Citation Nr: 21021898 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-17 898 DATE: April 14, 2021 ORDER Entitlement to a compensable disability rating for residuals of a right-hand ring finger fracture is denied. FINDING OF FACT Throughout the appeal period, the Veteran’s right-hand ring finger fracture residuals have been manifested by pain, weakness, and limitation of motion. CONCLUSION OF LAW The criteria for entitlement to a compensable disability rating for residuals of a right-hand ring finger fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5299-5230. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty from June 1988 to August 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). As a preliminary matter, the Board notes that this claim has previously been before the Board on multiple occasions. First, in September 2018 and most recently, in June 2020. Both times this claim was remanded to the Agency of Original Jurisdiction (AOJ) for further evidentiary development. In consideration of this appeal, the Board finds that there has been substantial compliance with the June 2020 remand directives, and as such, will proceed with appellate review. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to a compensable disability rating for residuals of a right-hand ring finger fracture is denied. Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Schedule). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7 and 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform any of the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. The Veteran's service-connected right ring finger disability has been rated noncompensably under DC 5299-5230 throughout the appeal period. However, the Veteran asserts that a compensable evaluation is warranted for this disability. The rating schedule cannot account for every disease; therefore, it is permissible to rate unlisted conditions under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Such ratings are to be “built-up” by selecting the first two digits from that part of the schedule most closely identifying the part of the body involved, and the last two digits 99, indicating an unlisted condition. See 38 C.F.R. §§ 4.20, 4.27. Under DC 5230, a noncompensable rating is assigned for any limitation of motion of the ring or little finger regardless of whether the affected hand is dominant or minor. DC 5230 does not provide for a compensable rating. 38 C.F.R. § 4.71a. For the second, third, fourth, and fifth digits of the hand, the metacarpophalangeal (MCP) joint has a range of 0 to 90 degrees of flexion, the proximal interphalangeal (PIP) joint has a range of 0 to 100 degrees, and the distal interphalangeal joint (DIP) has a range of 0 to 70 or 80 degrees. 38 C.F.R. § 4.71a, Evaluation of Ankylosis of Limitation of Motion of Single or Multiple Digits of the Hand, (1). Turning to the evidence of record, the Veteran was afforded a VA examination in connection with his claim for an increased rating in December 2013. During the December 2013 examination, the Veteran reported feeling intermittent pain in his right-hand ring finger, mostly exacerbated by powerful handgrip, early morning hours, and bad weather conditions. The Veteran reported that he takes over-the-counter medications for pain control as necessary. Upon range of motion testing, there was no limitation of motion or evidence of painful motion for any fingers of the right hand. The VA examiner reported that the Veteran had no functional loss or impairment for any of his fingers on his right hand. However, the VA examiner indicated that the Veteran had weakened movement of all fingers on his right hand and pain on movement of his right-hand ring finger. The VA examiner noted that the Veteran had tenderness or pain to palpation of his right hand. The VA examiner also noted that the Veteran’s right had grip muscle strength was a 4/5 (out of a possible 5/5). The VA examiner indicated that the Veteran had no ankylosis of the right-hand fingers. Pursuant to the September 2018 Board remand, the Veteran was afforded an additional VA examination for his right-hand ring finger disability because of new complaints involving numbness in his right hand. The Veteran was examined in February 2021. During the February 2021 examination, the Veteran reported tenderness on the palm side of the right hand, changes on the hand silhouette and callus formation on the right hand, difficulty with grabbing with the right hand, and limitation of motion of the right hand fingers. Upon range of motion testing, the VA examiner noted that the Veteran’s right-hand range of motion were all normal, however, pain was noted upon finger flexion. The VA examiner also noted that there was objective evidence of localized tenderness or pain on palpation of the right-hand ring finger, of moderate severity. Notably, the VA examiner found a bone deformity on the Veteran’s metacarpal, fourth finger, upon palpation. The VA examiner indicated that the Veteran’s right-hand grip strength was normal, coinciding with a 5/5. The VA examiner also noted no ankylosis of the Veteran’s right hand or any right-hand fingers. Upon review of the evidence of record, the Board acknowledges that the Veteran contends, and the medical evidence suggests, that the Veteran's right ring finger is manifested by pain, diminished grip, and limitation of motion. However, under DC 5230, a noncompensable rating is the maximum rating for limitation of motion. Under DC 5230, any level of limitation of motion of the ring finger results in a noncompensable rating, even where there is associated pain and functional loss. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016) (there is no minimum compensable rating available for painful motion under Diagnostic Code 5230 for the fourth and fifth fingers). Thus, even with consideration of 38 C.F.R. § 4.59, a compensable rating is not warranted. Lastly, the Board notes that the record contains no evidence of ankylosis or amputation of the right-hand ring finger. Thus, DCs 5156 and 5227 are not applicable. 38 C.F.R. § 4.71a. In sum, the Board finds that a compensable rating for the Veteran's right ring finger is not warranted. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. M. Lowman, 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.