FRACTURE OF METACARPAL OR PHALANX OF FINGER

MEGAN R. THOMAS · 2025 · Case ID: 25010571

MIXED

Summary

The Veteran, who served from June 1975 to June 1979, appeals the denial of a compensable rating for his service-connected right ring finger disability and entitlement to special monthly compensation (SMC) based on loss of use of his right hand. The Board found that the Veteran's right ring finger disability, which caused functional loss of his right hand including reduced grip strength and ankylosis of all five fingers, more nearly approximated loss of use of the right hand for the entire period on appeal. This finding, supported by multiple VA examinations and the Veteran's testimony, warranted a 70 percent rating under DC 5230-5125, which is the maximum schedular rating for loss of use of the dominant hand. Consequently, SMC based on loss of use of the right hand was also granted. The Board also considered an inferred claim for TDIU but found it inapplicable as the Veteran's functional impairment did not render him unemployable. The case was remanded for a VA examination to clarify the etiology and severity of claimed right arm neurological symptoms, and to determine if they are secondary to or aggravated by the service-connected right ring finger disability.

Rationale

Manifestations of right ring finger disability approximated loss of use of the right hand.; Resolution of all reasonable doubt in the Veteran's favor.; Maximum schedular rating for loss of use of dominant hand under DC 5125.

Special Benefit

SMC

Diagnostic Code

5125

Docket No.

20-03 313

Full Decision Text

Citation Nr: 25010571
Decision Date: 08/15/25 Archive Date: 08/15/25

DOCKET NO. 20-03 313
DATE: August 15, 2025

ORDER

For the entire period on appeal, entitlement to a disability rating of 70 percent, but no higher, based on loss of use of the right hand stemming from the Veteran's service-connected fracture, right 4th metacarpal (hereinafter referred to as "right ring finger disability") is granted, subject to the laws and regulations governing payment of monetary benefits.

For the entire period on appeal, entitlement to special monthly compensation (SMC) based on loss of use of the right hand is granted, subject to the laws and regulations governing payment of monetary benefits.

REMANDED

Entitlement to a separate compensable rating for a right arm neurological disability, as secondary to the Veteran's service-connected right ring finger disability, is remanded.

FINDINGS OF FACT

1. The evidence is in relative equipoise as to whether the Veteran's right ring finger disability has resulted in the functional equivalent of loss of use of the right hand for the entire period on appeal.

2. As the Veteran has been determined to have the functional equivalent of loss of use of the right hand for rating purposes, an award of SMC is also warranted based on loss of use of the right hand.

CONCLUSIONS OF LAW

1. Resolving all reasonable doubt in the Veteran's favor, the criteria for a disability rating of 70 percent, but no higher, based on loss of use of the right hand related to the Veteran's service-connected right ring finger disability are met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes (DCs) 5230-5125.

2. The criteria for SMC based on loss of use of the right hand are met for the entire period on appeal. 38 U.S.C. §§ 1114(k), 5107; 38 C.F.R. §§ 3.102, 3.350(a)(2)(i), 4.71a, DC 5125, footnote 1.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran, who is the appellant in this case, served on active duty from June 1975 to June 1979.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In February 2022, the Veteran testified at a virtual hearing before the undersigned Acting Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed.

In March 2022 and December 2024, the Board remanded this matter for additional development and to ensure substantial compliance with its previous remand directives.

Regarding the claims adjudicated herein, the Board finds there has been at least substantial compliance with the Board's previous remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998).

The Board considered whether an inferred claim for a total disability rating based on individual unemployability (TDIU) under Rice v. Shinseki, 22 Vet. App. 447 (2009) has been raised. Although the January 2025 VA examiner indicated that the Veteran's right ring finger disability causes occupational impairment, including inability to use his hand to lift and right hand pain, the record does not indicate that this functional impairment of the right hand rendered him unemployable during the period on appeal. The Board notes that a disability rating in itself is recognition that the ability to work is impaired. 38 C.F.R. § 4.1. While the Veteran has been determined by the Social Security Administration (SSA) to be disabled, this was attributed to degenerative disc disease of the lumbar and cervical spine, as well as osteoarthritis of the bilateral hips. See SSA Disability Determination and Transmittal form, received by VA in January 2025. Importantly, neither the Veteran nor his representative have indicated that the Veteran is unable to maintain substantially gainful employment due to his service-connected right ring finger disability and related loss of use of the right hand. The Board therefore finds that Rice is inapplicable, and a TDIU request has not been inferred.

The Board has limited the discussion below to the
§ 4.1. While the Veteran has been determined by the Social Security Administration (SSA) to be disabled, this was attributed to degenerative disc disease of the lumbar and cervical spine, as well as osteoarthritis of the bilateral hips. See SSA Disability Determination and Transmittal form, received by VA in January 2025. Importantly, neither the Veteran nor his representative have indicated that the Veteran is unable to maintain substantially gainful employment due to his service-connected right ring finger disability and related loss of use of the right hand. The Board therefore finds that Rice is inapplicable, and a TDIU request has not been inferred.

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the appellant and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015).

1. Entitlement to a compensable disability rating for the Veteran's service-connected right ring finger disability

Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular DC, the higher evaluation is assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3.

A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the veteran is appealing the rating for an already established service-connected condition, his or her present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007).

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 (ROM) 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 (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria.").

In evaluating disabilities of the musculoskeletal system, painful motion is an important factor of disability. See 38 C.F.R. § 4.59. The intent of the schedule is to recognize painful motion with joint or particular pathology as productive of disability. Id. Joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. Id. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the
on the § 4.71a [or 4.73] criteria.").

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). If the evidence persuasively weighs against the claim, the claim is denied.

Here, the Veteran is currently in receipt of a noncompensable rating for his service-connected right ring finger disability under DC 5230 for the entire period on appeal. He asserts that a compensable rating is warranted.

The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R.

§ 4.71a were amended effective February 7, 2021. However, those amendments did not affect the DCs that are applicable to the Veteran's right ring finger disability.

Ratings based on functional impairment of the upper extremities are predicated upon which extremity is the major (or dominant) extremity, with only one extremity being considered major. 38 C.F.R. § 4.69. In this case, the evidence reflects that the Veteran is right-handed. See VA "Hand and Finger Conditions" examination reports dated January 2018, November 2018, December 2022, and January 2025.

Under DC 5230, any limitation of motion of the ring or little finger is to be rated 0 percent disabling, for both the major (dominant) and the minor (non-dominant) hand. 38 C.F.R. § 4.71a, DC 5230.

Loss of use of the hand is evaluated under 38 C.F.R. § 4.71a, DC 5125. A maximum 70 percent evaluation is assigned for loss of use of the dominant (major) hand.

On review, and with resolution of all reasonable doubt in the Veteran's favor, the Board finds that the manifestations of the Veteran's right ring finger disability have more nearly approximated loss of use of the right hand for the entire period on appeal, warranting a disability rating of 70 percent under DC 5125.

Throughout the period on appeal, the Veteran has endorsed an inability to use his right hand due to pain, decreased ROM, and weakness, and VA examiners have found that the Veteran has reduced (or absent) grip strength in his right hand and ankylosis of all five fingers. See January 2018 VA "Hand and Finger Conditions" examination report (Veteran stated he was unable to move his right hand or use it for anything, and the VA examiner found he had 0/5 right hand grip strength, and had ankylosis of all five fingers on the right hand); November 2018 VA "Hand and Finger Conditions" examination report (Veteran stated he was unable to do anything with his right hand and the VA examiner found he had 4/5 grip strength in his right hand); February 2022 Board hearing transcript (Veteran testified that he is unable to manipulate and grasp objects with his right hand and that he experiences constant pain); December 2022 VA "Hand and Fingers" examination report (Veteran stated he cannot use his right hand at all, he has constant right hand pain and no ROM, and the VA examiner found he had 0/5 grip strength in his right hand), and January 2025 VA "Hand and Fingers" examination report (Veter
the right hand); November 2018 VA "Hand and Finger Conditions" examination report (Veteran stated he was unable to do anything with his right hand and the VA examiner found he had 4/5 grip strength in his right hand); February 2022 Board hearing transcript (Veteran testified that he is unable to manipulate and grasp objects with his right hand and that he experiences constant pain); December 2022 VA "Hand and Fingers" examination report (Veteran stated he cannot use his right hand at all, he has constant right hand pain and no ROM, and the VA examiner found he had 0/5 grip strength in his right hand), and January 2025 VA "Hand and Fingers" examination report (Veteran endorsed flare-ups of the right hand during which he could not grasp or move anything, and the VA examiner found he had 0/5 grip strength in the right hand). Notably, in a January 2025 VA medical opinion, the VA examiner determined that the Veteran's right hand functional impairments are at least as likely as not related to or caused by his service-connected right ring finger disability and any associated residuals.

Based on the foregoing evidence, the Board finds that the Veteran's right ring finger disability has resulted in the functional equivalent of loss of use of the right hand for the entire period on appeal. A 70 percent rating is the maximum schedular rating authorized under DC 5125 for loss of use of the dominant hand, and the Board does not find that a higher rating would be warranted under a different DC. No higher rating would be available to him under any of the other DCs applicable to disabilities of the hands or wrist, as he is being awarded the highest rating possible under DC 5125 - the rating applicable for the loss of a dominant extremity.

The Board also notes that under the "amputation rule" the combined rating for all disabilities of an extremity, including musculoskeletal and neurological disabilities, may not exceed the rating for the amputation at the elective level, were the amputation to be performed. 38 C.F.R. § 4.68. Here, the Veteran already receives the rating he would receive if his right hand were amputated. He experiences de facto loss of use of his right hand, which is most closely approximated by a rating analogous to what the Veteran would experience if his right hand were amputated. Therefore, no further discussion regarding whether a separate or higher rating based on neurological impairment of the right hand is warranted. To the extent that he has reported experiencing neurological manifestations in his right arm, above the level of an amputation of the hand, higher ratings are available for amputation above the level of the hand. Therefore, whether higher or separate ratings are warranted based on neurological manifestations in the right arm of the right hand disability are discussed in the remand section, below.

Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. As this rating under Diagnostic Code 5125 is related to the Veteran's residuals of a right 4th metacarpal fracture, the Board finds that a hyphenated diagnostic code, i.e., 5230-5125, is warranted.

Finally, the Board recognizes that the RO in a January 2023 rating decision granted service connection for mild degenerative changes of the right thumb as secondary to the Veteran's service-connected right ring finger disability and assigned an initial disability rating of 10 percent, effective December 8, 2022. To avoid pyramiding, per 38 C.F.R. § 4.14, the separate 10 percent rating for the right thumb disability will now be subsumed by the 70 percent rating awarded herein for loss of use of the right hand for the entire period on appeal. In so finding, the Board notes that the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and the demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625 (1992). The Board notes that this change in diagnostic codes results in a higher rating for the Veteran for his right hand disability, such that there is no prejudice to the Veteran in this change.

For these reasons and resolving all reasonable doubt in favor of the Veteran, the Board finds that a rating of
See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and the demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625 (1992). The Board notes that this change in diagnostic codes results in a higher rating for the Veteran for his right hand disability, such that there is no prejudice to the Veteran in this change.

For these reasons and resolving all reasonable doubt in favor of the Veteran, the Board finds that a rating of 70 percent, but no higher, is warranted for the Veteran's loss of use of the right hand, secondary to the fracture, right 4th metacarpal under DCs 5230-5125, for the entire period on appeal.

2. Entitlement to SMC based on loss of use of the right hand

Under 38 U.S.C. § 1114(k), SMC is payable to a veteran for anatomical loss or loss of use of a hand. Loss of use of a hand will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the elbow with use of a suitable prosthetic appliance. 38 C.F.R. §§ 3.350(a)(2), 4.63. Furthermore, a footnote to 38 C.F.R. § 4.71a, DC 5125 provides that assignment of a rating under that diagnostic code for loss of use of the hand results in entitlement to SMC.

For the reasons discussed above, and with resolution of all reasonable doubt in the Veteran's favor, the Board has awarded a 70 percent rating for loss of use of the right hand under DC 5125. Accordingly, entitlement to SMC based on loss of use of the right hand is also granted for the entire period on appeal. See 38 C.F.R.

§ 4.71a, DC 5125, footnote one.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, apart from those addressed in the Remand section below. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

REASONS FOR REMAND

1. Entitlement to a separate compensable rating for a right upper extremity neurological disability, as secondary to the Veteran's service-connected right ring finger disability, is remanded.

Throughout the pendency of the appeal, the Veteran has endorsed numbness, tingling, and shooting pain that radiates up the right arm to his elbow and shoulder. See VA "Hand and Finger Conditions" examination reports dated January 2018, December 2022, and January 2025; February 2022 Board hearing transcript; February 2023 Correspondence. Thus, the Board finds that the issue of entitlement to a separate compensable rating for a right arm neurological disability, as secondary to the Veteran's service-connected right ring finger disability, has been reasonably raised by the record and is potentially within the scope of the increased rating claim on appeal. See Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021) (finding that 38 C.F.R. § 3.155(d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal).

However, it is unclear whether these right arm neurological symptoms are related to the Veteran's service-connected right ring finger disability. Therefore, on remand, the Board finds that the Veteran should be provided with a VA examination to clarify the etiology and severity of his right arm neurological symptoms.

Accordingly, the matter is REMANDED for the following action:

1. Provide the Veteran with a VA examination to determine the nature and etiology of his claimed right arm neurological disability. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner.

After a review of the entire claims file and examination of the Veteran, the examiner is asked to:

(a) Elicit from the Veteran and the record the history of his right arm neurological symptoms.

(b) Identify all diagnoses pertaining to the Veteran's claimed right arm disability, to include symptoms resulting in functional impairment of
should be provided with a VA examination to clarify the etiology and severity of his right arm neurological symptoms.

Accordingly, the matter is REMANDED for the following action:

After a review of the entire claims file and examination of the Veteran, the examiner is asked to:

(a) Elicit from the Veteran and the record the history of his right arm neurological symptoms.

(b) Identify all diagnoses pertaining to the Veteran's claimed right arm disability, to include symptoms resulting in functional impairment of earning capacity.

a. Whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) caused by the Veteran's service-connected right ring finger disability.

b. Whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) aggravated (any incremental increase in disability regardless of permanence) by the Veteran's service-connected right ring finger disability.

" The examiner must consider any causal link between the Veteran's claimed right arm neurological disability and his service-connected right ring finger disability.

" In providing these opinions, please consider the following evidence:

o VA "Hand and Finger Conditions" examination reports dated January 2018, December 2022, and January 2025.

o February 2022 Board hearing transcript.

o February 2023 Correspondence from the Veteran.

2. Then, readjudicate the remanded legacy claim on appeal.

Megan R. Thomas

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. M. Gill, 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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