Citation Nr: 22014980 Decision Date: 03/15/22 Archive Date: 03/15/22 DOCKET NO. 16-34 573 DATE: March 15, 2022 ORDER Entitlement to an initial rating in excess of 10 percent for degenerative joint disease, right wrist is denied. Entitlement to a rating of 40 percent for degenerative joint disease, right wrist from January 20, 2020 is granted. Entitlement to a rating in excess of 40 percent for degenerative joint disease, right wrist is denied. FINDINGS OF FACT 1. Prior to January 20, 2020, degenerative joint disease, right wrist was manifested by pain and weakness. There was no ankylosis. 2. From January 20, 2020, the Veteran's right wrist has been ankylosed in a 0 degree position. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for degenerative joint disease, right wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5215-5003. 2. The criteria for a rating of 40 percent for degenerative joint disease, right wrist from January 20, 2020 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5214. 3. The criteria for a rating in excess of 40 percent for degenerative joint disease, right wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5214. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1972 to October 1977 and from December 1997 to March 2013. 1. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease, right wrist The Veteran's wrist disability was initially rated under hyphenated Diagnostic Code 5215-5003. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. DC 5003 provides ratings for degenerative arthritis. Degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. DC 5003 provides that when limitation of motion due to arthritis is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. In the absence of limitation of motion, DC 5003 provides for a 10 percent rating with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A 20 percent rating under DC 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. In Notes (1) and (2) in DC 5003, it is indicated these 20 and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a, DC 5003. In application of DC 5003, "painful motion of a major joint... caused by degenerative arthritis, where the arthritis is established by X-ray, is deemed to be limited motion and entitled to a minimum 10-percent rating, per joint, combined under Diagnostic Code 5003, even though there is no actual limitation of motion." See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). Diagnostic Code 5215 sets forth the criteria for limitation of motion of the wrist. Under Diagnostic Code 5215, a maximum 10 percent evaluation is warranted for either the major or minor extremity if dorsiflexion is less than 15 degrees or palmar flexion is limited in line with the forearm. 38 C.F.R. § 4.71a, Diagnostic Code 5215. In order to warrant a rating in excess of 10 percent, ankylosis of the wrist must be shown. Specifically, Diagnostic Code 5214 provides that where there is ankylosis of the wrist that is favorable in 20 degrees to 30 degrees of dorsiflexion, a 30 percent rating for the major extremity and a 20 percent rating for the minor extremity is warranted. Where there is ankylosis of the wrist in any other position, except favorable, a 40 percent rating for the major extremity and a 30 percent rating for the minor extremity is warranted. Where there is ankylosis of the wrist that is unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation, a 50 percent rating for the major extremity and a 40 percent rating for the minor extremity is warranted. Medical records show the Veteran was treated for wrist pain and diagnosed with degenerative joint disease of the right wrist in 2012. The Veteran received VA examinations for his in December 2013 and November 2019. At the December 2013 examination he reported wrist pain. Upon examination he exhibited dorsiflexion to 70 degrees after repetitive testing. There was no ankylosis. At the November 2019 VA examination, the Veteran reported constant pain in his wrist, for which he sometimes wore a brace. He denied flare-ups. Upon examination he exhibited dorsiflexion to 70 degrees. There was no additional loss of range of motion after repetitive testing. Muscle strength testing was 4/5 for both flexion and extension. There was no muscle atrophy and no ankylosis. Therefore, based on the foregoing, the Board finds that a rating greater than 10 percent is not warranted for the Veteran's right wrist degenerative joint disease. This is the maximum rating available under DC 5215. A higher rating under DC 5214 is not warranted as the Veteran did not have ankylosis of the right wrist during this period. Additionally, a 20 percent rating is not warranted under DC 5003 for X-ray findings of arthritis as the Veteran's right wrist disability does not involve multiple joints with occasional incapacitating exacerbations. In sum, the Board finds that an initial rating in excess of 10 percent is not warranted. The evidence persuasively weighs against the assignment of a higher or separate rating. Therefore, the benefit of the doubt doctrine is not applicable in such regard, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to a rating of 40 percent for degenerative joint disease, right wrist from January 20, 2020 Medical treatment records show that the Veteran underwent surgery to fuse his right wrist on January 20, 2020. At a July 2021 VA examination, the examiner indicated that the Veteran's right wrist was ankylosed after his fusion surgery. The wrist ankylosis was noted to be in "any other position except favorable." The examiner clarified that the wrist was surgically fused in the 0 degree position. It is clear from the evidence that the Veteran's right wrist condition did not change on the day of the examination. Rather, it was stable from the date of the surgery. Therefore, a rating of 40 percent is warranted from the date of the Veteran's right wrist fusion surgery, January 20, 2020. 3. Entitlement to a rating in excess of 40 percent for degenerative joint disease, right wrist As noted above, a rating in excess of 40 percent is not warranted under DC 5214 unless there is unfavorable ankylosis of the wrist. Unfavorable ankylosis is with any degree of palmar flexion, or ulnar or radial deviation. The July 2021 VA examiner indicated that the Veteran's ankylosis was in the 0 degree position, which does not involve either palmar flexion or ulnar or radial deviation. Therefore, a rating in excess of 40 percent for the Veteran's right wrist degenerative joint disease is not warranted. The evidence persuasively weighs against the assignment of a higher or separate rating. Therefore, the benefit of the doubt doctrine is not applicable in such regard, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Christopher Seppanen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Creegan, Amanda 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.