Citation Nr: 21029224 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-05 495A DATE: May 13, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for a chronic right wrist sprain is denied. FINDINGS OF FACT 1. The Veteran is right-arm dominant. 2. The Veteran has not displayed ankylosis of the right wrist at any point during the appeal period. CONCLUSION OF LAW The criteria for an initial rating in excess of 10 percent for a right wrist disability are not 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 Code 5215. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served in the United States Navy from May 2006 to December 2012, after service in the United States Naval Academy. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision. In August 2019, the Veteran testified at a Board videoconference hearing before the undersigned. In November 2019, the Board awarded a 10 percent rating for the entire appeal period for the Veteran's right wrist strain and remanded this matter for additional development. The Veteran asserts that he is entitled to greater than a 10 percent rating for his chronic right wrist strain. See April 2021 Appellate Brief, December 2013 Notice of Disagreement (NOD), and August 2019 Board Hearing Transcript at 2-4. As indicated above, the Board finds that the Veteran is not entitled to a disability rating greater than 10 percent for his service-connected right wrist strain. Thus, the Veteran's appeal as to an initial rating in excess of 10 percent is denied. In support of this determination, the Board first notes that the Veteran's current 10 percent rating was assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5215. This DC provides for maximum 10 percent ratings for limited palmar flexion (palmar flexion limited in line with forearm) and limited dorsiflexion (dorsiflexion less than 15 degrees), regardless of whether the major or minor extremity is involved. 38 C.F.R. § 4.71a, DC 5215. Accordingly, the Veteran is already in receipt of the maximum rating pursuant to Diagnostic Code 5215. In order to assign a rating greater than 10 percent for impairment of the wrist, ankylosis must be present. Specifically, 38 C.F.R. § 4.71a, Diagnostic Code 5214, indicates that a 30 percent rating is assignable for favorable ankylosis in 20 degrees to 30 degrees dorsiflexion. As mentioned previously in the Findings of Fact section, the Veteran's right hand is his dominant hand. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In this regard, the Veteran has submitted to three VA examinations throughout the appeal period. As noted in the November 2019 Board remand, the October 2013 and December 2016 VA examinations were inadequate for rating purposes. See Sharp v. Shulkin, 29Vet.App.26, 33 (2017). In October 2020, pursuant to the November 2019 Board remand, the Veteran submitted to another VA examination. The October 2020 VA examiner diagnosed a chronic right wrist strain with ulnar and median nerve neuropathy and complex regional pain syndrome. In an October 2020 rating decision, the RO granted service-connection for paralysis of the Veteran's right upper extremity radicular groups, rated as 40 percent disabling. See Morgan v. Wilkie, 31Vet. App.162 (2019). The October 2020 VA examiner, in conducting range of motion testing, measured the Veteran's right wrist palmar flexion as limited to 20 degrees, dorsiflexion limited to 60 degrees, ulnar deviation limited to 20 degrees, and radial deviation limited to 15 degrees. The October 2020 VA examiner noted that the Veteran's limited range of motion contributed to functional loss. The Veteran was unable to perform repetitive use testing due to significant neuropathic pain caused during initial range of motion testing. The October 2020 VA examiner opined that repeated use over time would result in pain, fatigue, weakness, and lack of endurance. These functional losses were predicted to result in palmar flexion limited to 40 degrees, dorsiflexion limited to 35 degrees, ulnar deviation limited to 20 degrees, and radial deviation limited to 5 degrees. The VA examiner then opined that flare-ups (reported by the Veteran) would result in pain, fatigue, weakness, and lack of endurance. These functional losses were predicted to result in palmar flexion limited to 30 degrees, dorsiflexion limited to 25 degrees, ulnar deviation limited to 15 degrees, and radial deviation limited to 5 degrees. Additional factors noted as contributing to the Veteran's right wrist disability were weakened movement due to atrophy of disuse. The October 2020 VA examiner opined that the Veteran's atrophy of disuse was due to nerve pathology and pain. During the October 2020 VA peripheral nerves examination, the VA examiner measure a 3-centimeter difference in the atrophied wrist when compared to the normal left wrist and noted the atrophy was in the right hypothenar eminence. See 38 C.F.R. § 4.124a, DCs 8513, 8515. The October 2020 VA examiner found the Veteran's wrist strength to be diminished and noted obvious muscle wasting of the hypothenar muscle. The Veteran reported that he constantly used a wrist brace to prevent mobility as moving his wrist caused pain. The Veteran did not report, and the October 2020 VA examiner did not find, that his right wrist was ankylosed, even during flare-ups. The October 2020 VA examiner reviewed x-rays and concluded there was no arthritis in the Veteran's right wrist. Despite the October 2013 VA examination's inadequacy regarding range of motion testing, it is notable that the Veteran did not report ankylosis and the examiner did not find that the Veteran's wrist was ankylosed. The December 2016 VA examiner failed to record any information regarding ankylosis. Finally, VA treatment records reflect various reports of right wrist pain, but there are no reports or symptoms indicative of ankylosis. See, generally, April 2013 to April 2021 VA treatment records. Thus, the Board finds that as the Veteran has been awarded the maximum rating based on limitation of motion, and ankylosis is not demonstrated in any examination report and has not been asserted by the Veteran or his representative, a rating in excess of 10 percent is denied. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Rouse, 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.