Citation Nr: 21025329 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-15 445 DATE: April 27, 2021 ORDER Service connection for cervical spine condition is denied. A single 10 percent, but no higher, rating for left 4th finger disability and right 5th finger disability, based on arthritis of two minor joint groups, is granted, subject to the regulations governing the payment of monetary awards. REMANDED Entitlement to service connection for rash of the legs, back, and feet is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s cervical spine condition was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The Veteran’s left 4th finger disability and right 5th finger disability is manifested by X-ray findings of arthritis of a group of minor joints with objective evidence of painful limitation of motion; and there is no evidence of amputation without metacarpal resection, at the proximal interphalangeal joint or proximal thereto on either hand. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a cervical spine condition are not met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 2. The criteria for a single 10 percent, but no higher, rating for a left 4th finger disability and right 5th finger disability are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5003 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from May 1977 to May 1980. The Veteran had an additional period of service from May 1980 to October 1980 that has been determined to be dishonorable for VA purposes. These matters are before the Board of Veterans’ Appeals (Board) on appeal from May 2013 and August 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2018, the Veteran appeared before the undersigned at a hearing on some of the issues addressed by this decision. A transcript of the hearing is of record. In a November 2018 Board decision, the Board denied the Veteran’s claim for a compensable rating for his left 4th finger disability. In a November 2019 Order, the United States Court of Appeals for Veterans Claims (Court) granted a Joint Motion for Partial Remand (Joint Motion) vacating the portion of the November 2018 decision relating to the Veteran’s left 4th finger disability and remanding the appeal for further action in compliance with the Joint Motion. The basis of the Joint Motion is that the Board “failed to provide an adequate statement of reasons or bases regarding whether it had jurisdiction over the increased rating claim for the left 4th finger disability.” The Board addressed the jurisdiction question in the June 2020 decision and remanded the claim for further development. The Board also remanded the other claims addressed in this decision in June 2020 for further development. Lastly, the Board notes that a review of the record illustrates that the Agency of Original Jurisdiction (AOJ) is currently undertaking development of the Veteran’s claims of entitlement to service connection for bilateral hearing loss and for an increased rating for an acquired psychiatric disorder, claims which the Board remanded in November 2020. As such, the claims are not currently before the Board. Service Connection – Cervical Spine Condition The Veteran and his representative contend the Veteran’s cervical spine condition is related to an in-service incident where he jumped out of a truck. See Board Hearing Transcript, dated July 2018. Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. § 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases (e.g., arthritis) may be presumptively service connected if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307, 3.309. If a condition listed as a chronic disease in § 3.309(a) is noted during service but is either shown not to be chronic or the diagnosis could be legitimately questioned, then a showing of continuity of related symptomatology after discharge is required to support the claim. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331(Fed. Cir. 2013). The Veteran has current diagnoses of degenerative arthritis of the spine and degenerative disc disease of the cervical spine as evidenced by the August 2018 and October 2020 VA examinations. The diagnosis of degenerative arthritis of the spine qualifies as a chronic condition under 38 C.F.R. § 3.309(a). However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Service treatment records are silent for treatment for a cervical spine condition other than an April 1978 post-motor vehicle accident treatment record which indicates the Veteran experienced “questionable discomfort on neck.” The Veteran declined to undergo a physical examination upon his separation from service. The Veteran has provided competent and credible reports of the in-service incident in which he injured his neck when he jumped out of a truck during a training exercise. Furthermore, the Veteran’s fellow servicemember has submitted a written statement received by VA in August 2018 in which he stated the Veteran instantly complained of neck pain after the training incident in Panama. In addition, the Veteran has reported since 2006 that he has had neck pain since he jumped off the truck during his service. At a July 2006 VA appointment, the Veteran described experiencing increased pain in his neck in the last two years. At a March 2007 VA appointment, the Veteran described experiencing intermittent pain since service. The Veteran was diagnosed with chronic neck pain in August 2009, and he underwent imaging in August 2009 that was normal. A November 2015 cervical spine MRI showed multilevel degenerative disc disease. The Veteran is competent to report observable symptomatology of his condition, such as neck pain. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran is not competent, however, to associate any of his claimed symptoms to a diagnosis of a cervical spine disability as the issue is medically complex as it requires specialized medical education to diagnose such disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). There is no evidence of a diagnosis of a cervical spine degenerative condition until 2015, decades after his separation from service and decades outside of the applicable presumptive period. Hence, a preponderance of the evidence is against a finding that arthritis of the cervical spine manifested to a compensable degree in service or within one year of the Veteran’s service discharge. As such, presumptive service connection for a cervical spine disability as a chronic disease is not warranted. Service connection for cervical spine condition may still be granted on a direct basis. As is noted above, the record reflects the Veteran has a current cervical spine disability. Additionally, the Board has found the Veteran to be competent and credible as to the in-service incident in which he jumped from a truck. Thus, the first two elements of direct service connection are met, so the question becomes whether the current disability is related to service. On this question there is a probative opinion against the claim. Following the June 2020 Board remand to obtain an additional VA opinion due to the August 2018 VA opinion being inadequate for evaluation purposes, a different VA examiner provided an opinion in October 2020 as to whether the Veteran’s cervical spine condition is directly related to his service. The VA examiner opined that the Veteran’s cervical spine condition was less likely than not incurred in or caused by the Veteran’s service. In support of the opinion, the VA examiner noted that there are no notations in the Veteran’s service treatment records of any in-service incident relating to a cervical spine condition other than the 1978 motor vehicle accident. However, because the VA examiner did not address the Veteran’s contention that he injured his cervical spine while jumping out of a truck in Panama, as is reflected in the August 2018 buddy statement, the RO requested the VA examiner to submit an addendum opinion addressing the Veteran’s contention. The VA examiner submitted an addendum opinion in November 2020 in which he stated that after reviewing the additional evidence, his opinion did not change from the opinion he provided in October 2020. In support of the opinion, the VA examiner noted the Veteran’s contention and the buddy statement, and then the VA examiner also noted how there was no notation of the resulting clinical effect in the Veteran’s service treatment records. The VA examiner then noted the gap in time between the Veteran’s service and his treatment for neck pain. The examiner also placed importance on the fact that the Veteran’s degenerative arthritis involved multiple joints, including the cervical spine, thoracic spine, lumbosacral spine, hands, wrist, knees, feet, and ankles. He reasoned that this pathology and clinical course is most consistent with a generalized arthritic disease that would have occurred irrespective of his military service. The VA examiner then concluded that there is no supporting evidence to relate the Veteran’s cervical spine mild degenerative disc disease to his military service. The Board finds that the collective October 2020 and November 2020 opinions is probative because it contains a discussion of the relevant medical history and provides an explanation that contains clear conclusions and supporting rationale. As such, the Board gives much probative weight to the collective October and November 2020 VA examiner’s opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). In making this finding, the Board acknowledges the Veteran’s multiple written statements and testimony at his July 2018 Board hearing where the Veteran has contended his current cervical spine condition is related to the in-service incident where he jumped from a truck during a training exercise in Panama; however, the Veteran is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377, 1377 n.4. Consequently, the Board places more weight of probative value on the October 2020 and November 2020 VA opinions. The Board has also considered whether service connection is warranted for his cervical spine disability based on a continuity of symptomatology theory of entitlement. However, although the record beginning in 2006 reflects that the Veteran reported experiencing intermittent neck pain since service, there is no record of treatment for cervical spine pain until 2006, which is over 25 years after the Veteran’s discharge from service. Therefore, the Board places greater weight of probative value on the October and November 2020 VA opinions than on the Veteran’s reports of continuity of symptomatology and finds that service connection is not warranted based on a continuity of symptomatology theory of entitlement. 38 C.F.R. § 3.303(b); Walker, 708 F.3d 1331; 3.307, 3.309(a). In summary, the preponderance of the evidence is against a finding that the Veteran’s current cervical spine condition is related to service. The Board has considered the benefit-of-the-doubt rule; however, since a preponderance of the evidence is against the Veteran’s claim for service connection, the benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  Increased Rating Entitlement to a single 10 percent, but no higher, rating for left 4th finger disability and right 5th finger disability, based on arthritis of two minor joint groups, is granted. The Veteran and his representative contend the Veteran is entitled to a compensable rating for his left 4th finger disability and right 5th finger disability. See VA Form 21-0958, Notice of Disagreement, dated January 2015. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating 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. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. A Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board acknowledges that with respect to a claim for an increased rating for an already service-connected disability, a Veteran may experience multiple distinct degrees of disability that might result in different levels of compensation. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The Veteran’s service-connected left 4th finger disability and right 5th finger disability have been provided with separate noncompensable ratings under Diagnostic Code 5230 throughout the appeal period. Under Diagnostic Code 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. Diagnostic Code 5230 does not provide for a compensable rating. 38 C.F.R. § 4.71a. Diagnostic Code 5155 evaluates amputation of the 4th finger and Diagnostic Code 5156 evaluates amputation of the 5th finger. The record contains no evidence of an amputation of the left 4th finger or right 5th finger. Therefore, this Diagnostic Code is not applicable and will be discussed no further. Diagnostic Code 5227 evaluates ankylosis of the 4th and 5th fingers and provides a noncompensable evaluation for favorable or unfavorable ankylosis. The record contains no evidence of ankylosis of the left 4th finger or right 5th finger, and the Veteran has not described symptoms that are suggestive of ankylosis. A note following the Code instructs that it should be considered whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with the overall function of the hand. 38 C.F.R. § 4.71a. The Board will also address Diagnostic Codes 5228 and 5229, although they are not for application in this instance. Limitation of motion of the thumb is rated under Diagnostic Code 5228. 38 C.F.R. § 4.71a. Under Diagnostic Code 5228, a 10 percent evaluation is assigned when there is a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. A 20 percent evaluation is assigned when there is a gap of more than two inches between the thumb pad and fingers, with the thumb attempting to oppose the fingers. Limitation of motion in the index or long finger is rated under Diagnostic Code 5229. 38 C.F.R. § 4.71a. Under Diagnostic Code 5229, a 10 percent evaluation is assigned when there is a gap of one inch 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. A gap of less than one inch is noncompensable. 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). In rating disabilities of the musculoskeletal system, VA may, in addition to applying the schedular criteria, consider functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. DeLuca v. Brown, 8 Vet. App. 202 (1995). Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Lastly under 38 C.F.R. § 4.71a, Diagnostic Code 5003, degenerative arthritis, and Diagnostic Code 5010, traumatic arthritis, arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined not added. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating will be assigned where there is X-ray evidence of involvement of 2 or more minor joint groups and a 20 percent rating where there is X-ray evidence of involvement of 2 or more minor joint groups, with occasional incapacitating exacerbations. Note (1) provides that the 10 and 20 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. 38 C.F.R. § 4.45(f). Turning to the medical evidence of record, the Veteran attended a VA examination in August 2018 for an evaluation of his finger disabilities. The examiner diagnosed the Veteran with a healed left 4th finger fracture and a healed right 5th metacarpal fracture. The Veteran had full range of motion in the thumb and all digits in both hands. The Veteran had no gap between the thumb pad and fingers bilaterally. The Veteran had no gap between the finger and proximal transverse crease of the hand on maximal finger flexion bilaterally. The Veteran had pain with finger flexion bilaterally, finger extension bilaterally, and opposition with the thumb bilaterally. The examiner noted that the pain did not result in functional loss bilaterally. The Veteran had pain with use of both hands. The Veteran was noted to have pain on palpation throughout both hands. The Veteran performed repetitive use testing without additional functional loss or range of motion bilaterally. The examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time bilaterally. There were no additional factors contributing to disability in either hand. The Veteran had reduced grip strength to 4/5 in the left hand and 3/5 in the right hand, no muscle atrophy bilaterally, and no ankylosis bilaterally. The Veteran’s left 4th finger disability and right 5th finger disability did not cause such functional impairment that no effective function remained other than that which would be equally well served by amputation with prosthesis. The examiner noted the disabilities caused no functional impact. Furthermore, the examiner stated that there are no residuals of bilateral hand fractures, and that the Veteran’s reports of symptoms are likely related to carpal tunnel syndrome. In addition, the examiner noted that the tenderness throughout both hands cannot be explained by residuals of the in-service hand fractures. The Veteran reported he has trouble holding onto objects, which he attributed to numbness and paresthesia in his hands. The Veteran attended an additional VA examination in August 2020 for an evaluation of his finger disabilities. Range of motion testing revealed the Veteran had limitation of motion and painful motion in all of the fingers and thumb bilaterally. The Veteran had no gap between the thumb pad and fingers bilaterally. The Veteran had no gap between the finger and proximal transverse crease of the hand on maximal finger flexion bilaterally. The Veteran had pain with finger flexion bilaterally, finger extension bilaterally, and opposition with the thumb bilaterally. The Veteran had pain with use of both hands. The Veteran had no localized tenderness or pain on palpation bilaterally. The Veteran performed repetitive use testing without additional functional loss or range of motion loss bilaterally. With repeated use, the examiner noted that pain significantly limited functional ability and caused reduced range of motion throughout the fingers and thumb bilaterally. During flare-ups, the examiner noted that pain significantly limited functional ability and caused reduced range of motion throughout the fingers and thumb bilaterally. There were no additional factors contributing to disability in either hand. The Veteran had normal grip strength bilaterally, no muscle atrophy bilaterally, and no ankylosis bilaterally. The Veteran’s left 4th finger disability and right 5th finger disability did not cause such functional impairment that no effective function remained other than that which would be equally well served by amputation with prosthesis. The examiner noted the disabilities caused functional impact in the form of pain limiting lifting up objects as a construction worker. The Veteran reported finger pain with stiffness for a long time. He described the pain as a burning sensation with stiffness. He reported that the pain has remained the same. Furthermore, he reported using ibuprofen and hydrocodone for pain control. In addition, he reported flare-ups consisting of severe stiffness and pain. The Veteran attended a final VA examination in October 2020 for an evaluation of his finger disabilities. The examiner diagnosed the Veteran with status post left 4th finger fracture and status post right 5th metacarpal fracture. The Veteran had full range of motion in the thumb and all digits in both hands. The Veteran had no gap between the thumb pad and fingers bilaterally. The Veteran had no gap between the finger and proximal transverse crease of the hand on maximal finger flexion bilaterally. The Veteran had pain with finger flexion bilaterally, finger extension bilaterally, and opposition with the thumb bilaterally. The examiner noted that the pain did not result in functional loss bilaterally. The Veteran had pain with use of both hands. The Veteran was noted to have pain on palpation in the form of slight tenderness to palpation of the hand, palm, the metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints of all the fingers. The Veteran performed repetitive use testing without additional functional loss or range of motion bilaterally. The examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time bilaterally. There were no additional factors contributing to disability in either hand. The Veteran had normal grip strength bilaterally, no muscle atrophy bilaterally, and no ankylosis bilaterally. The Veteran’s left 4th finger disability and right 5th finger disability did not cause such functional impairment that no effective function remained other than that which would be equally well served by amputation with prosthesis. The examiner noted that X-rays showed very mild osteoarthritis of the interphalangeal joints throughout the left hand and mild diffuse osteoarthritis of the interphalangeal joints throughout the right hand. The examiner noted the disabilities caused no functional impact. The Veteran reported residual pain that reoccurs with prolonged and firm hand grips. He reported no associated weakness or numbness, other than the residuals from his left carpal tunnel syndrome release. Furthermore, he reported relief from analgesics that he takes for all his other arthralgias. In addition, he reported no flare-ups of his left 4th finger and right 5th finger disabilities. In addition to the VA examinations addressed above, VA treatment notes throughout the appeal period reflect that the MCP, PIP, and distal interphalangeal (DIP) joints of both hands were not tender. In addition to the Veteran’s reports of symptoms at the August 2018, August 2020, and October 2020 VA examinations, the Veteran stated at his July 2018 Board hearing that his left 4th finger fracture affects his whole left hand and that he cannot hang onto objects. See Board Hearing Transcript, page 3. The Veteran reported in a June 2019 written statement that his whole left hand hurts on a daily basis, and he reported that there are times when the pain is a 10 on a scale of 1 to 10. Regarding the right hand, in the June 2019 statement, the Veteran reported that it is very painful and that it gets so inflamed that he cannot do anything with it, including write. Furthermore, the Veteran’s daughter reported in a July 2018 written statement that the Veteran complained of pain in his left hand and the Veteran’s spouse would have to rub the Veteran’s hand. In a July 2018 written statement, the Veteran’s son stated that the Veteran always talked about how his hand hurt. The Veteran’s son did not specify whether it was the Veteran’s left or right hand. Regarding Diagnostic Code 5230, the Board finds that the preponderance of the evidence is against a finding that compensable ratings are warranted under Diagnostic Code 5230 for the left 4th finger disability and the right 5th finger disability. Under Diagnostic Code 5230, any level of limitation of motion of a 4th or 5th 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 4th and 5th fingers). Thus, even with consideration of 38 C.F.R. § 4.59, compensable ratings are not warranted under Diagnostic Code 5230 for the left 4th finger disability and the right 5th finger disability. However, following a review of the evidence of record and the applicable regulations, the Board concludes that the Veteran’s left 4th finger disability and right 5th finger disability are most appropriately evaluated under Diagnostic Code 5003 for a group of minor joints based on the X-ray evidence of arthritis and objective evidence of painful limitation of motion of the left 4th finger and right 5th finger interphalangeal joints for the entire appeal period. The Board notes that the X-ray report at the October 2020 VA examination showed very mild osteoarthritis of the interphalangeal joints throughout the left hand and mild left wrist osteoarthritis. The X-ray report showed mild diffuse osteoarthritis of the interphalangeal joints throughout the right hand. As is noted above, Diagnostic Code 5003 provides that if arthritis is established in the joints involved, when “the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion.” The Board notes that the VA examinations showed pain with range of motion with the left 4th finger and the right 5th finger. Furthermore, the Board notes that the August 2020 VA examination report showed that the Veteran had reduced range of motion in the left 4th finger and right 5th finger. As such, the Board concludes that the evidence more nearly approximates a finding that the Veteran is entitled to a single 10 percent, but no higher, rating under Diagnostic Code 5003 for a group of minor joints affected by limitation of motion as demonstrated by objective evidence of painful limitation of motion of the left 4th finger and right 5th finger interphalangeal joints. This is the maximum rating allowed for limitation of motion of a group of minor joints under Diagnostic Code 5003. The 20 percent rating for X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations is not available, as the record reflects the Veteran has limitation of motion. VA can change the diagnostic code that a particular disability is rated under so long as the rating under that diagnostic code has not been in effect for 20 years. See 38 C.F.R. § 3.951(b); see Murray v. Shinskeki, 24 Vet. App. 420, 425 (2011). VA must explain the change in the diagnostic code. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In this case, Diagnostic Code 5003 offers the highest possible rating for the Veteran’s left 4th finger and right 5th finger disabilities, when considering arthritis of a group of minor joints. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). Assigning the single rating under Diagnostic Code 5003 instead of Diagnostic Code 5230 does not reduce the Veteran’s rating at any time during the appeal period. Furthermore, assigning the single rating under Diagnostic Code 5003 for the Veteran’s finger disabilities based on arthritis is more beneficial to the Veteran than using Diagnostic Code 5230 under 38 C.F.R. § 4.71a, as Diagnostic Code 5230 does not afford the Veteran a compensable rating for either the left 4th finger disability or the right 5th finger disability based on the evidence of record. In addition, assigning a separate rating under Diagnostic Code 5003 while maintaining the Veteran’s noncompensable ratings under Diagnostic Code 5230 for the Veteran’s left 4th finger disability and the right 5th finger disability would constitute impermissible pyramiding as the Veteran’s symptom of painful limitation of motion is contemplated under both diagnostic codes. See 38 C.F.R. § 4.14 (“[t]he evaluation of the same disability under various diagnoses, “a practice called ‘pyramiding,’” is to be avoided); Brady v. Brown, 4 Vet. App. 203, 206 (1993) (the rationale for the prohibition on pyramiding is that “the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment” suffered). Accordingly, the Board has assigned a single rating for the Veteran’s left 4th finger and the right 5th finger disabilities under Diagnostic Code 5003 for the entire appeal period. The Board notes that the rating criteria for arthritis under Diagnostic Code 5003 were revised during the course of the Veteran’s appeal, effective February 7, 2021. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76,453, 76,463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5003). However, the changes to Diagnostic Code 5003 are in name only in that the amended criteria encompass any degenerative arthritis, other than posttraumatic arthritis. Thus, the amended rating criteria have not affected the Veteran’s rating for his left 4th finger disability and right 5th finger disability under Diagnostic Code 5003. The Board has considered whether the schedular criteria indicates whether another diagnostic code more analogous to the service-connected disabilities would provide for a higher rating. In particular, the Board notes that injury to the intrinsic muscles of the hand may be rated under Diagnostic Code 5309 for muscle group IX, which controls grasping and delicate manipulative movements. Muscle Group IX consists of the intrinsic muscles of hand; thenar eminence; short flexor, opponens, abductor and adductor of the thumb; hypothenar eminence; short flexor, opponens and abductor of the little finger; four lumbricales; and four dorsal and three palmar interossei. The forearm muscles act in strong grasping movements and are supplemented by the intrinsic muscles in delicate manipulative movements. The hand is so compact a structure that isolated muscle injuries are rare, being nearly always complicated with injuries of bones, joints, tendons, etc. Thus, injury to muscle group IX should be rated on limitation of motion, with a minimum 10 percent assigned. 38 C.F.R. § 4.73, Diagnostic Code 5309, Note. However, regarding the Veteran’s left 4th finger and right 5th finger disabilities, the record does not support that a separate rating is warranted for either disability. The Board acknowledges the Veteran’s reports that his left 4th finger fracture affects his whole left hand and that he cannot hang onto objects, and that on the right, the Veteran reported that it is very painful and that it gets so inflamed that he cannot do anything with it, including write. The Board also acknowledges that the August 2020 VA examination report reflects that the functional impact of the Veteran’s finger disabilities was that pain limits lifting up objects as a construction worker. However, the August 2018 VA examiner noted that there are no residuals of the bilateral hand fractures, and that the Veteran’s reports are likely related to carpal tunnel syndrome. Furthermore, the August 2018 VA examiner stated that the tenderness throughout both hands cannot be explained by residuals of the fractures in service. In addition, the October 2020 VA examiner stated that the Veteran had no associated weakness or numbness other than the residuals from his left carpal tunnel syndrome release. The August 2018 and October 2020 VA examination reports also reflect that the Veteran’s left 4th finger and right 5th finger disabilities caused no functional impact. Moreover, the August 2020 and October 2020 VA examination reports reflect that the Veteran had normal grip strength in both hands. As such, the Board finds a separate rating is not warranted under Diagnostic Code 5309 for the Veteran’s left 4th finger and right 5th finger disabilities. A review of the schedular criteria also does not indicate another diagnostic code more analogous to the service-connected disabilities that would provide for a higher rating. In summary, a single 10 percent, but no higher, rating is warranted for the Veteran’s left 4th finger disability and right 5th finger disability under Diagnostic Code 5003, based on degenerative arthritis established by X-ray findings with objective evidence of painful limitation of motion of a group of minor joints. REASONS FOR REMAND 1. Entitlement to service connection for rash of the legs, back, and feet is remanded. The Board regrets the additional delay, but an additional remand is necessary as there has not been substantial compliance with the mandates of the June 2020 remand order. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure substantial compliance). In the June 2020 Board remand, the Board directed the VA medical professional to “specifically consider the Veteran’s December 2014 statement in which he contends his rash condition has existed since his service in a cyclical fashion.” In an October 2020 opinion, the medical professional opined that the Veteran’s rash condition was less likely than not incurred in or caused by the Veteran’s service. In the rationale provided, the medical professional noted that the Veteran was treated for a rash in 1978, and that the record is silent for a chronic dermatopathology diagnosis and treatment since his service. The Board concludes that this opinion does not comply with the specific request in the June 2020 Board remand as the opinion does not address the Veteran’s December 2014 statement in which he stated his rash condition has existed since service in a cyclical fashion. Therefore, an additional VA opinion is necessary. See Stegall, 11 Vet. App. at 271. 2. Entitlement to TDIU is remanded. The issue of entitlement to a TDIU is inextricably intertwined with the claim seeking entitlement to a higher rating for other specified trauma and stressor disorder that is currently pending before the AOJ. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, adjudication of the claim of entitlement to TDIU is deferred and is remanded to the AOJ. The matters are REMANDED for the following actions: 1. Obtain a medical opinion from an appropriate medical professional for the Veteran’s rash of legs, back, and feet claim. The electronic claims file must be made available to the medical professional for review in connection with the request for an opinion. If the medical professional determines that an in-person examination (including via telehealth interview) is needed in order to answer the questions posed, then such should be scheduled. After reviewing the claims file, the medical professional should address the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran’s rash condition (diagnosed as dermatitis) is related or attributable to his military service? In answering this question, the medical professional is to specifically address the Veteran’s December 2014 statement in which he contended his rash condition has existed since his service in a cyclical fashion. The medical professional must fully explain the rationale for all opinions, with citation to supporting clinical data/lay statements, as deemed appropriate. If the medical professional cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. 2. Undertake any development necessary to adjudicate the claim for TDIU. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Breitbach, 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.