Citation Nr: 21024163 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 09-04 041 DATE: April 22, 2021 ORDER A compensable rating for residuals, status post-fractures, of the long and ring fingers of the left hand is denied. A compensable rating for residuals, status post-fractures, of the ring and little fingers of the right hand is denied. FINDINGS OF FACT 1. The Veteran is right hand dominant. 2. For the entire appeal period, the Veteran’s residuals, status post-fractures, of the long and ring fingers of the left hand are manifested by subjective complaints of sensitivity to the cold, stiffness, numbness, tingling, pain, and loss of grip strength, and objective evidence of normal grip strength, an ability to approximate the left long finger to the proximal transverse crease of the palm, with no evidence of a gap of one inch between the fingertip and the transverse crease or extension limited by 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination or as a result of repetitive motion and/or flare-ups, ankylosis, or amputation. 3. For the entire appeal period, the Veteran’s residuals, status post-fractures, of the ring and little fingers of the right hand are manifested by subjective complaints of sensitivity to the cold, stiffness, numbness, tingling, pain, and loss of grip strength, and objective evidence of normal grip strength, without evidence of ankylosis or amputation. 4. The Veteran is in receipt of the maximum schedular rating available for limitation of motion and ankylosis of the left ring, and right ring and little fingers; none of the service-connected fingers have been amputated; and the conditions are not productive of extremely unfavorable ankylosis or loss of use of the hand. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for residuals, status post-fractures, of the long and ring fingers of the left hand 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 Codes (DCs) 5299-5223, 5229, 5230. 2. The criteria for a compensable rating for residuals, status post-fractures, of the ring and little fingers of the right hand 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, DCs 5299-5223, 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1979 to June 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2007 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2009, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In January 2011, the Board remanded the claims for additional development and, in December 2012, denied the appeal. The Veteran subsequently appealed the decision to the United States Court of Appeals for Veterans Claims (Court) and, in June 2013, pursuant to a Joint Motion for Remand (JMR) and order, the Board’s decision was vacated, and the appeal was returned to the Board. Based on the JMR, the Board remanded the appeal again in July 2014, and denied the Veteran’s claims in May 2017. The Veteran again appealed the decision to the Court and, pursuant to a December 2017 JMR and order, the decision was vacated and the appeal was again returned to the Board. In May 2018 and August 2019, the Board remanded the appeal for additional development and it now returns for further appellate review. The Board observes that, subsequent to the issuance of the supplemental statement of the case in October 2020, additional evidence, to include additional VA treatment records, was associated with the record. However, as such are irrelevant to the instant claims or include findings that are duplicative of those previously considered by the Agency of Original Jurisdiction (AOJ), no prejudice results to the Veteran in the Board proceeding with a decision at this time. 38 C.F.R. § 20.1305(c). Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (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 the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). However, a compensable rating pursuant to 38 C.F.R. § 4.59 is only available if an orthopedic disability is rated under a DC containing a 10 percent rating. Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015). The appeal period before the Board stems from the Veteran’s claims for increased ratings for his residuals, status post-fractures, of the long and ring fingers of the left hand and the ring and little fingers of the right hand, received on August 28, 2006, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). 1. Entitlement to a compensable rating for residuals, status post-fractures, of the long and ring fingers of the left hand. 2. Entitlement to a compensable rating for residuals, status post-fractures, of the ring and little fingers of the right hand. The Veteran contends that his finger disabilities are more severe than as reflected by the currently assigned ratings and, thus, warrant compensable ratings. At the December 2009 Board hearing and in documents of record, he reports that his service-connected finger disabilities are manifested by reduced range of motion after prolonged use during the day and reduced grip strength, which are worse in the cold weather months. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. As demonstrated by the medical evidence of record, the Veteran is right-handed and as such, major, as opposed to minor, finger disability ratings are applicable for his right finger disabilities. 38 C.F.R. § 4.69. The assignment of a particular DC is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One DC may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a DC by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Here, the RO assigned DCs 5299-5223. DC 5299 indicates the disability is not listed in the Schedule for Rating Disabilities, and it has been rated by analogy under a closely related disease or injury. 38 C.F.R. §§ 4.20, 4.27. DC 5223 pertains to favorable ankylosis of two digits on one hand. However, as will be discussed below, the Veteran’s finger disabilities are not characterized by ankylosis at any point during this appeal. Therefore, the Board finds that DCs 5299-5229 for limitation of motion of the index or long fingers, and 5299-5230 for limitation of motion of the ring or little fingers, are the appropriate codes under which the Veteran’s finger disabilities should be rated. DC 5229, regardless of whether it affects the major or minor hand, assigns a noncompensable rating for limitation of motion of the long or index finger with 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 disability rating is assigned for limitation of motion of the long or index finger with a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the plan, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Id. DC 5230 assigns a noncompensable rating for any limitation of motion of the ring or little finger regardless of whether it affects the major or minor hand. 38 C.F.R. § 4.71a, DC 5230. As a noncompensable disability evaluation represents the maximum schedular rating available for limitation of motion of the ring or little finger under DC 5230, the Veteran is not entitled to an increased evaluation for his left ring finger, or his right ring and little fingers, under this DC, to include based on joint pain pursuant to 38 C.F.R. § 4.59. Sowers, supra; Petitti, supra. DC 5227, which evaluates unfavorable or favorable ankylosis of the ring or little fingers, also only provides for a noncompensable evaluation. 38 C.F.R. § 4.71a, DC 5227. Therefore, even if ankylosis were shown, higher disability ratings cannot be assigned under such DC. A compensable rating for ring or little finger disabilities requires amputation. See 38 C.F.R. § 4.71a, DCs 5155, 5156. With ankylosis, consideration must also be given to whether an additional evaluation is warranted for resulting limitation of motion of other digits or for interference with overall function of the hand. See Note following DC 5227. In order for ankylosis to be rated as amputation, the condition must manifest with extremely unfavorable ankylosis. See Note (3)(i) preceding 38 C.F.R. § 4.71a, DC 5216. In other words, in order to be evaluated as amputation, there must be ankylosis of both the metacarpophalangeal and proximal interphalangeal joints either in extension or full flexion or with rotation or angluation of a bone. Id. Note (3)(ii) explains that, if both the metacarpophalangeal and proximal interphalangeal joints of a digit were ankylosed, it should be evaluated as unfavorable ankylosis even if each joint was individually fixed in a favorable position. Note (3)(iii) indicates that if only the metacarpophalangeal or proximal interphalangeal joint were ankylosed and there was a gap of more than 2 inches (5.1 cm.) between the fingertips and the proximal transverse crease of the palm, with the fingers flexed to the extent possible, the condition should be evaluated as unfavorable ankylosis. Amputation of the ring and little fingers warrant a 10 percent rating without metacarpal resection at the proximal interphalangeal joint, or proximal thereto. A 20 percent rating is warranted with full metacarpal resection (more than one-half the bone lost). 38 C.F.R. § 4.71a, DCs 5155, 5156. During the October 2006 VA examination, the Veteran reported pain in his fingers and increased difficulty holding items, particularly with his left hand. On examination, the examiner stated there were no arthritic changes or angluation of any fingers on either hand. Additionally, the Veteran exhibited good strength in both hands, and no neurological deficits. He could also touch his fingers to the palmar crease and touch the tip of the thumb to each finger on both hands. The Veteran also stated that, in cold weather, he will have blanching and aching of his fingers, but the examiner stated this is not a classic radiology phenomenon. Concerning range of motion, the examiner found it was normal for all digits. There were also no additional limitations of motion following repetitive use. The examiner concluded that there were mild degenerative changes in the interphalangeal joints in the ring and little fingers, bilaterally. Pursuant to the January 2011 remand, in March 2011, the Veteran underwent a second VA examination in order to reassess the severity of his finger disabilities. The Veteran reported that he had stiffness, pain, and sensitivity to the cold. On a scale of 1 to 10, he reported discomfort in the fingers on both hands as a 6 when he was cold. The Veteran stated the pain in the fingers on his right and left hands was the same. On examination, it was noted that there was a gap of 1.5 cm between all fingertips reaching the mid palmer crease. His strength and finger spread were normal. The examiner also noted there were no signs of deformity, tenderness, or swelling of any fingers. His range of motion for both the left long and ring finger joints revealed that flexion of the proximal interphalangeal (PIP) was to 90 degrees, metacarpal phalangeal joint (MP) flexion was to 70 degrees, and distal interphalangeal (DIP) flexion was to 50 degrees. The right ring finger joints revealed flexion of the PIP was to 80 degrees, MP flexion was to 70 degrees, and DIP flexion was to 45 degrees. The right little finger joints revealed flexion of the PIP was to 70 degrees, MP flexion was to 70 degrees, and DIP flexion was to 45 degrees. The examiner stated all extensions were to 0 degrees and painless with repetitive motion. X-rays of the left and right hands showed degenerative changes in the distal joints of his left long, ring, and bilateral small fingers. Consequently, the examiner determined the Veteran suffered from early degenerative arthritis related to age with cold sensitivity and discomfort from repetitive use. As for functional impairment, the examiner stated the Veteran had some stiffness, cold sensitivity, and discomfort in his hands. The Veteran was also provided with a general medical examination in July 2011, at which time he reported experiencing pain and stiffness in his hands and fingers that he ranked as being 4/10 on a 10 point pain scale. Functional limitations were described as having a decreased grip, especially in cold weather, and difficulty using small tools or picking up small objects. The Veteran reported that pain medication and repeated use of his fingers helped to alleviate his symptoms. Notably, this was contrary to his reports at the December 2009 hearing that his finger disabilities became more severe after repeated use. The Veteran was able to bring the tips of his right hand forefingers within 3 cm of the mid palmar crease and could bring his thumb within 4 cm of the base of the fifth finger. Regarding his left hand, the Veteran was able to bring the tips of the fingers within 2 cm of the mid palmar crease and could bring the thumb within 4 cm of the base of the fifth finger. There was no additional loss in range of motion due to pain, fatigue, weakness, or incoordination in either hand, although he did exhibit slightly decreased grip. During the July 2014 VA fingers examination, the Veteran reported that his hands became stiff during cold weather requiring him to “work them out[.]” On examination, there was evidence of limitation of motion in the right ring and little finger, but there was no objective evidence of painful motion and the examiner did not note any limitation of motion in the Veteran’s other fingers. There was also no evidence of limitation of extension or painful motion in the index or long fingers. A gap of less than one inch was noted to exist between the ring and little fingers on the right hand and the proximal transverse crease of the palm. There was no additional limitation of motion for any fingers following repeat testing and there was no evidence of functional loss. The Veteran exhibited full muscle strength in his bilateral hands and denied tenderness or pain to palpation of the joints or soft tissue of the hand. Ankylosis was not present and there was no evidence that the Veteran’s fingers were so impaired as to equate with loss of use or amputation of his service-connected fingers. X-rays of the right and left hands showed degenerative changes in multiple joints of the same hand. Specifically, the Veteran’s right hand x-rays revealed mild spurring in the interphalangeal joint of the thumb. Otherwise, joint spaces and carpal rows were maintained bilaterally and there were no fractures identified; soft tissues were normal. Ultimately, the examiner stated that the Veteran had normal degenerative changes due to normal wear and tear as a post office mail carrier. Additionally, he opined that aside from the difficulty in cold weather “…neither pain, weakness[,] fatigability, or incoordination [w]ould significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time.” Notably, VA treatment records dating from August 2005 to October 2020 only show the Veteran’s continued complaints of pain, stiffness, achiness, and discomfort associated with his finger disabilities, with reports that such were worse based on the weather conditions. While decreased range of motion of the first and fifth fingers was reported, the records do not provide any objective indication of compensable limitation of motion, amputation, or ankylosis of any of the affected digits. The Veteran also provided private treatment records from Dr. S. dated from October 2006 to February 2007, and a statement dated December 2009. These records from Dr. S. concern the Veteran’s service-connected spine disabilities and his nonservice-connected carpal tunnel syndrome (CTS), rather than his finger disabilities. Additionally, the December 2009 letter commented on the Veteran’s repetitive motion work, which Dr. S. states aggravates the Veteran’s CTS, not his finger disabilities. There is no indication of treatment from this provider for his finger disabilities and the Veteran declined to provide a new release for these records when asked to do so in June 2016. Similarly, the Veteran submitted treatment records from Dr. K., dated May to August 2006, but these records only concern his nonservice-connected stomach disorders. Here, the Board notes that, included in the records provided by the Social Security Administration, is a handwritten, undated, record indicating a ¼ inch gap between the Veteran’s left thumb and his little finger. The record also noted the Veteran’s use of plastic cups due to his reports of dropping them. As stated previously, the Board denied the Veteran’s claims in May 2017, primarily on the basis of the findings from the VA examinations dated in October 2006, March 2011, July 2011, and July 2014. However, as noted in the December 2017 JMR, the parties determined that such examination reports were inadequate for appellate review as they did not comply with the Court’s decision in Correia v. McDonald, 28 Vet. App. 158 (2016). Subsequently, following the issuance of the December 2017 JMR, the Veteran was afforded a VA examination in March 2019 pursuant to the May 2018 Board remand. At the March 2019 VA examination, the Veteran reported that, at times, he experienced stiffness, tingling, and loss of grip. He stated that he was unable to do things like he used to do with his hands. Reported functional loss/impairment included difficulty using tools, gripping objects, and using a fishing reel. The Veteran denied flare-ups. On examination, range of motion was normal for both hands without pain. There was no gap between the pad of the thumb and the fingers, or between the finger and proximal transverse crease of the palm. There was no additional limitation of motion for any fingers following repetitive testing and there was no evidence of functional loss. The Veteran exhibited full muscle strength in his bilateral hands. Ankylosis was not present and there was no evidence that the Veteran’s fingers were so impaired as to equate with loss of use or amputation. The examiner noted that the Veteran wore hand braces/splints at night to keep his fingers straight and keep them from curling under too much; however, his finger disabilities did not impact his ability to perform any type of occupational task. With respect to Correia, the examiner reported that there was no objective evidence of pain on passive range of motion testing, when the joint was used in non-weight bearing, or with the use of the hand, and assessment of the opposing/unclaimed joint was not applicable. The examiner further reported that, in general, objective examination was normal and there were no neurological manifestations of the Veteran’s bilateral finger disabilities. However, as March 2019 VA examiner failed to provide retrospective opinions regarding the Correia elements in prior VA examinations conducted in October 2006, March 2011, July 2011, and July 2014, and flare-ups of the Veteran’s bilateral finger disabilities, as reported in a subsequent May 2019 written statement, were not evaluated, the Veteran was afforded an additional VA examination in December 2019. At such time, he reported that he got achy joint during cold weather, had difficulty holding items, and dropped things easily. He endorsed the following symptoms: stiffness, pain, numbness, and tingling. The Veteran reported flare-ups that caused stiffness and aching joint pain in the fingers and hands. He denied having any functional loss/impairment. On examination, range of motion was normal for the bilateral fingers and hands without pain. There was no gap between the pad of the thumb and the fingers, or between the finger and proximal transverse crease of the palm. Additionally, there was no objective evidence of localized tenderness or pain to palpation of the joints or soft tissue of the hands. There was no additional limitation of motion for any fingers following repetitive testing and there was no evidence of functional loss. With respect to flare-ups, the examiner indicated that the examination was being conducted during such a flare-up, and pain, fatigue, and weakness significantly limited the Veteran’s right hand functional ability, but not his left hand. The examiner further indicated that she was unable to describe the Veteran’s right hand flare-ups functional loss in terms of range of motion. Here, she explained that, after review of the examination report, reported history, subjective complaints, and relevant evidence of record, using her medical knowledge and expertise, there remained no basis to offer additional loss of function or motion when it came to flare-ups. The Veteran exhibited 4/5 muscle strength in his bilateral hands. Here, the examiner noted that such reduction in muscle strength was not due to the Veteran’s bilateral hand diagnoses as he provided suboptimal effort. Ankylosis was not present and there was no evidence that the Veteran’s fingers were so impaired as to equate with loss of use or amputation. The examiner noted that his bilateral finger disabilities did not impact his ability to perform any type of occupational task. With respect to Correia, the examiner reported that there was no objective evidence of pain on passive range of motion testing, when the joint was used in non-weight bearing, or with the use of the hand. With respect to the concerns raised by the December 2017 JMR, in a July 2020 addendum opinion, the examiner indicated that, based on a review of the October 2006, March 2011, July 2011, and July 2014 VA examination reports and the Veteran’s May 2019 statement, he had a history of flare-ups during cold temperatures that caused limitations in both hands; however, objective findings during examination for hand range of motion was within normal limits. She explained that it would be mere speculation to conclude that range of motion of the Veteran’s fingers were severely limited due to pain, weakness, and stiffness, and difficulty grasping objects during flare-ups. An additional October 2020 addendum opinion reflects that the examiner reported, for the October 2006, March 2011, July 2011, and July 2014 VA examination reports as related to Correia, after reviewing all procurable data, the Veteran’s existing clinical evidence did not support any additional limitations of range of motion, and no member of the medical community could provide such information/opinion without resorting to mere speculation. Further, she reported that she was unable to offer estimates on the Veteran’s range of motion during flare-ups. In this regard, the examiner indicated that, after reviewing all procurable data, the Veteran’s existing clinical evidence did not support any additional limitations during flare-ups, and no member of the medical community could provide such information/opinion without resorting to mere speculation. Sharp v. Shulkin, 29 Vet. App. 26, 23 (2017). In this regard, the Board notes that, in her March 2021 Appellant’s Post-Remand Brief, the Veteran’s representative argued that the aforementioned opinions were essentially non-opinions and, thus, non-evidence. Consequently, she argued that a remand for yet another opinion is necessary. However, the VA examiner actually did opine that the entirety of the evidence, i.e., all procurable data, did not support any additional limitations of range of motion in light of the Correia factors or during flare-ups, which is a clear opinion. Rather, she indicated that no member of the medical community could provide such information/opinion, i.e., that there would, in fact, be additional limitations of range of motion in light of such factors/events, without resorting to mere speculation. Furthermore, as the Court made clear in Sharp, supra, and Jones v. Shinseki, 23 Vet. App. 382 (2010), a medical opinion that cannot be provided without resort to speculation is adequate when it is clear that it is predicated on a lack of knowledge among the medical community at large and not the insufficient knowledge of the specific examiner. Thus, the Board finds that the opinions offered in this case are adequate to adjudicate the Veteran’s claims for increased ratings for his bilateral finger disabilities and no further development is necessary. The Board has carefully reconsidered the facts of this case, including the concerns raised in the December 2017 JMR (as described above). Ultimately, based on the evidence of record, the Board again finds that compensable ratings for the left long and ring fingers, and right ring and little fingers, are not warranted. As outlined above, in order for the Veteran to receive a 10 percent rating for the left long finger, the evidence must show a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, or extension limited by more than 30 degrees. Here, the objective findings of the October 2006, March 2011, July 2011, July 2014, March 2019, and December 2019 VA examinations fail to show these requirements were met. In fact, his extension was normal at all examinations, and the March 2011 VA examiner specifically indicated the gap between the fingertip and he proximal transverse crease of the palm was only 1.5 cm. Additionally, the 2014 and 2019 examiners found no evidence of limitation of extension or a gap between the Veteran’s long finger and his proximal transverse crease, let alone a 2.5 cm gap. Concerning the left ring, and right ring and little fingers, the governing criteria provide for a compensable rating for these disabilities only where there is amputation of the finger or equivalent impairment (e.g., extremely unfavorable ankylosis as in the Note cited above). In this case, the left and right ring fingers, and the right little finger have not been amputated, and there is no indication that both the metacarpophalangeal and proximal interphalangeal joints were ankylosed. There is also no indication there was ankylosis of the MP and PIP joints for the left ring or right ring and little fingers. Significantly, the Veteran has never alleged, and it has not been shown, that he has ankylosis in any of his fingers. As extremely unfavorable ankylosis is not shown, a compensable rating based on such criteria is not warranted. The Board has considered whether compensable disability ratings are warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45, or as a result of repetitive motion and/or flare-ups. See DeLuca, supra. The Veteran has complained of pain, stiffness, tingling, numbness, and cold sensitivity, as noted during his VA examinations, and has reported a reduced range of motion, to include during flare-ups. However, despite such complaints, the Veteran had full range of motion of all fingers, to include following repetitive use, on examination in March 2006, July 2019, and December 2019, and, while he had reduced range of motion in March 2011, July 2011, and July 2014, he was still able to demonstrate range of motion in his fingers that greatly exceeded the points at which even the noncompensable ratings under DCs 5229 and 5230 are warranted. In this regard, although pain may cause functional loss, pain itself does not constitute functional loss. Mitchell, supra. In the instant case, the VA examiners were in agreement that the Veteran does not have additional functional impairment, including additional limitation of motion, on account of his pain, stiffness, tingling, numbness, and cold sensitivity, and/or as a result of repetitive motion and/or flare-ups. Moreover, as DC 5230 does not provide for a compensable rating, such is not warranted based on such factors for his left ring finger, and right ring and little finger, disabilities. Sowers, supra; Petitti, supra; Johnston v. Brown, 10 Vet. App. 80 (1997) (if a claimant is already receiving the maximum disability rating available based on symptomatology that includes limitation of motion, it is not necessary to consider whether 38 C.F.R. §§ 4.40 and 4.45 are applicable). In considering other potentially applicable codes that would allow for a compensable rating, the Board finds that DC 5216 pertaining to impairment of the nerves is not applicable in this claim because the medical evidence does not show that the Veteran has any neurological disorder related to his finger disabilities. Specifically, despite the Veteran’s complaints of decreased grip strength, numbness, tingling, and cold sensitivity, the 2006, 2011, 2014 and 2019 VA examinations found no indication of neurological impairment. Therefore, a compensable rating under DC 5216 is not warranted for any finger. Furthermore, the Veteran is separately service-connected for bilateral upper extremity radiculopathy. In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his bilateral finger disabilities are more severe than as reflected by the currently assigned disability ratings. The Board has further considered his reports regarding the presence of his reported symptoms of sensitivity to the cold, stiffness, numbness, tingling, pain, and loss of grip strength, as reported at his VA examinations, at his December 2009 Board hearing, and in statements of record, and his spouse’s reports regarding his pain, reduced grip strength, and inability to perform certain tasks, to include opening products, as documented in March 2011 and March 2018 statements. However, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran and his spouse are competent to describe his observable symptomatology, they are not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of his bilateral finger disabilities in light of the rating criteria to be more persuasive than his and his spouse’s reports regarding the severity of such disabilities. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected bilateral finger disabilities; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). In sum, the Board finds that compensable ratings in for the Veteran’s bilateral finger disabilities are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the instant claims, such doctrine is inapplicable and they must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.