PARALYSIS OF THE MEDIAN NERVE

GREGORY DEEMER · 2026 · Case ID: 26004841

MIXED

Summary

The veteran, who served in the Alabama Army National Guard from April 2007 to August 2007, appeals the denial of a compensable rating for amputation of the left ring finger and an increased rating for painful scars on the left hand ring finger. The Board granted entitlement to an initial 20 percent rating for left upper extremity neuropathy, median nerve, finding moderate incomplete paralysis throughout the period on appeal, based on VA examinations in February 2024 and September 2025. The Board also granted an initial 10 percent rating for painful scars on the left hand ring finger, finding the criteria for one or two painful scars met, but not higher ratings due to lack of evidence for larger areas or instability. The claim for a compensable rating for amputation of the left ring finger was remanded for a retrospective medical opinion to determine the nature and severity of the amputation and the ameliorative effects of medication, as the existing examinations were deemed inadequate. The Board noted that the veteran's lay statements regarding pain were considered but outweighed by objective medical findings for the neuropathy claim, and that the benefit of the doubt was resolved in the veteran's favor for both granted conditions.

Rationale

VA examinations in Feb 2024 and Sep 2025 found moderate incomplete paralysis of the left upper extremity median nerve.; Veteran's subjective reports of severe pain and functional limitations were considered but outweighed by objective medical findings.; Rating based on moderate incomplete paralysis of the median nerve, as per 38 C.F.R. § 4.124a, DC 8515.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8515

Docket No.

19-38 571

Full Decision Text

Citation Nr: 26004841
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 19-38 571
DATE: April 22, 2026

ORDER

Entitlement to an initial 20 percent rating, but no higher, for left upper extremity neuropathy, median nerve is granted.

Entitlement to an initial 10 percent rating, but no higher, for painful scars, left hand ring finger is granted.

REMANDED

Entitlement to a compensable rating for amputation of the left ring finger (also claimed as amputation, left hand right finger and/or residuals of amputation of the left ring finger) is remanded.

FINDINGS OF FACT

1. Throughout the entire period on appeal, the persuasive evidence shows that the Veteran's service-connected left upper extremity (minor extremity) neuropathy has been manifested by no more than moderate incomplete paralysis of the median nerve.

2. Throughout the entire period on appeal, the Veteran's service-connected left hand ring finger scars have been manifested by 2 linear, and at times, painful scars. The scars are not associated with underlying soft tissue damage, are not of compensable size, and do not manifest any disabling effects.

CONCLUSIONS OF LAW

1. Resolving reasonable doubt in the Veteran's favor, the criteria for entitlement to an initial 20 percent rating, but no higher, for left upper extremity neuropathy, median nerve have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.124a, Diagnostic Code (DC) 8515.

2. Resolving reasonable doubt in the Veteran's favor, the criteria for entitlement to an initial 10 percent rating, but no higher, for painful scars, left hand ring finger have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.118, DC 7804.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty for training as a member of the Alabama Army National Guard from April 2007 until his honorable discharge in August 2007. He also had additional service in the Reserves.

A discussion of the procedural history of this appeal is necessary prior to adjudication.

Here, a March 2009 rating decision granted service connection for left ring finger degenerative arthritis with an initial noncompensable (0 percent) rating from Augus 25, 2007 (day after discharge) under 38 C.F.R. § 4.71a, DCs 5010-5230.

A July 2013 rating decision granted service connection for amputation, left hand ring finger with a temporary 100 percent rating from January 10, 2013 (based on surgical or other treatment necessitating convalescence and 38 C.F.R. § 4.30) and a noncompensable rating from March 1, 2013 (day following convalescence) under 38 C.F.R. § 4.71a, DC 5227.

On March 10, 2016, VA received a fully developed claim for several issues, including an increased rating for service-connected amputation, left hand ring finger.

A November 2016 rating decision continued the noncompensable rating for amputation, left hand ring finger. It also granted service connection for scars, left ring finger with an initial noncompensable rating, effective March 10, 2016 (date VA received claim) under 38 C.F.R. § 4.118, DC 7805.

The Veteran filed a timely notice of disagreement (NOD) and an October 2019 Statement of the Case (SOC) continued the noncompensable rating for amputation, left hand ring finger and initial noncompensable rating for scars, left ring finger. The Veteran subsequently perfected his appeal to the Board.

In September 2022, the Veteran attended a hearing before the undersigned Acting Veterans Law Judge (VLJ). A transcript of the hearing is of record.

On December 14, 2023, VA received a fully developed claim seeking service connection for left hand carpal tunnel syndrome.

Also on December 14, 2023, and in pertinent part, the Board remanded the claim for entitlement to a compensable rating for amputation, left hand ring finger (characterized as entitlement to
9 Statement of the Case (SOC) continued the noncompensable rating for amputation, left hand ring finger and initial noncompensable rating for scars, left ring finger. The Veteran subsequently perfected his appeal to the Board.

In September 2022, the Veteran attended a hearing before the undersigned Acting Veterans Law Judge (VLJ). A transcript of the hearing is of record.

On December 14, 2023, VA received a fully developed claim seeking service connection for left hand carpal tunnel syndrome.

Also on December 14, 2023, and in pertinent part, the Board remanded the claim for entitlement to a compensable rating for amputation, left hand ring finger (characterized as entitlement to a compensable disability rating for (residual(s) of) amputation of the left ring finger) and entitlement to an initial compensable rating for scars, left ring finger (characterized as entitlement to an initial compensable evaluation for scarring of the left ring finger) for development.

Then, a March 2024 rating decision denied service connection for left hand carpal tunnel syndrome, but granted service connection for left upper extremity neuropathy, median nerve with an initial 10 percent rating, effective December 14, 2023 (date VA received claim) under 38 C.F.R. § 4.124a, DC 8515.

During development, a December 2024 rating decision granted service connection or painful scar, amputation, left ring finger with an initial 10 percent rating from February 9, 2024 (date of VA examination) under 38 C.F.R. § 4.118, DC 7804.

An April 2025 Supplemental Statement of the Case (SSOC) continued the noncompensable rating for (residuals of) amputation of the left ring finger and initial noncompensable rating for scarring of the left ring finger. It also denied entitlement to a rating more than 10 percent for painful scar, amputation of left ring finger from February 9, 2024.

On June 10, 2025, the Board remanded the issues of entitlement to a rating more than 10 percent for (residuals of) amputation of the left ring finger and entitlement to a rating more than 10 percent for scarring of the left ring finger for evidentiary development.

During development, a July 2025 rating decision continued the noncompensable rating for scars, left hand ring finger under 38 C.F.R. § 4.118, DC 7801.

A January 2026 SSOC denied entitlement to a rating more than 10 percent for (residuals of) amputation of the left ring finger and a rating more than 10 percent for scarring of the left ring finger. Notably, the SSOC stated that the 10 percent rating for left upper extremity neuropathy, median nerve was continued under DC 8515 and the noncompensable rating for amputation, left hand ring finger was continued under DC 5227.

Based on the above, the Veteran's appeal has resulted in staged ratings. The issues on appeal are as follows: 1) entitlement to an initial compensable rating for scars, left hand ring finger; 2) entitlement to a rating more than 10 percent for painful scars, left hand ring finger from February 9, 2024; 3) entitlement to an initial rating more than 10 percent for left upper extremity neuropathy, median nerve; 4) and entitlement to a compensable rating for amputation of the left ring finger. The remaining matters, as they have been characterized above, have since been returned to the Board for further consideration.

Increased Ratings

Disability ratings are determined by applying a schedule of ratings (Ratings Schedule) that is based on the average impairment of earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App.
activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2.

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged ratings." See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

All reasonable doubt will be resolved in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

1. Entitlement to an initial 20 percent rating, but no higher, for left upper extremity neuropathy, median nerve, is granted.

The Veteran seeks entitlement to an initial rating more than 10 percent for left upper extremity neuropathy, median nerve. It is noted that this issue has been incorporated into the present appeal based on discussion contained in the January 2026 SSOC. Further discussion follows.

The procedural history of this appeal has been discussed above. In relevant part, a March 2024 rating decision granted service connection for left upper extremity neuropathy, median nerve with an initial 10 percent rating, effective December 14, 2023 (date VA received claim) under 38 C.F.R. § 4.124a, DC 8515.

Following review of the procedural history and factual background, the Board finds that entitlement to an initial 20 percent rating for left upper extremity neuropathy, median nerve is warranted throughout the entire period on appeal.

Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8515. Neuritis and neuralgia of that group are evaluated DCs 8615 and 8715. Under these criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis is rated as 70 percent for the major extremity and 60 percent for the minor extremity, and characterized by the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and pain with trophic disturbances. 38 C.F.R. § 4.124a, DCs 8515, 8615, 8715.

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 on 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
ion of wrist weakened; and pain with trophic disturbances. 38 C.F.R. § 4.124a, DCs 8515, 8615, 8715.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of 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).

VA's Adjudication Procedures Manual (M21-1) provides benchmarks for mild, moderate, moderately severe, and severe nerve conditions. However, although the Board is not bound by the M21-1, it is required to discuss any relevant provisions contained in the M21-1 and conduct its own analysis before determining whether the M21-1 provisions may be relied upon to support its decision, thereby fulfilling part of its duty to provide adequate reasons or bases for its decision. See Overton v. Wilkie, 30 Vet. App. 257, 263-64 (2018).

M21-1 offers the following guidance on cases where a nerve disability is only manifested by sensory impairment: "The mild level of evaluation would be more reasonably assigned when sensory symptoms are recurrent but not continuous, assigned a lower medical grade reflecting less impairment, and/or affecting a smaller area in the nerve distribution. Reserve the moderate level of evaluation for the most significant and disabling cases of sensory-only involvement. These are cases where the sensory symptoms are continuous, the symptoms are assigned a higher medical grade reflecting greater impairment and/or they affect a larger area in the nerve distribution." M21-1, III. iv. 4. N. 4.b.

"Moderately severe" incomplete paralysis is the maximum rating for sciatic nerve neuritis not characterized by the organic changes specified in 38 C.F.R. § 4.123. This term would be appropriate for "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Atrophy may be present. However, for marked muscular atrophy, see the criteria for a severe evaluation under 38 C.F.R. § 4.124a, DC 8520." M21-1, III. iv. 4. N. 4.c.

M21-1 further provides, for "severe" incomplete paralysis of a nerve, with which marked muscle atrophy is expected. In general, severe incomplete paralysis of a nerve involves motor and/or reflex impairment (for example atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability." Id. "Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve." Id.

Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the
at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. §4.124.

Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. 38 C.F.R. § 4.69. Only one hand shall be considered dominant. Id. In this case, the record shows that the Veteran is right-handed. Therefore, his right upper extremity is considered major, and his left upper extremity is considered minor for rating purposes. 38 C.F.R. § 4.69.

As previously mentioned, VA received a fully developed claim on December 13, 2023 seeking entitlement to service connection for left hand carpal tunnel syndrome.

Initially, the Board observes that the Veteran has received VA and private treatment for several conditions, including joint and hand pain.

The Veteran received a VA peripheral nerves examination in February 2024, wherein he was diagnosed with left upper extremity neuropathy (ring finger/hand/wrist/forearm), s/p left ring finger trans phalangeal amputation with subsequent phantom limb syndrome. The Veteran reported that his condition onset during service in 2007 after his left ring finger got caught in a gun sling during basic training. He said the ring finger had to be amputated after 2 surgeries and since amputation, his finger aches daily with swelling 3-4 times weekly. He also reported numbness, tingling, and pain to his left hand/wrist that radiates up the medial aspect of his left forearm to elbow. The Veteran stated that his condition has progressed/worsened and it was noted that he takes medication for treatment. The examiner stated that the Veteran is right hand dominant. According to the examiner, the Veteran has mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness of his left upper extremity. Muscle strength testing was 4/5 (active movement against some resistance) for left elbow flexion, left elbow extension, left wrist flexion, left wrist extension, left hand grip, and left hand pinch (thumb to index finger). No atrophy was reported and the reflex exam was normal. The sensory exam was decreased for the Veteran's left inner/outer forearm and left hand/fingers. There were no trophic changes and the Veteran's gait was normal. Special tests for the median nerve were positive on the left side. The examiner stated that the median nerve is affected and it results in moderate incomplete paralysis of the left upper extremity. All other nerves were marked as normal except for the left radial nerve and left ulnar nerve. It was noted that the Veteran does not use an assistive device. The examiner indicated that functioning is not so diminished that amputation with prosthesis would equally serve the Veteran. No functional impact was reported and there were no other pertinent findings.

The Board acknowledges that this resulted in the March 2024 rating decision that granted service connection for left upper extremity neuropathy, median nerve with an initial 10 percent rating, effective December 14, 2023 (date VA received claim) under 38 C.F.R. § 4.124a, DC 8515.

The Veteran received another VA peripheral nerves examination in September 2025. He was diagnosed with left upper extremity neuropathy, median nerve. The Veteran described the in-service injury to his left hand ring finger. He sought an increased rating due to progressive pain. The Veteran said he drops things often, is unable to find things, and cannot hold items. He reported weakness and an inability to use both arms equally. He was also dealing with phantom limb pain. It was noted that he takes medication for treatment. Curiously, the examiner found that the Veteran is ambidextrous, which conflicts with the remaining evidence. Regardless, and according to the examiner, the Veteran has severe constant pain, severe paresthesias and/or dysesthesias, and severe numbness of his left upper extremity. No intermittent pain was noted. Muscle strength testing was normal, except 4/5 for left wrist flexion, left wrist extension, left
. He sought an increased rating due to progressive pain. The Veteran said he drops things often, is unable to find things, and cannot hold items. He reported weakness and an inability to use both arms equally. He was also dealing with phantom limb pain. It was noted that he takes medication for treatment. Curiously, the examiner found that the Veteran is ambidextrous, which conflicts with the remaining evidence. Regardless, and according to the examiner, the Veteran has severe constant pain, severe paresthesias and/or dysesthesias, and severe numbness of his left upper extremity. No intermittent pain was noted. Muscle strength testing was normal, except 4/5 for left wrist flexion, left wrist extension, left hand grip, and left hand pinch (thumb to index finger). No atrophy was reported and the reflex exam was normal. The sensory exam was decreased on the left inner/outer forearm and left hand/fingers. No trophic changes were reported and the Veteran's gait was normal. Special tests of the median nerve were not performed. The examiner found that all of the Veteran's nerves were normal except for the median nerve, which results in moderate incomplete paralysis of the left upper extremity. It was noted that the Veteran does not use an assistive device. The examiner indicated that functioning is not so diminished that amputation with prosthesis would equally serve the Veteran. As to functional impact, the Veteran reported days where he is unable to work due to intense pain. There were no other pertinent findings.

For the following reasons, an initial 20 percent rating, but no higher, is warranted for the Veteran's left (minor) upper extremity neuropathy, median nerve. The February 2024 examiner stated that the median nerve is affected and it results in moderate incomplete paralysis of the left upper extremity. According to that examiner, the Veteran has mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness of his left upper extremity. Likewise, the September 2025 examiner commented that the Veteran's left upper extremity neuropathy results in moderate incomplete paralysis of the left upper extremity. That examiner stated that the Veteran has severe constant pain, severe paresthesias and/or dysesthesias, and severe numbness of his left upper extremity, with no intermittent pain reported.

Importantly, the examiners accounted for the Veteran's statements and reported that the Veteran's symptoms were mostly moderate in nature. The Board considers the use of "moderate" at the VA examinations to be persuasive in view of the other evidence of record, including the objective findings on examination. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis of the left upper extremity median nerve; however, no severe incomplete paralysis was noted upon examination and therefore a 40 percent rating is not warranted (minor). Nor has complete paralysis been shown to warrant a 60 percent rating (minor). The February 2024 and September 2025 VA examination reports and findings discussed above are consistent with the M21-1 guidelines and support a finding of neuropathy that results in moderate incomplete paralysis in the left upper extremity (median nerve) throughout the entire period on appeal.

The Board has carefully considered the Veteran's assertions regarding the severity of his left upper extremity neuropathy, median nerve. He is competent to state how he experiences symptoms, such as pain, that require only personal knowledge as it comes to him through her senses. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, he is not competent to identify the specific level of disability for left upper extremity neuropathy according to the relevant DCs. Therefore, the Veteran's statements are outweighed by the objective medical evidence of record, which shows that he is not entitled an initial evaluation more than 20 percent for left upper extremity neuropathy, median nerve.

In reaching this determination, the Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130 (2025). Here, the beneficial effects of medication are not known and thus the Board has considered it in the adjudication of this matter, resolving all reasonable doubt in the Veteran's favor.

The Board has also considered all other potentially applicable DCs, but there is no evidence showing the Veteran has neurological impairment associated with any other nerves in the upper extremities. Therefore, a separate or higher rating under a different DC is not warranted.

In conclusion, the Board finds entitlement to an initial rating of 20 percent, but no higher, for left upper extremity neuropathy involving the median nerve is warranted. As the evidence of record persuasively weighs against the claim for a rating in excess of what is presently granted,
. App. 130 (2025). Here, the beneficial effects of medication are not known and thus the Board has considered it in the adjudication of this matter, resolving all reasonable doubt in the Veteran's favor.

In conclusion, the Board finds entitlement to an initial rating of 20 percent, but no higher, for left upper extremity neuropathy involving the median nerve is warranted. As the evidence of record persuasively weighs against the claim for a rating in excess of what is presently granted, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to an initial 10 percent rating, but no higher, for painful scars, left hand ring finger, is granted.

The Veteran's appeal has resulted in staged ratings. Essentially, the issues on appeal here are: 1) entitlement to an initial compensable rating for left hand ring finger scar; and 2) entitlement to a rating more than 10 percent for painful left hand ring finger scar from February 9, 2024.

Again, the procedural history of this appeal has been discussed above. In relevant part, a November 2016 rating decision granted service connection for scars, left ring finger with an initial noncompensable rating, effective March 10, 2016 (date VA received claim) under 38 C.F.R. § 4.118, DC 7805.

Then, during remand development, a December 13, 2024 rating decision granted service connection or painful scar, amputation, left ring finger with an initial 10 percent rating from February 9, 2024 (date of VA examination) under 38 C.F.R. § 4.118, DC 7804.

Scars other than scars of the head, face, or neck are rated under DCs 7801-7805. Amendments to the criteria for rating disabilities of the skin, including scars, were published in July 2018. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32,592 (July 13, 2018). The amendments were made effective as of August 13, 2018, and apply to claims, such as the Veteran's, that were pending before VA as of that date, with the provision that the more favorable of the old and new criteria are to be applied.

In this regard, when a law or regulation changes during the pendency of a Veteran's appeal, the version most favorable to the Veteran applies, absent congressional intent to the contrary. The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made. See 38 U.S.C. § 5110(g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Thus, the Veteran is entitled to application of the criteria that are most favorable to the claim, except that an award based on the amended regulations may not be made effective before the effective date of the change.

Under both the old and new criteria, scars other than those of the head, face, or neck that are deep and nonlinear are rated under DC 7801. Under DC 7801, a 10 percent rating is warranted if the area or areas affected is/are at least 6 square inches (39 square cm.), but less than 12 square inches (77 square cm.), in size. Higher ratings of 20, 30, and 40 percent are warranted if the affected area or areas measure at least 12 square inches (77 square cm.), 72 square inches (465 square cm.), and 144 square inches (929 square cm.), respectively. A "deep" scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801, Note 1 (2017).

Under both the old and the new criteria, superficial scars other than those of the head, face, or neck are rated under DC 7802. Under that diagnostic code, a 10 percent rating is warranted if the scar, or scars,
inches (77 square cm.), in size. Higher ratings of 20, 30, and 40 percent are warranted if the affected area or areas measure at least 12 square inches (77 square cm.), 72 square inches (465 square cm.), and 144 square inches (929 square cm.), respectively. A "deep" scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801, Note 1 (2017).

Under both the old and the new criteria, superficial scars other than those of the head, face, or neck are rated under DC 7802. Under that diagnostic code, a 10 percent rating is warranted if the scar, or scars, cover(s) an area, or areas, of 144 square inches (929 square cm.) or more. A "superficial" scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7802, Note 1 (2017).

Both before and after the 2018 amendments, scars that are unstable or painful are rated under DC 7804. Under that code, a 10 percent rating is warranted for one or two scars that are unstable or painful. Higher ratings of 20 and 30 percent are warranted if there are three or four, or five or more, such scars, respectively. Scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. Id. If one or more scars are both unstable and painful, a 10 percent evaluation is added to the evaluation that is based on the total number of unstable or painful scars. Id. An "unstable" scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, DC 7804, Note 1.

Any disabling effects of scars that are not considered in a rating provided under DCs 7800-04 are to be evaluated under an appropriate diagnostic code, to include, where applicable, diagnostic codes pertaining to limitation of function. 38 C.F.R. § 4.118, DC 7805.

Following review of the procedural and factual history, the Board finds entitlement to an initial of 10 percent rating, but no higher, for painful scars, left ring finger is warranted.

During a July 2016 VA amputations examination, it was noted that the Veteran has a scar associated with the amputation of his left ring finger. According to the examiner, the scar was not painful and/or unstable, nor did it have a total area greater than 39 square cm (6 square inches). In fact, the examiner stated that the Veteran has scars on his "distal left ring finger stump approx. 2 cm long 0.125 wide, posterior left ring finger 4.5 cm long x 0.25 wide."

At a July 2016 VA hand and fingers examination, the examiner reported that the Veteran has a scar located on his distal left ring finger stump that measures 2 cm long and 0.125 cm wide. However, the scar was not painful and/or unstable, nor did it have a total area greater than 39 square cm (6 square inches).

The Veteran received a VA scars/disfigurement examination in February 2024, wherein he was diagnosed with scar, amputation left ring finger (dated 2012). The examiner reported that the Veteran has scars on the trunk or extremities (regions other than the head, face, or neck). He did not have any scars or disfigurement of the head, face, or neck. The Veteran reported that his condition has progressed/worsened and his current symptoms were "needle sticking." The examiner stated that 1 scar of the trunk or extremities is painful, like "tingling needle sticking" on his left ring finger anterior. None of the scars were unstable, with frequent loss of skin over the scar. The examiner indicated that the Veteran has 2 scars on his left upper extremity: left ring finger anterior and left ring finger stump. Scar 1 measured 4 cm long x 0.1 cm wide and scar 2 measured 2.5 cm long x 0.1 cm wide. Scar 1 was found to be tender to palpation. None of the scars were tender or unstable and they did have underlying soft tissue damage. The examiner summarized that the approximate total area of the left upper extremity scars were 0.65 square cm. There were no other pertinent findings or additional scars noted.

The Veteran had another VA scars/disfigurement examination in June 2025. He was diagnosed with scars, left hand ring finger (dated 2016). The examiner reported that the
left upper extremity: left ring finger anterior and left ring finger stump. Scar 1 measured 4 cm long x 0.1 cm wide and scar 2 measured 2.5 cm long x 0.1 cm wide. Scar 1 was found to be tender to palpation. None of the scars were tender or unstable and they did have underlying soft tissue damage. The examiner summarized that the approximate total area of the left upper extremity scars were 0.65 square cm. There were no other pertinent findings or additional scars noted.

The Veteran had another VA scars/disfigurement examination in June 2025. He was diagnosed with scars, left hand ring finger (dated 2016). The examiner reported that the Veteran has scars on the trunk or extremities (regions other than the head, face, or neck). He did not have any scars or disfigurement of the head, face, or neck. The Veteran stated he received a scar after his left ring finger was amputated in 2012. His condition has remained the same and it was noted that the scar is well-healed, hypersensitive to touch, and feels like "needle sticking." The examiner stated that 1 scar of the trunk or extremities is painful, hypersensitive to touch, tingling and feels like a needle sticking him. None of the scars were unstable, with frequent loss of skin over the scar. The examiner indicated that scar 1 is on the tip of his left ring finger stump and scar 2 is on his anterior left ring finger. Scar 1 measured 2 cm long x 0.1 cm wide and scar 2 measured 2 cm long x 0.1 cm wide. Both scars have underlying soft tissue damage, but neither scar was tender to palpation or unstable upon inspection. The examiner summarized that the approximate total area of the left upper extremity scars were 0.40 square cm. There were no other pertinent findings or additional scars noted.

The Veteran underwent a VA scars/disfigurement examination in September 2025. He was diagnosed with scars, left hand ring finger (dated 2012). The examiner reported that the Veteran has scars on the trunk or extremities (regions other than the head, face, or neck). He did not have any scars or disfigurement of the head, face, or neck. The Veteran stated he underwent an amputation of his distal phalanx, left ring finger, with residual painful scars. He said his symptoms have worsened with more pain and he takes medication for treatment. The examiner stated that 1 scar of the trunk or extremities is painful, with achy, burning, shooting pain on his anterior left ring finger. None of the scars were unstable, with frequent loss of skin over the scar. The examiner indicated that scar 1 is on anterior left ring finger and scar 2 is on his left ring finger stump. Scar 1 measured 5 cm long x 0.2 cm wide and scar 2 measured 2 cm long x 0.2 cm wide. Scar 1 was tender to palpation and has underlying soft tissue damage, but neither scar was unstable upon inspection. The examiner summarized that the approximate total area of the left upper extremity scars were 1.4 square cm. There were no other pertinent findings or additional scars noted.

The Veteran had a VA scars/disfigurement examination in November 2025. He was diagnosed with status post-surgery for amputation of left ring finger "2/2 intractable osteomyelitis." The examiner reported that the Veteran has scars on the trunk or extremities (regions other than the head, face, or neck). He did not have any scars or disfigurement of the head, face, or neck. It was noted that the Veteran has 1 scar from his amputated left ring finger that is stable and well-healed. The examiner found that none of the scars of the trunk or extremities were painful or unstable. The examiner determined that the Veteran's left upper extremity is affected and he has 1 scar on his left ring finger measuring 2 cm long x 0.25 cm wide. The scar was not tender to palpation, nor was it unstable or associated with underlying tissue damage. The examiner summarized that the approximate total area of the left upper extremity scar was 0.5 square cm. As to functional impact, it was noted that the Veteran is unable to use scissors or hold a razor using his left hand due to pain. The Veteran also experiences phantom limb pain that radiates to his left upper extremity and throbs constantly. There were no other pertinent findings or additional scars noted.

In a December 2025 VA addendum, the examiner clarified that the Veteran' "actual scar is non-painful to palpation. Veteran's symptoms of achy, burning, shooting pain are attributed to
25 cm wide. The scar was not tender to palpation, nor was it unstable or associated with underlying tissue damage. The examiner summarized that the approximate total area of the left upper extremity scar was 0.5 square cm. As to functional impact, it was noted that the Veteran is unable to use scissors or hold a razor using his left hand due to pain. The Veteran also experiences phantom limb pain that radiates to his left upper extremity and throbs constantly. There were no other pertinent findings or additional scars noted.

For the following reasons, an initial rating of 10 percent, but no higher, is warranted for the Veteran's painful scars, left ring finger throughout the entire period on appeal. See Estevez v. McDonough, 36 Vet. App. 157, 175 (2023) ("As we have said before, the Board errs when it reflexively assigns the date of a VA examination as the date of an increased evaluation; instead, the Board must analyze the examination report alongside the other lay and medical evidence of record to determine when an increase in disability actually occurred") (citing Swain v. McDonald, 27 Vet. App. 219, 224-25 (2015) (rejecting the mechanical assignment of an effective date based on the date of examination and explaining that, for staged evaluation purposes, VA must examine all relevant facts to determine when an increase in a veteran's disability manifests); DeLisio v. Shinseki, 25 Vet. App. 45, 58 (2011) ("[A]n effective date should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined to determine the date that [a disability] first manifested")).

Put another way, the Veteran has at least 2 scars from his left ring finger amputation. While the July 2016 VA examiner reported the Veteran has a scar located on his distal left ring finger stump that measures 2 cm long and 0.125 cm wide, the scar was not was not painful and/or unstable, nor did it have a total area greater than 39 square cm (6 square inches). However, this conflicts with the Veteran's July 2022 Board hearing where the Veteran reported painful or unstable scars since the initial amputation procedure. Therefore, an initial 10 percent rating for painful left ring finger scars is warranted since the March 10, 2016 date of claim.

Based on the above, the Veteran's service-connected painful left ring finger scars do not warrant a rating in excess of 10 percent. The scars do not cover an area of 144 square inches (929 square centimeters) or greater. The Veteran had 2 scars that measure approximately 2-4 cm x 0.25 cm wide and the approximate total area was no greater than 1.4 square cm. As such, a compensable rating under DC 7802 is not warranted either.

However, under DC 7804, the record shows that Veteran had one or two scars that were painful to warrant a 10 percent rating throughout the appeal period. While the VA examination reports detailed above demonstrate that the scars may have improved, the 10 percent rating was continued because sustained improvement was not shown. Here, the Veteran did not have three or four scars that were painful and unstable to warrant a higher than 10 percent rating at any time. However, there is no evidence that the Veteran's scars were unstable or had an area or areas of 144 square inches (929 square centimeters) or greater at any point during the appeal period. As such, a rating in excess of 10 percent under DC 7804 is not warranted. See 38 C.F.R. § 4.118. The Board also finds that the Veteran's sensitivity and tenderness around the site of the scar did not result in disabling effects, as contemplated by DC 7805. Id. In this regard, the VA examiner found the Veteran's scars do not impact his ability to work, but sometimes cause him to be unable to use items in his left hand.

In assessing the severity of the Veteran's painful left ring finger scars, the Board has given due consideration to the competent lay assertions regarding symptoms experienced and observed. Certainly, the Veteran is competent to report complaints such as pain, as this observation comes to him through his senses. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings involve medical findings that are within the province and purview of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions of the Veteran are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to them through his senses, he is not competent to identify a specific level of disability of his scars according to the appropriate diagnostic codes. As such, the Board accords more probative weight to the competent medical evidence of record. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Moreover, the VA examiners have suggested that the additional pain the Veteran reports is associated with phantom limb pain from the amputation of his left ring finger.

Accordingly, the Board finds entitlement to an initial rating of 10 percent, but no higher, for painful scars, left hand ring finger warranted. As the evidence of record persuasively weighs against the claim for a rating in excess of what is presently granted, the benefit of the doubt rule does not apply. 38 U.S.C. § 5170(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, supra.

REASONS FOR REMAND

1. Entitlement to a compensable rating for amputation of the left ring finger is remanded.

A review of the record reveals that a remand is necessary to ensure substantial compliance with the Board's June 2025 remand directives and to satisfy the duty to assist. See also Stegall v. West, 11 Vet. App. 268, 271 (1998).

The Veteran seeks entitlement to a compensable rating for amputation of the left ring finger.

Again, the procedural history of this appeal has been discussed above. In pertinent part, a November 2016 rating decision continued the noncompensable rating for amputation, left hand ring finger under 38 C.F.R. § 4.71a, DC 5227. The matter was previously remanded by the Board in December 2023 and June 2025.

It is emphasized that while the Veteran is also service-connected for degenerative arthritis, left ring finger (rated noncompensable from August 25, 2007 to January 10, 2013), that issue/rating is not on appeal. See also July 2025 Rating Decision - Codesheet.

While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, DC 5227 was not changed.

As applicable to this case, the preamble to 38 C.F.R. § 4.71a, DCs 5216-5230 provides in particular, that:

(1) For the index, long, ring, and little (small) fingers (digits II-V), zero degrees of flexion represents the finger fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees, and the thumb (digit I) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flexion. 38 C.F.R. § 4.71a, Table "Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand."

(2) When two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level. Id.

(3) Evaluation of ankylosis of the index, long, ring, and little fingers: (i) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, and either is in extension or full flexion, or there is rotation or angulations of a bone, evaluate as amputation without metacarpal resection, at proximal interphalangeal joint or proximal thereto; (ii) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position; (iii) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, evaluate as unfavorable ankylosis; (iv) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, evaluate as favorable ankylosis.

(5) If there is limitation of motion of two or more digits, evaluate each digit separately and combine the evaluation. Id.

Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. 38 C.F.R. § 4.69. The examinations of record found that the Veteran's right hand is his dominant hand. The Veteran's left hand is therefore his "minor" extremity.

Under DC 5227, a maximum 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, DC 5227. A note accompanying DC 5227 provides that the Board should also 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. 38 C.F.R. § 4.71a, DC 5227, Note.

The Board is also cognizant of the amputation rule, which provides that the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. See 38 C.F.R. § 4.68.

Here, the Veteran is currently in receipt of the maximum noncompensable (0 percent) disability rating. However, the Note to DC 5227 states that an amputation evaluation should also be considered.

DC 5156 provides for a 10 percent rating for amputation without metacarp
or interference with overall function of the hand. 38 C.F.R. § 4.71a, DC 5227, Note.

Here, the Veteran is currently in receipt of the maximum noncompensable (0 percent) disability rating. However, the Note to DC 5227 states that an amputation evaluation should also be considered.

DC 5156 provides for a 10 percent rating for amputation without metacarpal resection, at proximal interphalangeal joint or proximal thereto, and a 20 percent rating for amputation with metacarpal resection (more than one-half the bone lost). 38 C.F.R. § 4.71a, DC 5156. Evaluation as amputation does not require physical amputation of the appendage; rather, it only requires that the functional equivalent of amputation. See, e.g., DC 5227, Note.

Initially, the Board acknowledges that the Veteran has received VA and private treatment for several conditions including joint and left hand pain.

The Veteran had a VA amputations examination in July 2016. He was diagnosed with amputation of left hand ring finger (dated 2012). The Veteran reported that during military training, he tore tendons in his left ring finger that resulted in functional loss of the distal portion of the finger. He reported pain with excessive movement and when bumping the stump. It was noted that there is amputation of the distal portion of digit. The examiner reported that the Veteran is right hand dominant. The examiner stated that the Veteran has amputation through the middle phalanx or at the distal joint of his left ring finger. It was noted that he has scars associated with the procedure. As to functional impact, the examiner commented that "the Veteran's claimed condition would moderately impact his ability to perform duties requiring him to grip with both hands, type, or other activities requiring dexterity with fingers."

At a February 2024 VA amputation examination, the Veteran was again diagnosed with left ring finger amputation and found to be right hand dominant. He stated that the amputation occurred in 2012 and it has progressed/worsened, with phantom pain to his left finger that radiates to his elbow. It was noted that he takes medication for treatment. The examiner stated that the Veteran has amputation through the middle phalanx or at the distal joint of his left ring finger. As to functional impact, the examiner remarked that the Veteran would have difficulty holding items between 2-6 ounces due to items falling out of his hand because of poor grip/grasp. It was noted that the Veteran was a barber and unable to hold a comb, scissors, or clippers due to his left hand injury.

During a June 2025 VA amputation examination, the Veteran's diagnosis of amputation, left hand ring finger was confirmed and he was determined to be right hand dominant. He explained the in-service incident and treatment history. His current symptoms were chronic phantom pain (10/10 today), with swelling. It was noted that he takes medication for treatment. The examiner stated that the Veteran has amputation through the middle phalanx or at the distal joint of his left ring finger. As to functional impact, the examiner reported that the Veteran has difficulty grasping and gripping with his left hand because he is unable to close it securely enough to maintain control. He also frequently drops items.

At a September 2025 VA amputations examination, the Veteran was diagnosed with amputation, left hand ring finger (dated 2012). The Veteran described the in-service incident and his current symptoms included daily left ring finger pain rated 10/10. He is also unable to grasp and hold things because his finger stays swollen. It was noted that he takes medication for treatment. The examiner stated that the Veteran has amputation through the middle phalanx or at the distal joint of his left ring finger. As to functional impact, it was noted that the Veteran's condition causes interference with lifting and carrying heavy loads, using tools, typing, driving, pushing/pulling, grasping, and holding objects.

During a November 2025 VA amputations examination, the Veteran was diagnosed with amputation, left hand ring finger involving DIP and distal 2/3rds of the middle phalanx. The examiner stated that the Veteran has amputation through the middle phalanx or at the distal joint of his left ring finger. As to functional impact, the examiner reported that the Veteran is unable to manipulate scissors or raz
has amputation through the middle phalanx or at the distal joint of his left ring finger. As to functional impact, it was noted that the Veteran's condition causes interference with lifting and carrying heavy loads, using tools, typing, driving, pushing/pulling, grasping, and holding objects.

The Board further acknowledges that the Veteran received VA hand and finger conditions examinations in July 2016, February 2024, and September 2025. At those examinations, the examiners reported that the Veteran takes prescription medication for his left ring finger disability. There are also multiple VA opinions that attempt to determine the functional impairment of his amputation of the left ring finger. Notably, a December 2025 VA addendum report contains the following remarks:

[The Veteran] has been taking Neurontin for phantom pain and states the medication was not relieving his symptoms. He has recently been referred to the pain clinic. It is not possible to evaluate the veteran's severity of phantom pain (post amputation) off medication without resorting to mere speculation.

Importantly, the VA examiners did not provide any indication as to what effect, if any, the Veteran's medication had on his left ring finger disability symptomatology. The Board notes that where a DC does not explicitly contemplate the ameliorative effects of medication on a disability, the Board must evaluate the disability without regard to the ameliorative effects of the medication. See Jones v. Shinseki, 26 Vet. App. 56, 62 (2012); see also McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) ("if a diagnostic code does not specifically contemplate the effects of medication, the Board is required pursuant to Jones to discount the ameliorative effects of medication"). The DCs potentially applicable to hand/finger disabilities do not explicitly contemplate the ameliorative effects of medication. Given the above, the Board finds the above described examinations to be inadequate for the purpose of adjudicating the Veteran's claims. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) ("[O]nce the Secretary undertakes the effort to provide an examination when developing a service-connection claim,... he must provide an adequate one."). Accordingly, remand is warranted for a retrospective medical opinion regarding what, if any, ameliorative effects the Veteran's medication have on his service-connected amputation of the left ring finger.

The matters are REMANDED for the following action:

1. Obtain a retrospective medical opinion from a clinician with appropriate expertise as to the nature and severity of the Veteran's amputation of the left ring finger throughout the entire period on appeal. The clinician should review the entire claims file and include a discussion of the Veteran's documented history and pertinent lay statements and testimony. The clinician must opine as to all signs and symptoms necessary for evaluation of the Veteran's left ring finger disability under the rating criteria as they presented throughout the entire period on appeal.

The clinician must opine as to whether any medications the Veteran used affected the severity of his left ring finger disability. If so, the clinician should identify each medication and clearly explain how such medication affected the condition. If any such medication was productive of ameliorative effects, the clinician must clearly identify such effects and opine as to how severe the condition would have been absent such medication, to specifically include whether there would have been any additional pain, weakened movement, excess fatigability, or incoordination on movement, or loss of range of motion.

The examiner is reminded to consider the Veteran's lay statements regarding the nature and onset of his left ring finger disability, including any evidence concerning continuity of symptomatology, as he is legally permitted to report his symptoms, past medical history, and experiences.

The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran's assertions.

A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board.

If the examiner relies on medical treatises, the examiner should identify and discuss the treatises.

If the examiner determines a disability was acute rather than chronic, the examiner should explain how he or she arrived at that conclusion rather
and onset of his left ring finger disability, including any evidence concerning continuity of symptomatology, as he is legally permitted to report his symptoms, past medical history, and experiences.

The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran's assertions.

A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board.

If the examiner relies on medical treatises, the examiner should identify and discuss the treatises.

If the examiner determines a disability was acute rather than chronic, the examiner should explain how he or she arrived at that conclusion rather than providing a conclusory opinion. For example, what evidence led to that conclusion, what would the examiner expect to see if a condition was chronic, how do the Veteran's lay statements, if any, affect the conclusion?

If the examiner determines that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required or the examiner does not have the needed knowledge or training).The examiner should review the record prior to the examination and elicit from the Veteran a detailed medical history.

2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once.

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3. After the above development, the AOJ must readjudicate the issues on appeal considering all pertinent evidence and legal authority. If the disposition remains unfavorable, the AOJ should furnish the Veteran and his representative with a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. This Supplemental Statement of the Case must address the relevant laws and regulations applicable for the remanded issues on appeal.

Gregory Deemer

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Miller, 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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