Citation Nr: 1323801 Decision Date: 07/25/13 Archive Date: 08/06/13 DOCKET NO. 10-16 334 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUE Entitlement to service connection for Raynaud's disease, to include as secondary to chemical exposure to carbon tetrachloride and lead paint. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Cryan, Counsel INTRODUCTION The Veteran served on active duty from February 1951 to February 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. The Veteran testified at a Video Conference hearing before the Board in December 2012. In April 2013, the Board remanded the Veteran's claim for additional development. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The Veteran does not have Raynaud's disease that is attributable to active service. CONCLUSION OF LAW The Veteran does not have Raynaud's disease that is the result of disease or injury incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from a notice error, rather than on VA to rebut presumed prejudice. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The Board finds that any defect with regard to the timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided throughout the adjudication and because the appellant had a meaningful opportunity to participate effectively in the processing of the claim with an adjudication of the claim by the RO subsequent to receipt of the required notice. The record does not show prejudice to the appellant, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specifically, the Veteran was notified in letters dated in October 2009 and April 2013. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing that an error is harmful, or prejudicial, falls upon the party attacking the agency's determination); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Thus, VA has satisfied its duty to notify the appellant and had satisfied that duty prior to the adjudication in the June 2013 supplemental statement of the case. Overton v. Nicholson, 20 Vet. App. 427 (2006) (veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. The appellant has not referred to any additional, unobtained, relevant, available evidence. VA has obtained an examination with respect to the claim. Thus, the Board finds that VA has satisfied the duty to assist provisions of law. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). The chronicity provisions are applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during an applicable presumptive period, and still has that disability. That evidence must be medical unless it relates to a condition as to which lay observation is competent. 38 C.F.R. § 3.303(b) (2012). Generally, service connection requires (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995). The Veteran contends that he has Raynaud's disease as a result of exposure to chemicals in service. Specifically, he claims that while serving aboard several naval vessels he was an electrician's mate and was exposed to carbon tetrachloride which was used to clean engine parts. He also indicated that he was exposed to lead paint which was all over the ship and to batteries made from lead. The Veteran's DD214 reflects that the Veteran's related civilian occupation was an electrical apprentice. The Veteran's service treatment records (STRs) do not reflect any complaints, findings, or treatment for Raynaud's disease. Associated with the claims file are VA outpatient treatment reports dated from April 2003 to August 2012. In April 2003, the Veteran was seen to establish care at VA. He was diagnosed with Raynaud's phenomenon at that time. In March 2004, a physician indicated that the Veteran had blood cell aberrations which might contribute to the Raynaud's phenomenon. The Veteran was started on Diltiazem to treat his Raynaud's disease in March 2004. In September 2005, the Veteran was continued on Diltiazem as needed for his Raynaud's disease. In October 2009, the Veteran was noted to have tried a calcium channel blocker for his Raynaud's phenomenon and the examiner noted that time release Nifedipine was being prescribed to see if the Veteran's symptoms improved. In December 2011, the Veteran's Raynaud's disease was noted to be much better. In a statement dated in February 2010, the Veteran's treating physician at VA indicated that the Veteran established care at VA in September 2003 and had a diagnosis of Raynaud's phenomenon three years prior to establishing care at VA. She indicated that various treatments have been attempted with very limited results and that the Veteran remains symptomatic. In a statement dated in March 2010, the physician indicated that the Veteran's diagnosis of Raynaud's phenomenon causes him to have intermittent painful symptoms. She noted that the Veteran had a history of exposure to lead-based paint and carbon tetrachloride and that it is possible that his Raynaud's phenomenon is related to those exposures. At a December 2012 hearing before the Board, the Veteran testified that he began noticing the symptoms of Raynaud's disease in 1998. He indicated that he was exposed to carbon tetrachloride in service and was not provided gloves when he worked with the chemical approximately three times per month. He also reported exposure to lead paint fumes during service. His representative indicated that the cause of Raynaud's disease is unknown. At a May 2013 VA examination, the Veteran reported trouble with cold exposure beginning in 1998. He was diagnosed with Raynaud's disease in 2002. The Veteran was noted to take Nifedipine to control his Raynaud's disease. The examiner reviewed the claims file, interviewed the Veteran, and performed a clinical evaluation. The examiner diagnosed the Veteran with Raynaud's disease and opined that it was less likely than not incurred in or caused by service. The examiner acknowledged the Veteran's report of exposure to carbon tetrachloride and lead paint. The examiner noted that carbon tetrachloride is a halogenated hydrocarbon that is primarily absorbed through the respiratory tract by inhalation or through the gastrointestinal tract by ingestion. Its primary toxicity is to the central nervous system (CNS) and it causes CNS depression. The examiner noted that the cause of Raynaud's is unknown although it appears to be related to dysregulation of the peripheral arterioles which are controlled by the autonomic immune system. The examiner concluded that there is no evidence to support the claim that carbon tetrachloride has a direct effect on the autonomic nervous system and if this compound had a direct effect on the autoimmune system, that effect would be manifest with an acute exposure. The examiner indicated that a review of the Veteran's claims file reveals that in March 2004, a cold agglutinins test was performed to determine the cause of the Veteran's Raynaud's disease. The examiner noted that the normal range for the test is less than 1:64 and the Veteran's result was 1:4064 which shows that the Veteran's Raynaud's phenomenon is likely due to cold agglutinins. The examiner explained that cold agglutinin disease is an autoimmune disorder that causes a hemolytic anemia and can alter normal blood flow. The disease is usually associated with very high titers of greater than 1:10,000. The examiner noted that therefore the Veteran does not have cold agglutinin disease, but his titers are high enough to explain the symptoms that he experiences. The examiner indicated that the Veteran's disease process became evident more than forty years after his exposure in service. The examiner concluded that it is not at least as likely as not that the Raynaud's disease was caused by these exposures. He indicated that it is at least as likely as not that Raynaud's is due to cold agglutinins, an autoimmune disease that is not associated with toxic exposure. With regard to the Veteran's claim that his exposure to lead paint caused his Raynaud's, the examiner noted that lead is an element that can accumulate within the system and cause toxic effects. The Veteran's blood lead level was 4 and the reference range is 0 to 19 and therefore, it is not at least as likely as not that the Veteran's Raynaud's is due to lead toxicity as his blood lead level is normal. In considering the evidence of record and the applicable laws and regulations, the Board concludes that the Veteran is not entitled to service connection for Raynaud's disease. The Board finds that the competent evidence does not show a relationship between the Veteran's Raynaud's disease and his period of active service. The earliest medical evidence of a diagnosis of Raynaud's was in 2005 when the Veteran established care at VA. Other evidence of record suggests that the Veteran was diagnosed with Raynaud's disease in 2002. Consequently, the earliest indication of a diagnosis of Raynaud's disease came more than forty years after the Veteran left service. A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after active service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The amount of time that passed between service and the first diagnosis of record of Raynaud's disease is also evidence that weighs against the Veteran's claim. The competent evidence of record does not show a relationship between the Veteran's Raynaud's disease and his period of active service. The only medical opinion of record indicates that it is less likely than not that Raynaud's disease was incurred in or aggravated by service. The examiner included a complete and thorough rationale for the opinion. The Veteran has not submitted any competent evidence which provides a basis for the conclusion that the Veteran's Raynaud's disease is related to his period of service. Although the Veteran contends that he has Raynaud's disease related to exposure to carbon tetrachloride and lead paint during his active service, he has submitted no competent medical evidence or opinion to corroborate that contention. 38 C.F.R. § 3.159(a)(1) (2012) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran's opinion is not competent to provide the requisite etiology of the Raynaud's disease because those matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (2012); Duenas v. Principi, 18 Vet. App. 512 (2004); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995). Therefore, his statements regarding his Raynaud's disease being related to service are not competent as he is not medically qualified to provide evidence regarding a matter requiring medical expertise, such as an opinion as to etiology. The Board finds that the preponderance of the competent evidence is against a finding that the Veteran had Raynaud's disease during service and the file does not contain competent evidence linking Raynaud's disease to service. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for Raynaud's disease, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). ORDER Entitlement to service connection for Raynaud's disease, to include as secondary to chemical exposure to carbon tetrachloride and lead paint is denied. ____________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs