Citation Nr: 25005487 Decision Date: 04/23/25 Archive Date: 04/23/25 DOCKET NO. 16-59 075 DATE: April 23, 2025 SUPPLEMENTAL ORDER From April 21, 2015, a 10 percent disability rating for limitation of motion, right thumb, is granted. FINDING OF FACT From April 21, 2015, limitation of motion of the right thumb is manifested by a gap of one to two inches, but not more, between the thumb pad and the fingers, with the thumb attempting to oppose the finger. CONCLUSION OF LAW From April 21, 2015, the criteria for a 10 percent disability rating for limitation of motion of the right thumb have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5228. REASONS AND BASES FOR FINDING AND CONCLUSION This matter came to the Board of Veterans' Appeals (Board) from an October 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which granted a 40 percent disability rating for amputation, ring and little fingers, with degenerative arthritis of the right hand, effective April 21, 2015. The Veteran testified at a Board hearing in November 2020; the transcript is of record. This matter was remanded in October 2021. In a March 11, 2022 decision, the Board denied entitlement to a disability rating in excess of 40 percent for amputation, ring and little fingers, with degenerative arthritis of the right hand; granted a 10 percent disability rating for limitation of motion of the long finger, effective April 21, 2015; granted a noncompensable disability rating for limitation of the index finger, effective April 21, 2015 to November 28, 2021; and granted a 10 percent disability rating for limitation of motion of the index finger, effective November 29, 2021. In December 2022, the Veteran filed a Motion for Reconsideration with the Board's March 2022 decision with regard to the Board's denial of a separate compensable rating for limitation of motion of the right thumb. Increased Rating Service connection is in effect for amputation ring and little fingers with degenerative arthritis of the right (major) hand, rated 40 percent disabling, effective July 28, 1970, pursuant to 38 C.F.R. § 4.71A, Diagnostic Code 5003 (degenerative arthritis) and Diagnostic Code 5151 (amputation of ring and little digits). A separate 0 percent rating is in effect for a surgical scar of the right hand, from July 28, 1970. Per the March 2022 Board decision, a separate 10 percent disability rating for limitation of motion of the long finger, effective April 21, 2015, was granted per 38 C.F.R. § 4.71A, Diagnostic Code 5229; and a separate disability rating for limitation of the index finger, 0 percent effective April 21, 2015 to November 28, 2021, and 10 percent effective November 29, 2021, was granted per 38 C.F.R. § 4.71A, Diagnostic Code 5229; the ratings were effectuated in a March 2022 rating decision. By way of history, it is noted that during service the Veteran had a traumatic amputation of the ring (4th digit) finger at the proximal PIP joint on the right hand and thereafter had a transplant of his right little finger onto the amputation site of the ring finger. His little (5th digit) finger was amputated and transplanted medially to fill space left by removal of ring finger (4th digit) and attached to the 4th metacarpal. The little finger (5th digit) angulates laterally approximately 10 degrees. Limitation of motion of the thumb is evaluated as zero percent disabling with a gap of less than one inch (2.5 cm.) between the thumb pad and the fingers, with the thumb attempting to opposed the fingers; 10 percent disabling with a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers; and 20 percent disabling with a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. 38 C.F.R. § 4.71a, Diagnostic Code 5228. At the Board hearing, the Veteran testified that he suffers from "constant pains in my finger joints, painful stiffness, painful flareups, painful locking of my thumb and index finger, tenderness of the metacarpal joint of the third digit as transpositioned of the fifth digit, meaning that's --the fifth digit was placed on that amputated right ring finger and metacarpal bone --including painful motions when the fingers are extended and flexed, more so when grabbing items over a period of time." 11/23/2020 Hearing Transcript at 4. He also testified to experiencing flare-ups associated with his disability. The Board has determined that a separate 10 percent rating is warranted for limitation of motion of the thumb per 38 C.F.R. § 4.71A, Diagnostic Code 5228. Specifically, the October 2015 C&P examination report reflects there is a gap between the pad of the thumb and fingers with a gap measurement of 2.5 centimeters. The November 2021 C&P examination report reflects the Veteran's report that fingers lock thumb and index finger, and occasional sharp shooting pains in thumb and index finger. His right thumb flexion endpoint was 70 degrees, and the right thumb IP was 60 degrees with no gap between the pad of the thumb and fingers. His digit exhibited pain. There was no ankylosis. In light of the objective findings contained in the October 2015 examination report, a 10 percent disability rating is warranted for a gap of one to two inches (2.5 cm) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. While the November 2021 examination does not reflect objective findings of a gap, in light of the subjective complaints of thumb locking and pain, the 10 percent rating will remain in effect. A disability rating of 20 percent is not warranted as a gap of more than two inches between the thumb pad and fingers is not shown. Also, as detailed ankylosis of the thumb is not present. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The 10 percent disability rating in effect contemplates his pain and functional limitations associated with the thumb, and as detailed the 10 percent disability rating remained in effect in light of his subjective complaints of pain and locking. The disability is not shown to involve any other factors warranting evaluation of the disability under any other provisions of VA's rating schedule. Thus, there is no further diagnostic criteria which could provide the basis for a higher rating. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kreindler, Marcy W. 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.