POST-TRAUMATIC ARTHRITIS

WILLIAM SKOWRONSKI · 2026 · Case ID: A26036848

DENIED

Summary

The Veteran, an Army veteran who served from October 2008 to May 2015, appeals the denial of an increased disability rating for his service-connected right thumb post-traumatic arthritis. The Veteran sought a rating higher than the current 10 percent. The Board reviewed the evidence of record, including a February 2023 VA examination. The examination diagnosed post-traumatic arthritis of the right thumb and noted pain, periodic locking, and functional limitations with repeated use and during flare-ups. However, the VA examiner found no gap between the thumb pad and fingers, no ankylosis, and opined that range of motion would not be significantly reduced after repetitive use or during flare-ups. The Board found the evidence persuasively weighed against the criteria for a higher rating, specifically noting the absence of a gap of more than two inches between the thumb pad and fingers or ankylosis. The Board also considered the Veteran's use of pain medication and his reported employment limitations, but concluded that the thumb disability did not impact his ability to secure or maintain employment during the period under consideration. Consequently, the Board denied entitlement to a disability rating higher than 10 percent for the right thumb post-traumatic arthritis.

Rationale

Evidence persuasively weighs against criteria for higher rating; No gap between thumb pad and fingers or ankylosis found; Range of motion not significantly reduced after repetitive use or flare-ups

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250616-555784

Full Decision Text

Citation Nr: A26036848
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 250616-555784
DATE: April 21, 2026

ORDER

Entitlement to a disability rating higher than 10 percent for right thumb post-traumatic arthritis is denied.

FINDING OF FACT

The probative evidence of record persuasively weighs against finding the Veteran's right thumb disability resulted in a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, or ankylosis.

CONCLUSION OF LAW

The criteria for a disability rating in excess of 10 percent for the Veteran's right thumb post-traumatic arthritis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010-5228.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from October 2008 to May 2015.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office, which serves as the Agency of Original Jurisdiction (AOJ).

An April 2023 rating decision granted an increased, 10 percent disability rating for the Veteran's service-connected right thumb traumatic arthritis.

In March 2024, the Veteran filed a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR) and requested review of the April 2023 decision.

In July 2024, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the April 2023 rating decision and denied entitlement to a disability rating higher than 10 percent for the Veteran's service-connected right thumb disability.

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2023 rating decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to a rating in excess of 10 percent for right thumb post-traumatic arthritis.

The Veteran is seeking a disability rating higher than 10 percent for his service-connected right thumb post-traumatic arthritis.

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3.

The Veteran's right thumb disability has been evaluated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5228. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Diagnostic code 5010 is used to rate post-traumatic arthritis and notes to rate the affected joint based on limitation of motion. Diagnostic code 5228 is used to rate limitation of motion of the thumb.

Under Diagnostic Code 5228, a 10 percent rating is warranted for limitation of motion of the thumb with a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. 38 C.F.R. § 4.71a, Diagnostic Code 5228. A 20 percent rating is warranted for limitation of motion of the thumb with a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Id.

Under Diagnostic Code 5224, a 10 percent rating is warranted for favorable ankylosis of the thumb, and a 20 percent rating is warranted for unfavorable ankylosis. Id.

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

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

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

Turning to the facts of the case, the Veteran filed a claim seeking an increased disability rating for his service-connected right thumb disability in January 2023.

The Veteran was provided a VA thumb examination in February 2023. The examiner diagnosed post traumatic arthritis of the right thumb. The Veteran reported right thumb pain with periodic locking up. He stated he had moderate flare-ups of pain that lasted a few hours and occurred once or twice a day. The pain was alleviated with rest and pain medication, ib
-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

Turning to the facts of the case, the Veteran filed a claim seeking an increased disability rating for his service-connected right thumb disability in January 2023.

The Veteran was provided a VA thumb examination in February 2023. The examiner diagnosed post traumatic arthritis of the right thumb. The Veteran reported right thumb pain with periodic locking up. He stated he had moderate flare-ups of pain that lasted a few hours and occurred once or twice a day. The pain was alleviated with rest and pain medication, ibuprofen, or ice. He reported he could not lift or push anything heavy.

On active and passive range-of-motion testing of the right thumb metacarpophalangeal (MCP) joint, flexion was to 90 degrees. Flexion of the interphalangeal (IP) joint was also limited to 90 degrees. There was no gap between the pad of the thumb and fingers or a gap between the finger and proximal traverse crease of the hand on maximal finger flexion. There was not additional loss of function or a decreased range of motion on repetitive-use testing.

The examiner indicated the Veteran was not being examined immediately after repeated use over time but found the statements from the Veteran suggested pain, weakness, and a lack of endurance significantly limited functional ability with repeated use over time. However, the examiner opined the range of motion of the right thumb would not be reduced immediately after repeated use over time.

The examiner indicated the Veteran was not being examined during a flare-up but found the statements from the Veteran suggested pain, weakness, and a lack of endurance significantly limited functional ability with flare-ups. The examiner opined the flexion of the right thumb MCP joint would be reduced to 80 degrees during a flare-up but that there would still be no gap between the pad of the thumb and fingers. Flexion of the IP joint would remain 90 degrees.

On examination, there was no ankylosis of the right thumb joints. On muscle strength testing, right hand grip strength was evaluated as active movement against some resistance, but there was no muscle atrophy.

The examiner opined the right thumb disability limited the Veteran's ability to handle heavy lifting, pulling, or pushing. He could not handle heavy duty power tools or equipment.

After considering the above evidence in conjunction with the applicable laws and regulations, the Board finds a disability rating in excess of 10 percent for the right thumb post-traumatic arthritis is not warranted. The probative evidence of record persuasively weighs against finding the Veteran's right thumb disability resulted in a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, or ankylosis, including during his reported flare-ups despite the noted limitation of motion, pain, and functional limitations. Therefore, an increased rating is not warranted under diagnostic code 5228 for limitation of motion of the thumb or diagnostic code 5224 for ankylosis. The Board has considered the application of the other potentially relevant diagnostic codes discussed above, but none are applicable in this instance.

In reaching the above conclusion, the Board has considered the recent holding in Ingram v. Collins, 38 Vet. App. 130 (2025), that the Board is to take due consideration that the beneficial effects of medication are discounted in assessing musculoskeletal ratings as such effects are not contemplated therein and, therefore, taking medication may make a veteran appear less disabled than in reality. The record reflects that the Veteran uses medication, including non-steroidal anti-inflammatory drugs, for thumb symptoms during a flare-up. In this case, however, the record does not show, nor has the Veteran asserted, that limitation of movement of the right thumb would be worse but for the relief provided by pain medication. The examiner acknowledged the use of the pain medication but did not indicate the severity of flare-ups was reduced by such medication, including as opposed to when the Veteran used ice instead of medication during the flare-ups. Accordingly, a remand to obtain an opinion regarding the ameliorative effects of the medication would not be useful and is not warranted in this case. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991).

In addition, while the VA examiner opined the thumb disability would limit the Veteran's ability to perform certain occupational tasks and the Veteran filed an application for a total disability rating based on individual unemployability (TDIU) in April 2025, the Veteran did not assert and the evidence did not show his thumb disability impacted his ability to secure or maintain employment during the period under consideration. Notably, in a January 2023 statement, he asserted his claimed posttraumatic stress disorder (PTSD) impacted his ability to maintain employment, but did not indicate his thumb disability affected his employment. He reported he stopped working his most recent job because it was too far of a commute. A June 2022 VA treatment record shows he reported he was looking for employment. When asked about barriers to employment, he discussed his psychiatric symptoms but did not indicate his thumb was such a barrier. He reported he thought a job that allowed him to work alone would be sustainable.

In short, the evidence of record persuasively weighs against finding the Veteran's right thumb disability resulted in a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, or ankylosis during the period under consideration. Accordingly, the criteria for a disability rating in excess of 10 percent for the Veteran's right thumb disability have not been met at any time during the period on appeal, and the appeal must be denied. 38 C.F.R. § 4.71a.

William Skowronski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jackman, Bridget

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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