Citation Nr: 21022233 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 11-06 123 DATE: April 15, 2021 ORDER Entitlement to an extraschedular rating for residuals of a right hand injury is denied. FINDINGS OF FACT The preponderance of the evidence is against finding that the Veteran’s right hand injury manifested with functional impairment not contemplated by the schedular rating criteria. CONCLUSIONS OF LAW 1. The criteria for a greater than 20 percent disability rating for a right thumb disability on an extraschedular basis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5152. 2. The criteria for a disability rating greater than 10 percent for a right index finger disability on an extraschedular basis, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5229. 3. The criteria for a disability rating greater than 10 percent for a right long finger disability on an extraschedular basis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5229. 4. The criteria for a compensable rating for a right ring finger disability on an extraschedular basis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1979 to September 1985. This matter comes to the Board of Veterans’ Appeals (Board) from a decision of the Agency of Original Jurisdiction (AOJ). In December 2008, the AOJ issued a rating decision that denied the Veteran’s claims for a right hand injury. The Veteran timely disagreed in a November 2009 Notice of Disagreement (NOD) and perfected his appeal in a February 2011 VA Form 9. The Board notes that, since the filing of the Veteran’s February 2011 VA Form 9, the Veteran’s claim has been recharacterized to include entitlement to service connection for his right thumb, index, long, and ring fingers, as well as entitlement to an extraschedular rating for residuals of a right hand injury. Also, the Veteran has been granted service-connection for his right thumb and fingers. So, the only issue before the Board is entitlement to an extraschedular rating. In December 2020, the Board referred the Veteran’s claim to the Director of Compensation Service for consideration of an assignment of a compensable rating on an extraschedular basis. Then, in January 2021, the Director of Compensation services decided that an extraschedular rating is not warranted. In February 2021, the Veteran’s case was returned to the Board. Entitlement to an extraschedular rating for residuals of a right hand injury. The question for the Board is whether the Veteran’s right hand injury, to include disabilities of the thumb, index, long, and ring fingers is so exceptional that a compensable rating on an extraschedular basis is warranted. For the reasons discussed below, the Board finds the available schedular criteria for each of those service-connected disabilities is adequate to evaluate the Veteran’s right hand injury. The Board notes it did not consider an extraschedular rating on the combined effect of his service-connected finger disabilities because a rating based on their combined effect is no longer available. 38 C.F.R. § 3.321(b)(1)(b). There is a three-step test for determining if referral for extraschedular rating is warranted. The first step is to determine if the evidence “presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate.” This step requires “a comparison between the level of severity and symptomatology of the Veteran’s service-connected disability with the established criteria found in the rating schedule for that disability.” Thun v. Peake, 22 Vet. App. 111, 115 (2008). This step is satisfied only when the Veteran presents symptoms that are truly unusual or exceptional. Long v. Wilkie, No. 16-1537, 2020 U.S. App. Vet. Claims LEXIS 2371 at *9 (Vet. App. Dec. 30, 2020). If “the schedular evaluation does not contemplate the [Veteran’s] level of disability and symptomatology and is found inadequate,” the second step is to determine “whether the [Veteran’s] exceptional disability picture exhibits other related factors such as those provided by the regulation as ‘governing norms,’” such as “marked interference with employment” and “frequent periods of hospitalization.” If the criteria at step two are not satisfied, then no referral is warranted; if the criteria are satisfied, the Board proceeds to the third step. At the third step, the Board must refer the matter to the [Director (Director) Compensation Service] who will determine whether, “[t]o accord justice,” the Veteran’s disability picture requires assigning an extraschedular rating. Thun, 22 Vet. App. at 115-17. After the Director makes an initial extraschedular-evaluation determination in the first instance, the Board can review the Director’s decision and, if warranted, assign an extraschedular rating. Kuppamala v. McDonald, 27 Vet. App. 447, 456-57 (2015). The Veteran was granted service connection for four fingers of the right hand, to include his thumb, index, long, and ring fingers. His right thumb disability was assigned a 20 percent rating under DC 5152; his right index finger disability was assigned a 10 percent rating under DC 5010-5229; his right long finger disability was assigned at 10 percent rating under 5229; and his right ring finger disability was assigned a noncompensable rating under DC 5230. Under DC 5152, rates are based on the location of the amputation of the thumb. A 20 percent rating is assigned when the amputation occurs at the distal joint or through the distal phalanx. A 30 percent rating is assigned when the amputation occurs at the metacarpophalangeal joint or through proximal phalanx. A 40 percent rating is assigned for metacarpal resection. The highest rating under that code is 40 percent. 38 C.F.R. § 4.71a. Under DC 5230, rates are based on the degree of limited motion of the ring finger. he maximum allowable rating for limitation of motion of the little finger is a noncompensable rating. Id. Under DC 5229, rates are based on the degree of limited motion of the index or long finger. A 10 percent rating is the maximum allowable rating for limited The evaluation of functional loss due to musculoskeletal disabilities is addressed in 38 C.F.R. § 4.40, which contemplates the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Any reasonable doubt regarding a degree of disability is resolved in favor of the veteran. 38 C.F.R. § 4.3. Reasonable doubt exists when there is an approximate balance of positive and negative evidence for and against the claim. 38 C.F.R.§ 3.102. Beginning with the Veteran’s service, his service treatment records noted he jammed his hand between a locker and a wall. See August 6, 1984, Record by L.F., DO. VA Medical Center (VAMC) records generated after the Veteran’s separation from service show he reported to an emergency room with complaints of right hand pain and swelling that interfered with his ability to flex his wrist. That visit led to a consult with an orthopedic doctor, who noted there is no numbness of the wrist. The doctor diagnosed dorsal tenosynovitis. Later, during a follow up visit, the Veteran reiterated that he observes pain and swelling at his wrist. In another follow up visit, the doctor noted there is no numbness. See November 8, 2007, Record by R.L.S., PA; November 15, 2007, Record by J.H., MD; February 5, 2008, Record by P.G.E., CMSW; July 24, 2008, Record by J.H., MD. In August 2008, the VA received a claim for a right hand disability. Then, in September, the VA received a statement wherein the Veteran reports his right hand was smashed between a wall locker and the wall. Now, he observes the fingers of his right hand swell. See September 2008 Statement in Support of Claim at 1. In October 2008, the Veteran underwent a VA disability examination for his right hand. He reported pain and swelling at that hand. See October 2008 VA Compensation and Pension (C&P) Exam at 2. The examiner noted pain at the dorsum of the right hand. Id. The examiner noted the diagnosis of residuals of a fracture, that, combined with his shoulder condition, caused a lost time from work. Id. at 6. Later, in February 2011, the Veteran reported constant pain and swelling at his right index and long fingers. He adds that the swelling never goes away. He also reported he cannot bend fingers and observes numbness at his fingers. He states that it interferes with his ability to hold objects. See February 2011 VA Form 9. In February 2012, the VA received a letter from the Veteran’s spouse wherein she describes her observations of the Veteran’s right hand condition. She reports she has observed that the fingers of his right hand are swollen most of the time, which has made it difficult for him to close his hand all the way. She added that he has difficulty holding things, like a cup of coffee. She has observed him drop things that were held in his right hand. She states that his right hand and shoulder disabilities have interfered with his ability to work. See January 2012 Statement from Spouse. In May 2012, the Veteran submitted a rehabilitation needs inventory as part of his participation in the VA Vocational Rehabilitation and Employment (VR&E, since renamed Veteran Readiness and Employment Service) program. In it, the Veteran reported that his shoulders, knees, and right hand interfere with his ability to work. He also reported his right hand condition interferes with his ability to use tools, climb equipment, and climb up a ladder. See May 2012 VA Form 28-1902W, Rehabilitation Needs Inventory (RNI), at 3-4. During his participation in the VR&E program, he provided a resume wherein he reported his work history following service, through May 2012. Following service, the Veteran worked as a truck driver, through 1996. Then he went to school through 1999, when he obtained a degree in the electrical field. He worked as an electrician from 1999 to June 2000. He obtained another degree in 2000. After obtaining his second degree, he worked as a mechanic through 2002. Then, he worked as a mold repairman through 2006. Afterwards, he worked as an electrician through July 2009. He later worked at a staffing company for three months, then as a maintenance technician through July 2010. Afterwards, he worked at short term staffing jobs in construction, maintenance, electrical field, and equipment operation through May 2012. In January 2014, the Veteran underwent another VA disability examination for his right hand condition. The Veteran reported intermittent pain with extension, lifting, and grasping. He reported fatigue and weakness with repetitive range of motion. See January 2014 VA DBQ at 2. He also reported flare-ups that impact his ability to lift and grasp items. Also, his ability to extend the affected fingers. Id. The examiner noted the diagnoses of degenerative joint disease of the right hand and residuals of a fracture, right metacarpal bone of the index finger. Id. at 2. The examiner noted the Veterans hand, thumb, and finger conditions impact his ability to work. She noted that his conditions impact his ability to lift and grasp objects. Id. at 7. As part of the evaluation, the examiner assessed the Veteran’s grip strength. The examiner noted the Veteran’s right hand grip strength is a 3 of 5 (5 is normal strength and 0 is no muscle movement). Id. at 5. The Veteran underwent a VA disability examination for his right hand disability in October 2017. The Veteran reported a crushing injury to his right hand during service and, over the years, he has observed increased swelling and pain. He added that he used to work as an electrician but had to quit because he could no longer depend on his right hand; that is, he would lose his grip on things. It interfered with his ability to hold on to items, climb a ladder. See October 2017 DBQ at 2. The Veteran reported his current observations of his right hand disability. He reported that his hand swells every day. And he observes numbness at the ulnar (side of the palm with the little finger) and medial aspects of the hand and across the dorsum (back of the hand, opposite the palm) of the hand/wrist. Id. He also reported flare ups of the right hand. He reported his hand swells every night. Sometimes he observes sharp pains in his forearm. He also observes numbness at his right hand some of the time. Id. at 3. The examiner noted the diagnoses of degenerative arthritis metacarpophalangeal joint (MCP, large knuckle located where the finger meets the hand), proximal interphalangeal joint (PIP, located between the first two bones of the finger), distal interphalangeal joint (DIP, located at the tip of the finger, just before the fingernail starts) of the right hand. Also, amputation, distal tip of the right thumb. And crushing injury with post-traumatic changes of the right hand. Id. at 1-2. The examiner added that the Veteran has Dupuyten’s disease in both hands involving the ring finger tendons, which results in a loss of 10 degrees of full extension at the right ring finger. Id. 1,10. The examiner noted that the Veteran’s right hand conditions interfere with his ability to work. She noted that swelling and pain may cause stiffness and difficulty with grip on the right hand. Id. at 11. As part of the evaluation, the examiner assessed the Veteran’s grip strength. On that day, the examiner noted the Veteran’s right hand grip strength is a 5 of 5 (5 is normal strength and 0 is no muscle movement). Id. at 9. VAMC records generated between November 2017 and January 2018 show the Veteran’s has been homeless, for some of the time. The records note he was in a shelter, but left. He had lived in subsidized housing, but found the conditions inhospitable and resided in his care. They also indicate he was working, at least, some of that period of time. See November 7, 2017, Record by L.M., LMSW; December 21, 2017, and January 18, 2018, Records by A.C., LMSW. In August 2019, the Board remanded the Veteran’s claims for disability ratings for the fingers of his right hand. The AOJ was directed to provide another VA disability examination, which it scheduled for December 2019. The Veteran did not show for his appointment. Later, in February 2020, the Veteran was incarcerated (and has remained incarcerated since then). But, in December 2020, the Board remanded the claim again for the Director, Compensation Services (Director) to adjudicate whether an extraschedular rating for the right hand is warranted. In January 2021, the Director concluded the evidence does not support an extraschedular rating for residuals of a right hand injury. The Director explained that some of the limitation of motion of the Veteran’s right hand was due to Dupuytren’s disease, which is not related to his right hand disability. Also, there is no impairment of earning capacity that is due to exceptional or unusual factors related to marked interference with employment and frequent periods of hospitalization. See January 2021 Advisory Opinion from Executive Director, Compensation Service. A. The record suggests the Veteran’s disability picture before February 11, 2011, may have differed than the disability picture after that date. Turning to the Veteran’ s claim for disability compensation, the Board must first determine the symptomatology and severity associated with his right thumb, index, long, and ring fingers (right hand disability) so it can evaluate whether any one of them presented an exceptional disability picture that the schedular rating criteria was inadequate to rate. Because the referral for extraschedular consideration was, in part, based on his February 11, 2011 statement reporting numbness in the right hand that makes it difficult to hold objects, the Board will first determine the disability picture before his assertion, his disability after that assertion, and then evaluate whether the available schedular criteria are adequate to evaluate them. B. The Veteran’s right hand disability picture prior to February 11, 2011, included pain and swelling at the right hand that interfered with his ability to grab objects, like tools and rungs of ladders. The lay evidence of record supports finding the Veteran observed pain and swelling that made grabbing objects, like tools and rungs of ladders, difficult. The Veteran has personal knowledge of symptoms, like pain and swelling of his right hand. Also, whether he has difficulty using his hand. So, he is competent to report those observations. Layno v. Brown, 6 Vet. App. 465, 467-70 (1994). Here, he consistently reported to medical providers that he observed pain and swelling at his right hand that interfered with his ability to work. See November 8, 2007, Record by R.L.S., PA; November 15, 2007, Record by J.H., MD; February 5, 2008, Record by P.G.E., CMSW; October 2008 VA Compensation and Pension Examination at 2. Considering reports to medical providers are generally found to be reliable, the Board finds his observations of pain and swelling credible and assigned them significant weight. Because the Veteran reported observable symptoms, like pain and swelling to his health providers, the Board finds it likely the Veteran would have reported other symptoms, like numbness, as well. Because he did not, the Board finds it unlikely that observed those symptoms at that time. His VAMC records support that conclusion: an orthopedic doctor noted there is no numbness at his fingers, nor wrist. November 15, 2007, and July 24, 2008, Records by J.H., MD. So, the Board assigned the absence of medical evidence of additional symptoms, to include numbness at his right fingers, some, but not significant, weight. In this case, the evidence weighs in favor of finding that, before February 11, 2011, the Veteran’s disability picture was limited to pain and swelling at the right hand that interfered with his ability to grab objects, like tools and rungs of ladders. And the evidence of record is not approximately balanced in finding other symptoms were observed during that period, to include numbness at his fingers. As to the severity of the pain and swelling of the Veteran’s right hand, the lay and medical evidence agree that his right hand disability picture impaired his ability to work, but they disagree on the severity of the impairment. The Board finds the Veteran’s lay assertions are not helpful in determining the extent to which his right hand disability picture impaired his ability to work. Although the Veteran reported pain and swelling and difficulty working with his right hand early, he attributed most of his difficulties at work to (now service-connected) right and left shoulder disabilities. See February 2011 VA Form 9 at 4. And later, he added that his knees interfered with his ability to work. See May 2012 VA Form 28-1902W, RNI at 3-4. Because he tended to describe the combined effects of his disabilities on his ability to work, the Board is unable to separate the impact of each condition, isolate the interference caused by his right hand disability, and approximate the extent to which it affected him. Although the lay evidence was not helpful in determining the severity of his disability picture, the examiner who prepared the October 2008 disability examination did opine on that matter. The examiner concluded that the Veteran’s shoulder disabilities led to greater impairment than the right hand disability. More importantly, though, the examiner quantified it in terms of mild, moderate, or severe: He determined the right hand disability caused mild impairment. See October 2008 Compensation and Pension Exam at 6, 15. Considering the examiner is a medical professional who is qualified to quantify the Veteran’s disabilities in those terms, the Board assigned the examination great weight. In this case, the evidence weighs in favor of finding that, before February 11, 2011, the Veteran’s disability picture, which included difficulty grabbing and holding on to objects, like tools and rungs of ladders, caused functional loss that closely approximates mild impairment on his ability to work. The Veteran’s lay statements were considered but not helpful in isolating the impact of his right hand disability from the impact of his other disabilities. However, a VA examiner was able to do so, and he determined the functional impact on his ability to work was not severe.   C. The Veteran’s disability picture on and after February 11, 2011, included difficulty grabbing and holding on to objects, like tools and rungs of ladders. Because the Veteran began reporting the additional symptom of numbness at his fingers on February 11, 2011, the Board finds the Veteran’s disability picture included numbness at his fingers on and after that date. And it contributed to his difficulty grabbing and holding on to objects. The Board finds his assertions of numbness of his right fingers credible. The Veteran has personal knowledge of the feeling of numbness at any of his fingers. So, he is competent to report it. Layno, 6 Vet. App. at 467-70. In addition to his report of numbness at the fingers of his right hand, he reported the numbing interferes with his ability to hold on to objects. See February 2011 VA Form 9 at 4. His observations are supported by his wife’s statement, who reported observations that the Veteran drops things he had been holding in his right hand. See February 2012 Statement of Wife. Considering his observations have been consistent and are supported by his wife’s statement, the Board assigned his assertions significant weight. As to the severity of the Veteran’s disability picture, that now includes numbness, the lay and medical evidence agree that his right hand disability interfered with his ability to work as an electrician. See January 2014 VA DBQ at 2, 7; October 2017 VA DBQ at 2, 11, 9. But the evidence indicates it was not so severe it precluded him from working: The evidence shows he continued to work in short term staffing jobs in construction, maintenance, electrical field, equipment operation through May 2012. And, later, he was working for the VA, in construction, and other jobs. See March 15, 2016, VAMC Record by A.B., RN; October 10, 2017, Record by J.R.P., NP; January 5, 2018 Record by A.L., LMSW. The Board recognizes that, due to economic reasons, the Veteran may have continued to work despite the effects of his disability picture. But even if that were the case, his demonstrated ability to remain employed in occupations that required the use of his right hand to perform tasks associated with maintenance, equipment operation, and construction, indicate his disability picture was not so severe he was precluded from utilizing the hand. Also, it was not so severe he was precluded from working. In this case, the evidence weighs in favor of finding that, on and after February 11, 2011, the Veteran’s disability picture, which included difficulty grabbing and holding on to objects with his right hand, impaired his ability to work, but did not preclude him from working. D. Whether the schedular criteria for musculoskeletal disabilities of the hand are adequate to evaluate the Veteran’s disability picture. Now that the Board has determined the symptomatology and functional impairment of the Veteran’s right hand disability picture, the first issue is whether the available schedular rating criteria was adequate to evaluate it (Thun’s first step). Thun, 22 Vet. App. at 115. The schedular criteria for musculoskeletal disabilities contemplate factors such as pain, weakened movement and interference with gripping and lifting. 38 C.F.R. §§ 4.40, 4.45, 4.59; Deluca v. Brown, 8 Vet. App. 202, 207 (1995). In this case, those are the same symptoms that make up the Veteran’s right hand disability picture. Particularly, the Veteran’s difficulty gripping and holding on to objects. The Board recognizes that it has not been definitively determined which particular service-connected finger or fingers causes the Veteran’s difficulty grabbing and holding on to objects. None of the VA examiners have opined on that matter. And even though the Veteran has attributed that functional loss to the deformity of his index finger, he is not qualified to make that determination. See February 2011 VA Form 9 at 3. Determining the cause of his difficulty grasping requires distinguishing among and ruling out other potential etiologies. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). Although it has not been definitively determined whether one or more of his service-connected fingers results in the Veteran’s difficulty grasping things, the DCs already assigned contemplate the loss of motion that causes it. As to his right ring finger, DC 5230 contemplates any loss of motion. As to his long and index fingers, DC 5229 contemplates loss of motion. As to his thumb, DC 5152 contemplates loss of use of that finger. Although numbness is not specifically noted in the rating criteria for those DCs, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss, in this case the Veteran’s difficulty holding on to objects, which may appear to relate to muscle and nerve conditions. Deluca, 8 Vet. App. at 207. To the extent that the Veteran’s disability picture—to include difficulty grasping objects—interferes with his employment, the level of interference is recognized by the disability ratings currently assigned to the Veteran’s right thumb (20 percent), index (10 percent), long (10 percent), and ring (zero percent) fingers. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. So, the schedular criteria considers the impact on the Veteran’s ability to work. Since the Veteran’s disability picture and the interference with work caused by it is contemplated by the criteria for his service-connected right thumb, index, long, and ring fingers, the available schedular criteria could evaluate his disability. That means the evidence does not support finding his disability picture is unusual or exceptional. As a result, he has not satisfied Thun’s first step. Long, 2020 U.S. App. Vet. Claims LEXIS 2371 at *9. Although the Veteran has not satisfied Thun’s first step, the Board also notes the Veteran had not satisfied Thun’s second step. In the second step, the issue is whether the Veteran’s right hand disability picture exhibited other related factors such as marked interference with employment and frequent periods of hospitalizations. Id. at *13. The Veteran has not alleged nor does the record reflect frequent hospitalizations due to the Veteran’s right hand disability. The record reflects at least one visit to the emergency room in 2008; however, that visit did not result in a hospitalization. And even though VAMC records show complaints of symptoms associated with his right hand disability, they were not associated with periods of hospitalization due to his right hand disability. Whether or not the Veteran’s right hand disability led to marked interference with employment is less clear. In part, that is due to the multiple service-connected disabilities the Veteran has tended to refer to when discussing his ability to work. See February 2011 VA Form 9; May 2012 VA Form 28-1902W, RNI at 3-4. Also, the record reflects other factors, like incarceration during the appeal period, which may have been the main factor that led to interference with employment, at least since February 2020. The evidence weighs against finding that the Veteran’s right hand disability caused marked interference from the filing of his claim (August 2008) through February 2012, when he returned to school to change career paths. The record reflects that, for that period of time, the Veteran was able to maintain employment. See May 2012 VA Form 28-1902W, RNI at 3-4. The record reflects that following the Veteran’s schooling, he was able to return to work. Several VAMC records note the Veteran worked at the VA, in construction, and temporary jobs, through 2017. The Board’s inference is supported by the findings in the October 2017 VA DBQ. The examiner who conducted it found the Veteran’s right hand disability interferes with his work, but did not indicate it closely approximated marked interference with employment. See October 2017 VA DBQ at 11. It is unclear what transpired from 2018 to February 2020, but circumstances like homelessness and his incarceration appeared to overshadow whatever impact the Veteran’s right hand disability had on his ability to work. Although VAMC records note periods of time he lived in his car or alternative housing, notes generated from his social workers indicate he was working, at least, some of that time. See November 7, 2017, VAMC Record by L.M., LMSW; December 21, 2017, VAMC Record by A.C., LMSW. Considering the Veteran was incarcerated in February 2020, the Board finds his right hand disability has not been the factor for any period of unemployment since that time. Because the Veteran’s right hand disability did not cause marked interference with employment nor frequent periods of hospitalizations, the Veteran did not satisfy Thun’s second step. That means, even if he had shown the schedular criteria did not contemplate his disability picture, he would not have met the requirements for an extraschedular rating. In this case, the evidence is not approximately balanced in favor of finding the Veteran’s right hand disability was manifested by an exceptional disability picture. The functional effects of the Veteran’s disability picture are contemplated by the rating criteria for limitation of motion of his right long, index, and ring fingers as well as amputation of his right thumb. Also, the Board finds the functional effects did not cause marked interference with his employment at any time across the appeal period. So, doubt as to the presence of an exceptional disability picture at any time during the appeal period could not be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Accordingly, an extraschedular rating for residuals of a right hand injury, evaluated separately as the disabilities of the thumb, index, long, and ring fingers, on an extraschedular basis is not warranted in this case. The Board regrets a more favorable decision could not be reached in the Veteran’s case. E. The Board’s decision does not conflict with the referral for extraschedular consideration. The Board recognizes that its referral for extraschedular consideration, in its December 2020 remand, is viewed as a factual finding; therefore, it must explain its reasoning when a factual finding at the review stage comes out differently. Smiddy v. Wilkie, 32 Vet. App. 350, 358 (2020). In this case, the Board’s December 2020 Remand noted here is a “reasonable possibility” the one or more Thun factors may be met. See December 2020 Board Remand at 12. A reasonable possibility is not a conclusive finding. Nor did the Board make a finding as to any step in   requisite three-step analysis set forth in Thun. So, there is no conflict between Board’s referral and its denial of an extraschedular rating at the award stage. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Dean, Michael S. 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.