Citation Nr: 21042575 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 07-20 241 DATE: July 13, 2021 ORDER Entitlement to a rating greater than 20 percent for limitation of pronation, status post radial and ulnar fracture of the right upper extremity, is denied. For the entire period on appeal, entitlement to a 30 percent rating, but no higher, for limitation of flexion, status post radial and ulnar fracture of the right upper extremity, is granted. Entitlement to a rating greater than 10 percent for gunshot wound (GSW) residuals of the right thumb is denied. Entitlement to a rating greater than 10 percent for GSW residuals of the right index finger is denied. Entitlement to a rating greater than 10 percent for GSW residuals of the right long finger is denied. Entitlement to a compensable rating for limitation of extension, status post radial and ulnar fracture of the right upper extremity, is denied. Entitlement to a compensable rating for GSW residuals of the right ring finger is denied. Entitlement to a compensable rating for GSW residuals of the right little finger is denied. For the entire period on appeal, entitlement to a rating of 10 percent, but no higher, for a deep scar of the right upper extremity, is granted. Entitlement to a compensable rating for superficial scars of the right upper extremity is denied. Entitlement to a compensable rating for a superficial scar of the anterior trunk is denied. Entitlement to a compensable rating for a superficial scar of the right lower extremity is denied. Entitlement to a compensable rating for a superficial scar of the left lower extremity is denied. From January 6, 2021, entitlement to a rating of 30 percent for six painful scars is granted. REMANDED Entitlement to a rating greater than 40 percent for GSW residuals of the right forearm and thumb is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) for the period prior to September 26, 2007, is remanded. FINDINGS OF FACT 1. Throughout the appeal period, objective evidence shows the Veteran had limited pronation with motion lost beyond the last quarter of the arc; motion lost beyond the middle of the arc, or fixation of the hand has not been demonstrated. 2. Throughout the appeal period, the Veteran's right elbow demonstrated limitation of flexion to 80 degrees with painful motion. 3. Throughout the appeal period, the Veteran's right thumb has demonstrated limitation of motion and a gap of 2.5 centimeters (cm.) between the pad of the thumb and the fingers; a gap greater than 2.5 cm. or ankylosis of the thumb have not been shown. 4. Throughout the appeal period, the Veteran's right index finger has demonstrated painful limitation of motion; ankylosis has not been shown. 5. Throughout the appeal period, the Veteran's right long finger has demonstrated painful limitation of motion; ankylosis has not been shown. 6. Throughout the appeal period, the Veteran's right elbow did not demonstrate limitation of extension to 45 degrees or less. 7. Throughout the appeal period, the Veteran's right ring finger has been manifested by loss of sensation and painful motion. 8. Throughout the appeal period, the Veteran's right little finger has been manifested by loss of sensation and painful motion. 9. Throughout the appeal period, the Veteran's right upper extremity manifested by the presence of a deep scar that measured at least 39 sq. cm. but not more than 77 sq. cm. 10. Throughout the appeal period, the Veteran's remaining scars of the right upper extremity were superficial and did not cover an area of 144 square inches (929 sq. cm.) or more. 11. Throughout the appeal period, the Veteran's scar of the anterior trunk was superficial and did not cover an area of 144 square inches (929 sq. cm.) or more. 12. Throughout the appeal period, the Veteran's scar of the right lower extremity was superficial and did not cover an area of 144 square inches (929 sq. cm.) or more. 13. Throughout the appeal period, the Veteran's scar of the left lower extremity was superficial and did not cover an area of 144 square inches (929 sq. cm.) or more. 14. From January 6, 2021, the Veteran was noted to have six painful scars. CONCLUSIONS OF LAW 1. For the period on appeal, the criteria for a rating greater than 20 percent for limited pronation, status post radial and ulnar fracture of the right upper extremity, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5213. 2. For the period on appeal, the criteria for a rating of 30 percent, but no higher, for limitation of flexion, status post radial and ulnar fracture of the right upper extremity, have been met or approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, DC 5206. 3. For the period on appeal, the criteria for a rating greater than 10 percent for GSW residuals of the right thumb have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5228. 4. For the period on appeal, the criteria for a rating greater than 10 percent for GSW residuals of the right index finger have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5229. 5. For the period on appeal, the criteria for a rating greater than 10 percent for GSW residuals of the right long finger have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5229. 6. For the period on appeal, the criteria for a compensable rating based on limitation of extension, status post radial and ulnar fracture of the right upper extremity, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, DC 5207. 7. For the period on appeal, the criteria for a compensable rating for GSW residuals of the right ring finger have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5227, 5230. 8. For the period on appeal, the criteria for a compensable rating for GSW residuals of the right little finger have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5227, 5230. 9. For the period on appeal, the criteria for a rating of 10 percent, but no higher, for a deep scar of the right upper extremity have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, DC 7801 (2002-08). 10. For the period on appeal, the criteria for a compensable rating for superficial scars of the right upper extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, DC 7802. 11. For the period on appeal, the criteria for a compensable rating for a superficial scar of the right anterior trunk have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, DC 7802. 12. For the period on appeal, the criteria for a compensable rating for a superficial scar of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, DC 7802. 13. For the period on appeal, the criteria for a compensable rating for a superficial scar of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, DC 7802. 14. From January 6, 2021, the criteria for a rating of 30 percent, but no higher, for painful scars have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1968 to February 1970. This case has a long procedural history. The Veteran appealed an April 2003 rating decision by the Agency of Original Jurisdiction (AOJ) which continued a 40 percent rating for GSW residuals, right forearm and thumb with radius and ulna fracture with scars. The appeal was remanded by the Board for additional development in May 2006, February 2009, October 2018, and October 2020. The Board also notes that in a March 2021 rating decision, the AOJ granted service connection for scarring alopecia. Accordingly, that matter is no longer before the Board. Finally, in a May 2008 rating decision, the AOJ granted TDIU effective September 26, 2007. The Veteran has not disagreed with that decision, but a claim for TDIU prior to that date remains part and parcel of the Veteran's increased rating claims. See Harper v. Wilkie, 30 Vet. App. 356 (2018). Accordingly, the Board has characterized the issues on appeal to include a claim of entitlement to TDIU prior to September 26, 2007. Increased Ratings Disability ratings are determined by applying a schedule of ratings based on average impairment of earning capacity. Separate DCs 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. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an initial rating case or not. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Importantly, the evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. In March 2021 and May 2021 rating decisions, the AOJ assigned separate ratings for different manifestations of residuals of the Veteran's service-connected GSW muscle injury. Additionally, the Board observes that throughout the record there is conflicting information regarding which upper extremity is dominant. Although in its October 2020 remand the Board observed the Veteran was left-handed, at the time of the grant of service connection the Veteran was determined to be right-hand dominant. See April 1970 VA examination report. Given this fact and to afford the Veteran the benefit of reasonable doubt, the Board will consider the Veteran right-hand dominant for the purposes of adjudicating the issues below. 1. Limitation of pronation of the right forearm in excess of 20 percent The Veteran is in receipt of a 20 percent rating for limitation of pronation of the right forearm from April 28, 2000, under DC 5213. See May 2021 rating decision. DC 5213 provides ratings based on impairment of supination and pronation of the forearm. Under this Code, supination of the forearm limited to 30 degrees or less is rated 10 percent disabling for the major side. Limitation of pronation with motion lost beyond the last quarter of arc, so the hand does not approach full pronation, is rated 20 percent disabling for the major side; limitation of pronation with motion lost beyond the middle of arc is rated 30 percent disabling for the major side. Loss of supination or pronation due to bone fusion, with the hand fixed near the middle of the arc or moderate pronation, is rated 20 percent disabling for the major side; loss of supination or pronation due to bone fusion, with the hand fixed in full pronation, is rated 30 percent disabling for the major side; and loss of supination or pronation due to bone fusion, with the hand fixed in supination or hyperpronation, is rated 40 percent disabling for the major side. 38 C.F.R. § 4.71a, DC 5213. Although the ratings for musculoskeletal disabilities have been revised during the pendency of the appeal, those changes are not applicable with respect to this issue and will not be addressed further. Examination reports from March 2008, May 2011, and August 2015 all show pronation limited to no less than 80 degrees, and supination limited to no less than 62 degrees. Pain was noted during the March 2008 examination, but not during the May 2011 or August 2015 examinations. A January 2021 elbow and forearm examination report noted abnormal range of motion findings, with pronation from 0 to 40 degrees and supination from 0 to 55 degrees. Pain was observed with weightbearing and caused functional loss, with the examiner observing the pain was progressive on activity and resulted in progressively decreased range of motion. Repetitive use testing resulted in additional loss of function, with supination reduced to 45 degrees, while pronation remained the same at 40 degrees. Although the Veteran was not examined immediately after repetitive use over time or during flare-ups, the examiner opined that pain significantly limited the Veteran's functionality with repeated use over time or during a flare-up. The examiner estimated under such circumstances the Veteran's pronation would be from 0 to 40 degrees, and supination would be from 0 to 45 degrees. The examiner further noted that the Veteran had limited pronation with motion lost beyond the last quarter of the arc, and that the hand did not approach full pronation. At no time has pronation been shown to be limited with motion lost beyond the middle of arc. Loss of supination or pronation due to bone fusion, with the hand fixed in full pronation, or with the hand fixed in supination or hyperpronation, have not been demonstrated. Accordingly, a rating greater than 20 percent for limitation of pronation is not warranted. 2. Limitation of flexion greater than 10 percent prior to January 6, 2021, and greater than 20 percent thereafter The May 2021 rating decision granted service connection for limitation of flexion of the right elbow, and assigned a 10 percent rating from April 28, 2000 to January 6, 2021, and a 20 percent rating thereafter, under DC 5206. Although the ratings for musculoskeletal disabilities have been revised during the pendency of the appeal, those changes are not applicable with respect to this issue and will not be addressed further. The normal range of motion of the elbow is from 0 degrees of extension to 145 degrees of flexion. 38 C.F.R. § 4.71, Plate I. Under DC 5206, a 10 percent disability rating is assigned where flexion of the major arm is limited to 100 degrees. A 20 percent disability rating is contemplated where flexion of the major arm is limited to 90 degrees. A 30 percent disability rating is warranted where flexion of the major arm is limited to 70 degrees. A 40 percent disability rating is assigned where flexion of the major arm is limited to 55 degrees. Finally, a maximum schedular 50 percent disability rating is warranted were flexion of the major arm is limited to 45 degrees. A March 2008 VA examination report noted the Veteran had flexion from 0 to 135 degrees, with pain. The examiner observed that the Veteran's range of motion was not additionally limited by weakness, fatigue, or incoordination, and that there was no change between active and passive range of motion. However, the examiner did not provide an estimate of how pain would limit the functional ability of the elbow with repeated use over time. Records from Total Rehab of Harlingen dated from 2007 through 2008 noted flexion limited to no less than 110 degrees. A May 2011 VA joints examination report noted the Veteran had limited motion of the elbow. Range of motion testing showed flexion from 25 degrees to 130 degrees, without pain. There was no objective evidence of pain following repetitive motion, or additional limitation after three repetitions of range of motion. The examiner noted that pain, stiffness, and weakness affected motion of the elbow, but did not advise on how those symptoms additionally limited the functional ability of the elbow with repeated use over time. According to the August 2015 elbow and forearm examination report, the Veteran's range of motion for the right elbow was normal, with flexion from 0 to 145 degrees. No pain was observed, with or without weight bearing, and there was no objective evidence of localized tenderness, pain on palpation of the joint or soft tissue, or crepitus. The Veteran reported flare-ups in the form of swelling and locking episodes that self-resolved, but those symptoms were not present upon examination of the Veteran. The examiner was unable to comment on whether pain, weakness, fatigability, or incoordination limited functional ability with repeated use over time without resorting to speculation. The January 2021 elbow and forearm examination report noted the Veteran's reports of elbow and forearm pain. He reported severe daily flare-ups lasting "at least 24 hours every day." Range of motion figures showed flexion from 0 to 80 degrees. Repetitive use testing and estimated loss of function after repeated use over time and during flare-ups did not result in any further limitation of motion. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board observes that the March 2008, May 2011, and August 2015 examination reports were not compliant with the Court's guidance in Sharp. However, it is apparent that the January 2021 range of motion findings are Sharp compliant. As the January 2021 examiner's findings regarding limitation of motion are the only adequate findings of record, the Board will consider their application for the totality of the appeal period. The January 2021 examiner found the Veteran is limited to 80 degrees of flexion on initial testing, repetitive use testing, during flare-ups and after repetitive use over time. As the Veteran's flexion would be limited to 80 degrees during all circumstances, the Board finds the evidence more closely approximates a 30 percent rating for the entire period on appeal. However, as there is no indication that the Veteran has been limited to 70 degrees of flexion or less at any time, a rating greater than 30 percent is not warranted. 3. Limitation of motion of the thumb greater than 10 percent The March 2021 rating decision granted service connection for GSW residuals affecting the right thumb, and assigned a 10 percent rating from April 28, 2000, under DC 5228. The rating criteria applicable to individual fingers changed during the pendency of the appeal. Prior to August 26, 2002, there was no DC 5228. According to the relevant rating criteria effective prior to August 26, 2002, evidence of favorable ankylosis of the major thumb warranted the disability evaluation of 10 percent. Evidence of unfavorable ankylosis of the major thumb was required for the grant of a 20 percent disability rating. 38 C.F.R. § 4.71a, DC 5224 (effective prior to August 26, 2002). No higher evaluation was allowable pursuant to this DC. However, extremely unfavorable ankylosis would be rated as amputation under DCs 5152 through 5156. 38 C.F.R. § 4.71a, Note following DC 5227 (effective prior to August 26, 2002). The relevant evaluation requirements effective since August 26, 2002 established DC 5228 which addresses limitation of motion of the thumb. DC 5228 provides a 10 percent rating for limitation of motion of the thumb with a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. See 38 C.F.R. § 4.71a DC 5228. It provides a 20 percent rating when there is a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Id. The March 2008 VA examination report contains the earliest findings pertinent to the right thumb. Range of motion testing revealed interphalangeal (IP) motion right of 0 to 80 degrees; metacarpophalangeal (MCP / MP) motion right thumb symmetrical 0 to 50 degrees; carpometacarpal (CMC) joint flexion extension 0 to 55 degrees. There is no indication of the existence or extent of a gap between the thumbpad and fingers. The May 2011 VA examination report noted pain and limited motion in the base of the thumb. Range of motion testing showed extension of the thumb MP and IP joints was symmetrical. Flexion of the MP joint was limited to 10 degrees, and flexion of the IP joint was limited to 20 degrees. There is no indication of the existence or extent of a gap between the thumbpad and fingers. An August 2015 examination report noted that range of motion findings throughout the right hand and fingers were all normal. The examiner reported there was no gap between the thumb and fingers. There was no evidence of pain with the use of the hand. The January 2021 examination report noted abnormal range of motion testing, with full extension and flexion of the MCP to 85 degrees and of the IP to 80 degrees. There was no additional functional loss or range of motion after three repetitions. The examiner estimated that during flare-ups, the Veteran's flexion of the MCP would be limited to 75 degrees, and flexion of the IP would be limited to 80 degrees. There was a gap of 2.5 cm. between the pad of the thumb and the fingers. Throughout the appeal period there has been no demonstration of a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Nor has ankylosis of the thumb been shown. For these reasons, a rating greater than 10 percent for GSW residuals affecting the Veteran's right thumb is not warranted for the entire period on appeal. 4. Limitation of motion of the right index finger greater than 10 percent The March 2021 rating decision granted service connection for GSW residuals affecting the right index finger, and assigned a 10 percent rating from April 28, 2000, under DC 5229. As noted above, the rating criteria applicable to individual fingers changed during the pendency of the appeal. Prior to August 26, 2002, there was no DC 5229. According to the relevant rating criteria effective prior to August 26, 2002, evidence of favorable or unfavorable ankylosis of the major index finger warranted the disability evaluation of 10 percent. 38 C.F.R. § 4.71a, DC 5225 (effective prior to August 26, 2002). No higher evaluation was allowable pursuant to this DC. However, extremely unfavorable ankylosis would be rated as amputation under DC 5152 through 5156. 38 C.F.R. § 4.71a, Note following DC 5227 (effective prior to August 26, 2002). The relevant evaluation requirements effective since August 26, 2002 established DC 5229, which addresses limitation of motion of the index finger and long (middle) finger. DC 5229 provides a maximum 10 percent rating for limitation of motion of the index or long finger with a gap of one inch (2.5 cm.) 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. See 38 C.F.R. § 4.71a DC 5229. The August 2015 hand and finger examination report noted that range of motion findings throughout the right hand and fingers were all normal. The examiner reported there was no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. There was no evidence of pain with the use of the hand. The January 2021 examination report noted abnormal range of motion testing, with full extension and flexion of the MCP to 75 degrees, flexion of the PIP to 80 degrees, and flexion of the DIP to 70 degrees. There was no additional functional loss or range of motion after three repetitions. The examiner estimated that with repeated use over time and during flare-ups, the Veteran's index finger would maintain the same range of motion. There was no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. Throughout the appeal period, the Veteran has maintained range of motion of the index finger, and ankylosis of the index finger has not been shown. For these reasons, a rating greater than 10 percent for GSW residuals affecting the Veteran's right index finger is not warranted for the entire period on appeal. 5. Limitation of motion of the right long finger greater than 10 percent The March 2021 rating decision granted service connection for GSW residuals affecting the right long finger, and assigned a 10 percent rating from April 28, 2000, under DC 5229. VA treatment records dated from October 2012 through October 2013 note the Veteran reported triggering and locking of the right middle fingertip into the palm. The condition was described as a jerking movement of the finger caused by the sticking of a tendon. The Veteran was diagnosed with right middle trigger finger. The August 2015 hand and finger examination report noted that range of motion findings throughout the right hand and fingers were all normal. The examiner reported there was no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. There was no evidence of pain with the use of the hand. The examiner indicated that the Veteran's middle finger arthritis would correlate with his locking episodes, and that the trigger finger interfered with grasp and fine motor movement of the hand. The January 2021 examination report noted abnormal range of motion testing, with full extension and flexion of the MCP to 75 degrees, flexion of the PIP to 80 degrees, and flexion of the DIP to 70 degrees. There was no additional functional loss or range of motion after three repetitions. The examiner estimated that with repeated use over time and during flare-ups, the Veteran's long finger would maintain the same range of motion. There was no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. Throughout the appeal period, the Veteran has maintained range of motion of the long finger; ankylosis of the long finger has not been shown. To the extent the Veteran experienced trigger finger during the appeal period, that symptomatology is contemplated by the assigned 10 percent rating. For these reasons, a rating greater than 10 percent for GSW residuals affecting the Veteran's long finger is not warranted for the entire period on appeal. 6. Compensable rating for limitation of extension of the elbow The May 2021 rating decision granted service connection for limitation of extension, and assigned a noncompensable rating from April 28, 2000, under DC 5207. Although the ratings for musculoskeletal disabilities have been revised during the pendency of the appeal, those changes are not applicable with respect to this issue and will not be addressed further. DC 5207 provides that extension of the major forearm limited to 45 degrees is rated as 10 percent disabling; limited to 60 degrees is rated as 10 percent; limited to 75 degrees is rated as 20 percent; limited to 90 degrees is rated 30 percent; limited to 100 degrees is rated 40 percent; and limited to 110 degrees is rated 50 percent disabling. A March 2008 VA examination report noted the Veteran had extension to -10 degrees, with pain. The examiner stated the Veteran could not extend the elbow to 0 degrees and lacked 10 degrees effort. The examiner observed that the Veteran's range of motion was not additionally limited by weakness, fatigue, or incoordination, and that there was no change between active and passive range of motion. A May 2011 VA joints examination report noted the Veteran had limited motion of the elbow. Range of motion testing showed extension from -25 degrees to -25 degrees, without pain. There was no objective evidence of pain following repetitive motion, or additional limitation after three repetitions of range of motion. The examiner noted that pain, stiffness, and weakness affected motion of the elbow. According to the August 2015 elbow and forearm examination report, the Veteran's range of motion for the right elbow was normal, with extension from 145 degrees to 0 degrees. No pain was observed, with or without weight bearing, and there was no objective evidence of localized tenderness, pain on palpation of the joint or soft tissue, or crepitus. The Veteran reported flare-ups in the form of swelling and locking episodes that self-resolved, but those symptoms were not present upon examination of the Veteran. The January 2021 elbow and forearm examination report notes the Veteran's reports of elbow and forearm pain. He reported daily flare-ups lasting "at least 24 hours every day." Addendum range of motion figures provided in May 2021 showed extension from 80 degrees to 0 degrees. Repetitive use testing and estimated loss of function after repeated use over time and during flare-ups did not result in any further limitation of motion. Based on the foregoing, a compensable rating based on limitation of extension is not warranted, as at no time during the appeal period has the Veteran been shown to have extension limited to 45 degrees. 7. Compensable ratings for limitation of motion of the right ring and little fingers The March 2021 rating decision granted service connection for GSW residuals affecting the right ring and little fingers, and assigned noncompensable ratings for each from April 28, 2000, under DC 5230. As noted above, the rating criteria applicable to individual fingers changed during the pendency of the appeal. Prior to August 26, 2002, there was no DC 5230. According to the relevant rating criteria effective prior to August 26, 2002, evidence of favorable or unfavorable ankylosis of any finger other than the thumb, index, and middle finger was rated as noncompensable. 38 C.F.R. § 4.71a, DC 5227 (effective prior to August 26, 2002). No higher evaluation was allowable pursuant to this DC. However, extremely unfavorable ankylosis would be rated as amputation under DCs 5152 through 5156. 38 C.F.R. § 4.71a, Note following DC 5227 (effective prior to August 26, 2002). DC 5230 provides a noncompensable rating for any limitation of motion of the ring finger and little finger. While examination reports throughout the appeal period have shown that the Veteran had loss of motion of the ring and little fingers, a rating based on limitation of motion is not available. Furthermore, a Note to DC 5227 directs the Board to "consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interferences with overall function of the hand." 38 C.F.R. § 4.71a, DC 5227. While as a general matter when painful motion is present the minimum compensable rating for the joint should be assigned, in this case there is no level of disability that warrants a compensable rating based on limited motion or painful motion under DCs 5227 or 5230. Sowers v. McDonald, 27 Vet. App. 472, 479-81 (2016). In evaluating the Veteran's current level of disability, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. The Veteran has reported that he experiences pain. However, the January 2021 examiner found that the Veteran's disability does not result in loss of use of the finger such that the Veteran would be equally served by amputation. 38 C.F.R. § 4.71a, DC 5156. As such, the Board finds that the Veteran's statements concerning further limitation of function due to additional factors are outweighed by the objective observation of the VA examiner. 38 C.F.R. §§ 4.40, 4.45. The Board acknowledges that the May 2011 VA examination report noted the Veteran had numbness of the ring and small fingers and indicated the presence of a partial injury to the dorsal sensory branch of the radial nerve and partial ulnar nerve injuries. As the symptom of numbness is the result of neurological impairment, the assignment of a rating for these symptoms must await the resolution of the neurological impairment matter being remanded. As such, a compensable rating under DC 5230 for limitation of motion of the ring and little fingers is not warranted, and the appeals must be denied. 8. Compensable ratings for scars The March 2021 rating decision granted service connection for scars of the right upper extremity, and assigned a noncompensable rating from April 28, 2000, under DC 7802. In that same decision, the AOJ granted service connection for a scar of the anterior trunk, a scar on the left thigh, and a scar on the right thigh, and assigned noncompensable ratings for each scar under DC 7802. The criteria in effect prior to August 30, 2002 provided that a 10 percent rating was assigned for superficial scars that are poorly nourished, with repeated ulceration, or that are tender and painful on objective demonstration. 38 C.F.R. § 4.118, DCs 7803, 7804 (2001). Other scars that were not on the head, face, or neck, and that are not from burns, were rated based on the limitation of function of the part affected. 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7805 (2001). The rating criteria were revised effective August 30, 2002. 67 Fed. Reg. 49590 (July 31, 2002). In pertinent part, scars (other than those involving the head, face, or neck) that were deep or caused limited motion warranted a 10 percent rating for an area or areas exceeding 6 square inches (39 sq. cm.). 38 C.F.R. § 4.118, DC 7801 (2002-08); Id. Note (2) (a deep scar was one associated with underlying soft tissue damage). Scars (other than those involving the head, face, or neck) that were superficial and did not cause limited motion warranted a 10 percent rating for an area or areas exceeding 144 sq. inches (929 sq. cm.). 38 C.F.R. § 4.118, DC 7802 (2002-08); Id. Note (2) (a deep scar was one associated with underlying soft tissue damage). A 10 percent rating was warranted for scars which were superficial and unstable or superficial and painful on examination. 38 C.F.R. § 4.118, DC 7803, 7804 (2002-08) (noting that an unstable scar was one where, for any reason, there was frequent loss of covering of skin over the scar). Other scars were rated based on the limitation of function of the affected part. 38 C.F.R. § 4.118, DC 7805 (2002-08). VA revised the criteria for the evaluation of scars to allow for separate evaluations for scars that are both disfiguring and painful effective October 23, 2008. 73 Fed. Reg. 54,710-12 (Sept. 23, 2008). The implementing regulation for the new rating criteria provided that these revisions apply only to applications for benefits received by VA on or after October 23, 2008, or by request of the claimant. See also 77 Fed. Reg. 2909 (Jan. 20, 2012). Under DC 7801, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear, that covered an area at least 6 sq. inches (39 sq. cm.) but less than 12 sq. inches (77 sq. cm.) warranted a 10 percent rating. Scars of that nature covering an area or areas of at least 12 sq. inches (77 sq. cm.) but less than 72 sq. inches (465 sq. cm.) warranted a 20 percent rating. Scars of that nature covering an area or areas of at least 72 sq. inches (465 sq. cm.) but less than 144 sq. inches (929 sq. cm.) warranted a 30 percent rating. Scars of that nature covering an area or areas of 144 sq. inches (929 sq. cm.) or greater warranted a 40 percent rating. A deep scar was one associated with underlying soft tissue damage. Id. Note (1). If multiple qualifying scars were present, or if a single qualifying scar affected more than one extremity, or a single qualifying scar affected one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars were scars that are nonlinear, deep, and are not located on the head, face, or neck. Id. Note (2). Under DC 7802, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that were superficial and nonlinear and covered an area or areas of 144 sq. inches (929 sq. cm.) or greater warranted a 10 percent rating. 38 C.F.R. § 4.118, DC 7802 (2009-2018). A superficial scar was one not associated with underlying soft tissue damage. Id. Note (1). Note (2) mirrors the note (2) associated with DC 7801. Under DC 7804, one or two scars which were unstable or painful warranted a 10 percent rating. 38 C.F.R. § 4.118, DC 7804 (2009-18). A 20 percent rating required the involvement of 3 or 4 scars. Id. If one or more scars were both unstable and painful, 10 percent was added to the evaluation based on the total number of unstable or painful scars. Id. Note (2). VA revised the criteria for evaluating skin disorders again in 2018. 83 Fed. Reg. 32592-97 (July 13, 2018), as corrected at 83 Fed. Reg. 38663 (Aug. 7, 2018). The August 13, 2018 skin amendments introduced a General Rating Formula for skin conditions and amend DCs 7801 and 7802 by characterizing multiple scars by 6 body zones affected rather than by extremity. In addition, under the August 2018 amendments, two or more skin conditions may be combined in accordance with § 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used. See 38 C.F.R. § 4.118(b) (August 13, 2018). However, the August 13, 2018 skin amendments presented no changes to the rating criteria for DCs 7800, 7804, and 7805. In other words, DCs 7800, 7804, and 7805 are exactly same both prior to and after August 13, 2018. Compare 38 C.F.R. § 4.118 (October 23, 2008) with 38 C.F.R. § 4.118 (August 13, 2018). Finally, both prior to and after August 13, 2018, DC 7803 no longer exists, as it was incorporated into DC 7804. At present, DC 7801 provides a 10 percent rating for scars not of the head, face, or neck that are associated with underlying soft tissue damage of an area of at least 39 sq. cm. but less than 77 sq. cm. Additional ratings are available for scars of greater area. 38 C.F.R. § 4.118, DC 7801. DC 7802 provides a 10 percent rating for scars, not of the head, face or neck and that are not associated with underlying soft tissue damage, that cover an area of 929 sq. cm. or greater. 38 C.F.R. § 4.118, DC 7802. DC 7804 provides a 10 percent rating for one or two scars that are unstable or painful, a 20 percent rating for three or four scars that are painful or unstable, and a 30 percent rating for five or more scars that are painful or unstable. 38 C.F.R. § 4.118, DC 7804. Note (1): an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2): if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, DC 7804. The March 2008 VA examination report noted the Veteran had a large divot that was a depressed scar on his forearm about 14 cm. long on the palmar surface, medial side. The May 2011 VA examination report noted the Veteran had three scars on his right upper extremity. The first scar was at the volar aspect of the forearm and measured maximum width of 3.0 cm. and maximum length of 16.0 cm. The total area was at least 6 sq. inches but less than 12 sq. inches. The scar was deep, not painful and showed no signs of skin breakdown. No inflammation, edema, keloid formation, or other disabling effects were noted. The second scar was a linear scar located at the radial aspect of the base of the thumb. The scar measured 1.0 cm. by 3.0 cm. The scar was superficial, not painful, and there were no signs of skin breakdown. The examiner stated that no inflammation, edema, keloid formation, or other disabling effects were observed. The third scar was a linear located at the posterior aspect of the elbow. It measured 0.5 cm. by 4.0 cm. The scar was superficial, not painful, and there were no signs of skin breakdown. The examiner stated that no inflammation, edema, keloid formation, or other disabling effects were observed. The Veteran reported he experienced no limitations due to the scars. The August 2015 elbow and forearm examination report documented the presence of two scars. The first scar was located at the forearm and extended the entire length, was flat and smooth, and measured 17 cm. by 3 cm. The second scar measured 4 cm. by 1.5 cm. and was located near the elbow region. The scars were not painful or unstable and did not cover a total area larger than 39 sq. cm. The August 2015 hand and finger examination report also documented the presence of scars. A scar was noted at the base of the thumb and measured 4 cm. by 1 cm. A second scar extended transversely across the wrist, measuring 4 cm. by 0.25 cm. The scars were noted to be healed, smooth, stable, without problems. There was no pain, and the scars did not exceed a total area larger than 39 sq. cm. According to a September 2019 scars examination report, the Veteran had three scars, all of which were not painful or unstable. The first scar, located at the ventral right forearm, measured 17.5 cm. by 4.0 cm., and manifested by underlying soft tissue damage, but was not tender or unstable. The second scar, located at the lateral thumb / wrist, measured 5.5 cm. by 1.3 cm., did not demonstrate underlying soft tissue damage, and was not tender or unstable. The third scar, located at the elbow, measured 4.9 cm. by 1.5 cm., did not demonstrate underlying soft tissue damage, and was not tender or unstable. The examiner observed the total area of scars with underlying soft tissue damage was 70 sq. cm., and the total area of scars without underlying soft tissue damage was 14.5 sq. cm. The scars did not cause limitation of function and resulted in no functional impact. The January 2021 scars examination report noted that the Veteran had five or more painful scars. The pain was described as sharp and throbbing. None of the Veteran's scars were noted to be unstable. The examiner identified three scars of the right upper extremity. The first, located at the right thumb base, measured 3.0 cm. by 1.0 cm. The second, located at the right middle forearm, measured 25.0 cm. by 3.0 cm. The third, located at the right central elbow, measured 4.0 cm. by 0.10 cm. The examiner noted that the total area of the scars of the right upper extremity was 32.0 by 4.10 cm. sq., the entirety of which contained no underlying tissue damage. Based on the foregoing, the Board finds that for the entire period on appeal, the Veteran is entitled to a 10 percent rating under DC 7801. This finding is based on the presence of a deep scar that measured at least 39 sq. cm. but not more than 77 sq. cm., as noted in the May 2011 and September 2019 VA examination reports. The Veteran's remaining scars of the right arm did not warrant a compensable rating under any applicable DCs as they were superficial, not painful, did not result in any functional impairment, and did not cover an area of at least 929 sq. cm. Individually, none of the separately rated scars cover an area of 929 sq. cm. or greater, nor does their combine total area meet or exceed 929 sq. cm. Thus, compensable ratings under DC 7802 are not warranted for these scars at any time. However, from January 6, 2021, the Board finds the evidence supports a separate rating of 30 percent under DC 7804, for scars that are painful. The January 6, 2021 examination report is the earliest indication that the Veteran's scars on the right upper extremity were painful. Moreover the examiner identified three other painful scars, including a 16.0 cm. by 0.5 cm. scar on the right central abdomen, a 26.0 cm. by 7.0 cm. scar on the left central thigh, and a 15.0 cm. by 0.10 cm. scar on the right lateral thigh. None of the scars were unstable or associated with underlying soft tissue damage. The scar on the right thigh is consistent with the evidence of record, as that location was the site of a skin graft for the Veteran's forearm repair during service. However, there does not appear to be any evidence regarding the left thigh or central abdomen being affected by the GSW the Veteran sustained in 1969, or any indication that those areas were otherwise injured during service. Nevertheless, the January 2021 examiner identified those scars as related to in-service injuries, and the AOJ established service connection for those scars in the March 2021 rating decision. As the January 2021 examination report indicates the Veteran has five or more painful scars, a rating of 30 percent is warranted under DC 7804 from January 6, 2021. None of the scars were associated with underlying soft tissue damage, apart from the scar on the forearm discussed above. Accordingly, a rating greater than 30 percent is not warranted under an alternate DC. REASONS FOR REMAND The Veteran is in receipt of the maximum schedular rating under DC 5307. However, the Board observes that the March 2008 VA examination report indicated the Veteran's GSW residuals affected muscle groups VII and VIII. The May 2011 and May 2017 examination reports indicated that the affected muscle group was group VII, or manifested by no significant muscle involvement at all, respectively. A September 2019 examination report found that muscle groups VII, VIII, and IX were affected. Lastly, the January 2021 examination report observed that only muscle groups VII and XII were involved. Given these conflicting findings, remand is necessary for an examination to determine the extent of any muscle group damage other than Group VII, so those manifestations may be properly evaluated. If the Veteran is found to have multiple muscle groups affected by his in-service GSW injury, the combined rating may exceed the assigned schedular rating under DC 5307. See 38 C.F.R. § 4.55(e). Accordingly, pending resolution of the applicability of other muscle group ratings, the Veteran's claim for a rating greater than 40 percent under DC 5307 must be remanded. As noted above, the May 2011 VA examination report noted the Veteran had numbness of the ring and small fingers and indicated the presence of a partial injury to the dorsal sensory branch of the radial nerve and partial ulnar nerve injuries. However, the examination report did not specify the severity of the impairment of those peripheral nerves. The May 2011 VA examination report appears to be the only neurological evaluation of the residuals of the Veteran's GSW of the right arm. Accordingly, remand is necessary to evaluate the current status of any neurological impairments resulting from the Veteran's GSW residuals. As the Board is remanding the Veteran's claim for an increased rating for GSW residuals, the appeal for TDIU prior to September 26, 2007 is inextricably intertwined and must be remanded as well. Moreover, the record is unclear as to the Veteran's employment history prior to April 2007. Thus, the AOJ should request information from the Veteran regarding his education and employment history. The matters are REMANDED for the following actions: 1. Obtain a complete post-service employment and education history of the Veteran. The employment history should indicate the type of position, whether any position held was full time or part time (including hours per week worked if part time) and the wages earned. Any employment accommodations should be described in detail. 2. Schedule the Veteran for a muscle injuries examination to evaluate the current extent and severity of his service-connected GSW residuals, with specific regard to affected muscle groups. The examiner is asked to specify which muscle groups are affected by the Veteran's in-service GSW injury and the extent of those effects. Any studies, tests, and evaluations deemed necessary should be performed. 3. Thereafter, schedule the Veteran for a peripheral nerves examination to identify the extent of any peripheral nerve impairment resulting from his service-connected GSW residuals. Any studies, tests, and evaluations deemed necessary should be performed. 4. After the above has been completed, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pelican, Luke H. 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.