Citation Nr: 22012186 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 16-47 278 DATE: March 2, 2022 ORDER Entitlement to a compensable rating for service-connected right little finger distal interphalangeal (DIP) joint dislocation with deformity is denied. FINDING OF FACT The Veteran's right little finger disability manifested with pain and limitation of motion; however, a compensable rating cannot be assigned as a matter of law. CONCLUSION OF LAW The criteria for a compensable rating for the right little finger disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5230. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the U.S. Marine Corps from July 1996 to July 2000. This case comes before the Board on appeal of a January 2015 and July 2015 rating decision. In November 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ) via live video conference. A transcript of the proceeding has been associated with the record. This case was previously before the Board in October 2021, where the issue on appeal was remanded for further evidentiary development. Increased Rating Claim 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). Additionally, separate ratings for distinct periods of time, based on the facts may be for consideration. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board has reviewed all the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as deemed appropriate and the analysis will focus on what the evidence shows, or fails to show, as to the claims. 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to a compensable rating for service-connected right little finger distal interphalangeal (DIP) joint dislocation with deformity Here, the Veteran contends that he is entitled to a compensable rating for his service-connected right little finger disability. As a matter of law, a compensable rating is not warranted. In this instance, the Veteran's right little finger has been rated noncompensable under DC 5230. Under DC 5230, a zero percent rating is assigned for any limitation of motion of the ring or little finger. Under this diagnostic code, a higher rating cannot be assigned as a matter of law. In the October 2018 VA examination, the Veteran was shown to have right little finger DIP joint dislocation with deformity. Additionally, the Veteran was diagnosed with De Quervain's tendonitis of the right thumb. The Veteran reported that in May 2081, he started having pain in his wrist and hand, with mild weakness. He stated he could not recall what triggered it but stated he was a system administrator and had to type on a keyboard most of the time while at work. The Veteran continued that he had pain and decreased range of motion (ROM) in right wrist and thumb. Importantly, the Veteran did not report flare-ups of his service-connected right little finger. He stated that it was hard for him to push objects upward with right wrist or thumb. On examination, the Veteran's right little finger manifested with max extension of the metacarpophalangeal (MCP) joint to 10 degrees, proximal interphalangeal (PIP) joint extension to 40 degrees, and distal interphalangeal (DIP) joint extension to 10 degrees. Max flexion of the MCP joint was 75 degrees, PIP to 80 degrees, and DIP to 50 degrees. There was no evidence of a gap between the pad of the thumb and fingers. There was evidence of pain on finger flexion and opposition with thumb. There was no evidence of pain with use of the hand and no objective evidence of localized tenderness or pain on palpation. Based on the Veteran's report, the examiner indicated that the Veteran would be able to perform repeated use over time without additional limitation of motion. The examiner indicated that there was a gap between the finger and proximal transverse crease of the hand on maximal finger flexion. Index finger had a 5 cm gap and long finger had 3 cm gap. There were no additional factors contributing to the disability identified. The Veteran had active movement against some resistance on muscle strength testing which indicated slight reduction in muscle strength. There was no evidence of right hand ankylosis of right little finger ankylosis. The Veteran reported the regular use a wrist brace due to De Quervain's tendonitis of the right wrist. There was no evidence of arthritis. The examiner remarked that the Veteran would have difficulties with any occupation that required him to grip objects with his right hand or lift heavy objects. The examiner added that the right-hand exhibited pain on ROM with all fingers except the little finger. There was also objective evidence of pain in the right hand when used in non-weight bearing. Additionally, passive ROM was the same as active ROM. Lastly, the examiner explained that De Quervain's tendonitis is a disorder that affects the wrist and thumb. However, there was no known pathology to indicate that a dislocation of the little finger DIP joint would cause De Quervain's tendonitis. In the November 2021 VA examination, the Veteran's diagnosis of right little finger DIP joint dislocation was shown to be resolved. However, the Veteran had tendinopathy of the right little finger. The Veteran reported that he had pain in the right fifth digit during cold weather periods. He had wrist pain also. The Veteran reported flare-ups of his right little finger for a few days per week. Characterized as aching pain that lasted minutes to a couple of hours due to increased activity. The severity was indicated to be mild. The examiner added that there would be a minimal decline in ROM with the finger. The Veteran explained that when he typed his little finger bothered him more and made it hard to use at time when typing frequently. On examination, the Veteran's right little finger manifested with max extension of the metacarpophalangeal (MCP) joint to 0 degrees, proximal interphalangeal (PIP) joint extension to 0 degrees, and distal interphalangeal (DIP) joint extension to 0 degrees. Max flexion of the MCP joint was 80 degrees, PIP to 90 degrees, and DIP to 50 degrees. There was no evidence of a gap between the pad of the thumb and fingers. There was evidence of pain on finger flexion and opposition with thumb. There was evidence of mild pain in fifth digit. Passive ROM was the same active ROM. There was evidence of pain with weight-bearing and on passive and active motion but did not result in or cause functional loss. Based on the Veteran's report, the examiner indicated that the Veteran would be able to perform repeated use over time with a ten degree decrease in DIP flexion. However, the Veteran would suffer from pain. There was no gap between the finger and proximal transverse crease of the hand on maximal finger flexion. During flare-ups the examiner indicated the Veteran would have increased pain with a 10 degree decrease in DIP flexion. Additionally, during a flare-up there would be no gap between finger and transverse crease of the hand. There were no additional factors contributing to the disability identified. The Veteran had normal hand grip strength. There was no evidence of right hand ankylosis of right little finger ankylosis. The Veteran did not report the use a wrist brace. There was no evidence of arthritis. The examiner remarked that the Veteran would have slight decline in ability to perform tasks that required fine motor use of the right fifth digit. Based on the foregoing, the Veteran's right little finger disability does not warrant a compensable rating. As discussed above, any limitation of motion of the ring or little finger warrants a noncompensable rating. As a general matter, when painful motion is present, the minimum compensable rating for the joint should be assigned. However, in this case there is no level of disability that warrants a compensable rating under DC 5230. Sowers v. McDonald, 27 Vet. App. 472, 479-81 (2016). Therefore, a compensable rating for painful motion cannot be assigned in this case. See id.; 38 C.F.R. § 4.59. The Board notes right hand symptoms were reported by the Veteran, including painful motion and weakness. However, there is no evidence supportive of arthritis with x-ray evidence, right little finger ankylosis, as well as no evidence of total loss of use of the right little finger such that the Veteran would be equally served by amputation. DC 5277. In sum, the Board finds that a compensable rating is not warranted for the right little finger disability. Accordingly, as the more probative evidence is against the claim, the benefit of the doubt doctrine is not for application and the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Umo, 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.