Citation Nr: 1322994 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 05-41 054 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for Raynaud's syndrome. 2. Entitlement to service connection for residuals of cold weather injuries to the feet. 3. Entitlement to service connection for residuals of cold weather injuries to the ears. 4. Entitlement to service connection for coronary artery disease (CAD), claimed as heart attack. 5. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD A. Haddock, Associate Counsel INTRODUCTION The Veteran served on active duty from October 1966 to September 1968. These matters come before the Board of Veterans' Appeals (Board) on appeal from August 2004 and October 2005 rating decisions by the St. Louis, Missouri Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously remanded by the Board in January 2009, May 2010, and April 2012 for further development. The Board notes that the issue of entitlement to service connection for posttraumatic stress disorder (PTSD) was previously before the Board. However, in a December 2012 rating decision, the Veteran was granted service connection for PTSD and assigned a 50 percent evaluation, effective March 4, 2004. There is no indication in the record that the Veteran is dissatisfied with the rating assigned, and the Board therefore considers the December 2012 rating decision a full grant of the benefit sought on appeal as to that issue. Therefore, the issue of entitlement to service connection for PTSD is no longer before the Board. The Veteran filed a request in November 2006 for a personal hearing before a Veterans Law Judge. Shortly thereafter, in a statement received in March 2007, the Veteran withdrew his request for a hearing of any type. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a complete review of the evidence. FINDINGS OF FACT 1. The more credible evidence of record does not show that the Veteran's Raynaud's syndrome of his feet is etiologically related to his active service and Raynaud's syndrome was not diagnosed within one year of his separation from active service. 2. The more credible evidence of record does not show that the Veteran's residuals of cold weather injuries to the feet are etiologically related to his active service. 3. The Veteran does not have a disability as a residual of cold injuries to the ears. 4. CAD was not manifested during the Veteran's active duty service or for many years thereafter, nor is CAD otherwise related to such service. 5. The Veteran's service-connected disability does not render him unable to obtain and maintain gainful employment and there are no unusual or exceptional disability factors warranting referral of the Veteran's claim for TDIU for extra-schedular consideration. CONCLUSIONS OF LAW 1. The criteria for service connection for Raynaud's syndrome have not been met. 38 U.S.C.A. §§ 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. The criteria for service connection for residuals of cold weather injuries to the feet have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303 (2012). 3. The criteria for service connection for residuals for cold weather injuries to the ears have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303 (2012). 4. The criteria for service connection for CAD have not been met. 38 U.S.C.A. §§ 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 5. The criteria for a TDIU have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.15, 4.16 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Legal Criteria The Board has reviewed all of the evidence in the claims folders. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to these claims. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2012). In general, service connection requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). Certain chronic diseases, including Raynaud's syndrome and arteriosclerosis (which encompasses CAD) may be presumed to have been incurred in service, although not otherwise established as such, if manifested to a degree of ten percent or more within one year of the date of separation from service. 38 U.S.C.A. § 1112(a)(1); 38 C.F.R. § 3.307(a)(3), 3.309. TDIU It is the established policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16. "Substantially gainful employment" is that employment that "is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment will not be considered substantially gainful employment." 38 C.F.R. § 4.16(a). A TDIU may be assigned, if the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40 percent or more and the combined rating is 70 percent or more. 38 C.F.R. § 4.16(a). The central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). A claim for a TDIU presupposes that the rating for the service-connected disabilities is less than 100 percent, and only asks for a TDIU because of "subjective" factors that the "objective" rating does not consider. Vittese v. Brown, 7 Vet. App. 31, 34-35 (1994). II. Analysis Service Connection for Residuals of Cold Injuries to the Feet and Raynaud's Syndrome The Veteran claims he is entitled to service connection for residuals of cold weather injuries to the feet and Raynaud's syndrome, as such disabilities were incurred in, or caused by, his active service. Specifically, the Veteran contends that while working as a guard at the Ft. Riley Stockade in Kansas during his active duty, he was exposed to cold weather conditions and sustained frostbite that has resulted in his current foot disabilities. A review of the Veteran's service treatment records (STRs) is silent for any complaints or diagnosis related to cold weather injuries to his feet or Raynaud's syndrome. On August 1968 separation examination, the Veteran's feet were found to be clinically normal. Additionally, on the associated report of medical history, the Veteran denied any foot trouble and did not report any circulatory trouble that could have been associated with Raynaud's syndrome. The Veteran has reported that he received occasional treatment at Irwin Army Hospital and the Ft. Riley Stockade Infirmary. Efforts have been made to obtain treatment records from both of these facilities; however, after proper procedures were followed, treatment records for the Veteran could not be located at either facility. Formal findings of such are of record. Of record are the Veteran's Social Security Administration (SSA) records showing that the Veteran filed for SSA disability benefits in April 2002. These records show that among the disabilities that the Veteran was alleging contributed to his entitlement to SSA disability benefits was a bilateral foot disability that began approximately three years prior to his SSA claim. In his SSA claim, the Veteran reported that he had an operation on his left foot in March 2002, because of his Raynaud's syndrome, and that this operation resulted in his unemployment. In a written statement associated with his SSA disability claim, the Veteran reported that from 1978 to 1993, while working as a truck driver, he sustained multiple episodes of frostbite and that he has also since developed Raynaud's syndrome. A June 2002 private medical examination, associated with the Veteran's SSA records, documents the Veteran's history of cold injuries while working as a truck driver. The report of the examination reflects that the Veteran reported that 20 years prior, while working as a truck driver, the Veteran was driving in Northern Wisconsin, where it was negative 95 degrees, and he sustained frostbite in his hands and feet. He reported that he was sleeping in his truck at the time and his feet and hands became white and painful. He reported experiencing two other episodes of frostbite and a prior diagnosis of Raynaud's syndrome. There is no indication in the Veteran's SSA records that he ever attributed his cold injuries or his Raynaud's syndrome to his active military service. Also of record are numerous VA treatment records that show the Veteran receives relatively regular treatment for a variety of medical conditions. Records as early as 1992 reference the Veteran's complaints of foot pain and mycotic nails. None of those early records make any reference to frostbite or cold injuries much less his active service. Interestingly, when he was seen in April 2002, the Veteran reported that while working as a truck driver, he would sleep in his truck while driving across northern states in temperatures below 40 degrees and that he possibly sustained frostbite on both of his feet on several occasions. An October 2003 VA treatment record shows that the Veteran was seen for complaints of numbness in his left foot and Raynaud's syndrome was assessed. No opinion as to the etiology of the Raynaud's syndrome was provided. The remainder of the VA treatment records show that the Veteran has received intermittent treatment for complaints of numbness in his feet and symptoms associated with his above mentioned frostbite injuries. In a December 2006 VA treatment record, the Veteran reported that he first sustained a cold injury to his feet while in training for the Army and subsequent cold injuries while working as a truck driver in minus 40 weather conditions. These later treatment records relate the Veteran's Raynaud's syndrome and neuropathy of the feet to cold injuries. Evidence of a current disability as well as nexus opinion is thereby of record. The outcome the appeal rests on whether there is evidence of cold injuries occurring during the Veteran's active service. The Board notes that the Veteran is generally competent to report when he first experienced cold injuries and that he has continued to suffer residuals, including Raynaud's syndrome, of such injuries. However, once evidence is determined to be competent, the Board must determine whether such evidence is credible. Competency is a legal concept determining whether testimony may be heard and considered and credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno v. Brown, 6 Vet. App. 465 (1994). In weighing credibility, VA must consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial implausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 133 (Fed. Cir. 2006). The Board may not ignore a Veteran's testimony simply because he is an interested party and stands to gain monetary benefits. However, personal interest may affect the credibility of the evidence. Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Board finds that the Veteran's statements that he has had residuals of cold injuries and Raynaud's syndrome since active service are inconsistent with the other evidence of record. There is no evidence that the Veteran was treated for cold weather injuries or symptoms of Raynaud's syndrome while on active service. The Veteran also specifically denied any foot trouble at the time of his August 1968 separation examination. Next, when he filed a claim for benefits in 1991, the Veteran made no mention of foot or neurological problems. He was clearly aware of the Veteran's benefits system and even the claims process. Had he suffered cold injuries at that time, and been experiencing problems since that time, it would be reasonable to believe that he would have claimed such at time. The Veteran's credibility is further compromised by the lack of reference to cold injury or frostbite in 1992. He was seeking treatment for his foot pain and problems. Reporting a history of cold injury or frostbite to his feet would have been in his best interest if such had really occurred. Buczynski v. Shinseki, 24 Vet. App. 221 (2011) ( a lack of notation of symptoms where such notation would normally be expected may be considered as evidence that the symptoms did not exist). Similarly, while he reported cold injuries to his extremities in 2002, he only described cold injuries occurring post-service. Again, had he experienced cold injuries to his feet in service, reporting such would have been in his best interest in seeking out medical care. See Curry v. Brown, 7 Vet. App. 59 (1994) (finding no error with the Board's conclusion that contemporaneous evidence had greater probative value than reported history); Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Reference if also made to the fact that the Veteran made no reference to in-service cold injuries when he filed his claim for SSA disability benefits in April 2002. As noted above, associated with his SSA disability claim is a June 2002 medical examination that documents the Veteran's statements that he sustained numerous cold injuries while working as a truck driver between 1978 and 1993, and has suffered from the residuals of those injuries since. There is no indication that the Veteran reported experiencing a cold injury during active service at the time of the June 2002 examination. This examination report further states that his diagnosed Raynaud's syndrome is secondary to his reported cold injuries between 1978 and 1993, approximately 10 years following his separation from active service. Furthermore, the first, and only, postservice medical evidence documenting the Veteran's allegations that the residuals of his cold injuries were related to his active service is the December 2006 VA treatment record (more than 2 years following his claim and more than 40 years following his separation from active service), that documents that he reported sustaining a cold injury during his Army training. However, as discussed, there is no evidence in the Veteran's STRs, or anywhere else in the record, to corroborate this report. The Veteran's statements regarding cold injuries and frostbite are inconsistent with the other evidence of record. The Board finds that they are not credible. Additionally, there is no indication from the record that the Veteran was diagnosed with Raynaud's syndrome within one year of his separation from active service. Presumptive service connection is not applicable in this case. Further, as his claim of experiencing chronic neurological, skin, or foot problems since service has been found to lack credibility, any assertion of continuity of symptomatology of Raynaud's syndrome under 38 C.F.R. § 3.303(b) will also fail. In sum, there is no indication from the Veteran's 1968 separation examination report that he reported a cold injury, or was found to have residuals of such or Raynaud's syndrome at the time of his separation from active service. The Veteran's reports of experiencing residuals of in service cold injuries to the feet and Raynaud's syndrome since his active service have been found not credible by the Board. The more credible evidence of record indicates that the Veteran's residuals of cold injuries and Raynaud's syndrome are the result of cold injuries sustained during his postservice employment as a truck driver. Further, the Veteran was not diagnosed with Raynaud's syndrome within one year of his separation from active service and as noted above; his reports of continuity of symptomatology have been found not credible. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for residuals of cold injuries to the feet and Raynaud's syndrome is not warranted. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of- the-doubt rule. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2012). Service Connection for Residuals of Cold Injuries to Ears The Veteran claims he is entitled to service connection for residuals of cold weather injuries to the ears; as such disability was incurred in, or caused by his active service. Specifically, as stated above, the Veteran contends that while working as a guard at the Ft. Riley Stockade, he sustained frostbite that has caused his current ear disability. A review of the Veteran's STRs is silent for any complaints or diagnosis related to cold weather injuries to his ears. On August 1968 separation examination, the Veteran's ears were found to be clinically normal. Additionally, on the associated reported of medical history, the Veteran denied any ear, nose, or throat trouble. Records from the Irwin Army Hospital and the Ft. Riley Stockade Infirmary were unable to be located. Of record are numerous VA treatment records dating back to 1991. A review of the VA treatment records is silent for any complaints, treatment, or diagnosis of cold injuries, or any residual of such, to the ears. Furthermore, aside from his March 2004 claim for service connection, there is no evidence of record that the Veteran has made any allegation that he ever sustained any cold injuries to his ears. Consideration has been given to the Veteran's assertion that he has residuals of cold injuries to the ears. However, for the reasons set forth above, his claim of having cold injuries in service is not deemed credible. Moreover, the Board emphasizes that the Veteran has not been shown to have medical experience, training, or skill needed to assess and diagnose cold injury residuals. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); and Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Even if there was evidence of a current disability of the ears, which there is none, nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating skin or cardiovascular disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed.Cir.2012). The Board notes that under 38 U.S.C.A. § 1110, a claimant must submit proof of a presently existing disability resulting from service in order to merit an award of compensation. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). As there is no evidence that the Veteran currently suffers, or has ever suffered from, a disability as a residual of cold injuries to the ears, service connection for such a disability is not warranted. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the requirement of the existence of a current disability is satisfied when the Veteran has a disability at the time he files his claim for service connection or during the pendency of that claim). The evidence in this case is not so evenly balanced so as to allow application of the benefit of the doubt rule. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2012). Service Connection for CAD The Veteran filed a March 2004 claim of service connection for a heart attack, which was recharacterized as a claim for service connection CAD. Preliminarily, there is no controversy in this case with regard to whether the Veteran currently suffers from CAD. The medical evidence of record shows that the Veteran receives consistent treatment for CAD and its associated symptoms. A review of the Veteran's STRs is silent for any complaints or diagnosis related to a heart disability or CAD. On August 1968 separation examination, the Veteran's heart was found to be clinically normal. On the associated report of medical history, the Veteran denied any history, or current symptoms, of pain or pressure in his chest, shortness of breath, and palpitation or pounding heart. July 1996 private medical records from Baptist Medical Center show that the Veteran was admitted to the emergency unit for complaints of prolonged angina. After an emergency cardiac catheterization (CATH) with angioplasty of the proximal left anterior descending artery and placement of a stent, the Veteran was given a diagnosis of an acute anterior myocardial infarction (MI). He was noted to be obese, he had a history of bicuspid aortic valve with mild aortic insufficiency, which was stable without any significant valvular abnormality, he had a history of infected olecranon bursa on the right elbow, he was status post appendectomy, and he had a history of hypertension. There was no indication from the record that the Veteran's MI or heart disability was related to his active service. January 2005 private medical records from St. Joseph Health Center show that the Veteran was seen for a carotid artery percutaneous transluminal angioplasty and stent. The Veteran was noted to have tolerated the procedure well, with some minor hypotension initially following the procedure. On discharge, the Veteran's diagnosis was chronic occlusive disease of the left internal carotid artery; high grade carotid stenosis with subsequent stent placement; CAD with previous MI in 1996 and percutaneous transluminal coronary angioplasty performed at that time; recent CATH with diagnosis of aortic valvular disease. It was noted that the Veteran intended to have valve replacement surgery in the future. There was no indication that the Veteran's heart disability was related to his active service. Also of record are extensive VA treatment records that show the Veteran has been receiving regular care at the VA medical center for his heart disability since 1991. A May 1991 VA treatment record shows that the Veteran was seen for complaints of chest tightness. At that time the Veteran reported that his mother died of atherosclerotic heart disease and his brother was currently suffering from atherosclerotic heart disease. The records show that the Veteran receives regular treatment at the cardiology clinic for his CAD. There is no indication from his treatment records that his CAD is related to his active service. There is no evidence of record indicating that the Veteran has, at any time, related his current CAD to his active service. The Veteran has not submitted any statements in support of his claim which document any such alleged relationship, nor is there any indication from the postservice medical notes of record that he has made any such statements to his treatment providers. To the extent that, by filing a claim for service connection, the Veteran has attempted to assert that his current CAD had its onset in service and it has continued since, the Board finds that the preponderance of the evidence is against the claim. Not only is there no evidence that the Veteran was treated for symptoms related to CAD while on active service, but the Veteran's treatment records show that he did not begin receiving treatment for CAD related symptoms until 1991 (23 years following separation from active service). Had the Veteran experienced any cardiovascular symptoms in service, which he doesn't necessarily contend, one would expect that the Veteran would have provided such a history to his treating physicians. See Curry and Rucker. Additionally, as there is no evidence the Veteran's CAD was manifest in the first postservice year, there is no basis for considering (and applying) the 38 U.S.C.A. § 1112 chronic disease presumptions (for CAD as a form of arteriosclerosis). There is also no basis for service connection under 38 C.F.R. § 3.303(b) because the Veteran has made no assertions of continuity of symptomatology. Therefore, as there is no medical evidence indicating that the Veteran's current CAD had its onset in service, or for many years thereafter, and as the Veteran has not alleged any such relationship, entitlement to service connection for CAD must be denied. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of- the-doubt rule. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2012). Entitlement to a TDIU The Veteran claims that he is unable to obtain or maintain employment due to his various disabilities. The Veteran is currently service connected for PTSD, rated as 50 percent disabling. This is his only service connected disability. As noted above, 38 C.F.R. § 4.16, requires that a Veteran be in receipt of either a single 60 percent disability rating, or have a total combined disability rating, for multiple disabilities, of 70 percent. As the Veteran's total disability rating is currently only 50 percent, he does not meet the schedular criteria for a TDIU under 38 C.F.R. § 4.16. However, 38 C.F.R. § 4.16(b) provides that when a Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, but fails to meet the percentage requirements for a TDIU set forth in 38 C.F.R. § 4.16(a), consideration to such benefits on an extra-schedular basis may be given. The evidence of record indicates that the Veteran has been unemployed since March 2002, when he had surgery on his left foot for his Raynaud's syndrome. There is no indication from the record as to whether he has sought further employment since that time. However, the Board notes that the Veteran is not service-connected for his Raynaud's syndrome. In fact, entitlement to service connection for such disability has been denied herein. Further, the Board acknowledges that the Veteran is in receipt of SSA disability benefits. However, a review of the SSA determination shows that the Veteran was found to be unable to work for the purposes of SSA disability compensation as a result of injuries to the nervous system and disorders of the muscle, ligaments, and fascia. The Board notes that the Veteran is not currently service-connected for any sort of injury to the nervous system or disorder of the muscle, ligaments, and fascia. There is no indication from the SSA records on file that the Veteran's service-connected PTSD renders the Veteran unable to maintain gainful employment. Consideration is also given to the fact that that the Veteran is competent to report symptoms of his psychiatric disability. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). He is also credible in his reports of symptoms and their effect on his activities. However, notwithstanding that he has made no allegation that his PTSD renders him unemployable (as opposed to the above referenced physical problems), the Board finds that he is not competent to identify a specific level of disability of his psychiatric disability or provide an opinion as to its effect on his employability. Such competent evidence concerning the nature and extent of the Veteran's service-connected psychiatric disability has been provided by a VA medical professional who has examined him. Specifically, when he was examined in September 2012, the psychologist determined that the Veteran's PTSD only resulted in occupational impairment with reduced reliability and productivity. This finding addresses the question of whether the Veteran's service connected PTSD renders him unable to secure and follow a substantially gainful occupation and provides a negative opinion. The Board finds these records to be the only competent and probative evidence of record, and therefore is accorded greater weight than the Veteran's subjective complaints of symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). Therefore, the Board has concluded that referral of the TDIU claim for extra-schedular consideration is also unwarranted. Entitlement to a TDIU is denied. Duties to Notify and Assist Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In accordance with 38 C.F.R. § 3.159(b)(1), proper notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). While the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: (1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and (2) the appeal is readjudicated (e.g., in a Supplemental Statement of the Case). See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Here, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in March 2004, May 2004, and March 2005 that fully addressed all notice elements and were sent prior to the initial RO decisions in these matters. The letters informed the Veteran of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. A March 2006 letter, sent subsequent to the Court's holding in Dingess, informed the Veteran how disability ratings and effective dates were established. Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied as to both timing and content. VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). The RO has obtained the Veteran's service treatment records, SSA records, and pertinent postservice medical records. The matter was remanded in May 2010 and April 2012 in an attempt to obtain medical records from the Fort Riley Stockade Infirmary and Irwin Army Hospital. The RO has substantially complied with the Board's May 2010 and April 2012 remand instructions with respect to the disabilities herein decided. Of record is an April 2011 memorandum to the file stating that procedures to obtain records were correctly followed, but that treatment records for the Veteran from the Ft. Riley Stockade Infirmary were unable to be located. Also of record is a November 2012 memorandum to the file stating that after all proper efforts were followed in the attempt to obtain treatment records for the Veteran from Irwin Army Hospital, no such records were found. Under these circumstances, the Board finds that there has been substantial compliance with the May 2010 and April 2012 remand instructions, and an additional remand to comply with the Board's directives is not required. See D'Aries v. Peake, 22 Vet. App. 97, 104-106 (2008); Stegall v. West, 11 Vet. App. 268 (1998). With regard to a VA examination, the Board finds that such is not necessary to decide the aforementioned claim, as the standards outlined by the Court in McLendon v. Nicholson, 20 Vet. App. 79 (2006), have not been met. Under McLendon, VA must provide a medical examination in a service connection claim when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Id. at 81. The evidence of record does not indicate that the Veteran's claimed disabilities are in anyway related to his active service; and, thus, the duty to provide a VA examination has not been triggered. Specifically, with regard to his claims for service connection for Raynaud's syndrome and cold weather injuries of the feet and ears, the Veteran's claim of in-service injury has been found to lack credibility. Element (2) of McLendon is therefore missing. He has also failed to provide any evidence of a current disability of the ears that has been associated to a cold injury. The Veteran has similarly failed to provide any evidence that his CAD had its onset in service or is otherwise etiologically related to his active service, which means that elements (2) and (3) of McLendon are missing. The Board also notes that the Veteran has not been examined by VA in connection with his claim for a TDIU. However, as discussed above, the September 2012 VA examination for his PTSD, which is his only service connected disability, provided sufficient evidence to address the TDIU question. Indeed, notwithstanding the findings of the VA examination, the Board emphasizes that the Veteran does not meet the percentage criteria for TDIU under 38 C.F.R. § 4.16(a) and his only service-connected disability, PTSD, is not indicative of unemployability. A remand to provide the Veteran with a medical examination and/or obtain a medical opinion is not required with respect to his claim of entitlement to a TDIU. In light of the above, the Board finds that the medical evidence of record is sufficient to resolve this appeal; VA has no further duty to provide an examination or medical opinion. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R. § 3.159(c)(4) (2012). See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Based on the foregoing, it is the Board's determination that VA fulfilled its VCAA duties to notify and to assist the Veteran as to the issue discussed above, and thus, no additional assistance or notification was required. The Veteran has suffered no prejudice that would warrant a remand, and his procedural rights have not been abridged. See Bernard v. Brown, 4 Vet. App. 384. ORDER Entitlement to service connection for Raynaud's syndrome is denied. Entitlement to service connection for residuals of cold weather injuries to the feet is denied. Entitlement to service connection for residuals for cold weather injuries to the ears is denied. Entitlement to service connection for CAD (claimed as heart attack) is denied. Entitlement to a TDIU is denied. ____________________________________________ MICHAEL A. HERMAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs