OSTEOARTHRITIS

Summary

The veteran, who served in the U.S. Army from November 1979 to October 1983, appeals the denial of increased ratings for left thumb degenerative arthritis and a left thumb surgical scar, as well as service connection for hypertension secondary to PTSD. The Board denied the increased rating for left thumb degenerative arthritis, finding the VA examination adequate despite not being conducted during a flare-up, as the examiner properly estimated functional loss. The evidence did not support a gap of more than two inches or ankylosis. The claim for a compensable rating for the left thumb surgical scar was also denied, as the scars were neither painful nor unstable, and the total scar area was less than the threshold for compensation. Regarding hypertension secondary to PTSD, the Board denied service connection. The veteran's service treatment records did not indicate hypertension, and his first post-service treatment was over 20 years after separation. While the veteran claimed onset during service, this was not supported by objective evidence, and continuity of symptoms was not established. A VA examiner opined that the hypertension was not related to PTSD, finding the veteran's reported symptoms did not impact blood pressure, and this opinion was deemed adequate and probative. The Board found no positive opinions to rebut the VA examiner's conclusions, and the veteran's lay statements regarding the etiology of his hypertension lacked competency as it is not a condition with simple identification for laypersons. Therefore, service connection for hypertension was denied.

Rationale

VA examination adequate for rating purposes; Examiner properly estimated functional loss during flare-ups; Evidence does not support gap of more than two inches or ankylosis

Full Decision Text

Citation Nr: A26032181
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 210609-164988
DATE: April 8, 2026

ORDER

Entitlement to a rating greater than 10 percent for left thumb degenerative arthritis is denied.

Entitlement to a compensable rating for left thumb surgical scar is denied.

Entitlement to service connection for hypertension, to include as secondary to PTSD, is denied.

FINDINGS OF FACT

1. The Veteran's left thumb degenerative arthritis has not been manifested by a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, or ankylosis.

2. The Veteran's left thumb surgical scars have not been manifested by one or two scars that are unstable or painful or a total scar area of 929 square centimeters or greater.

3. The Veteran's hypertension is not proximately due to his service-connected PTSD.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating greater than 10 percent for left thumb degenerative arthritis have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a Diagnostic Code 5003-5228.

2. The criteria for entitlement to a compensable rating for left thumb surgical scar have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118 Diagnostic Code 7805.

3. The criteria for entitlement to service connection for hypertension, to include as secondary to PTSD, have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The served honorably in the United States Army from November 1979 to October 1983 with additional service in the Army Reserve.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2021 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).  

In the June 2021VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  On February 10, 2025, the Veteran withdrew the hearing request.  Therefore, the Board may only consider the evidence of record at the time of the April 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302 (b).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302 (b), 20.801. 

Increased Ratings

Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  The Veteran's entire history is reviewed when making disability evaluations.  See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1.  Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required.  See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999).  Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.  See Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  Further, "[w]here there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned."  
 medical evidence since the effective date of the award of service connection is required.  See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999).  Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.  See Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  Further, "[w]here there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned."  38 C.F.R. § 4.7.

A disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion.  Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled.  38 C.F.R. § 4.40.  With respect to joints, the factors of disability reside in reductions of normal excursion of movements in different planes.  Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse.  38 C.F.R. § 4.45.  Although pain may cause functional loss, pain itself does not constitute functional loss.  Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss.  Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995).

Specifically, consideration must be given to the impact on range of motion from flare-ups and pain on both active and passive motion in weight-bearing and non-weight bearing.  See Mitchell v. Shinseki, 25 Vet. App. 32 (2011), Sharp v. Shulkin, 29 Vet. App. 26 (2017), and Correia v. McDonald, 28 Vet. App. 158 (2016).

1. Entitlement to a rating greater than 10 percent for left thumb degenerative arthritis.

The Veteran seeks a higher rating than the 10 percent he currently receives for his left thumb arthritis.  After a review of the evidence, the Board finds that the next higher 20 percent rating is not warranted.  

The Veteran's left thumb arthritis is rated under 38 C.F.R. § 4.71a Diagnostic Code (DC) 5003-5228.  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.  Here, the hyphenated diagnostic code indicates that the limitation of motion of the Veteran's left thumb (DC 5228) was rated under the criteria for degenerative arthritis (DC 5003).

Under 38 C.F.R. § 4.71a Diagnostic Code (DC) 5228, which compensates for limitation of motion of the thumb, a 10 percent evaluation is assigned when there is a gap of one to two inches between the thumb pad and the fingers with the thumb attempting to oppose the fingers.  A maximum 20 percent evaluation is assigned for a gap of more than two inches.  A 20 percent evaluation is also available under DC 5224 for unfavorable ankylosis.  38 C.F.R. § 4.71a.

Turning to the evidence, the Veteran reported tingling, diminished grip strength, and sharp pain at the base of the thumb at his April 2021 VA examination.  He reported moderate to severe flare-ups 2-3 times a week that lasted an hour or two.  Range of motion testing revealed near full range of motion.  Although the examination was not conducted during a flare-up, the examiner estimated flexion endpoint to be 85 out of 90 during flare-ups.  Ankylosis, functional or otherwise, was not reported by the Veteran or noted by the examiner.

Based on the clinical evidence,
 DC 5224 for unfavorable ankylosis.  38 C.F.R. § 4.71a.

Turning to the evidence, the Veteran reported tingling, diminished grip strength, and sharp pain at the base of the thumb at his April 2021 VA examination.  He reported moderate to severe flare-ups 2-3 times a week that lasted an hour or two.  Range of motion testing revealed near full range of motion.  Although the examination was not conducted during a flare-up, the examiner estimated flexion endpoint to be 85 out of 90 during flare-ups.  Ankylosis, functional or otherwise, was not reported by the Veteran or noted by the examiner.

Based on the clinical evidence, the Board finds that the next higher 20 percent rating is not warranted.  The Veteran's representative argues that the examination was inadequate because the Veteran was not examined during an actual flare-up as required under Sharp v. Shulkin, 29 Vet. App. 26 (2017).  However, this contention misconstrues the holding in Sharp.  In that case, the United Staes Court of Appeals for Veterans Claims held that an examiner must estimate manifestations of functional loss during flare-ups if medically possible.  Here, the examiner properly estimated the Veteran's functional loss in terms of limited range of motion in accordance with Sharp.  Hence, the examination is adequate for rating purposes.

In summation, the evidence of record does not support finding that the Veteran's left thumb arthritis has been manifested by a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, or ankylosis during the period on appeal.  Accordingly, the claim is denied.

2. Entitlement to a compensable rating for left thumb surgical scar.

The Veteran seeks a compensable rating for his left thumb surgical scars.  After a review of the evidence, the Board finds that the next higher 10 percent rating is not warranted.

The Veteran's scars are rated pursuant to Diagnostic Code (DC) 7805, governing unstable or painful scars.  38 C.F.R. § 4.118.  Under DC 7805, a 10 percent rating is warranted for one or two scars that are unstable or painful.  An unstable scars is one where, for any reason, there is frequent loss of covering of skin over the scar.  A 20 percent rating is warranted for three or four scars that are unstable or painful.  Finally, a 30 percent rating is warranted for five or more scars that are unstable or painful.

Alternatively, a 10 percent rating is warranted for scars that are not associated with underlying tissue damage but cover a total area of 144 square inches (929 sq. cm.) or greater.

At the Veteran's April 2021 VA examination, his left thumb scars were found to be neither painful nor unstable.  Indeed, the Veteran denied any current symptoms.  Moreover, the scars are not of such a size that any compensable rating may be assigned based on coverage of an exposed area.

Based on the medical and lay evidence, the Board finds that a compensable rating for left thumb scars is not warranted.  The medical evidence does not show painful or unstable scars, and the total area of scarring is less than 144 square inches.  Moreover, the Veteran has not reported a loss of skin covering his scars or that they are painful.  The claim is denied.

3. Entitlement to service connection for hypertension. 

The Veteran contends that his hypertension is related to his service-connected PTSD.  After a review of the evidence, the Board finds that service connection is not warranted.

As an initial matter, the Board notes that symptoms of hypertension are not contained in the Veteran's active duty service treatment records.  He was diagnosed with hypertension in April 2021.

The post-service clinical evidence also lack diagnosis or treatment for hypertension until many years after separation from active service.  In August 2017, over 20 years removed from active service, hypertension medication is listed under current medications.  This is the first indication of treatment for hypertension after separation.  Moreover, a thorough review of the post-service clinical evidence does not show blood pressure levels high enough to qualify for VA disability compensation prior to 2017.  At this April 2021 VA examination, the Veteran reported on onset of symptoms during service with a diagnosis of 2008.  However, as noted, these assertions are not supported by the objective medical evidence of record.  Hence, based on the evidence, the Board finds that a continuity of symptoms since service has not been established.

 As to nexus, the Board observes that the Veteran has not been afforded a VA examination specifically to address service connection for hypertension on a direct basis.  However, given the lack of any in-service incident, illness, or injury to
 after separation.  Moreover, a thorough review of the post-service clinical evidence does not show blood pressure levels high enough to qualify for VA disability compensation prior to 2017.  At this April 2021 VA examination, the Veteran reported on onset of symptoms during service with a diagnosis of 2008.  However, as noted, these assertions are not supported by the objective medical evidence of record.  Hence, based on the evidence, the Board finds that a continuity of symptoms since service has not been established.

 As to nexus, the Board observes that the Veteran has not been afforded a VA examination specifically to address service connection for hypertension on a direct basis.  However, given the lack of any in-service incident, illness, or injury to which the disability may be linked combined with the absence of evidence of symptoms for many years after separation from active service, the duty to assist does not require such development.  38 C.F.R. § 3.159 (c) (4) (i); McLendon v. Nicholson, 20 Vet. App. 79 (2006).  Here, the evidence does not show the onset of the Veteran's migraine disorder until many years after separation from active service.  As such, based on the evidence of record, the Board finds that a nexus has not been established for a hypertension on a direct basis.

Next, with regard to service connection on a secondary basis, the April 2021 VA examiner opined that the Veteran's hypertension was not related to his service-connected PTSD.  In providing this opinion the examiner reflected that heightened blood pressure may be present in situations where the Veteran exhibits certain "fear-related" symptoms such as hypervigilance or exaggerated startle, his symptoms were mostly comprised of "mild depressive symptoms" which, the Board infers, were not impacting his blood pressure. 

The Board finds that this opinion is probative and adequate for adjudication purposes.  Specifically, it is supported by an adequate rationale and has been based on a thorough review of the Veteran's claims file.  Moreover, there are no positive opinions of record to rebut the VA examiner's conclusions.  

In considering this appeal, the Board acknowledges the Veteran's statements that his hypertension is related to a service-connected disability.  However, the Veteran is not competent to testify regarding the etiology this disorder.  of his supranuclear palsy. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Because such a disorder is not diagnosed by unique and readily identifiable features, it does not have a simple identification that a layperson is competent to make.  Therefore, the lay statements of belief that the Veteran's disorder is related to service lacks competency. 

Based on the foregoing, the Board finds that service connection for hypertension is not warranted.  The medical evidence does not support a causal link between the Veteran's PTSD and the development of his hypertension.  Accordingly, the claim is denied.  ?

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.

 

 

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ballinger, Daniel