Entitlement to a compensable rating for right wrist scars (associated with residuals perilunate dislocation, right wrist) is dismissed.

Citation Nr: 26001451 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 18-14 492 DATE: January 30, 2026 ORDER Entitlement to a compensable rating for right wrist scars (associated with residuals perilunate dislocation, right wrist) is dismissed. Entitlement to a rating in excess of 10 percent for residuals perilunate dislocation, right wrist (right wrist disability), to include on an extraschedular basis, is denied. REMANDED Entitlement to total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. In a correspondence dated December 30, 2025, the Veteran's authorized representative withdrew his appeal of the issue of entitlement to a compensable rating for right wrist scars. 2. The Veteran is in receipt of the maximum schedular disability rating available under Diagnostic Code (DC) 5215 for limitation of motion of his right wrist disability and the evidence of record persuasively weighs against a finding that the Veteran's right wrist disability and associated symptomatology presented such an exceptional disability picture that the schedular ratings, as a whole, were inadequate when comparing the level of severity of the Veteran's right wrist disability with the established rating criteria under DC 5215. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the claim of entitlement to a compensable rating for right wrist scars have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.205. 2. The criteria for entitlement to a rating in excess of 10 percent, to include on an extraschedular basis, for the right wrist disability have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110; 38 C.F.R. §§ 4.1, 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5003-5215. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1978 to March 1982. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a virtual hearing before the undersigned. A copy of the transcript is associated with the evidentiary record. By way of background, these claims were denied in a November 2023 Board decision. Thereafter, the Veteran appealed the November 2023 Board decision to the Court of Appeals for Veterans Claims (CAVC or Court), which vacated the decision and remanded it back to the Board for further development in December 2024, pursuant to a Joint Motion for Remand (JMR). Entitlement to a compensable rating for right wrist scars is dismissed. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by his or her authorized representative. Id. In the present case, the Veteran, through a written correspondence from his authorized representative, received on December 30, 2025, has withdrawn the issue of entitlement to a compensable rating for right wrist scars and, hence, there remain no allegations of errors of fact or law for appellate consideration. The Board will therefore consider the issue of entitlement to a compensable rating for right wrist scars withdrawn. 38 U.S.C. § 7105(b)(2), (d); 38 C.F.R. § 20.205. Accordingly, the Board does not have jurisdiction to review the issue on appeal, and the claim is dismissed. Increased Rating Legal Criteria Disability evaluations are determined by the application of the Schedule for Rating Disabilities (Rating Schedule), which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of life, including employment, by comparing his symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In the case of an initial rating, the entire evidentiary record from the time of a veteran's claim for service connection to the present is of importance in determining the proper evaluation of disability, and staged ratings are to be considered in order to reflect the changing level of severity of a disability during this period. Fenderson v. West, 12 Vet. App. 119 (1999). However, where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Additionally, the Board must consider whether the disability has undergone varying and distinct levels of severity while the claim has been pending and provide staged ratings during those periods. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or if there is an approximate balance of positive and negative evidence, with the appellant prevailing in either event, or whether the evidence persuasively weighs against a claim, in which case, the claim is denied. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. §§ 4.7, 4.21. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of another. 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 262 (1994). 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 § 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). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of ROM testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with [ROM] measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Effective February 7, 2021, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, Fed. Reg. 76453, 76463 (Nov. 30, 2020). These amendments revised certain DCs "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. Entitlement to a rating in excess of 10 percent for a right wrist disability, to include on an extraschedular basis. The Veteran contends that a higher rating is warranted for his right wrist disability. Specifically, he asserts that a higher rating is warranted for his right wrist disability because x-ray imaging confirms degenerative arthritis of 2 or more major/minor joint groups with occasional incapacitation and ankylosis in 20 to 30 degrees of dorsiflexion. See March 2018 VA Form 9. By way of background, a September 1983 rating decision granted service connection for a right wrist disability and assigned a noncompensable rating effective March 13, 1982 (the date the Veteran separated from service). The Veteran did not disagree with this decision, nor did he submit new and material evidence. 38 C.F.R. §§ 3.156(b), 19.21, 19.52. In May 1988, the Veteran filed an increased rating claim for his service-connected right wrist disability. Subsequently, a September 1988 rating decision granted an increased rating of 10 percent effective January 20, 1988 (the date VA treatment records note the Veteran's complaint of right wrist pain). He did not appeal the rating assigned in that decision within one year of the issuance of the September 1988 rating decision nor did he submit new and material evidence. Id. Thereafter, the Veteran filed the current claim for an increased rating by filing a VA Form 21-526EZ, which was received by VA on July 8, 2016. An October 2016 rating decision continued the 10 percent rating for the right wrist disability. The appeal period for the therefore begins on July 8, 2016. 38 U.S.C. § 5110(b)(3). The Board finds that the evidence does not demonstrate that a factually ascertainable increase in the right wrist disability occurred in the one year prior to July 8, 2016. See 38 C.F.R. § 3.400; see Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Rating Criteria - Right Wrist Preliminarily, the Board notes that the Veteran's right wrist disability is currently rated as 10 percent disabling under 38 C.F.R. § 4.71a, DC 5003-5215. 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 assigned. 38 C.F.R. § 4.27. Here, the use of DCs 5003-5215 reflects that the Veteran's right wrist disability is described as degenerative arthritis, other than post-traumatic under DC 5003 and that the rating assigned is based on limitation of motion of the hand under DC 5215. Under DC 5215, a 10 percent rating is warranted for limitation of motion of wrist evidenced by palmar flexion limited in line with forearm or dorsiflexion less than 15 degrees. This is the maximum disability rating under DC 5215. Diagnostic Code 5003 provides ratings for degenerative arthritis, other than post-traumatic. Degenerative arthritis established by x-ray findings is rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Diagnostic Code 5003 further provides that when limitation of motion due to arthritis is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. In the absence of limitation of motion, Diagnostic Code 5003 provides for a 10 percent rating with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A 20 percent rating under Diagnostic Code 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. In Notes (1) and (2) in Diagnostic Code 5003, it is indicated these 20 and 10 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The February 7, 2021, amendment in the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a did not affect the rating criteria under DC 5215 for limitation of motion of the wrist. Factual Background Turning to the evidence, VA treatment records from May 2016 noted chronic pain of the right wrist with limited range of passive motion with hard endpoints on flexion and extension. He treats the condition by avoiding certain activities. VA treatment records from June 2016 noted advanced lunocapitate and scaphocapitate arthritis were seen. Scapholunate interval was slightly widened. The findings can be seen in association with chronic scapholunate advanced collapse (given proximal positioning of capitate) or sequela of remote trauma, although the degree of scapholunate interval widening is typically greater in SLAC wrists. Multifocal arthritis demonstrated elsewhere in the wrist, notable at the first carpometacarpal, radiocarpal and ulnar carpal joints. No characteristic erosions have developed. No acute fracture or dislocation. Findings also suggested stigmata of a remote triquetral fracture. Diffuse peripheral vascular calcification, without significant soft tissue swelling or radio dense foreign body identified. Chronic deformity of the ulnar styloid was also seen. He had an old dorsal incision. He dorsiflexes 30 degrees and forward flexes 40 degrees. He had full supination and pronation. He had some mild midcarpal tenderness. Imaging x-rays showed the wrist has arthritis predominantly between the capitate and the lunate, but other joints are also affected. He had minimal arthritis between the distal radius and the proximal row. VA treatment records from August 2016 noted that the Veteran saw an Ortho about right wrist pain, he was prescribed an immobilizer for the wrist which does not help much and prevents him from doing things. He gets pains in his fingers and in both wrists, and it can be extraordinarily painful at times. At the time of the September 2016 VA wrist conditions examination, the Veteran reported constant pain in the center of the right wrist. He described the pain as swollen and thick, 2 to 3 out of 10, intermittent stabbing and pulsating pain, 10 out of 10. He reported he is right hand dominant. He reported he is a manual labor guy, so he has to complete activities using his left arm. He reports he can feel the bone-on-bone grating when he does any movement of the wrist. He reported he has difficulty handwriting more than five to six words and his signature has changed. When he has to fill out paperwork by hand, he has difficulty doing this quickly. He reports he has trouble picking up a coffee can using his right hand, he must use both hands in order to hold an object, and he cannot lift more than a gallon of fluid. He reported difficulty completing daily tasks, but he is still able to use right hand when shaving and brushing his teeth despite having pain. He reported having difficulty wiping himself after having a bowel movement. He reported the pain will wake him up in the middle of the night due to stabbing pains. At the end of the day, he will have significant swelling compared to the left wrist. He reported difficulty using manual tools or opening a jar or pill bottles, and over time he is having to complete repetitive movements while working for the postal service. He denied any urgent or emergent care visits due to right wrist pain, and he has not been through occupational or physical therapy. His current treatment includes 500 mg naproxen (as needed) and a wrist brace. Upon examination, the examiner confirmed the Veteran's diagnosis of right wrist traumatic arthritis (residuals perilunate dislocation). The examination was largely limited to the right wrist. Range of motion (ROM) testing at that time revealed palmar flexion to 40 degrees, dorsiflexion to 50 degrees, ulnar deviation to 30 degrees, and radial deviation to 10 degrees. The examiner noted that ROM contributes to functional loss as the Veteran is unable to write more than five to six words without taking a break; unable to pick up more than a gallon of fluid using right hand/wrist; and unable to use manual tools or open jars. The Veteran exhibited pain on dorsiflexion, ulnar deviation, and radial deviation. There was evidence of moderate pain elicited with palpation at the center of the wrist, which was consistent with the diagnosis. The was no objective evidence of crepitus. The examiner noted that the Veteran was not being examined immediately after repetitive use over time. However, the examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. Pain and incoordination significantly limited functional ability with repeated use over a period of time. The examiner also noted that it is not possible without resorting to mere speculation to estimate either loss of ROM or describe loss of function, because there is no conceptual or empirical basis for making such a determination without directly observing function under these conditions. The Veteran did not report flare-ups of the right wrist. Flexion rate strength was a 5 out of 5 and extension rate strength was a 4 out of 5. There was no muscle atrophy or ankylosis. The examiner noted mild swelling at the center of the right wrist. In his July 2017 NOD, the Veteran stated that he sought help for the constant pain, loss of range of motion, inability to perform daily tasks, and occasional incapacitation in his right hand and arm. During the August 2017 VA wrist conditions examination, the Veteran reported continued worsening of right wrist pain over time. He complained of constant dull ventral right wrist pain which becomes sharp with any movement of the wrist. He uses naproxen sparingly as needed for pain. He denied wrist injections, and he reported that he uses a prescribed right wrist brace occasionally at night. Upon examination, the examiner diagnosed the Veteran with posttraumatic right wrist osteoarthritis. She noted that this is a corrected diagnosis which represents the progression of the Veteran's service-connected right wrist condition. The examiner conducted a complete examination of the right and left wrists. With respect to the right wrist, ROM testing at that time revealed palmar flexion to 35 degrees, dorsiflexion to 30 degrees, ulnar deviation to 25 degrees, and radial deviation to 5 degrees. The Veteran exhibited pain on palmar flexion, dorsiflexion, ulnar deviation, radial deviation and with weight bearing. There was evidence of localized tenderness of the right wrist. There was no additional loss of function or ROM after 3 repetitions. The examiner noted that the Veteran was not being examined immediately after repetitive use over time. However, the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. Pain and weakness limit functional ability with repeated use over a period of time. While the examiner noted that limitation of ROM could not be estimated, she explained that loss of function during flare-ups or repeated use over a period of time would lead to increased right wrist pain (with forceful gripping or twisting with the right hand). The Veteran did not report flare-ups. Flexion rate strength was a 4 out of 5 and extension rate strength was a 5 out of 5. There was no muscle atrophy or ankylosis. The examiner explained that there is functional impairment during activities that involve forceful gripping or twisting the right wrist. VA treatment records from August 2017 noted the Veteran's report that his right wrist always hurts, but the orthopedist from last year told him it is not time yet for surgery and he takes over the counter Aleve only occasionally as he wants to minimize medications. VA treatment records from May 2021 noted the Veteran's report of increased right wrist pain. The examiner noted dorsal angulation of the lunate and significant narrowing of the lunate-capitate joint, differential to include dorsal intercalated segmental instability. There was no significant widening of the scapholunate joint at that time. Degenerative findings were otherwise mild of the radial-carpal joints and intercarpal joints. There was flattening of the ulnar styloid process and adjacent triquetrum which could be degenerative in nature. There was no ulnar positive variance. There was a well-defined ossification about the ulnar margin of the distal radius which could be the sequela of old trauma. Degenerative findings were moderate of the thumb carpal metacarpal joint and appeared increased since the 2016 study. A wrist x-ray showed degenerative changes and referral to orthopedic was requested for further evaluation. VA treatment records from June 2021 note that the Veteran was assessed with wrist degenerative joint disease (DJD). During the August 2021 Board hearing, the Veteran reported that his right wrist is painful each day and there are times when the pain becomes overwhelming (beyond a 10). Sometimes the pain will make his knees buckle. He was referred to a surgeon to discuss the option of fusing his wrist, but he got a cortisone injection instead. He added that he had been prescribed ibuprofen by VA. If he runs out of the ibuprofen, he will buy Aleve or Advil, and lately he has been prescribed diclofenac (a topical). VA treatment records from February 2023 note the Veteran's report of feeling a little better overall and he has been able to get out and do yard work. In a March 2023 VA wrist conditions examination, the Veteran reported constant pain and loss of range of motion (ROM) in his right wrist and that he is taking diclofenac gel as needed. He also reported the need to take off one day per week due to right wrist symptoms. Upon examination, the examiner noted a diagnosis of right wrist residuals of perilunate dislocation. The examiner conducted a complete examination of the right and left wrists. With respect to the right wrist, ROM testing at that time revealed palmar flexion to 45 degrees, dorsiflexion to 30 degrees, ulnar deviation to 20 degrees, and radial deviation to 0 degrees. The Veteran exhibited pain on palmar flexion, dorsiflexion, ulnar deviation, radial deviation and on active and passive motion. The examiner noted that pain from active and passive motion does not result in or cause functional loss. There was no evidence of crepitus. However, there was moderate to severe pain with light palpation, on the extensor surface of the wrist along the carpals. There was no additional loss of function or ROM after 3 repetitions. The examiner noted that pain, weakness, and loss of ROM significantly limit functional ability with repeated use over time. Estimated ROM measurements after repeated use over time were palmar flexion to 40 degrees, dorsiflexion to 30 degrees, ulnar deviation to 20 degrees, and radial deviation to 0 degrees. The Veteran denied flare-ups of the right wrist. The examiner noted that less movement than normal contributes to the disability. There was no muscle atrophy or ankylosis. When describing residuals of the Veteran's right wrist surgery, the examiner noted less ROM, scarring, and chronic pain at the site. The examiner added that, with repeated use of the right wrist, there is an increase in pain and resultant fatigability. VA treatment records from November 2023 note that the Veteran treats wrist pain by avoiding certain activities and bicycles intermittently for exercise. VA treatment records from October 2025 note that the Veteran was evaluated for right wrist pain. He reported stiffness and pain and that over the last 5 to 10 years his pain has gotten exponentially worse. He did receive a corticosteroid injection into the wrist in 2021, and he stated that this provided him with excellent relief for a number of months, but he was concerned that repeating the injection may make the injections less effective, so he has just been dealing with the pain. He added that the pain is now so severe that it basically dictates how his day will progress. He explained that some days he is able to function reasonably well, but other days the pain is so severe that it will make his legs give out. He reported a constant throbbing, stiffness, and dull ache. He also reported intermittent sharp stabbing pains. He has tried bracing, cool comfort brace, topical diclofenac gel, naproxen, and meloxicam. He is now on an anticoagulant, so he is unable to take oral NSAIDs. He stated that his pain does not really improve with any of these conservative treatment measures. He stated that his ability to perform his desired day-to-day activities is notably limited at this point due to his pain. The examiner noted that there is tenderness over the radiocarpal joint and the dorsal carpus in general. There is tenderness over the thumb CMC joint. His wrist ROM is quite limited, especially extension of the wrist. He has about 15 to 20 degrees of flexion of the wrist but can extend the wrist only about 5 degrees. His finger range of motion is normal. Positive basal joint grind test of the thumb. Grossly neurovascularly intact. The October 2025 x-ray revealed polyarticular arthritic changes in the wrist and hand most notable in the carpus where there is advanced arthrosis. He has a DISI deformity. His wrist pain is consistent with the noted posttraumatic degenerative changes of the wrist. The Veteran was hoping to avoid surgical intervention, but none of the conservative treatments he has tried thus far have been significantly helpful for him, other than the steroid injection performed in 2021. The examiner injected 20 mg of Depo-Medrol and 0.5 cc of 1% lidocaine into the right thumb CMC joint. In December 2025, the Veteran submitted a buddy statement from his daughter which explained that the Veteran has experienced persistent pain and limited mobility in his wrist. She has witnessed him wince or cry out in pain on numerous occasions, and it is clear that his wrist has been a continuous source of discomfort. The Veteran does not use very strong medication for his pain, and his use of over-the-counter medications and creams has not given him much relief. Over time, his pain has become unbearable even when he is using creams on a consistent basis. This ongoing issue has significantly affected his ability to perform everyday tasks. Some specific limitations she has observed include difficulty and/or pain when opening jars, bottles, or similar containers, pain while holding or turning the steering wheel while driving, the inability to comfortably hold his grandchildren in certain positions, difficulty pushing or holding onto a stroller due to wrist pain, struggling to open doors that require twisting motions (such as doorknobs), and general discomfort with any tasks requiring wrist movement (gripping, or twisting). Over the years, she has seen how much her father's injury has diminished his quality of life and his ability to perform routine activities without pain. His wrist condition has not only caused him physical discomfort but has also restricted his ability to fully engage in family life and daily responsibilities. In December 2025, the Board received a vocational assessment report from a certified rehabilitation counselor. The Veteran reported that he continues to have pain in his wrist. The pain is constant and is a dull throbbing pain. He experiences electrical jolts every day. If he grabs his door handle or does something in a certain way, he is in danger of getting one of those electrical jolts. From the moment he wakes up to the moment he goes to bed he must guard his right wrist. The counselor noted physical limitations with gripping, fine manipulation, lifting, wrist position, and sleep. Analysis Considering the above, the Board finds that the evidence of record persuasively weighs against a rating in excess of 10 percent for the Veteran's right wrist disability. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc). The presently assigned 10 percent rating is the maximum rating possible under DC 5215 for limitation of motion of the wrist. Additionally, the Board has considered the impact of functional loss, weakened movement, excess fatigability, incoordination, and pain for the period on appeal. DeLuca, 8 Vet. App. at 206-07. While acknowledging the complaints of pain, loss of ROM and weakened movements associated with the right wrist and functional limitations, the Veteran is already receiving the maximum disability rating available based on symptomatology that includes limitation of motion per Diagnostic Code 5215 Johnston v. Brown, 10 Vet. App. 80, 85 (1997). In any event, the provisions of 38 CFR § 4.40 and § 4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, as cited in DeLuca v. Brown and Mitchell v. Shinseki, have been considered and were applied based on additional joint limitation in awarding the 10 percent disability evaluation. Moreover, the Board notes that the Veteran has argued that he should be given a higher evaluation due to x-ray evidence that shows involvement of 2 or more major/minor joints. Specifically, he stated "x-ray confirms degenerative arthritis of 2 or more major/minor joint groups with occasional incapacitation and ankyloses in 20-30 degrees of dorsiflexion." See March 2018 VA Form 9. Although there is x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with reports of occasional incapacitating exacerbations, as indicated in the July 2017 NOD, it is not appropriate to rate the Veteran's right wrist disability under DC 5003. The Board notes that the express terms of DC 5003 provide that degenerative arthritis will be rated on the basis of limitation of motion under the appropriate diagnostic code for the affected joint involved. More specifically, DC 5003 provides that degenerative arthritis should only be rated based on x-ray evidence in the absence of limitation of motion. Here, there is evidence of limitation of motion, as noted in the September 2016, August 2017, and March 2023 examinations. Therefore, the Veteran's right wrist is properly evaluated based on those limitations under the General Formula. The Board notes that the August 2017 examiner diagnosed the Veteran with posttraumatic right wrist osteoarthritis. Posttraumatic arthritis is rated under DC 5010. However, under DC 5010, traumatic arthritis is to be rated under DC 5003, which provides that arthritis will be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint involved, unless the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic code. In the absence of limitation of motion, a 10 percent rating is warranted for x-ray evidence of involvement of two or more major joints or two or more minor joint groups. A 20 percent rating is warranted for x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, DCs 5003, 5010. Again, as noted above, the September 2016, August 2017, and March 2023 examinations recorded limited ROM, the Veteran's right wrist is properly evaluated based on those limitations under the General Formula. At this juncture, the Board acknowledges that in the December 2024 JMR, the parties found that the Board erred when it failed to provide analysis regarding the extent to which it considered and discounted the effects of the Veteran's use of medication. In that regard, the Board recognizes 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). The Veteran reported in his September 2016 and August 2017 VA examinations that he takes 500 mg naproxen as needed, noting in his August 2017 VA examination that he used it "sparingly." In his March 2023 VA examination, the Veteran reported that he takes diclofenac gel. During his August 2021 Board hearing, the Veteran testified that he used medications such as Aleve, Advil, and ibuprofen, in addition to topicals such as diclofenac and a sodium cream, to alleviate pain. Finally, in an October 2025 VA treatment record, the Veteran noted receiving a corticosteroid injection in 2021, which provided excellent relief for a number of months, but he was concerned that repeating the injection may make the injections less effective so he has just been dealing with the pain. He reported he has tried bracing, cool comfort brace, topical diclofenac gel, naproxen, and meloxicam. However, he stated that his pain does not really improve with any of these conservative treatment measures. There is no indication that the Veteran was using pain medication on the day of his examinations or that any of the examiners considered the ameliorative effects of medication in rendering the findings in their reports. Additionally, with the exception of the corticosteroid injection in 2021 which provided relief for a number of months, the effectiveness of his conservative medication has been called into question. Notably, the Veteran reported that his pain does not really improve with any of the conservative treatments, to include a cool comfort brace, topical diclofenac gel, naproxen, and meloxicam. There was otherwise no specific indication that the Veteran was using medication on the day of examinations or that if he was using medication, his wrist symptoms were alleviated to any appreciable degree. For that reason, the Board finds that a remand for an addendum opinion to discuss effects of medication would unnecessarily delay adjudication of the Veteran's claim while offering him no additional benefit. Therefore, the Board finds the examination reports are adequate to base a decision. The Board acknowledges that the VA treatment records from October 2025 showed signs of worsening with flexion between 15 to 20 degrees and noted that Veteran's report that over the last 5 to 10 years his pain has gotten exponentially worse. However, as the Veteran is presently assigned the highest rating available for his right wrist disability given his reported limitations (that is, limitation of motion), and consistent with the medical evidence of record, the Board finds there is no benefit to remanding this claim for an updated VA examination. The Board has also considered whether a separate rating may be assigned under other DCs pertaining to the wrist. The only relevant DC is 5214 for ankylosis. See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 94 (32nd ed.) (2012) (defining "ankylosis" as the immobility and consolidation of the joint due to disease, injury or surgical procedure). There is no evidence of record suggesting ankylosis, either favorable or unfavorable, of the right wrist or the functional equivalent thereof. See Chavis v. McDonough, 34 Vet. App. 1, 23-24 (2021). The Board acknowledges that the Veteran reported in his July 2017 NOD that his right wrist cannot dorsiflex at all without extreme pain. However, the Board finds this is not the functional equivalent of ankylosis. Throughout the period on appeal, the Veteran has maintained the ability to dorsiflex his wrist. For example, in the most recent VA examination, he denied flare ups and was able to dorsiflex to 30 degrees with repeated use despite the pain. The examiner found no ankylosis of the right wrist. Finally, as the Veteran is seeking a rating in excess of 10 percent, the Board must consider whether a referral for extraschedular rating is warranted. In the exceptional case when the schedular evaluation is inadequate to rate a single service-connected disability, the matter is to be referred to the Director of Compensation for consideration of an extraschedular rating commensurate with the average impairment of earning capacity due exclusively to the disability. The governing norm in such cases is that the disability is exceptional or unusual due to such factors such as marked interference with employment or frequent periods of hospitalization. 38 C.F.R. § 3.321(b); Thun v. Peake, 22 Vet. App. 111, 114 (2008); aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). These criteria have been broken up into two elements: (1) the schedular criteria must be inadequate to describe the claimant's disability level and symptomatology and (2) there must be related factors such as marked interference with employment or frequent periods of hospitalization. Thun, 22 Vet. App. 111, 114 (2008); Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009). If both elements are met, the case must be referred to the Under Secretary for Benefits or the Director, Compensation Service, for a determination of whether the Veteran's disability picture requires the assignment of an extraschedular rating. Thun, 22 Vet. App. at 116; 38 C.F.R. § 3.321(b). If either element is not satisfied, then referral is not warranted. Yancy v. McDonald, 27 Vet. App. 484, 494-95 (2016). Notably, the application of the first Thun step is not a mere "mechanical test," and as such it is not automatically satisfied because a certain symptom or functional effect is not expressly listed under a diagnostic code; "[it] is satisfied only when a veteran presents symptoms that are truly unusual or exceptional." See Long v. Wilkie, 33 Vet. App. 167, 173 (2020). Further, Thun's first step is a broad analysis focusing on whether the Veteran's disability picture as a whole (i.e., the full symptomatology) presents an impairment so exceptional that the rating schedule is not capable of assessing it in the first instance. Id. Upon review, the Board finds that the first element of Thun is not satisfied. As above, the schedular criteria are adequate to encompass the Veteran's disability level and symptomatology. Aside from pain, weakness, and loss of ROM associated with the Veteran's right wrist, the medical evidence of record does not confirm that he consistently experienced any other symptoms. Again, the VA examination reports during the appeal period considered these symptoms and show the Veteran has not experienced ankylosis or even functional ankylosis at any time during the period on appeal. Therefore, all of the Veteran's right wrist symptoms are contemplated by the currently assigned 10 percent rating under DC 5215 and an increased rating is not warranted. See 38 C.F.R. § 4.71a, DC 5215. As shown, the Veteran has not met the first element of Thun because the schedular criteria are adequate to describe his disability level and symptomatology. 22 Vet. App. at 111. Therefore, his symptom presentation is not "truly unusual or exceptional." See Long, 33 Vet. App. at 173. In view of the above, the Board finds that the evidence of record does not demonstrate that the Veteran's right wrist disability presents such an exceptional disability picture that the schedular ratings, as a whole, are inadequate to evaluate the severity of the disability. See Thun, 22 Vet. App. at 115. As the threshold factor for referral to the Director, Compensation Service, has not been met, the Board need not discuss the second required element of Thun or remaining elements. Id. Consequently, the Board finds that referral to the Director, Compensation Service, for consideration of an extraschedular basis is not warranted. In conclusion, the Veteran's request for an increased rating for his right wrist disability, to include consideration of extraschedular benefits under 38 C.F.R. § 3.321(b), is denied. As shown, the positive and negative evidence is not in a state of approximate balance. Therefore, the Veteran cannot receive benefit of the doubt. See Lynch, supra. REASONS FOR REMAND Entitlement to TDIU is remanded. The Veteran asserts that he is entitled to a TDIU based on an inability to secure or follow substantially gainful employment due to his service-connected right wrist disability. See December 2025 VA 21-8940. A claim for a TDIU is not a separate claim for benefits. In Rice v. Shinseki, the Court held that a claim for a TDIU is "part of the claim for benefits of the underlying disability" regardless of whether the claim is raised expressly or reasonably raised by the record. 22 Vet. App. 447, 453-54 (2009). As such, the issue of entitlement to a TDIU under Rice is not limited to claims reasonably raised by the record. Thus, the Board must adjudicate any claim for a TDIU in accordance with Rice when it has been raised during the initial adjudication of a claim or a claim for an increased rating for an underlying disability. Once the issue of entitlement to a TDIU is at issue as part of a claim for an increased rating, a veteran does not need to appeal a denial of that issue by the AOJ for it to be in or remain in appellate status. Payne v. Wilkie, 31 Vet. App. 373 (2019); Harper v. Wilkie, 30 Vet. App. 356 (2018). Here, the Veteran raised a claim of entitlement to a TDIU during the pendency of a claim for an increased rating for his right wrist disability. See December 2025 VA Form 21-8940. Therefore, the issue of entitlement to a TDIU is part and parcel of the claim for an increased rating for his right wrist disability. According to the December 2025 VA Form 21-8940 submitted by the Veteran, he indicated the last time he worked full-time was on December 31, 2015. A review of the December 2025 VA Form 21-8940 indicates that the Veteran worked 40 hours per week as a postal worker from January 1, 1983, to December 31, 2015. However, during the March 2023 VA examination, the Veteran reported that he needed to take off one day per week due to right wrist symptoms. The examiner also noted more than 5 weeks work time lost in the last 12 months. Additionally, October 2025 VA treatment records noted the Veteran's report that he enjoys flipping homes and he has been financially successful. Here, it remains unclear whether the Veteran is working. If the Veteran did stop work, it is unclear when (or if) it ended, and why. In view of the seemingly inconsistent information above, the Board is unable to determine whether there is sufficient evidence to substantiate a reasonable possibility that the Veteran had been unemployable by reason of his service-connected right wrist disability for consideration of entitlement to a TDIU on an extraschedular basis. Consequently, the Board finds that a remand is appropriate to obtain additional information regarding the Veteran's employment history. Additionally, the record shows that the Veteran was awarded monthly Social Security Administration (SSA) Supplemental Security Income (SSI) disability payments beginning May 2020. However, the Board notes that the documents underlying the favorable SSA decision are not associated with the record and should be obtained on remand. The matter is REMANDED for the following action: 1. Ask the Veteran to complete and submit an updated VA Form 21-8940, Veteran's Application for Increased Compensation Based on Individual Unemployability. 2. After receiving the Veteran's VA Form 21-8940, the AOJ should contact his former employers and ask them to complete and return VA Form 21-4192, or other appropriate form, detailing the dates of the Veteran's employment and the reasons that he stopped working. 3. Request all documents pertaining to any application by the Veteran for SSA disability benefits, to include any records considered in deciding the Veteran's SSI claim in 2020. Document all requests for information as well as all responses in the claims file. (Continued on next page) 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issue to entitlement to TDIU. If the benefit sought is not granted to the Veterans satisfaction, send the Veteran and representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Jenna Brant Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Miller, D. M. Associate 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.