Citation Nr: 0005651 Decision Date: 03/02/00 Archive Date: 03/14/00 DOCKET NO. 94-19 492 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to a rating for left wrist disability in excess of 10 percent, prior to March 1, 1996. 2. Entitlement to an increased rating for left wrist disability, currently rated as 20 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael P. Vander Meer, Counsel INTRODUCTION The veteran served on active duty from August 1959 to September 1965. This case is before the Board of Veterans' Appeals (Board) on appeal from rating decisions, the earliest of which was entered in August 1993, of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. A hearing was held before a hearing officer at the RO in February 1994, and the hearing officer's decision was entered in February 1995. Another hearing was held at the RO in October 1995. FINDINGS OF FACT 1. The manifestations of the veteran's service-connected left wrist disability, prior to March 1, 1996, included an ability to dorsiflex the wrist to less than 15 degrees, with palmar flexion limited to being in line with the forearm or greater; ankylosis involving the left wrist was not shown. 2. Current manifestations of the veteran's service-connected left wrist disability include a normal median nerve and only a mildly prolonged latency on pertinent electrodiagnostic study, productive, collectively, of not more than mild related incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a rating for left wrist disability in excess of 10 percent, prior to March 1, 1996, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 5215 (1996). 2. The criteria for a rating in excess of 20 percent for left wrist disability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.40, 4.45 and Part 4, Diagnostic Code 8514 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the veteran's claim, as stated in the two issues listed on the title page, is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the Board finds that this claim is plausible. The Board is also satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (1999). The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1999). Service connection is in effect for residuals of fractured left wrist, for which the RO has assigned a 20 percent rating (with a 10 percent rating, under Diagnostic Code 5215, having been in effect until March 1, 1996) under the provisions of Diagnostic Code 8514 of the Rating Schedule. In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 and 4.42 (1999), and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the veteran's left wrist disability. The Board has found nothing in the historical record which would lead it to conclude that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of the remote clinical histories and findings pertaining to such disability. I. Rating for Left Wrist Disability in Excess of 10 Percent, Prior to March 1, 1996 Pursuant to Diagnostic Code 5215, prior to March 1, 1996, if the ability to dorsiflex the wrist was limited to less than 15 degrees, or if palmar flexion was limited to being in line with the forearm, a 10 percent rating was warranted. The veteran, who is right-handed, indicates that he is unable to make a fist with his left hand and that, upon use-related motion involving his left wrist, he experiences severe pain which radiates up his left upper extremity. In this regard, when the veteran was seen for VA outpatient treatment in January 1993, left wrist flexion in the palmar and dorsal excursion was exhibited to, in each instance, 15 degrees. When he was examined by VA in June 1994, motion in his left wrist was deemed to be "[l]imit[ed]" in palmar and dorsal flexion. Thereafter, in November 1995, apparently in response to a torn ligament, the veteran underwent, under non-VA auspices, a triscaphoid fusion involving his left wrist. In considering the matter of entitlement to a rating for left wrist disability in excess of 10 percent, prior to March 1, 1996, the Board would emphasize that the above-addressed evidence documents that the veteran's ability to flex his left wrist in the dorsal excursion was, on the occasion of his presentation for VA outpatient treatment in January 1993, demonstrated to precisely 15 degrees. In addition, palmar flexion of the left wrist is temporally shown to have been limited to being in line with the forearm or better (when the veteran was seen in January 1993). Given the foregoing, then, a 10 percent rating (the maximum evaluation allowable under such Code) under Diagnostic Code 5215, relative to the duration implicated in this aspect of the appeal, is found to have been wholly appropriate. Finally, while a 20 percent rating is pertinently (the veteran being right-handed) allowable under the provisions of 38 C.F.R. Part 4, Diagnostic Code 5214 (1996) in the event the veteran's wrist is shown to have been fixed in ankylosis, the latter, based on the evidence addressed in the preceding paragraph, is not temporally evident. In view of the foregoing observations, then, the Board is persuaded that a rating for left wrist disability in excess of the 10 percent evaluation that was in effect through the end of February 1996 was not in order. II. Increased Rating, Left Wrist Disability, Currently Rated as 20 Percent Disabling In accordance with the provisions of Diagnostic Code 8514, mild incomplete paralysis of the musculospiral nerve (radial nerve) involving the non-dominant upper extremity warrants a 20 percent rating; if severe incomplete paralysis involving such (i.e., the minor) upper extremity is shown, a 40 percent rating is warranted. When the veteran was examined by VA in June 1996, he exhibited an ability to "active[ly]" flex his left wrist in either the palmar or dorsal excursion, though "passive" motion to 40 degrees in each such excursion existed. When he was neurologically examined by VA the same month, sensory examination revealed decreased pin prick and light touch over the C6-8 dermatomal distributions of the left upper extremity. Owing to such finding, the VA examiner recommended that pertinent electrodiagnostic study be accomplished. Two months later, in August 1996, an electrodiagnostic study administered the veteran by VA, relative to his left upper extremity, was interpreted to reveal abnormal findings. When he was examined by VA in December 1997, motion in the veteran's left wrist was noted to be "severe[ly]" limited, with apparently no active motion. The veteran also had pain in the wrist at night as well as numbness involving the left thumb and index finger. In April 1998, the veteran underwent procedures under VA auspices including a radial styloidectomy, the latter having been accomplished apparently in response to localized degenerative changes. Thereafter, when he was examined by VA in July 1999, the veteran complained of experiencing (as recorded by the examiner) both "numbness and tingling over his [left] dorsal thumb". Findings on physical examination included, relative to the left wrist, an ability to dorsiflex to 60 degrees, with palmar flexion being exhibited to 70 degrees. The pertinent examination assessment implicated, relative to the left wrist, "a neuroma of [the] sensory branch of the radial nerve". In considering the veteran's claim for an increased rating for his left wrist disability, presently rated as 20 percent disabling, the Board is of the opinion, owing to the reasoning advanced hereinbelow, that such evaluation is fully appropriate. In reaching such conclusion, the Board is constrained to point out that the report pertaining to the August 1996 VA electrodiagnostic study reflects that the left median nerve was normal and the apparently lone abnormal aspect of such study was "prolonged latency" relative to antidromic sensory potential, and that being only "mildly" so. Further, when he was examined by VA in December 1997, Tinel's sign relative to the superficial radial nerve was "negative". The foregoing, in the Board's view, are productive of incomplete paralysis within the distribution of the radial nerve on the left which is, at most, not more than mild, a degree of sensory deficit representative of his presently assigned 20 percent rating under the provisions of Diagnostic Code 8514. Therefore, the Board concludes that the preponderance of the evidence is against an increased rating for the veteran's left wrist disability. In reaching the foregoing determination, the Board has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45, as pertinent to factors, traceable to service-connected disability involving the left wrist, including general functional loss, weakened movement and excess fatigability. The Board has also been attentive for indication of loss of functional ability, within the purview of 38 C.F.R. § 4.40, specifically traceable to pain on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). However, the Board finds it noteworthy that, on the occasion of his June 1996 VA orthopedic examination, the veteran's left wrist joint was specifically found to be free of synovitis. Further, the report of the June 1996 VA neurological examination reflects that grip strength on the left, though diminished, was still "3-4/5". The foregoing considerations, in the Board's view, militate persuasively against the existence of sufficient disablement, relative to the left wrist, as to warrant the assignment of a higher disability rating predicated on either 38 C.F.R. § 4.40 or 38 C.F.R. § 4.45. The Board has also given consideration to the provisions of 38 C.F.R. § 4.7, which provide that, where there is a question as to which of two evaluations should be assigned, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. However, the record does not show that the actual manifestations of service- connected disablement, relative to the left wrist, more closely approximate those required for a 40 percent rating than they do the disability rating currently assigned. Accordingly, the Board is unable to identify a reasonable basis for a grant of this aspect of the benefit sought on appeal. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.40, 4.45 and Part 4, Diagnostic Code 8514. ORDER A rating for left wrist disability in excess of 10 percent, prior to March 1, 1996, is denied. An increased rating for left wrist disability, rated as 20 percent disabling since March 1, 1996, is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals