Citation Nr: 22012384 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 17-01 993 DATE: March 3, 2022 ORDER Entitlement to a rating in excess of 20 percent prior to November 10, 2021, and in excess of 30 percent thereafter for left carpal tunnel syndrome is denied. FINDINGS OF FACT 1. Prior to November 10, 2021, the Veteran's left carpal tunnel syndrome has been manifested by moderate incomplete paralysis; severe incomplete paralysis has not been shown. 2. Since November 10, 2021, the Veteran's left carpal tunnel syndrome has not manifested in complete paralysis or severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 20 percent prior to November 10, 2021 for left carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8515. 2. The criteria for entitlement to a disability rating in excess of 30 percent from November 10, 2021 for left carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8515. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 1993 to September 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to a rating in excess of 20 percent prior to November 10, 2021, and in excess of 30 percent thereafter for left carpal tunnel syndrome The Veteran contends that he is entitled to a higher disability rating for his service-connected left carpal tunnel syndrome. In a November 2009 statement, the Veteran stated that he experienced constant pain in the left wrist and hand and that he experienced numbness on the top of his and in his fingers. He also reported loss of strength and inability to grip for extended periods. In March 2014, he reported that the pain is so bad that even the slightest touch is unbearable. The condition was assigned an initial rating of 20 percent disabling, effective December 26, 2012. From November 10, 2021, the condition has been assigned a rating of 30 percent disabling. The Veteran's left carpal tunnel syndrome is currently rated under DC 8515, paralysis of the median nerve. See 38 C.F.R. § 4.124a. The Veteran is right-handed, so left carpal tunnel syndrome is his minor extremity. Under DC 8515, a 10 percent rating is warranted for mild incomplete paralysis in the minor extremity. For moderate incomplete paralysis in the minor extremity a 20 percent rating is warranted. For severe incomplete paralysis of the minor extremity a 40 percent rating is warranted. A 60 percent rating is warranted for complete paralysis of the minor extremity. Indications of complete paralysis include: the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and, pain with trophic disturbances. 38 C.F.R. § 4.124a, DC 8515. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture 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 is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). In May 2015, the Veteran underwent a VA peripheral nerves condition examination in which he was diagnosed with left carpal tunnel syndrome. See May 2015 C&P Examination, p. 11. The Veteran's right hand was noted as dominant. The Veteran reported severe constant pain and paresthesias and/or dysesthesias of the left upper extremity. Left wrist flexion, extension, grip, and pinch were rated as 4 out of 5. The examiner noted that the Veteran did not have muscle atrophy or trophic changes. Gait was normal. The examiner also noted decreased sensation for light touch of the left hand and fingers. As to functional impact, the examiner noted that the Veteran would have difficulty performing physical labor that required repetitive movement of the wrist such as commercial painting, mechanical work, or plumbing. The examiner further noted that he could perform sedentary work such as supervision or consulting. The examiner concluded that the Veteran experienced mild incomplete paralysis of the radial and median nerves. In November 2021, the Veteran underwent another VA peripheral nerves conditions examination and was diagnosed with left carpal tunnel syndrome and mild incomplete paralysis of the left radial nerve. The Veteran's right hand was noted as dominant. The examiner noted moderate constant and intermittent pain and moderate paresthesias and/or dysesthesias of the left upper extremity. The examiner also found moderate numbness of the left upper extremity. Left wrist extension, flexion, grip, and pinch were rated as 3 out of 5. The examiner noted that the Veteran did not have muscle atrophy or trophic changes. Gait was normal. The examiner also noted absent sensation for light touch of the left hand and fingers. As to functional impact, the examiner noted that the Veteran cannot exercise on the left side and that he has sharp pain when picking up objects. Further, he often drops things due to weakness and pain and is unable to lift more than 10 pounds with the left wrist. He also reported an altered sleep pattern due to pain and that increased pain results in difficulty tying shoes, zipping coats, and buttoning clothing. He has increased pain and difficulty with driving and typically only uses his right hand while driving. He is unable to mow the lawn using a riding mower due to pain and limited range of motion. He is also unable to garden, change a tire, or perform other various tasks. The examiner concluded that the Veteran experienced mild incomplete paralysis of the radial nerve and moderate incomplete paralysis of the median nerve. The Board finds both the May 2015 and November 2021 VA examinations to be thorough and adequately address the Veteran's statements regarding the symptomatology of his left carpal tunnel syndrome. Accordingly, the Board assigns significant probative value to both examinations as to the severity of the condition. Specifically, the Board notes that both examiners opined as to the severity of the Veteran's incomplete paralysis of the left hand and that both examiners elicited significant detail from the Veteran regarding the condition. As outlined above under DC 8515, in order for the Veteran to obtain an increased disability rating throughout the entire appeal period, the evidence would have to reflect that he experienced either complete paralysis of the left hand or severe incomplete paralysis of the left hand. Unfortunately, the evidence of record does not support such a finding. While the Veteran has discussed his symptoms of his left carpal tunnel syndrome in significant detail, the Board affords significant weight to the examiner's conclusions regarding severity of incomplete paralysis, as both examiners performed in-person examinations to assess the severity of the condition. Accordingly, the Board finds that an increased rating for the Veteran's left carpal tunnel syndrome is not warranted at any time during the period on appeal. SONJA S. AN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Watkins, 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.