, ring finger, little finger, and thumb The Veteran is currently service connected for painful motion of the right index finger, long finger, and thumb evaluated at 10 percent under Diagnostic Code 5228; painful motion of the right ring finger with a noncompensable rating under Diagnostic Code 5230; and for painful motion on the right little finger with a noncompensable rating under Diagnostic Code 5230. When evaluating musculoskeletal disabilities, VA must consider whether a higher evaluation is warranted, where the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Painful motion is an important factor of disability, and it is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). The Board notes that 38 C.F.R. § 4.59, entitled “Painful motion,” states, in pertinent part, “The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.” In Burton v. Shinseki, the Court stated that the scope of § 4.59 is not limited to arthritis claims. 25 Vet. App. 1, 5 (2011). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a). DC 5229 provides that a gap of one inch (2.5cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or with extension limited by more than 30 degrees is rated 10 percent, which is the maximum rating provided under DC 5229. Id. DC 5230 provides for a noncompensable rating for any limitation of motion of the ring or little finger. See 38 C.F.R. § 4.71a. Higher ratings are available for favorable and unfavorable ankylosis. DC 5219 provides different ratings for unfavorable ankylosis of the index and long fingers: 30 percent rating for a major joint and 20 percent rating for a minor joint. See 38 C.F.R. § 4.71a, DC 5219. DC 5223 provides for a 20 percent rating for favorable ankylosis of the index and long fingers. See 38 C.F.R. § 4.71a, DC 5223. Higher ratings are also warranted for amputations of the index and long fingers. See generally 38 C.F.R. § 4.17a, DCs 5146, 5153, 5154. Multiple involvement of the interphalangeal, metacarpal and carpal joints of each upper extremity is considered a group of minor joints. 38 C.F.R. § 4.45 (f). In a January 2003 VA examination, the Veteran reported no difficulty flexing or extending his fingers. At the March 2006 hearing, the Veteran testified that he felt cramps and soreness in his wrist. The Veteran stated that he would feel a little ache when moving his fingers and at times could not feel them but reported no swelling other than his wrist. In a June 2006 VA examination, the Veteran reported symptoms of occasional cramp with no functional limitation. The examiner found the Veteran was able to tie his shoelaces; fasten his buttons; and pick up and tear paper without difficulty. The Veteran demonstrated strength within functional limits with full range of motion. In a May 2009 NOD, the Veteran reported swelling in his right wrist at times whenever he used his hand for pushing or carrying objects. In a July 2009 X-ray, the treating provider found a congenital complete fusion of the lunate and triquetral bone, but no other bone abnormalities, fractures or evidence of arthritis was found. In an August 2009 statement the Veteran stated that he had swelling in his right wrist that could be a result of his fall in service. At the July 2012 hearing, the Veteran testified to symptoms of cramping, swelling and soreness of his wrist resulting form overuse and lifting. The Veteran noted that the pain was more in his hand wrist and not with his scar and denied any pain in his scar. The Veteran stated that his providers had mentioned that he had arthritis and currently his strength was unaffected. In a June 2016 VA examination, the examiner diagnosed the Veteran with strain of the extensor muscle, fascia, and tendons of the fingers, wrist and hand. The Veteran stated that following his inservice fall and injury, he experienced symptoms of pain, cramping in his hands, fingers “sticking together”, and swelling. The Veteran reported flareups of cramping, soreness and swelling; and functional impairment where he experienced difficulty grabbing door knobs, picking up objects, and unable to use his fork with his right hand. Upon physical examination of the Veteran’s right index, long, ring and little fingers, the Veteran’s ROM of the MCP joint was found to be 0 degrees (extension) to 80 through 90 degrees (flexion); range of motion of the PIP joint was 90 to 95 degrees; and range of motion of the DIP joint was from 0 to 60 through 70 degrees of flexion. Examination of the thumb ROM of the MCP joint was found to be 0 to 50 degrees and the IP joint from 0 to 90 degrees. The examiner noted there was no pain on examination and no localized tenderness. The Veteran was able to perform repetitive testing with no loss of motion. The examiner found the findings to be medically consistent with the Veteran’s statements on flareups and functional impairment. The Veteran demonstrated 4/5 strength with no atrophy. No evidence of ankylosis was found. Review of the x-ray test resulted in normal findings and the examiner found no objective findings to support a diagnosis for right-hand arthritis. In a September 2016 statement the Veteran reported symptoms of intermittent pain and swelling in his right wrist. In May 2018 the Veteran was seen for complaints of right-hand index trigger finger. The Veterans stated that recently when he woke up his index finger would be stuck in a flexed position and would need to pop it again; the Veteran noted that the finger would be painful at times. X-ray tests were unremarkable with no cause of the Veteran’s right trigger finger. In a later followup visit, the treating provider was unable to elicit the Veteran’s right-hand index trigger finger at the visit but did not the Veteran’s reported overall pain, weakness and reduced strength in his hand and wrist. The Veteran reported that his right index finger would get stuck in a “fisted position” and required him to pull it straight; the Veteran was unable to reproduce this issue at the visit but stated that it would snap and lock frequently at work. In May 2018 a Board decision denied an increased evaluation for the Veteran’s right-hand disability to include scars and arthritis, finding no evidence of arthritis or pain. In August 2018 the Veteran was seen regarding his right index trigger finger with an onset from 2 months prior. The Veteran described his index finger getting stuck in a “fisted position” and needed to pull it straight; the Veteran reported increased stiffness in the morning and tenderness in the palm of his hand. The treating provider diagnosed the Veteran with tendinitis of the second right finger and noted the Veteran ha d be doing more typing at work; the Veteran stated that he felt slight pain whenever he was flexing his fingers. In an undated statement received in June 2019 from the Veteran’s wife, she observed the Veteran’s frustration with pain and noted his struggles in putting gon clothes; opening jars and bottles; writing; and pain from his fingers getting stuck. In a November 2019 CAVC decision, the Court found the June 2016 VA examination relied upon by the Board decision was inadequate or not explaining whether the diagnosed strain was a new and separate diagnosis in relation to his inservice injury and not addressing the Veteran’s reported history of cramps, swelling and “fingers sticking together.” The Board remanded this appeal in May 2020 for further development. In September 2020 the Veteran was seen for evaluation for his hand because of difficulties gripping. The Veteran reported pain and dropping things for the past 20 years and unable to open jars for the past 2 to 3 days. The Veteran reported that hi right index and longer fingers were “sticking” along with spams, shaking and tremors in his right hand. The treating provider diagnosed the Veteran with trigger finger of the Veteran’s right index and middle finger. The Veteran was afforded an October 2020 VA examination. The Veteran reported symptoms of intermittent pain and cramping in his right hand. The Veteran stated that he had flareups of cramping pain and functional impairment where it was difficult to write or type at times. Upon physical testing, the Veteran’s range of motion of his right index, long ring and little fingers was found to be from 0 extension to 80 to 90 degrees flexion in the MCP joint; 90 to 95 degrees flexion in the PIP joint; and 65 to 70 degrees flexion in the DIP joint. Examination of the thumb found flexion to 70 degrees in the MCP joint and to 70 degrees in the IP joint. The examiner found no gap between the thumb and fingers and pain upon finger flexion. Mild pain and tenderness were noted in the hand and finger due to strain with no loss of motion upon repetitive testing. The examiner found the findings to be medically consistent with the Veteran’s statements on flareups and repetitive use. The examiner estimated the Veteran’s ROM to be from 0 extension to 78 to 90 degrees flexion in the MCP joint; 88 to 95 degrees flexion in the PIP joint; and 58 to 70 degrees flexion in the DIP joint. For the Veteran’s thumb the examiner estimated the Veteran’s ROM to 68 degrees in the MCP joint and to 68 degrees in the IP joint upon flexion. The Veteran demonstrated 5/5 strength with no atrophy and no evidence of ankylosis. X-ray tests found no evidence of arthritis, no fracture or dislocation, and unremarkable soft tissue. The examiner found functional impact where writing and typing would be limited. After review of the evidence of record, the Board finds that the preponderance of evidence does not support findings of an increased evaluation in excess of 10 percent for the Veteran’s painful motion of the painful motion of the right index finger, long finger and thumb; and a compensable rating for the right ring and little finger. As discussed above, the Veteran has been assigned a 10 percent rating for residuals of the right-hand injury and for the right index finger under DC 5010-5229. This is the maximum rating under DC 5229. Under Diagnostic Code 5229, a 0 percent rating is warranted for a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees; a 10 percent rating is warranted for a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. 38 C.F.R. § 4.71a , Diagnostic Code 5229. A higher 20 percent rating can be assigned under DC 5010 for traumatic arthritis that affects two or more major/minor joints with occasional episodes of incapacitating episodes. However, a higher rating under DC 5010 is not warranted as the medical evidence to include the most recent x-ray tests in October 2020 fails to indicate that the Veteran has any arthritis. The Board has considered whether a higher rating is warranted under another relevant diagnostic code. Under Diagnostic Code 5003, a 10 percent rating is for application for each major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a , Diagnostic Code 5003. As previously stated, a 10 percent disability rating is assigned for each major joint or group of minor joints affected by limitation of motion, to be combined, not added. The evidence reflects that the motion of the Veteran’s right long finger, index finger and thumb are painful. However, he is already receiving a 10 percent disability rating for painful motion of the right index finger, long finger and thumb under Code 5228. As the thumb, long finger, index finger, ring finger, and little finger are part of the same minor joint group, an additional disability rating cannot be added. Moreover, the evidence does not show the involvement of two or more major joints, or two or more minor joint groups. As the Veteran’s service-connected condition involves only one group of minor joints, a rating in excess of 10 percent under DCs 5003 and 5010 is not possible. With regard to the Veteran’s right ring and little finger, the disorder is rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5230, which does not provide for a compensable rating for any limitation of motion of the ring or little finger. Under DC 5230, a noncompensable rating is the maximum rating for limitation of motion. The Board acknowledges the Veteran’s reported symptoms, including painful and reduced movement, as well as swelling and numbness; however, any level of limitation of motion of the right ring and little fingers results in noncompensable ratings for each finger respectively. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016) (there is no minimum compensable rating available for painful motion under DC 5230 for the ring and little finger). The United States Court of Appeals for Veterans Claims (Court) held in Sowers that because DC 5230 provided no minimum compensable rating, this trumped the general intent of section 4.59 to account for actually painful joints. This is directly applicable here as DC 5230 is the most appropriate DC for the Veteran’s disabilities of the right ring and little finger, and it does not provide for any minimum compensable rating. Thus, a compensable rating is not warranted on this basis. Additionally, Diagnostic Codes 5216-5227 are inapplicable because there is no evidence of ankylosis. The Board has also considered whether rating as amputation is warranted. However, the VA examiners of record have not found that the Veteran right hand and fingers would not be equally well served by amputation and, as such, the Board finds that the symptoms of the right finger disabilities are not equivalent to amputation of the fingers or loss of use of the right hand. Under these circumstances, a rating pursuant to Diagnostic Codes 5126-5227 is not appropriate. The Board notes that the Veteran has stated that he has difficulty grasping or opening jars along with weakness or reduced strength. Injury to the intrinsic muscles of the hand may be rated under the diagnostic code for muscle group VII or IX that control grasping and delicate manipulative movements. 38 C.F.R. § 4.73, Diagnostic Code 5307, 5309. Generally, muscle group damage is categorized as slight, moderate, moderately severe and/or severe and evaluated accordingly under 38 C.F.R. § 4.56. With respect to Diagnostic Code 5309; however, different criteria apply. As indicated in that diagnostic code, Muscle Group IX consists of the intrinsic muscles of hand, the thenar eminence, short flexor, opponens, abductor and adductor of the thumb, the hypothenar eminence, and the short flexor, opponens and abductor of the little finger. The forearm muscles act in strong grasping movements and are supplemented by the intrinsic muscles in delicate manipulative movements. The hand is so compact a structure that isolated muscle injuries are rare, being nearly always complicated with injuries of bones, joints, tendons, etc. Thus, injury to muscle group IX should be rated on limitation of motion, with a minimum 10 percent assigned. 38 C.F.R. § 4.73, Diagnostic Code 5309, Note (2016). However, the Board finds there is no evidence beyond the Veteran’s own statements that any muscle or nerve symptoms are caused by his painful motion of the right-hand index, long finger and thumb. While treatment records show that the Veteran reported such symptoms when being treated, there is no competent medical evidence establishing a relationship between the painful motion of the fingers and any muscle or nerve disability. The Veteran at the most recent October 2020 VA examination only reported symptoms of cramping and difficulty writing and typing; demonstrated full strength with no atrophy; and the examiner only found functional impairment in difficulty writing and typing. Finally, as the Veteran is already service connected for painful motion of the right index, middle finger and thumb and has been awarded a 10 percent evaluation under Diagnostic Code 5228 for limitation of motion. The Veteran is therefore already compensated for any limitation of motion of the fingers, and an additional rating for limitation of motion in the thumb would constitute unlawful pyramiding. 38 C.F.R. § 4.14. The Board has considered the Veteran’s statements regarding the severity of the Veteran’s right hand and finger disabilities. However, as a lay person, the Veteran does not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinion on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Thus, the lay opinions by themselves are outweighed by the VA examiner’s findings. See id. ; see also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court’s conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert’s opinion more probative on the issue of medical causation). In sum, the Board finds the preponderance of the evidence is against an increased evaluation in excess of 10 percent for the Veteran’s painful motion of the right index finger, long finger and thumb, and a compensable rating for the right ring and little finger. The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.