Citation Nr: 22036014 Decision Date: 06/22/22 Archive Date: 06/22/22 DOCKET NO. 19-37 217 DATE: June 22, 2022 ORDER Entitlement to a disability rating in excess of 10 percent for right wrist sprain is denied. Entitlement to extension of the temporary 100 percent disability rating based on service-connected right wrist sprain surgery necessitating convalescence past July 1, 2016, is denied. FINDINGS OF FACT 1. Throughout the appeal period, there was no actual or functional ankylosis of the Veteran's right wrist. 2. After July 1, 2016, the Veteran did not have severe postoperative residuals or immobilization by cast of the right wrist. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for right wrist sprain are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5215. 2. The criteria for entitlement to extension of the temporary 100 percent disability rating based on service-connected right wrist sprain surgery necessitating convalescence past July 1, 2016, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.30. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2011 to November 2011 and April 2013 to March 2014. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision by a Department of Veterans Affairs (VA) regional office. In October 2020, the Veteran testified before the undersigned Veterans Law Judge; a transcript of the hearing is of record. The Veteran underwent VA examination in May and August 2015. Range of motion measurements yielded palmar flexion to 60 and 70 degrees respectively, dorsiflexion to 60 and 68 respectively, ulnar radial deviation to 45 and 35 degrees respectively, and radial deviation to 20 and 15 respectively. Each examiner noted pain upon examination but no ankylosis of the wrist. The record reflects the Veteran underwent three separate surgical operations on her right wrist, including arthroscopy in February 2016, repair and reconstruction in March 2016, and removal of implanted devices in May 2016. On September 8, 2016, the Veteran underwent private, post-surgery examination. The clinician noted the scar healed nicely with no signs of infection. Range of motion measurements yielded extension and flexion to 45 degrees, radial deviation to 10 degrees, and ulnar deviation to 25 degrees. The Veteran had full digital motion including full active extension and flexion to a complete fist without difficulty or discomfort. On the same date, the clinician wrote a letter stating that the Veteran was seen in the office, had previously had ligament reconstruction, and, as a result, has severe ankylosis of the right wrist, limiting her motion and weight bearing. On September 15, 2016, the Veteran underwent a VA examination. The examiner diagnosed a right wrist strain status post ligament reconstruction with residuals. Range of motion measurements were palmar flexion to 60 degrees, dorsiflexion to 50 degrees, ulnar deviation to 35 degrees, and radial deviation to 15 degrees, with pain not resulting in functional loss noted upon movement during the first three measurements. The examiner noted localized tenderness of the joint and reduction in muscle strength but no ankylosis. A July 2019 VA examination yielded range of motion measurements of palmar flexion to 25 degrees, dorsiflexion to 40 degrees, ulnar deviation to 40 degrees, and radial deviation to 10 degrees with pain exhibited with each measurement. The examiner noted pain with weight bearing and evidence of crepitus, but no additional loss of function or range of motion after three repetitions. The examiner was able to describe the Veteran's pain that limited functional ability with repeated use over a period of time and during flare ups in terms of range of motion as palmar flexion to 25 degrees, dorsiflexion and ulnar deviation to 40 degrees, and radial deviation to 10 degrees. The examiner also noted no ankylosis. During October 2020 hearing testimony, the Veteran noted currently having pain, loss of strength and grip, and ankylosis due to her right wrist disability. The Veteran underwent VA examination in January 2022. The Veteran stated that it was still hard to write, brush her teeth, and hold her 18 month old baby. She also noted that she has to type at work and it now takes her a lot longer. Range of motion measurements yielded palmar flexion to 50 degrees, dorsiflexion to 40 degrees, ulnar deviation to 20 degrees and radial deviation to 10 degrees with pain exhibited during each measurement. The examiner noted pain on weight-bearing, and active and passive motion but not resulting in or causing functional loss. There was moderate localized tenderness or pain on palpation of the right wrist dorsum related to post ligament repair. Estimated range of motion after repeated use over time was palmar flexion to 45 degrees, dorsiflexion to 35 degrees, ulnar deviation to 15 degrees, and radial deviation to 10 degrees. The examiner opined no significant limits of functional ability with flare ups. The examiner noted the right wrist had less movement than normal and weakened movement due to pain but no muscle atrophy or ankylosis. Increased Rating The Veteran contends her condition is worse than the current rating reflects due to limitations her right wrist disability imposes on her life. The Veteran is right hand dominant. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. The Veteran's right wrist sprain is currently rated as 10 percent disabling under DC 5215 based on painful motion of the wrist. C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. DC 5215 provides for a rating of 10 percent, the minimum rating, for limitation of motion of the wrist for either the dominant or non-dominant hand when dorsiflexion is less than 15 degrees or when palmar flexion is limited in line with the forearm. 38 C.F.R. § 4.71a. To warrant a higher rating, the right wrist must be ankylosed. 38 C.F.R. § 4.71a, DC 5214. The criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis. Chavis v. McDonough, 34 Vet. App. 1, 19 (2021). Therefore, ankylosis can be shown via functional loss consistent with that contemplated by ankylosis. Id. 38 C.F.R. §§ 4.40, 4.45. The Board finds a rating in excess of 10 percent is not warranted. Except for the time periods corresponding to her surgical procedures and convalescence, there is no probative and credible medical evidence the Veteran's right wrist disability has resulted in ankylosis or functional ankylosis. During these convalescence periods, the disability has been appropriately compensated, and that claim will be discussed below. A higher rating under Diagnostic Code 5215 cannot be assigned even with further limitation of motion and functional loss. Also, a higher rating is not warranted under another diagnostic code. Diagnostic codes evaluating limitation of motion or ankylosis of the digits are not appropriate, as the medical record does not document any of these conditions. Rather, the evidence shows findings consistent with the assigned disability rating. The Board acknowledges the private clinician's September 8, 2016, letter stating the Veteran had severe ankylosis of right wrist. However, in clinical notes from an examination on the same day, the clinician reported the Veteran was doing well following surgery with right wrist range of motion measurements of 45 degrees in extension and flexion. The clinician further noted the Veteran had full digital range of motion including full active extension and flexion to complete a fist without difficulty or discomfort. She had discontinued use of the splint and denied pain in the right wrist although stiffness remained. The Board finds this letter is not credible evidence of ankylosis of the Veteran's right wrist as it is inconsistent with the results of the physical examination done on the same day. Likewise, a VA examination a week later showed no evidence of ankylosis. Therefore, the letter is of little probative value. In reaching its determination, the Board has considered the Veteran's complaints of functional loss of her right wrist. In this case, the lay reports of loss of strength, difficulty with grip, and similar symptoms cannot establish entitlement to a higher rating. The Veteran also testified that she suffered from ankylosis of her right wrist. Whether this testimony echoes the clinician's letter mentioned above or was her personal observation, the Veteran lacks training and credentials in medicine, and her lay opinion is thus of minimal probative value, particularly compared to the detailed VA examination opinions described above. Jandreau v. Nicholson, 492 F.3d 1372, 1375 (Fed. Cir. 2007). The limitations the Veteran's right wrist disability imposes on her life are contemplated by the assigned 10 percent disability rating. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Entitlement to a disability rating in excess of 10 percent for right wrist sprain is not warranted, and the claim is denied. The Board notes that this case raises no other issues, particularly as the Veteran confirmed during her January 2022 VA examination that she was currently employed. Extension of the Temporary Evaluation of 100 percent Based on Surgical Convalescence Under 38 C.F.R. § 4.30, a total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge or outpatient release that entitlement is warranted under paragraph (a)(1), (2), or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. Under subsection (a)(1), a total rating will be assigned if treatment of a service-connected disability resulted in surgery necessitating at least one month of convalescence. The United States Court of Appeals for Veterans Claims has defined convalescence as "the stage of recovery following a surgical operation" and recovery as the "act of regaining or returning toward a normal or healthy state." See Feldon v. West, 11 Vet. App. 427, 430 (1998). The Veteran contends that her right wrist temporary evaluation of 100 percent based on surgical convalescence should be extended to January 1, 2017. As noted above, the record reflects that the Veteran underwent three separate surgical operations on her right wrist in March, April, and May 2016. The Veteran was assigned a temporary evaluation of 100 percent from March 22, 2016 until July 1, 2016. The Veteran underwent post-surgical examination with a private clinician in July 2016. The clinician noted that the Veteran was doing well, and the surgery scar healed nicely with no signs of infection. She had discontinued use of the postoperative splint. The fingers were well-vascularized, and right wrist range of motion was extension to 50 degrees, flexion to 45 degrees, radial deviation to 10 degrees, and ulnar deviation to 30 degrees. The Veteran had full digital motion, including full active extension and flexion to complete a fist without difficulty or discomfort. She denied pain but noted stiffness. An August 2016 post-surgical examination noted similar results with right wrist range of motion to 45 degrees in extension and flexion, radial deviation to 10 degrees, and ulnar deviation to 25 degrees. The Veteran noted right wrist pain with work. Competent medical evidence of record demonstrates that by July 2016, the Veteran did not have severe postoperative residuals or immobilization by cast to warrant an extension of the temporary total rating. Rather, the evidence shows the surgical scar was in the healing process with no signs of infection, and the Veteran had enough range of motion in her right wrist to return to work. The Board acknowledges the private clinician's September 2016 letter stating that the Veteran would be able to return to work on January 2, 2017. However, the clinician gives no medical reason why the Veteran would need that extended period of convalescence following her right wrist surgeries. Likewise, this extended period of time conflicts with the clinical notes showing no severe postoperative residuals. Therefore, the letter is of little probative value. The Veteran's contentions regarding her degree of impairment following the surgical procedures have also been considered by the Board. While the Veteran is competent to report such observable symptomatology, she lacks training and credentials in medicine, and her lay opinion is thus of minimal probative value, particularly compared to the clinical observations described above. Jandreau v. Nicholson, supra. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Entitlement to extension of the temporary 100 percent disability rating based on service-connected right wrist sprain surgery necessitating convalescence past July 1, 2016, is not warranted, and the claim is denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C.L. Hamilton, 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.