Citation Nr: 21022426 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 12-01 590 DATE: April 15, 2021 ORDER Entitlement to a rating in excess of 10 percent for right hand strain with tendonitis and painful thumb motion is denied. Entitlement to a rating in excess of 10 percent for right hand strain with tendonitis and painful motion of the long finger is denied. FINDINGS OF FACT 1. The Veteran’s right thumb disability has been manifested by painful motion; however, there is no evidence of ankylosis, amputation, or a gap one inch or greater between the Veteran's left thumb pad and fingers. 2. The Veteran is currently in receipt of the maximum schedular rating for his service-connected long finger disability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for right hand strain with tendonitis and painful thumb motion have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5024-5228. 2. The criteria for a rating in excess of 10 percent for right hand strain with tendonitis and painful motion of the long finger have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5024-5229. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 2005 to June 2010 with service in Iraq from August 2007 to November 2008. This matter was last before the Board in December 2020, at which time it was remanded for further development. The matter is now returned to the Board for further appellate review. Increased Rating 1. Entitlement to a rating in excess of 10 percent for right hand strain with tendonitis and painful thumb motion The Veteran’s right hand strain with tendonitis and painful thumb motion has been initially evaluated as 10 percent disabling under Diagnostic Code 5024-5228. He generally claims that the condition is more disabling than currently rated. Diagnostic Code 5024 refers to tenosynovitis. Under this diagnostic code, tenosynovitis is rated on limitation of motion of the affected parts, as arthritis, degenerative. 38 C.F.R. § 4.71a, Diagnostic Code 5024. A 10 percent disability rating is warranted under Diagnostic Code 5228 for limitation of motion of the major thumb with a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. A maximum 20 percent rating under Diagnostic Code 5228 is warranted for limitation of motion of the major thumb with a gap of more than two inches between the thumb pad and the ringers, with the thumb attempting to oppose the fingers. In determining disability ratings, Diagnostic Code 5228 makes no differentiation between the major and minor hands. Prior to a July 2019 remand, the Veteran had been afforded four VA examinations to address his right hand strain with tendonitis and painful thumb motion. VA examinations were conducted in July 2010, August 2011, October 2018, and April 2019. The July 2010, August 2011, and April 2019 examiners noted that his range of motion for the thumb was within normal limits, and that there was no ankylosis or amputation of the thumb. The October 2018 examiner noted normal range of motion with pain on flexion and no ankylosis or amputation. No examination of record has noted a gap between the Veteran’s thumb pad and fingers. When this matter was before the Board in July 2019, it was remanded to afford the Veteran a new VA examination. The Board determined that both the October 2018 and April 2019 examiner failed to fully describe the Veteran’s functional impairment, including limitation of motion, during a flare up. Upon VA examination in December 2019, the examiner noted that his range of motion for the thumb was within normal limits with pain, including after three repetitions, and that there was no ankylosis or amputation of the thumb. There was no evidence of a gap between the Veteran’s thumb pad and fingers. At the time of the examination, the Veteran reportedly denied flare-ups. This matter was again before the Board in December 2020. The Board determined that given the Veteran had reported flare ups and other symptoms during prior VA examinations, a remand was warranted to consider the Veteran’s limitation of motion of the right hand due to flare-ups. On remand, the Veteran was afforded a VA examination in February 2021. The examiner noted that his range of motion for the thumb was within normal limits with pain, including after three repetitions, and that there was no ankylosis or amputation of the thumb. There was no evidence of a gap between the Veteran’s thumb pad and fingers. There was no additional loss of function after three repetitions. Pain was noted on active motion, passive motion, and weight-bearing. Pain and weakness were found to significantly limit functional ability with repeated use over time. While the Veteran reported flare-ups, the examiner indicated that the flare-ups did not significantly limit his functional ability. Based on information procured from relevant sources including the lay statements of the Veteran, the examiner estimated that there would be no loss of range of motion on flare up. The additional contributing factors of the Veteran’s disability were noted as difficulty with holding, gripping, and pulling objects for extended periods of time, due to increased pain and weakness with prolonged use of hands. This information substantially complies with the most recent remand directives. The record indicates that a higher disability rating is not warranted under Diagnostic Code 5228. In order to assign the next-higher, 20 percent rating under this diagnostic code, the medical evidence must show limitation of motion of the major thumb with a gap of more than 2 inches between the Veteran's right thumb pad and fingers when attempting to oppose his fingers. As outlined above, even with pain and on repetitive motion, no examination of record has noted limitation of motion or a gap between the Veteran’s thumb pad and fingers. Further, as he has not been diagnosed with ankylosis or amputation of the ring finger, there are no alternative diagnostic codes providing a higher schedular rating under which he could be evaluated. 2. Entitlement to a rating in excess of 10 percent for right hand strain with tendonitis and painful motion of the long finger The Veteran was initially in receipt of a noncompensable rating for his right hand strain with tendonitis and painful long finger motion under Diagnostic Code 5229-5024. He was then awarded an increased 10 percent rating in a February 2021 rating decision. He generally claims that the condition is more disabling than currently rated. Diagnostic Code 5024 refers to tenosynovitis. Under this diagnostic code, tenosynovitis is rated on limitation of motion of the affected parts, as arthritis, degenerative. 38 C.F.R. § 4.71a, Diagnostic Code 5024. Diagnostic Code 5229 refers to limitation of motion of the index or long finger. A maximum 10 percent rating is assigned for limitation of motion with 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. Prior to a July 2019 remand, the Veteran had been afforded four VA examinations to address his right hand strain with tendonitis and painful long finger motion. VA examinations were conducted in July 2010, August 2011, October 2018, April 2019. The July 2010, August 2011, and April 2019 examiners noted that his range of motion for the long finger was within normal limits, and that there was no ankylosis or amputation of the long finger. The October 2018 examiner noted normal range of motion with pain on flexion and no ankylosis or amputation. No examination of record has noted a gap between the Veteran’s fingertip and the proximal transverse crease of the palm. When this matter was before the Board in July 2019, it was remanded to afford the Veteran a new VA examination. The Board determined that both the October 2018 and April 2019 examiner failed to fully describe the Veteran’s functional impairment, including limitation of motion, during a flare up. The Veteran was then afforded a VA examination in December 2019. The examiner noted that his range of motion for the long finger was within normal limits with pain, including after three repetitions, and that there was no ankylosis or amputation of the long finger. There was no evidence of a gap between the Veteran’s fingertip and palm. At the time of the examination, the Veteran reportedly denied flare-ups. This matter was again before the Board in December 2020. The Board determined that given the Veteran had reported flare ups and other symptoms during prior VA examinations, remand was warranted to consider the Veteran’s limitation of motion of the right hand due to flare-ups. On remand, the Veteran was afforded a VA examination in February 2021. The examiner noted that his range of motion for the long finger was within normal limits with pain, including after three repetitions, and that there was no ankylosis or amputation of the long finger. There was no evidence of a gap between the Veteran’s fingertip and the proximal transverse crease of the palm. There was no   additional loss of function after three repetitions. Pain was noted on active motion, passive motion, and weight-bearing. Pain and weakness were found to significantly limit functional ability with repeated use over time. While the Veteran reported flare-ups, the examiner indicated that the flare-ups did not significantly limit his functional ability. Based on information procured from relevant sources including the lay statements of the Veteran, the examiner estimated that there would be no loss of range of motion on flare up. The additional contributing factors of the Veteran’s disability were noted as difficulty with holding, gripping, and pulling objects for extended periods of time, due to increased pain and weakness with prolonged use of hands. While the Board acknowledges the Veteran’s long finger symptoms and the effect they have on him, he is already receiving the maximum rating available for long finger limitation of motion. No higher rating is legally available under his currently assigned diagnostic code. Further, as he has not been diagnosed with ankylosis or amputation of the long finger, there are no alternative diagnostic codes providing a higher schedular rating under which he could be evaluated. In reaching the above conclusions, the Board has not overlooked the Veteran’s statements with regard to the severity of his disability during this period. The Veteran is competent to report on factual matters of which he had firsthand knowledge, e.g., experiencing pain; and the Board finds that the Veteran’s reports have been credible. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Board has considered the Veteran’s reports along with findings from the Veteran’s VA examinations. The Board notes, with respect to the Rating Schedule, where the criteria set forth therein require medical expertise which the Veteran has not been shown to have, the objective medical findings and opinions provided by the Veteran’s VA examination reports in particular, have been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993).   For the reasons stated above, a rating in excess of 10 percent is not warranted for the Veteran’s right thumb disability. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Marsh II, 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.