Citation Nr: 22010653 Decision Date: 02/24/22 Archive Date: 02/24/22 DOCKET NO. 16-42 471 DATE: February 24, 2022 ORDER Entitlement to a disability rating in excess of 10 percent for middorsal spine strain with degenerative disc disease for the period prior to May 23, 2016 is denied. Entitlement to a disability rating in excess of 20 percent for middorsal spine strain with degenerative disc disease for the period from May 23, 2016 is denied. Entitlement to a disability rating in excess of 10 percent for patellofemoral pain syndrome of the right knee is denied. Entitlement to a disability rating in excess of 40 percent for residual injury, right ring finger, post-operative with paresthesias and weakness of the right hand and wrist is denied. REMAND Entitlement to disability rating in excess of 10 percent for talonavicular degenerative changes right foot is remanded. FINDINGS OF FACT 1. For the period prior to May 23, 2016, the Veteran's back disability has not resulted in forward flexion of the thoracolumbar spine 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. For the period from May 23, 2016, the Veteran's back disability has not resulted in unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. 3. The Veteran's right knee limitation of motion has been manifested with flexion limited to no worse than 45 degrees, with painful motion, and full extension without pain. 4. The evidence persuasively favors finding that the Veteran's disability has not resulted in more than moderate incomplete paralysis in his dominant right upper extremity. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for middorsal spine strain with degenerative disc disease for the period prior to May 23, 2016 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321(a), 4.1, 4.3, 4.7, 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Diagnostic Codes (DC) 5242, 5243. 2. The criteria for entitlement to a disability rating in excess of 20 percent for middorsal spine strain with degenerative disc disease for the period from May 23, 2016 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321(a), 4.1, 4.3, 4.7, 4.71a, General Rating Formula for Diseases and Injuries of the Spine, DCs 5242, 5243. 3. The criteria for entitlement to disability rating in excess of 10 percent for talonavicular degenerative changes right foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5271. 4. The criteria for entitlement to a disability rating in excess of 40 percent for residual injury, right ring finger, post-operative with paresthesias and weakness of the right hand and wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.40, 4.71a, DC 8512. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from August 1993 to August 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from November 2014 and August 2016 rating decisions of a VA Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a July 2021 hearing before the Board of Veterans' Appeals (Board). In October 2021, the Board remanded the claims on appeal for additional development. These claims are now before the Board once again. Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. To evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). As in the instant case, separate ratings for distinct periods of time, based on the facts may be for consideration. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part or all the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59 (2019). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). 1. and 2. Entitlement to a disability rating in excess of 10 percent for middorsal spine strain with degenerative disc disease for the period prior to May 23, 2016 and in excess of 20 percent from May 23, 2016 onward The Veteran asserts that his back disability is more severe than is reflected by his current staged evaluations. At the outset, the Veteran's disorder is rated as 10 percent disabling prior to May 23, 2016 and 20 percent disabling thereafter under DC 5242. See August 2016 codesheet. The General Rating Formula DCs 5235-5243 provides for the rating of disabilities of the spine mostly based on limitation of motion. With or without symptoms such as pain (whether or not it radiates), stiffness, or aching around the spine affected by residuals of injury or disease, the relevant parts of the formula for the cervical spine are as follows: Under DC 5242, the minimum 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent of more of height. 38 C.F.R. § 4.71a, DC 5242. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine. Id. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. The maximum 100 percent rating is warranted for with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, unfavorable ankylosis of the entire spine. Id. Additionally, DC 5243 provides the Formula for Rating Intervertebral Disc Syndrome (IVDS). A 20 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. IVDS is evaluated either under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71a, DC 5243. Note (1) of 38 C.F.R. § 4.71a, DC 5243 states that an "incapacitating episode" is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. The Board notes, however, that no physician-prescribed bedrest has been shown in this case. Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. 38C.F.R. § 4.71a. When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3-2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. As the Veteran's claim was pending prior to February 7, 2021, the Board will consider entitlement under the prior regulations as well as the updated regulations from February 7, 2021 forward, applying the most favorable criteria for the Veteran. The changes effective February 7, 2021 under 38 C.F.R. § 4.71a, DC 5242 and 5243 were not to the rating schedule itself but added instruction to classify disabilities associated with IVDS under DC 5243 and all other intervertebral disc disabilities under 5242. As such, DC 5242 now reflects "Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)"; DC 5243 now reflects "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve route; assign diagnostic code 5242 for all other disc diagnoses." Thus, the changes do not impact the general rating formula and evaluation of the disability under the pre- and post-February 7, 2021 regulations is not required. Another change, the addition of DC 5244 for traumatic paralysis, is not applicable in this case because such has not been shown. In this case, the Veteran filed a claim for an increased rating for his back disability in October 2013. During the June 2014 VA examination for back conditions, the Veteran was negative for flare-ups. His initial range of motion (ROM) measurements were as follows: forward flexion to 90 degrees, extension to 30 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. Repetitive use testing was performed and did not result in increased functional loss. He was negative for radiculopathy, other neurologic abnormalities, and IVDS. During the April 2016 Decision Review Officer (DRO) hearing, the Veteran testified that his condition had worsened, and he sometimes experienced pain and cramping in his back. During the May 2016 VA examination for back conditions, the Veteran was negative for flare-ups. His initial range of motion (ROM) measurements were as follows: forward flexion to 60 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 20 degrees. Repetitive use testing was performed and did not result in increased functional loss. He was negative for radiculopathy, other neurologic abnormalities, and IVDS. During the July 2020 Board hearing, the Veteran testified that his back occasionally seized up and left him disabled. During the November 2021 VA examination for back conditions, the Veteran was negative for flare-ups. His initial range of motion (ROM) measurements were as follows: forward flexion to 80 degrees, extension to 20 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. Repetitive use testing was performed and did not result in increased functional loss. He was negative for radiculopathy, other neurologic abnormalities, and IVDS. The Veteran's VA and private treatment records reflect treatment for his back disability, but they are negative for evidence of symptoms consistent with higher or separate disability ratings. The Veteran has consistently asserted that his back disability is more severe than is reflected by his current staged evaluations. While the Veteran is competent to observe his back disability symptoms, he does not have the training or credentials to determine the current nature, extent, and severity of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluation concerning his back disability symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). For the period prior to May 23, 2016, the evidence of record persuasively favors finding that the Veteran's back disability did not result in forward flexion of the thoracolumbar spine 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The record is also negative for radiculopathy, other neurologic abnormalities, or ankylosis. Accordingly, for the period prior to May 26, 2016, the Veteran's claim for a disability rating in excess of 10 percent for his back disability is denied. There is also no basis for any separate evaluations for associated objective neurological abnormalities. For the period from May 23, 2016 onward, the evidence of record persuasively favors finding that the Veteran's back disability did not result in forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. The record is also negative for radiculopathy, other neurologic abnormalities, or ankylosis. Accordingly, for the period from May 26, 2016 onward, the Veteran's claim for a disability rating in excess of 20 percent for his back disability is denied. There is also no basis for any separate evaluations for associated objective neurological abnormalities. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable here. 38 U.S.C. § 5107(b). 3. Entitlement to a disability rating in excess of 10 percent for patellofemoral pain syndrome of the right knee The Veteran asserts that his right knee disability is more severe than is reflected by his current evaluation. His disability is rated as 10 percent disabling under DC 5260, for limitation of flexion of the leg. See August 2016 codesheet. The regulations pertaining to rating the musculoskeletal system including DCs 5000-5331 were amended, effective February 7, 2021. See 85 Fed. Reg. 76453, 76460 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, DCs 5000-5331). The amended rating criteria, if favorable to the Veteran's claim, can be applied only for periods from the effective date of the regulatory change. However, the old regulations will be considered for the periods both before and after the change was made. See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Knee disabilities may be rated under 38 C.F.R. § 4.71a, DC 5256 (for ankylosis), DC 5257 (for other impairment, including recurrent subluxation or lateral instability), DC 5258 (or dislocated semilunar cartilage), DC 5259 (for symptomatic removal of semilunar cartilage), DC 5260 (for limitation of flexion), DC 5261 (for limitation of flexion), DC 5262 (for impairment of the tibia and fibula), and DC 5263 (for genu recurvatum). 38 C.F.R. § 4.71a. The Board finds that DCs 5256, 5258, 5259, 5261, 5262, and 5263 are not applicable in this appeal, as the medical evidence does not establish that the Veteran experienced these symptoms at any point during the pendency of the appeal. 38 C.F.R. § 4.71a. Additionally, the evidence of record does not reflect complaints of or treatment for knee instability, so DC 5257 is not applicable in this appeal. Diagnostic Code 5003 (degenerative arthritis), states that degenerative 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. 38 C.F.R. § 4.71a, DC 5003. At the outset of this analysis, the Board notes the applicability of multiple DCs addressing limited range of motion (ROM) have been considered in order to maximize the Veteran's disability rating. Additionally, the Board has considered both the old and new criteria for DCs 5260 and 5261. Following a thorough review of the criteria, the Board notes that these two rating criteria were not changed. Under DC 5260 (for limitation of flexion), a 10 percent rating is warranted when flexion of the leg limited to 45 degrees, a 20 percent rating is warranted when flexion is limited to 30 degrees, and a maximum 30 percent rating is warranted when flexion is limited to 15 degrees. Under DC 5261 (for limitation of extension), a 10 percent rating is warranted when extension is limited at 10 degrees, a 20 percent rating is warranted when extension is limited at 15 degrees, a 30 percent rating is warranted when extension is limited to 20 degrees, a 40 percent rating is warranted when extension is limited to 30 degrees, and a maximum 50 percent rating is warranted when extension is limited to 45 degrees. Flexion of the knee to 140 degrees is considered full; extension to 0 degrees is considered full. Plate II. 38 C.F.R. § 4.71a. Separate ratings may be assigned where a knee disability includes both compensable limitation of flexion under DC 5260 and compensable limitation of extension under DC 5261, provided that the degree of disability is compensable under each set of criteria. VAOPGCPREC 09-04; 69 Fed. Reg. 59990 (2004). In this case, during the Veteran's October 2002 VA examination, the Veteran's right knee flexion was to 120 degrees, and he had full extension. There was no joint instability. In October 2013, the Veteran filed a claim for an increased rating for his right knee disability. During the Veteran's August 2014 VA examination for knee conditions, the Veteran reported flare-ups of his condition that resulted in pain and guarding during climbing and descending stairs. The Veteran had full ROM in flexion and extension, but flexion was painful and resulted in less movement than normal. Repetitive use testing did not result in additional functional loss. There was no evidence of joint instability and muscle strength was 5/5 for flexion and extension. There was no history of meniscal conditions or joint replacement. He did not make use of assistive devices. During his April 2016 DRO Hearing, the Veteran testified that his knee would swell occasionally. During the Veteran's May 2016 VA examination for knee conditions, the Veteran did not report flare-ups of his condition. Flexion and extension were from zero to 85 degrees. Repetitive use testing did not result in additional functional loss. There was no evidence of joint instability and muscle strength was 5/5 for flexion and extension. No swelling was reported. There was no history of meniscal conditions, ankylosis, or joint replacement. He made occasional use of a cane. During the Veteran's July 2021 Board hearing, the Veteran testified that his right knee experienced swelling occasionally, and he frequently took anti-inflammatory medication for his condition. During the Veteran's November 2021 VA examination for knee and lower leg conditions, the examiner noted diagnoses for PFS and degenerative arthritis, other than post-traumatic, with diagnoses dating to August 1997. He did not report flare-ups of his condition. Flexion and extension were from zero to 130 degrees for active and passive motion, but there was pain during passive and active flexion. Repetitive use testing did not result in additional functional loss. There was no evidence of joint instability and muscle strength was 5/5 for flexion and extension. No swelling was reported. There was no history of meniscal conditions, ankylosis, or joint replacement. He made occasional use of a brace on his right knee, but he did not require a prescription for the device. The Veteran's VA and private treatment records reflect ongoing treatment for his right knee condition; however, they are negative for symptoms consistent with higher or separate disability ratings. While the Veteran is competent to observe his right knee symptoms, he does not have the training or credentials to determine the current nature, extent, and severity of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluation concerning his right knee symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds the evidence of record persuasively favors finding that the Veteran's right knee has not resulted in limitation of flexion to 30 degrees or less. The VA examinations and medical evidence of record indicate that the Veteran's right knee flexion has been greater than 60 degrees, which is commensurate with a zero percent rating under DC 5260; however, his right knee flexion has also consistently been painful. Therefore, under 38 C.F.R. § 4.59, the Veteran is entitled to a minimum rating of at least 10 percent. Based on these facts, the evidence of record persuasively favors finding that the criteria for a 20 percent or higher disability have not been met. Finally, a knee disability may receive separate ratings based on symptoms related to arthritis, instability, flexion, and extension. Where a Veteran has degenerative joint disease which is evaluated under DC 5003, a separate, compensable evaluation may be assigned under Diagnostic Code 5257 or 5258 if there are concomitant symptoms, such as knee instability or subluxation. See VAOPGCPREC 23-97. When a veteran has a knee disability evaluated under DC 5257, to warrant a separate rating for arthritis based on x-ray findings, the limitation of motion need not be compensable under DC 5260 or DC 5261; rather, such limited motion must at least meet the criteria for a zero-percent rating. See VAOPGCPREC 9-98. Also, a veteran may receive a rating for limitation of flexion only, limitation of extension only, or separate ratings for limitations of both flexion and extension under DCs 5260 and 5261. See VAOPGCPREC 9-2004. "[E]valuation of a knee disability under [Diagnostic Codes] 5257 or 5261 or both does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under [Diagnostic Codes] 5258 or 5259, and vice versa." Lyles v. Shulkin, 29 Vet. App. 107, 109 (2017). In this case, the Veteran does have a diagnosis for degenerative arthritis of the right knee; however, he has already received a rating for limitation of flexion, there is no evidence of meniscal conditions, no evidence or complaints of knee instability, and no evidence that the Veteran's extension has been limited to zero degrees or greater. Based on these facts, no separate evaluations are warranted. Accordingly, the claim for a disability rating in excess of 10 percent for the Veteran's right knee disability is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable here. 38 U.S.C. § 5107(b). 4. Entitlement to a disability rating in excess of 40 percent for residual injury, right ring finger, post-operative with paresthesias and weakness of the right hand and wrist The Veteran asserts that his ring finger disability is more severe than is reflected by his current evaluation. The Veteran is right-hand dominant. See November 2021 VA examination for hand and finger conditions. The disability is rated as 40 percent disabling under DC 8512. See August 2016 codesheet. 38 C.F.R. § 4.124a, DC 8512 provides that mild incomplete paralysis is rated at 20 percent disabling on the major and minor side. Moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis is rated 70 percent disabling on the major side and 60 percent on the minor side. Id. The words "slight," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. In this case, during the Veteran's July 1999 VA examination, the Veteran reported that he experienced chronic pain, numbness, and tingling in his right ring finger and hand due to an in-service injury. In May 1999, he underwent an operation to attempt the correct the problem; however, his post-operative symptoms were the same. He also experienced weakness in the affected hand and limitation of range of motion due to his disability. In October 2013, the Veteran filed a claim for an increased rating for his right knee, right ankle, back, and right hand and wrist. During the Veteran's June 2014 VA examination for hand and finger conditions, he was positive for ankylosis and limitation of range of motion in the ring finger. In an accompanying VA examination for wrist conditions, the VA examiner noted that the Veteran was positive for right wrist paresthesias and weakness. The examiner found he had limited motion of the ring finger, with painful motion beginning at a gap of less than 1 inch (2.5 cm) between the ring fingertip and the proximal transverse crease of the palm. There were no additional limitations on repetitive use. Hand grip was 4/5 on the right. There was ankylosis of the ring finger at the proximal interphalangeal joint flexed to 30 degrees. There was a gap of two inches (5.1) cm or less between the fingertip and the proximal transverse crease of the palm with the finger flexed to the extent possible. He reported occasional use of a brace on the right hand off and on. He had palmar flexion of the wrist to 75 degrees (80 degrees is normal), dorsiflexion to 65 degrees (70 degrees is normal), radial deviation was normal to 20 degrees, and ulnar deviation was normal to 45 degrees. Motion was painful. Palmar flexion was reduced to 65 degrees on repetitive use. Wrist flexion and extension strength was reduced to 4/5. During the Veteran's August 2014 VA examination for peripheral nerve conditions, the examiner found he had mild numbness in the right upper extremity. His grip was 4/5. He had normal reflexes. There was no atrophy. He had decreased sensation of hand/fingers. The examiner found he had mild involvement of the median nerve. During the Veteran's April 2016 Decision Review Officer (DRO) hearing, the Veteran testified that his condition had worsened, and he sometimes lost the functional use of his right hand due to his condition. During the Veteran's May 2016 VA examination for hand and finger conditions, the VA examiner noted that the Veteran continued to experience paresthesias and weakness in the affected hand. He was right-handed. He had decreased sensation in the right hand/fingers. He had full reflexes. He did not have constant or intermittent pain, paresthesias and/or dysesthesias, or numbness. There was no atrophy. Muscle strength testing was all normal. He had mild involvement of the ulnar nerve. The examiner found this condition does not impact the ability to work. The examiner found the Veteran had decreased range of motion in the right ring finger at the proximal interphalangeal joint (PIP) with maximum extension to 20 degrees (0 degrees is normal), and at the dorsal proximal interphalangeal (PIP) joint with maximum flexion to 20 degrees (70 degrees is normal). During the May 2016 VA examination for peripheral nerve conditions, the Veteran reported decreased sensation in his right hand and fingers. Mild incomplete paralysis of the right ulnar nerve was noted. During the July 2021 Board hearing, the Veteran testified that his right ring finger condition had worsened. During the Veteran's November 2021 VA examination for wrist conditions, the VA examiner indicated that the Veteran reported his condition had stayed the same since its onset, and he did not report flare-ups. His range of motion (ROM) was normal for active and passive ROM testing and after repetitive use. He was negative for muscle atrophy and ankylosis. He did not use assistive devices. During the Veteran's November 2021 VA examination for hand and finger conditions, the VA examiner indicated that the Veteran reported his condition had stayed the same since its onset, and he did not report flare-ups. The 4th distal interphalangeal (DIP) joint was ankylosed. The remainder of the hand functioned with normal strength. Grip was slightly reduced due to lack of flexion in the DIP joint. No other impairments were noted. There was no weakness of the muscles in the hand or wrist and no nerve injury affecting the muscles of the hand or wrist. A superficial nerve injury of the palmar aspect of the right 4th and 5th fingers was noted. During the Veteran's November 2021 VA examination for peripheral nerve conditions, his right upper extremity nerves were all normal, and no incomplete or complete paralysis was found. The Veteran's VA and private treatment records reflect treatment for the Veteran's right ring finger and hand disability, but they are negative for evidence of severe incomplete or complete paralysis of the affected extremity or for other symptoms consistent with higher disability ratings. The Veteran has consistently asserted that his right ring finger and hand symptoms are more severe than is reflected by his current evaluation. While the Veteran is competent to observe his disability's symptoms, he does not have the training or credentials to determine the current nature, extent, and severity of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluation concerning his disability's symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board has also considered whether separate or higher ratings are warranted under alternative diagnostic codes. Under DC 5230, a noncompensable disability rating is assigned for any limitation of motion of the ring or little finger; no higher disability ratings are available for limitation of motion either of those fingers. 38 C.F.R. § 4.71a. Higher disability ratings are available under DCs 5216 through 5227 for disabilities of the finger where ankylosis of one or more digits is present, and higher disability ratings are also available under Codes 5228 and 5229 where limitation of motion of the thumb, index or long fingers is present. Furthermore, if there is limitation of motion of two or more digits, each digit shall be evaluated separately, and the evaluations then combined. 38 C.F.R. § 4.71a, DCs 5216-5230. The Board finds that the most pertinent evidence relating to this issue includes the Veteran's statements, his medical records, and the VA examination reports pertaining to his hand and fingers that are of record. At the outset, the Board notes that the evidence of record only reflects ankylosis in his right ring finger during the period on appeal; thus, the Veteran is not entitled to an increased evaluation under DC 5216-5227. DC 5227 contemplated ankylosis of the ring finger and only offers a zero percent (noncompensable) evaluation. Additionally, DCs 5228 and 5229 provide the schedular ratings for limitation of motion of the thumb, index and long fingers, and not the ring or little fingers, so the Veteran is not entitled to an increased evaluation under those Codes either. See id. DC 5215 pertains to limitation of motion of the wrists. Under this DC, limitation of motion of a wrist is to be assigned a 10 percent evaluation where dorsiflexion of the wrist is limited to less than 15 degrees or where palmar flexion of the wrist is limited in line with the forearm. Higher disability ratings are available under DC 5214 where there is ankylosis of a wrist. The evidence of record does not support granting higher or separate disability ratings under these diagnostic codes. Turning back to DC 8512, which the Veteran's disability is rated under, the Board finds that the evidence of record persuasively favors finding that the Veteran has not met the criteria for a disability rating in excess of 40 percent. The evidence of record generally indicates that the Veteran has experience mild to moderate incomplete paralysis in his dominant right hand. There is no evidence of severe incomplete or complete paralysis of the hand. The Board has considered the Veteran's lay statements and finds them competent and credible; however, they are outweighed by the VA examinations and medical evidence of record. Based on these facts, the Board finds the evidence persuasively favors finding that his disability symptoms are most consistent with mild to moderate incomplete paralysis. Accordingly, the claim for an increased rating for residual injury, right ring finger, post-operative with paresthesias and weakness of the right hand and wrist is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against claim, that doctrine is not applicable here. 38 U.S.C. § 5107(b). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Notably, the evidence and contentions of record do not suggest that the question of entitlement to a total disability rating based on individual unemployability due to a service-connected disability has been raised in this case. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran submitted a claim for TDIU in August 2002, prior to the period on appeal; however, this claim was denied in an October 2002 rating decision and was not appealed. April and June 2020 VA treatment records indicate the Veteran is employed as an immigration officer. Additionally, during his April 2016 DRO hearing, the Veteran stated that he worked as an Armed Security Officer. REASONS FOR REMAND 1. Entitlement to disability rating in excess of 10 percent for talonavicular degenerative changes right foot is remanded. The Veteran asserts that his service-connected right ankle disability, currently rated under DC 5271, is more severe than the current 10 percent rating reflects. See August 2016 codesheet. During the Veteran's July 2021 Board hearing, the Veteran testified that he experienced chronic pain in his right foot, with occasional swelling, and his condition had worsened over time. In its October 2021 remand, the Board requested a new VA examination for the Veteran's right ankle and instructed that the examination must contain full range of motion testing. During the Veteran's November 2021 VA examination for foot conditions, the VA examiner found he had no functional loss for the right lower extremity attributable to the disability; however, no range of motion testing was conducted or recorded. Accordingly, the Board finds that the RO did not substantially comply with the Board's October 2021 remand directives, and this issue must be remanded to fully comply with those directives. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following actions: Afford the Veteran a VA examinations by an appropriate clinician to ascertain the current severity of his right foot disability. The claims file must be reviewed by the examiner. The most up-to-date Disability Benefits Questionnaire must be employed. The examiner is specifically requested to consider the Veteran's Board hearing testimony. The examination must contain full range of motion testing, with commentary as to the significance of any functional loss and flare-ups, as well as notations of all symptoms reported by the Veteran or shown upon examination. All opinions must be supported by a complete rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Hicks, 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.