Citation Nr: 21010503 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 15-31 599 DATE: February 25, 2021 ORDER Entitlement to an initial increased rating in excess of 10 percent for chronic scaphoid fracture with degenerative joint disease of the right wrist is denied. FINDING OF FACT 1. The Veteran has not been diagnosed with ankylosis of the right wrist at any time during the period on appeal. 2. The Veteran’s right wrist disability is rated as 10 percent disabling, which is the maximum schedular rating permitted for limited motion of the wrist without ankylosis. 3. The Veteran has right wrist pain that flare-ups up frequently throughout the week limiting his ability to drive, open jars, and complete other tasks. 4. The Veteran’s right wrist disability is manifest by dorsiflexion of 60 degrees and palmar flexion of 65 degrees. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for residuals of a right wrist fracture with traumatic arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010, Diagnostic Code 5215. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1965 to June 1968 and from June 1970 until his honorable discharge in July 1989. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision of the Regional Office (RO) of the Department of Veterans Affairs (VA). In July 2019, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to obtain a new VA examination regarding the severity of the Veteran’s right wrist disability for rating purposes. The Veteran had a VA examination for rating purposes in December 2019. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. 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 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). Entitlement to an initial increased rating in excess of 10 percent for chronic scaphoid fracture with degenerative joint disease of the right wrist. The Veteran asserts that he is entitled to a higher rating for his right wrist disability because of pain on movement, functional loss, and the effects of treating medications. A right wrist disability limiting range of motion can be found in 38 C.F.R. § 4.71a under DC 5003-5215. The relevant rating criteria is as follows: Dorsiflexion less than 15 degrees [10 percent]; Palmar flexion limited in line with forearm [10 percent]. 38 C.F.R. § 4.71a. The Veteran was awarded service connection for his right wrist disability and filed his Notice of Disagreement for an increased rating in March 2013. This is an initial increased rating claim and so the period on appeal is from the date of claim to the present. The Veteran retired from his position in a penitentiary in November 2010 and worked part time as a bus driver in the beginning of the appeal period. The Veteran’s first VA examination occurred in June 2011. The Veteran reported that he had recurrent right wrist pain that started around one year prior to retirement from service. Since retirement, he reported that his “right wrist pain has worsened and lifting, twisting, and [a] firm handshake makes the pain worse.” Pain and weakness were present. Severe flare-ups occurred weekly for several hours, which caused him to avoid using his had due to radial and ulnar deviation pain. His dorsiflexion was 25 degrees and his palmer flexion was 40 degrees. Objective evidence of pain occurred following repetitive motion. Right dorsiflexion was 20 degrees and palmer flexion was 30 degrees after repetitive motion. Ankylosis was not present. The examiner concluded that his right wrist condition would not preclude the Veteran from being able to obtain or maintain gainful employment. The Veteran’s next VA examination took place in September 2012 and was an addendum to the June 2011 exam. This exam found that the Veteran’s degenerative joint disease of the right wrist was a progression of residuals of his in-service fracture. The Veteran was awarded 10 percent service connection in March 2013 under § 4.59 because his symptoms did not meet the 10 percent schedular requirements of § 4.71a, DC 5215. VA treatment records support the 10 percent rating award. Ankylosis of the right wrist was never found. The Veteran’s range of motion was again outside the rating criteria; however, the treatment records support the Veteran’s statements that he has chronic pain. His most recent VA examination in December 2019 diagnosed the Veteran with degenerative arthritis and chronic scaphoid fracture of the right wrist, his dominant hand. His range of motion was abnormal with a dorsiflexion of 65 degrees, palmar flexion of 70 degrees, ulnar deviation of 40 degrees, and radial deviation of 15 degrees. The examiner stated that the range of motion caused a functional loss due to “weakness, loss of range of motion, and weakened grip.” Pain was noted upon examination and found to cause functional loss. There was also pain with weight bearing, but no crepitus nor objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The left wrist range of motion was normal, and no pain was noted. After three repetitive motions the Veteran’s right wrist range of motion of the palmar flexion and dorsiflexion were the same. Repetition over time changed the palmar flexion to 65 and dorsiflexion to 60 degrees. The record shows that the Veteran experienced functional loss that manifested as decreased use and pain, and he was unable to drive or open containers. The Veteran’s left wrist was tested and had normal range of motion without pain. The Veteran reported having flare-ups every other day or more often. These were moderate unless he was driving, which would cause a severe flare-up that forced him to use his left hand. These could last several hours and were relieved with medication. This wrist range of motion findings do not meet the rating criteria in § 4.71a, DC 5215. The record does not contain evidence that wrist dorsiflexion or limitation of palmar flexion met the criteria for any compensable rating based solely on limitation of motion and the Veteran did not have other manifestations of the right wrist joint disability associated with sarcoidosis. However, the intent of the Rating Schedule is to recognize actually painful, unstable, or malaligned joints, due to healed injury with entitlement to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In this instance, the minimum compensable rating for the Veteran’s wrist disability under Diagnostic Code 5215 is also the maximum compensable rating under the relevant Diagnostic Code, 10 percent. Therefore, a 10 percent rating is warranted under DC 5215 after applying the principles set forth in 38 C.F.R. §§ 4.40, 4.45, 4.59. The Board has considered other or higher ratings, but the 10 percent rating adequately compensates for the pain, weakness, and associated functional limitations of the right wrist joint. The Veteran has never had ankylosis of the right wrist and so is not entitled to the next highest rating under DC 5214. (Continued on the next page)   The preponderance of the evidence is against the appeal for a rating in excess of 10 percent. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Johnston, 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.