DEGENERATIVE ARTHRITIS

JEREMY J. OLSEN · 2022 · Case ID: 22032560

DENIED

Summary

The veteran, who served in the U.S. Navy from February 1967 to July 1968, appeals the denial of increased disability ratings for his left thumb degenerative arthritis, left thumb neuropathy, and left fourth finger deformity, all residuals of a tendon transfer surgery. The Board reviewed the claims under both pre- and post-February 7, 2021, rating criteria, applying the more favorable version. For the left thumb degenerative arthritis, the Board considered diagnostic codes for limitation of motion and degenerative arthritis. The evidence, including VA examinations, indicated no significant gap between the thumb pad and fingers, no ankylosis, and no objective findings of painful motion or functional loss that would warrant a compensable rating prior to August 15, 2011. For the period after August 15, 2011, while some subjective complaints of pain and numbness were noted, objective findings from VA examinations showed normal muscle strength, grip, and reflexes, with only mild incomplete paralysis of the median nerve. The Board found the evidence weighed against a higher rating, denying the claim. For the left thumb neuropathy, the Board considered diagnostic code 8615 for median nerve paralysis. Despite the Veteran's subjective complaints and some atrophy, the Board found the evidence supported no more than mild incomplete paralysis, citing normal nerve conduction studies and intermittent symptoms. The Board denied a higher rating. For the left fourth finger deformity, the Board considered diagnostic code 5230. Examination reports indicated no ankylosis of the ring finger, and the Board found no basis for a compensable rating under the applicable codes. The Board denied the claim, finding the evidence weighed against it and the benefit of the doubt doctrine was not applicable.

Rationale

No objective findings of painful motion or functional loss prior to August 15, 2011.; Post-August 15, 2011, VA exams showed normal muscle strength and reflexes.; Mild incomplete paralysis of median nerve, no ankylosis or significant gap found.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-26 473

Full Decision Text

Citation Nr: 22032560
Decision Date: 06/03/22 Archive Date: 06/03/22

DOCKET NO. 16-26 473
DATE: June 3, 2022

ORDER

An initial compensable disability rating for left thumb degenerative arthritis with limitation of motion, status post laceration and tendon transfer surgery, prior to August 15, 2011, and in excess of 10 percent thereafter, is denied.

An initial disability rating in excess of 10 percent for left thumb neuropathy, status post tendon transfer, is denied.

An initial compensable disability rating for left fourth finger deformity, status post tendon transfer surgery, is denied.

FINDINGS OF FACT

1. For the period prior to August 15, 2011, the preponderance of the evidence of record is against finding that the Veteran's service-connected left thumb disability has been manifested by a gap of at least one inch between the thumb pad and fingers; limitation of motion of the index finger with a gap of at least one inch between the fingertip and the proximal transverse crease of the palm; or have extension limited by more than 30 degrees, nor has there been ankylosis of any fingers of the right hand or symptoms consistent with amputation of the fingers.

2. For the period from August 15, 2011, and thereafter, the preponderance of the evidence of record is against finding that the Veteran's service-connected limitation of motion of the left thumb was productive of a gap of more than 2 inches (5.1 cm.) between the thumb pad and the fingers with the thumb attempting to oppose to the fingers, to include consideration of whether the episodes of spasms and locking due to A1 pulley with triggering of the left thumb cause increased limitation of motion.

3. Neuropathy of the left hand is manifested by subjective complaints of pain and numbness; objective findings include mild incomplete paralysis.

4. The Veteran's left ring finger disability has been manifested by decreased motion and pain; however, the left ring finger is not ankylosed nor amputated.

CONCLUSIONS OF LAW

1. The criteria for an initial compensable rating for left thumb degenerative arthritis with limitation of motion, status post laceration and tendon transfer surgery, prior to August 15, 2011, and in excess of 10 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5103, 5103A and 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59 and 4.71a, Diagnostic Codes 5003, 5010, 5024, 5228.

2. The criteria for an initial rating in excess of 10 percent for left thumb neuropathy, status post tendon transfer disability, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A and 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59 and 4.71a, Diagnostic Code 8615.

3. The criteria for an initial compensable rating for left fourth finger deformity, status post tendon transfer surgery have not been met. 38 U.S.C. §§ 1155, 5103, 5103A and 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59 and 4.71a, Diagnostic Code 5230.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from February 1967 to July 1968.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California.

The Board remanded this appeal in June 2019 and October 2021 for further development. It finds that there has been substantial compliance with its remand instructions, such that further appellate review is appropriate. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order); Dyment
Veteran served on active duty in the United States Navy from February 1967 to July 1968.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California.

The Board remanded this appeal in June 2019 and October 2021 for further development. It finds that there has been substantial compliance with its remand instructions, such that further appellate review is appropriate. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order); Dyment v. West, 13 Vet. App. 141, 147 (1999) (clarifying that substantial compliance with Board remand is required).

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. The Board attempts to determine the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10.

When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to a veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

A Veteran's entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the issue involves the assignment of a disability rating following the initial award of service connection for that disability, as is the case here, the entire history of the disability must be considered, and separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999).

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin,
motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

In making all determinations, the Board must fully consider the lay assertions of record. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine on a case by case basis whether a veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376 -77 (Fed. Cir. 2007).

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value.

1. Entitlement to an initial compensable rating for left thumb degenerative arthritis with limitation of motion, status post laceration and tendon transfer surgery, prior to August 15, 2011, and in excess of 10 percent thereafter.

The Veteran contends that his status post tendon transfer surgery residuals are more severe than as reflected by the ratings currently assigned. Specifically, the Veteran contends that as a result of the surgery he experiences limitation of motion, pain, and ankylosis.

The Veteran's left thumb disability, diagnosed as left thumb arthritis, is rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5228-5010. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. In this case, Diagnostic Code 5228-5010 reflects consideration of the effects of limitation of motion (5228) and degenerative arthritis (5010).

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). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id.

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021
also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, 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 from February 7, 2021. The criteria that is more favorable to the Veteran will be applied.

Diagnostic Code 5228 was not changed, however Diagnostic Code 5003 was updated. Prior to the regulatory change, post traumatic arthritis was rated in accordance with Diagnostic Code 5003, however since the change, Diagnostic COde 5003 is limited to degenerative arthritis, other than post traumatic. Pursuant to Diagnostic Code 5003, degenerative arthritis is rated based on limitation of motion under the appropriate diagnostic codes for the specific joint(s) involved. When the limitation of motion is noncompensable under the appropriate diagnostic code, a 10 percent rating is for application for each such major joint affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.

Under Diagnostic Code 5228, a noncompensable rating is warranted when there is a gap of less than one inch (2.5 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. Diagnostic Code 5228 indicates that a 10 percent rating is warranted for limitation of motion of either thumb if there is 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. A 20 percent rating is warranted for limitation of motion of either thumb if there is a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers.

Diagnostic Code 5224 is a potential alternative for the Veteran's left thumb disability. Diagnostic Code 5224 governs ankylosis of the thumb, favorable or unfavorable. A 10 percent disability rating is warranted for favorable ankylosis of the thumb of either hand while a 20 percent is warranted for unfavorable ankylosis of the thumb of either hand. 38 C.F.R. § 4.71a, Diagnostic Code 5224.

The Note to Diagnostic Code 5224 also instructs the rater to consider 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. Id.

Concerning amputation, Diagnostic Code 5152 contemplates amputation of the thumb. 38 C.F.R. § 4.71a. Under Diagnostic Code 5152, a 20 percent rating is warranted for amputation of the thumb at a distal joint or through the distal phalanx. A 30 percent rating is warranted for the major hand when the thumb is amputated at the metacarpophalangeal joint or through the proximal phalanx. A 40 percent rating is warranted for the major hand when the thumb is amputated with metacarpal resection. 38 C.F.R. § 4.71a (2018).

The Veteran contends that he should be granted a higher rating for his left thumb arthritis due to the severity of his symptoms. The Veteran states that the condition mainly caused decreased grip strength and limited motion in his left thumb.

For the period prior to August 15, 2011

During this period on appeal, based on the objective evidence of record, the Veteran's left hand was capable of a full range of motion for all digits and there was no gap between the pad of his thumb and his fingers. When there is "no actual or compensable limitation of motion," compensation for functional limitation in the form of pain is limited to a single 10 percent disability rating per joint. See Mitchell v. Shinseki, 25 Vet. App. 32, 36 (2011). However, in this case, the Veteran's left thumb disability did not result in functional limitation due to pain, as detailed in the December 2022 respective opinion, detailed below. Additionally,
to August 15, 2011

For the period from August 15, 2011, and thereafter

During a March 2013 VA examination, the Veteran reported that his tendon transfer surgery made it worse as he now has pain, numbness in the thumb, and decreased ROM to the left thumb. The Veteran reported that he did not seek treatment for the condition since his discharge from service. The examiner diagnosed the Veteran with left hand sprain, arthralgia, and neuropathy. The examiner noted that there was no objective evidence of pain on motion. The examiner stated there was no evidence of ankylosis and range of motion was within normal limits and was not limited by pain, fatigue, weakness, or incoordination after repetitive use. Id. Upon examination, the Veteran had a gap of 1 cm between the pad of the thumb and fingers. The Veteran's thumb does not have ankylosis.

The Veteran was afforded a VA examination in December 2021, to include a retrospective opinion for the period on appeal. Upon examination, range of motion of the MCP of the thumb was to 50 degrees flexion and 0 degrees extension and IP range of motion was to 60 degrees flexion and 0 degrees extension with pain. There was no gap between the pad of the thumb and fingers. There is objective evidence of localized tenderness or pain on palpation of the thumb MCP and IP and fourth finger PIP. Following repeated use over time and during a flare-up, the examiner indicated that range of motion of the MCP of the thumb would be to 100 degrees flexion and 0 degrees extension. IP range of motion would be to 60 degrees flexion and 0 degrees extension. The Veteran had a gap of 1 cm between the pad of the thumb and fingers. The Veteran's thumb does not have ankylosis. His left thumb thenar atrophy and thumb IP limitations interfere with grasping. The Veteran reported that he was unable to close his thumb around objects and do buttons and zippers with his left hand. He also reported that he has difficulty doing woodworking projects due to left hand range of motion and grip limitations. The Veteran's limitations have not changed since his surgery in 1971. Id.

The Board finds that the Veteran did not have limitation of motion of his left thumb 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, or evidence of ankylosis. The medical evidence also does not indicate amputation of the index finger without metacarpal resection, at proximal interphalangeal joint or proximal thereto; amputation of the long, ring or middle finger with metacarpal resection (more than one-half the bone lost); or amputation of the thumb at distal joint or through distal phalanx; or, favorable ankylosis involving the index finger and any other finger; or, favorable ankylosis involving the long, ring and little fingers; or, limited motion of the thumb: with a gap of more than two inches (5.1 cm.) between the thumbpad and the fingers, with the thumb attempting to oppose the fingers; or, unfavorable ankylosis involving the long and little fingers; or, unfavorable ankylosis involving the long and ring fingers; or, unfavorable ankylosis involving the ring and little fingers; or, unfavorable ankylosis involving the thumb.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether an initial compensable rating for left thumb degenerative arthritis with limitation of motion, status post laceration and tendon transfer surgery, prior to August 15, 2011, and in excess of 10 percent thereafter is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. 38 U.S.C. §
ankylosis involving the long and ring fingers; or, unfavorable ankylosis involving the ring and little fingers; or, unfavorable ankylosis involving the thumb.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether an initial compensable rating for left thumb degenerative arthritis with limitation of motion, status post laceration and tendon transfer surgery, prior to August 15, 2011, and in excess of 10 percent thereafter is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). The claim is denied.

2. Entitlement to an initial rating in excess of 10 percent for left thumb neuropathy, status post tendon transfer.

Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8615.

Under Diagnostic Code 8615, an evaluation of 10 percent is assigned for incomplete paralysis of hand movements which is mild. A higher evaluation of 30 percent is not warranted unless evidence demonstrates incomplete paralysis of hand movements which is moderate. A higher evaluation of 50 percent is not warranted unless there is evidence of incomplete paralysis of hand movements which is severe.

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).

The Veteran was afforded a VA peripheral nerve examination in January 2020. The Veteran reported mild pain, moderate numbness in the left upper extremity, specifically his thumb and finger. Upon examination, muscle strength testing was normal, including grip. Deep tendon reflexes were normal. Sensation to light touch was decreased in the hand/fingers. The examiner noted muscle atrophy at the base of the thumb. The examiner noted that the numbness and incomplete paralysis of the median nerve was mild.

The Veteran was afforded another VA peripheral nerve examination in December 2021. The Veteran reported mild constant pain, intermittent pain, and paresthesias and/or dysesthesias and moderate numbness in the left upper extremity. Upon examination, muscle strength testing was normal, including grip. Deep tendon reflexes were normal. Sensation to light touch was decreased in the hand/fingers. The Veteran has complete loss of thenar muscles due to nerve damage in the left hand with moderate reduction in prolonged, repetitive grip of more than 30 pounds. The examiner noted that the Veteran has moderate loss of dexterity of the left hand with complete atrophy of the three thenar muscles, which are from the median nerve. The examiner stated that given the complete atrophy of this group of muscles, impairment would be moderately severe. The Veteran's left thumb thenar atrophy and thumb IP limitations interfere with grasping.

The VA examiner noted that the Veteran had been able to work as a left
muscle strength testing was normal, including grip. Deep tendon reflexes were normal. Sensation to light touch was decreased in the hand/fingers. The Veteran has complete loss of thenar muscles due to nerve damage in the left hand with moderate reduction in prolonged, repetitive grip of more than 30 pounds. The examiner noted that the Veteran has moderate loss of dexterity of the left hand with complete atrophy of the three thenar muscles, which are from the median nerve. The examiner stated that given the complete atrophy of this group of muscles, impairment would be moderately severe. The Veteran's left thumb thenar atrophy and thumb IP limitations interfere with grasping.

The VA examiner noted that the Veteran had been able to work as a left-hand-dominant carpenter, which requires significant hand strength and dexterity, for many years. She noted no reduction in muscle strength and reported that he is able to make a fist. Some decreased sensation and pain/numbness were noted to be present. The Veteran's limitations have not changed since his surgery in 1971.

VA has considered the Veteran's statements regarding worsening of the muscle atrophy and worsened pain of the area. However, based on the examination results and the examiner's opinion regarding the work-related cause of the muscle atrophy, an evaluation of 10 percent is found to best represent the portion of disability of the Veteran's median nerve due to the in-service surgical repair of his pre-existing left-hand injury.

Based on this evidence the Board finds that the disability is primarily manifest by mild incomplete paralysis of the median nerve. While the Veteran has had subjective complaints of numbness and pain, the nerve conduction studies were normal. Moreover, the subjective symptoms are intermittent and do not result in weakness. On balance, the medical evidence supports no more than mild incomplete paralysis of the median nerve. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, or moderate or complete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis.

The Board has considered all other potentially applicable diagnostic codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different diagnostic code is not warranted.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether an initial rating in excess of 10 percent for left thumb neuropathy, status post tendon transfer is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Lynch, supra. The claim is denied.

3. Entitlement to an initial compensable rating for left fourth finger deformity, status post tendon transfer surgery.

Under Diagnostic Code 5230, a noncompensable evaluation is assigned for any limitation of motion of the ring or little fingers and for ankylosis of the ring or little finger. A noncompensable evaluation is also assigned unless there is amputation of the ring finger at the proximal interphalangeal joint or proximal thereto.

When the thumb and ring finger are affected, an evaluation of 30 percent is assigned whenever the thumb and any other finger are favorably ankylosed. An evaluation of 40 percent is assigned for amputation of the thumb and ring finger and whenever the thumb and any other finger are unfavorably ankylosed.

The Veteran was provided VA examinations in March 2013, January 2020, and December 2022. While the January 2020 notes ankylosis in its written findings, the examiner also notes that the ring finger and thumb are not ankylosed. All of the other examination reports indicated that the Veteran's left ring finger was not ankylosed.

In this case, a compensable rating is not available under Diagnostic Code 5230 for ring finger limitation of motion. Additionally, as the examination reports indicated that the Veteran's ring finger was not ankylosed, Diagnostic Codes 5227, 5223, and 5219 are not applicable.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to an initial compensable rating for left fourth finger deformity, status post tendon transfer surgery, is warranted. Rather, the evidence persuasively weighs against the claim. The
examiner also notes that the ring finger and thumb are not ankylosed. All of the other examination reports indicated that the Veteran's left ring finger was not ankylosed.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to an initial compensable rating for left fourth finger deformity, status post tendon transfer surgery, is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Lynch, supra. The claim is denied.

JEREMY J. OLSEN

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Michael J. O'Connor, 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.

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