Citation Nr: 25011981 Decision Date: 09/23/25 Archive Date: 09/23/25 DOCKET NO. 17-36 853 DATE: September 23, 2025 ORDER Entitlement to an initial compensable rating for residuals of left little finger open reduction and internal fixation with traumatic arthritis is denied. A separate 10 percent, but no higher, rating for left little finger disability based on interference with overall function of the left hand, is granted, subject to the regulations governing the payment of monetary awards. Entitlement to an initial compensable rating for surgical scar, left little finger open reduction and internal fixation with traumatic arthritis is denied. REMANDED Entitlement to a compensable rating for scar, bottom of left foot, residuals of gunshot wound is remanded. Entitlement to a total disability rating due to individual unemployability due to service-connected disabilities (TDIU) is remanded. ? FINDINGS OF FACT 1. Throughout the appeal period, there has been no amputation of all or part of the left little finger and the Veteran's left little finger disability has resulted in symptoms most nearly approximating ankylosis of the joint. 2. Throughout the appeal period, the Veteran's left little finger disability has resulted in symptoms most nearly approximating ankylosis of the joint of the left little finger, which has interfered with the overall function of the hand, including his grip ability and grip strength. 3. The Veteran's surgical scar, left little finger open reduction and internal fixation with traumatic arthritis is not painful, measures 3 cm x 1 cm, has no underlying soft tissue damage, and is not tender or unstable. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for residuals of left little finger open reduction and internal fixation with traumatic arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5010-5227. 2. The criteria for a separate 10 percent, but no higher, rating for left little finger disability based on interference with overall function of the left hand have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.59, 4.71a, 4.73, Diagnostic Codes 5227, 5309. 3. The criteria for a compensable rating for surgical scar, left little finger open reduction and internal fixation with traumatic arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(a), 4.1, 4.2, 4.7, 4.118, Diagnostic Code 7802. ? REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1962 to March 1985. This matter is before the Board of Veterans' Appeals (Board) on appeal from March 2013 and June 2013 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, a hearing was held before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in March 2022, February 2023, and April 2025 when it was remanded for further development. Increased Rating In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). 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. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Although all the evidence of record has been thoroughly reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The analysis in this decision focuses on what the evidence shows or fails to show with respect to the matters decided herein. The Veteran should not assume that pieces of evidence not explicitly discussed herein have been overlooked. See Allday v. Brown, 7 Vet. App. 517, 527 (1995). Residuals of left little finger open reduction and internal fixation with traumatic arthritis The Veteran's service-connected residuals of left little finger open reduction and internal fixation with traumatic arthritis is rated under Diagnostic Code 5010-5227. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). The Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria as of February 7, 2021, applying the criteria that is more favorable to him. Diagnostic Code 5010, for traumatic arthritis, directs the evaluator to rate the disability as degenerative arthritis under Diagnostic Code 5003. Diagnostic Code 5003 provides that degenerative arthritis will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. As of February 7, 2021, under the amended criteria, Diagnostic Code 5010 still pertains to post-traumatic arthritis, but such is now rated as limitation of motion, dislocation, or other specified instability under the affected joint rather than degenerative arthritis. If there are 2 or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. Thus, in practice, both versions of Diagnostic Code 5010 ultimately provide that arthritis of an affected joint will be rated based on limitation of motion. Diagnostic Code 5227 was not affected by the February 2021 regulatory change. Under Diagnostic Code 5227, a noncompensable rating is assigned for unfavorable or favorable ankylosis of the ring or little finger regardless of whether the finger is on the major (dominant) or minor (non-dominant) hand. 38 C.F.R. § 4.71a, Diagnostic Code 5227. The Board notes the right hand is the major hand for the Veteran. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. Lewis v. Derwinski, 3 Vet. App. 259 (1992). A Note following Diagnostic Code 5227 requires consideration of whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. See 38 C.F.R. § 4.71a, Code 5227, Note (1). Diagnostic Code 5155, which assigns ratings based on finger amputation, provides for assignment of a 10 percent rating with amputation of the ring finger without metacarpal resection, at the proximal interphalangeal joint or proximal thereto. The maximum 20 percent rating requires amputation of the ring finger with metacarpal resection and more than one-half of the bone lost. 38 C.F.R. § 4.71a. Under Diagnostic Code 5230, any ring or little finger limitation of motion is rated 0 percent. 38 C.F.R. § 4.71a. When rating by analogy, the listed and unlisted conditions need only be "closely related" and the Board must determine whether the listed condition is "closely related" to the unlisted condition, and then consider whether the functions affected, anatomical location, and symptoms of the conditions are analogous. See Webb v. McDonough, 71 F.4th 1377 (Fed. Cir. 2023); Lendenmann v. Principi, 3 Vet. App. 345, 350 (1992). Additionally, when rating by analogy, the law recognizes that disabilities rated under analogous code sections will not show all the objective criteria of the analogous rating. Stankevich v. Nicholson, 19 Vet. App. 470 (2006). The Veteran underwent a VA examination in April 2013. The Veteran indicated that his left little finger was sore and painful to touch and without active range of motion. His daily pain ranged from 0 to 7/10. The severe pain was due to bumping or hitting the small finger. The Veteran retired in December 2012, but he could not use his finger when he typed and had to protect it from getting inadvertently hit. He could not grasp the steering wheel with his full hand. He could not make a full fist to fully grasp anything with his left hand because he could not flex the DIP or PIP joint. He reported flare-ups, which were described as when he bumps or hits his finger, the pain was severe, lasting 1 to 8 hours. He had to leave work due to pain, and his hand was not functional until pain subsided to moderate. He could not concentrate due to pain and would have to leave work or sit in a chair until the pain eased. He treated the flare ups with over the counter pain medication. Range of motion testing showed limitation of motion in the left thumb and little finger. There was no gap between the thumb pad and the fingers. Regarding flexion, there was a gap of one inch or more from the left little finger and the proximal transverse crease of the palm with painful motion. There was no limitation of extension or evidence of painful motion for the index finger or long finger. The Veteran was not able to perform repetitive use testing with three repetitions. The Veteran had functional loss of less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity, and atrophy of disuse in the left little finger. He had tenderness or pain to palpation of the left little finger. Muscle strength testing showed active movement against some resistance in left hand grip. There was ankylosis in the left little finger, in the MCP joint flexed to 30 degrees, in the PIP joint in extension and flexed to 30 degrees, and there was a gap of more than two inches between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. Because of ankylosis of DIP and PIP, he did not have full flexion of MCP, and diminished strength in gripping. He did not have full adduction of the little finger as well. No scar was visible. Finger resting position is in 15 degrees adduction and he cannot improve that status with attempts of adduct further. There was a constant gap between the ring and little finger. He had a very swollen DIP joint with loss of wrinkles, shiny skin with minimal erythema, and joint was nodular and distorted skin so that the condyles of the phalanx were easily visible. The DIP was fixed at 40 degrees flexion, PIP was +3 hyperextension to 30 degrees flexion, attempts to move joint allowed for more movement but resulted in pain. Flexion was best achieved when he relaxed. MCP joint range of motion was from 0 to 70, with pain. Attempted flexion and extension of the MCP joint resulted in abducted finger and he could not flex the MCP joint without this variance into abduction. He could abduct at MCP from 15 to 30 degrees but could not adduct to 0 degrees. Motions were poorly controlled. His left little finger provided no active functional use and was so painful that any contact resulted in immediate pain. His finger condition impacted his ability to work, as he had no functional capacity, and attempts to utilize the left little finger resulted in immediate pain if bumped or bent, and severe pain would last 1-8 hours. For sedentary work, if the Veteran did not bump the little finger, there would be no impact. For physical work, grip strength in the left hand was markedly reduced and strong vibrations into the hand would increase pain. In February 2015 VA treatment records, the Veteran reported pain of 7/10 in the left little finger. At his March 2021 hearing, the Veteran indicated that there was significant impairment of function in his left hand. He stated that he could not lift anything with his finger due to pain and he could not wrap his hand. He could not make a full grip with his left hand, and it would cause him to drop things. He could not use his left hand and could only type using his middle finger. The Veteran underwent a VA examination in July 2022. He reported current symptoms of pain, stiffness, and tingling, which caused difficulty with lifting or carrying heavy objects, pushing/pulling, driving, and household chores. He also had a decrease in ability to complete certain activities of daily living. He reported flare-ups three times a week, lasting three hours with increased pain and stiffness. Flare-ups would occur with lifting or carrying heavy objects, pushing/pulling, driving, and household chores. They were moderate, and relieved by rest and Motrin. The extent of functional impairment was difficulty with lifting or carrying heavy objects, pushing/pulling, driving, and household chores. Range of motion testing in the left hand showed flexion endpoint in the left little finger MCP of 45 degrees and extension endpoint 0 degrees. Flexion endpoint in the left little finger PIP of 50 degrees and extension endpoint 0 degrees. Flexion endpoint in the left little finger DIP of 35 degrees and extension endpoint 0 degrees. There was no gap between the pad of the thumb and fingers, no gap between the finger and proximal transverse crease of the hand on maximal finger flexion, and no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was pain on examination of the left little finger. Passive range of motion testing was the same as active. There was evidence of pain on weight-bearing, non-weight bearing, active motion, passive motion, and caused functional loss, which was previously described. The Veteran was able to perform repetitive use testing with at least three repetitions. Additional loss of range of motion was flexion endpoint in the left little finger MCP of 35 degrees and extension endpoint 0 degrees. Flexion endpoint in the left little finger PIP of 40 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger DIP of 30 degrees and extension endpoint 0 degrees. Pain, fatigability, weakness, lack of endurance, incoordination significantly limited functional ability with repeated use over time and with flare-ups. Estimated range of motion would be flexion endpoint in the left little finger MCP of 35 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger PIP would be 40 degrees and extension endpoint would be 0 degrees. Flexion endpoint in the left little finger DIP would be 30 degrees and extension endpoint would be 0 degrees. Estimated gap between the pad of the thumb and fingers and gap between the finger and proximal transverse crease of the hand on maximal finger flexion was 0 cm. There were no additional contributing factors of disability. Muscle strength testing showed active movement against some resistance in the left-hand grip. There was no muscle atrophy. The examiner indicated there was no ankylosis. The Veteran's condition impacted his ability to perform any type of occupational task, as pain, stiffness, and tingling in the left hand caused difficulty with lifting or carrying heavy objects, pushing/pulling objects, driving, and household chores. He also had decreased ability to complete certain activities of daily living, which affected the quality of his life and work. A medical opinion was obtained in September 2023. The clinician providing the opinion indicated that given the Veteran's prior history, it would be anticipated that a residual incisional scar would be present, however there was no documentation in the treatment records. Given that the Veteran was not seen for this opinion, it was not possible to specify the character or measurements of the scar. The Veteran underwent a VA examination in May 2025. The Veteran complained of worsening and peristent pain, tingling, and stiffness in the left hand. He reported flare-ups three times a week, lasting three hours with increased pain and stiffness. Flare-ups would occur with lifting or carrying heavy objects, pushing/pulling, driving, and household chores. They were moderate, and relieved by rest and Motrin. The extent of functional impairment was difficulty with lifting or carrying heavy objects, pushing/pulling, driving, and household chores. Range of motion testing in the left hand showed flexion endpoint in the left little finger MCP of 45 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger PIP of 50 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger DIP of 35 degrees and extension endpoint of 0 degrees. There was no gap between the pad of the thumb and fingers, no gap between the finger and proximal transverse crease of the hand on maximal finger flexion, and no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was pain on examination of the left little finger. Passive range of motion testing was the same as active. There was evidence of pain on weight-bearing, non-weight bearing, active motion, passive motion, which caused functional loss, which was previously described. The Veteran was able to perform repetitive use testing with at least three repetitions. Additional loss of range of motion was flexion endpoint in the left little finger MCP of 35 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger PIP of 40 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger DIP of 30 degrees and extension endpoint of 0 degrees. Pain, fatigability, weakness, lack of endurance, and incoordination significantly limited functional ability with repeated use over time and with flare-ups. Estimated range of motion would be flexion endpoint in the left little finger MCP of 35 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger PIP of 40 degrees and extension endpoint of 0 degrees. Flexion endpoint in the left little finger DIP of 30 degrees and extension endpoint of 0 degrees. Estimated gap between the pad of the thumb and fingers and gap between the finger and proximal transverse crease of the hand on maximal finger flexion was 0 cm. There were no additional contributing factors of disability. Muscle strength testing showed active movement against some resistance in the left hand grip. There was no muscle atrophy. The examiner indicated there was no ankylosis. The Veteran's condition impacted his ability to perform any type of occupational task, as pain, stiffness, and tingling in the left hand caused difficulty with lifting or carrying heavy objects, pushing/pulling objects, driving, and household chores. He also had decreased ability to complete certain activities of daily living, which affected the quality of his life and work. A May 2025 scars VA examination report indicates that the Veteran did not have any painful scars. He had a left little finger scar, measuring 3 cm x 1 cm. The scar was not tender to palpation, not unstable, and did not have underlying soft tissue damage. The scar area in the left upper extremity was approximately 3 cm squared. The scar did not result in limitation of function. The scar impacted on the Veteran's ability to work, as it was frozen and painful, affected his chores, and made it hard to hold a cup or eat with that hand without pain. As indicated above, the applicable diagnostic criteria pertaining to the Veteran's left little finger disability provide that any limitation of motion of the little finger is noncompensable. 38 C.F.R. § 4.71a. Moreover, although 38 C.F.R. § 4.59 and Burton v. Shinseki, 25 Vet. App. 1 (2011) provide that actual painful, unstable, or malaligned joints, due to healed injury are entitled to at least the minimum compensable rating for the joint, there is no compensable rating for limitation of motion of the little finger. Therefore, application of 38 C.F.R. § 4.59 does not assist the Veteran in this case. See Sowers v. McDonald, 27 Vet. App. 472 (2016). As such, even with consideration of 38 C.F.R. § 4.59, a compensable rating is not warranted under Diagnostic Code 5230 at any point throughout the appeal period. A compensable rating is not warranted under Diagnostic Code 5227 as it provides that ankylosis of the fifth finger is noncompensable. 38 C.F.R. § 4.71a. However, as indicated above, the Note to Diagnostic Code 5227 states that an additional evaluation is warranted for any resulting limitation of motion of other digits or interference with the overall function of the hand due to the service-connected residuals of left little finger open reduction and internal fixation with traumatic arthritis. The evidence reflects that in all VA examinations, muscle strength testing showed active movement against some resistance in left hand grip. The VA examiners also found that the Veteran had difficulty with lifting or carrying heavy objects, pushing/pulling objects, driving, and household chores due to his left little finger disability. While the April 2013 VA examiner found that the Veteran had ankylosis of the left little finger, the July 2022 and May 2025 VA examiners found that the Veteran did not have ankylosis. However, the Veteran's reports of symptoms of stiffness and functional loss including not assisting with hand gripping, illustrate that the Veteran's fifth finger is the equivalent of ankylosed. After reviewing the evidence of record, the Board finds that a separate 10 percent rating is warranted for the Veteran's left little finger disability based on the impact of the disability on the overall function of the hand. The diagnostic code which best approximates this disability picture is found in 38 C.F.R. § 4.73a, Diagnostic Code 5309. Thus, an additional evaluation under Diagnostic Code 5309 is warranted, based on the anatomical location and functions affected. 38 C.F.R. § 4.20. Injury to the intrinsic muscles of the hand may be rated under Diagnostic Code 5309 for muscle group IX, which controls grasping and delicate manipulative movements. Muscle Group IX consists of the intrinsic muscles of hand; thenar eminence; short flexor, opponens, abductor, and adductor of the thumb; hypothenar eminence; short flexor, opponens, and abductor of the little finger; four lumbricales; and four dorsal and three palmar interossei. The forearm muscles act in strong grasping movements and are supplemented by the intrinsic muscles in delicate manipulative movements. The hand is so compact a structure that isolated muscle injuries are rare, being nearly always complicated with injuries of bones, joints, tendons, etc. Thus, injury to muscle group IX should be rated on limitation of motion, with a minimum 10 percent assigned. 38 C.F.R. § 4.73, Diagnostic Code 5309, Note. The evidence demonstrates that the Veteran has had problems with gripping with the left hand and decreased hand strength throughout the appeal period. The Veteran has reported constant symptoms of stiffness in the left little finger. Furthermore, he reported constant discomfort and difficulty with flexion and extension at times. All the VA examiners reported that the Veteran's left little finger disability causes functional impairment. The Veteran also has reported taking over the counter pain medications to deal with pain causing functional loss during flare ups. Ingram v. Collins, 38 Vet. App. 130 (2025) (stating that where a DC does "not explicitly contemplate a veteran using medication to allay symptoms of a service-connected disability, the Board... must discount the beneficial effects of medication used"). When considering the Veteran's symptoms and functional loss and discounting any beneficial effects of pain medication taken during flare ups, the Board concludes that ankylosis in the left little finger has impacted on the overall function of the left hand. Therefore, a separate 10 percent rating under Diagnostic Code 5309 is appropriate. A review of the schedular criteria does not indicate another diagnostic code more analogous to the service-connected disability that would provide for a higher rating. Additionally, there is no other impairment that would entitle the Veteran to any further separate ratings. In summary, a separate 10 percent, but no higher, rating is warranted for the Veteran's residuals of left little finger open reduction and internal fixation with traumatic arthritis under Diagnostic Code 5309, based on the Note to Diagnostic Code 5227 that provides for an additional evaluation where there is interference with overall function of the hand. Surgical scar, left little finger open reduction and internal fixation with traumatic arthritis The Veteran's surgical scar left little finger open reduction and internal fixation with traumatic arthritis has been rated as noncompensable under Diagnostic Code 7805 prior to August 13, 2018 and 7802 from that date. Under revisions that took effect August 13, 2018, Diagnostic Codes 7801 and 7802 were amended to characterize multiple scars by six body zones, which are defined as each extremity, anterior trunk, and posterior trunk. There were no changes to Diagnostic Codes 7800, 7804, or 7805. 83 Fed. Reg. 32,592 (July 13, 2018). Under the pre-amended Diagnostic Code 7802, scars not of the head, face, or neck, that are superficial and nonlinear are assigned a rating of 10 percent with area or areas of 144 square inches (929 sq. cm.) or greater. Under the amended Diagnostic Code 7802, scars not of the head, face, or neck, that are not associated with underlying soft tissue damage are assigned a rating of 10 percent with area or areas of 144 square inches (929 sq. cm.) or greater. Under both versions of Diagnostic Code 7805, scars, other (including linear scars) and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, and 7804, are evaluated on the basis of any disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code. As indicated above, a May 2025 VA examination report indicates that the Veteran did not have any painful scars. He had a left little finger scar, measuring 3 cm x 1 cm. The scar was not tender to palpation, not unstable, and did not have underlying soft tissue damage. The area of the scar in the left upper extremity was approximately 3 cm squared. The scar did not result in limitation of function. The examiner indicated that the scar impacted the Veteran's ability to work, as the Veteran stated that the first finger in his left hand was frozen and painful, affected his chores, and made it hard to hold a cup and drink water or eat with that hand without pain. As the evidence states, the Veteran's left little finger scar covers an area that is significantly less than 144 square inches. Accordingly, a compensable rating under Diagnostic Code 7802 is not warranted. The evidence also reflects that no disabling effects were identified during the May 2025 VA examination, as well as any other reports, to warrant a compensable rating pursuant to Diagnostic Code 7805. The VA examiner found that the scar did not result in limitation of function. While the May 2025 VA examiner indicated that the scar impacted the Veteran's ability to work, the reason given was that the Veteran stated that the first finger in his left hand was frozen and painful, affected his chores, and made it hard to hold a cup or eat with that hand without pain. As indicated in the prior section, these disabling effects were considered in the rating assigned under Diagnostic Code 5309. As there are no other disabling effects that were not considered in the rating assigned under Diagnostic Code 5309, a compensable rating is not warranted under Diagnostic Code 7805. The Board has considered the other diagnostic codes relating to scars. Diagnostic Code 7800 applies to scars or other disfigurement of the head, face, or neck. As the scar is located on the Veteran's left little finger, Diagnostic Code 7800 is not for application in this case. The pre-amended version of Diagnostic Code 7801 applies to scars that are deep and nonlinear (not of head, face, or neck) and provides for a 10 percent rating when such scars cover an area or areas of at least 6 square inches (39 sq. cm.). Note (1) states that a deep scar is one associated with underlying soft tissue damage. The amended version also applies to scars that are associated with underlying soft tissue damage. As the Veteran's scars have not been assessed as deep and nonlinear, or associated with underlying soft tissue damage, this code is not for application. Under Diagnostic Code 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent disability rating is assigned for five or more scars that are unstable or painful. Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. In this case, the evidence shows that the Veteran has one left little finger scar that is not painful and not unstable. The Board again acknowledges that the May 2025 VA examiner indicated that the Veteran's first finger was frozen and painful; however, this description did not indicate that the scar itself was painful or unstable. Instead, the description was discussing function of the finger itself, rather than characteristics of the scar. As noted above, such functional impact has already been compensated by the separate rating being granted herein. Thus, the Board places greater weight of probative value on the examiner's finding that the scar itself was not painful or unstable and finds that a separate compensable rating under Diagnostic Code 7804 is not warranted. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The weight of the probative evidence is against finding that a compensable rating for the Veteran's service-connected surgical scar left little finger open reduction and internal fixation with traumatic arthritis. As such, the claim is denied. ? Extraschedular Rating The Board must also consider the Veteran's assertion that he is entitled to a higher rating for his left little finger disability based on extraschedular consideration, given that he indicated he sought an extraschedular rating at his March 2021 hearing before the Board. An extraschedular evaluation may be provided for exceptional cases. 38 C.F.R. § 3.321. The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral under the next step is required. Then, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the AOJ or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. § 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). If such an exhibition is determined, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation Service for a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. Id. Here, the rating criteria reasonably describe the Veteran's symptoms, including pain, stiffness, limitation of motion and loss of grip strength. Such symptoms are anticipated by the rating schedule. See 38 C.F.R. §§ 4.40-4.45. The evidence does not show that the Veteran has unusual symptoms not included in the schedular criteria. The rating criteria encompass symptoms such as favorable and unfavorable ankylosis and loss of function, of which the Veteran complains. Accordingly, the Board finds the Veteran has been properly rated for the entire appeal period. As the disability picture is contemplated by the rating schedule, the assigned schedular ratings are adequate and referral for extraschedular consideration is not required. 38 C.F.R. § 3.321(b)(1). REASONS FOR REMAND Entitlement to a compensable rating for scar, bottom of left foot, residuals of gunshot wound is remanded. The April 2025 remand directed that the Veteran undergo a VA examination and that the examiner also provide an opinion as to whether the Veteran's symptomatology, primarily pain with walking, of the Veteran's scar, bottom left foot, residuals of gunshot wound is separate and distinct from symptomatology of the Veteran's bilateral pes planus and plantar fasciitis. If the answer was yes, then the examiner was asked to describe which symptoms are properly associated with each diagnosis. If the answer was no, then the examiner was asked to attempt to determine which diagnosis is the primary cause of the Veteran's symptomatology. It was also directed that a complete rationale for all opinions must be provided. The Veteran underwent a VA examination in May 2025. The examiner provided an opinion that the Veteran's pain with walking is not related to the scar, left foot, residuals of gunshot wound itself, but is rather related to the Veteran's pes planus and plantar fasciitis. The scar itself was superficial, stable, well-healed and nonpainful. In an addendum opinion, the examiner indicated that while the examination report indicated that the left foot scar was tender to palpation, pain with walking was subjective. While the VA examiner indicated that pain with walking was associated with his pes planus and plantar fasciitis, the examiner did not address the Veteran's complaints of numbness, tingling, swelling, as well as problems with standing. Also, while the examiner indicated that the Veteran's pain with walking due to his pes planus and plantar fasciitis was subjective, the examiner did not address why it was found that the left foot scar was tender to palpation but that the scar itself was superficial, stable, well-healed and nonpainful. Remand is needed for an addendum opinion to address these questions. Entitlement to TDIU is remanded. When evidence of unemployability is submitted during the course of an appeal for an increased rating, a claim for TDIU will be considered part and parcel of the increased rating claim. Rice v. Shinseki, 22 App. 447, 453-54 (2009). The Board finds that the matter of entitlement to TDIU is raised by the record. During the April 2013 VA examination, the Veteran reported that he retired in 2012. The evidence also indicates that his little finger disability has affected his ability to perform occupational tasks throughout the period on appeal. For example, during the July 2022 VA examination the examiner noted that his little finger disability affected his ability to complete any type of occupational task, as pain, stiffness, and tingling in the left hand caused difficulty with lifting or carrying heavy objects, pushing/pulling objects, and driving. Thus, the Board finds that a claim of TDIU has been raised as part of his increased rating claim. The claim is remanded for development and adjudication. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from July 2025 to the present. 2. Return the claims file to the May 2025 VA examiner, or another qualified clinician, for an addendum medical opinion regarding the nature and current severity of the Veteran's service-connected scar, bottom of left foot, residuals of gunshot wound. The complete claims file and a copy of this Remand must be made available to the reviewing clinician. The examiner must address the following: a) Whether the Veteran's symptomatology of the scar, bottom left foot, residuals of gunshot wound, including but not limited to, pain with walking, numbness, tingling, swelling, as well as problems with standing, is separate and distinct from symptomatology of the Veteran's bilateral pes planus and plantar fasciitis. If the answer is Yes, describe which symptoms are properly associated with each diagnosis. For any symptoms which may be attributable to both diagnoses, attempt to determine which diagnosis is primarily responsible. If the answer is No, attempt to determine which diagnosis is the primary cause of the Veteran's symptomatology. b) The examiner must also address and explain the contradictory findings in the May 2025 VA scars examination that the Veteran's left foot scar was tender to palpation, and the conclusion in the May 2025 VA opinion that the scar was superficial, stable, well-healed and nonpainful. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Provide any needed notice and complete any development required on the claim for TDIU and adjudicate the matter of entitlement to a TDIU. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Yoon, 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.