Citation Nr: 18155464 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 14-34 730A DATE: December 4, 2018 ORDER Service connection for residuals of frostbite of the right hand is granted. Service connection for residuals of frostbite of the left hand is granted. Service connection for residuals of frostbite of the right foot is granted. Service connection for residuals of frostbite of the left foot is granted. FINDINGS OF FACT 1. The Veteran currently has residuals of frostbite in both hands that are at least as likely as not related to his in-service cold exposure. 2. The Veteran currently has residuals of frostbite in both feet that are at least as likely as not related to his in-service cold exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for residuals of frostbite of the right hand have been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303 (2018). 2. The criteria for entitlement to service connection for residuals of frostbite of the left hand have been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303 (2018). 3. The criteria for entitlement to service connection for residuals of frostbite of the right foot have been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303 (2018). 4. The criteria for entitlement to service connection for residuals of frostbite of the left foot have been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1973 to January 1977. The Board observes that additional evidence relevant to the Veteran’s claim of entitlement to service connection for residuals of frostbite of the hands and feet has been associated with the claims file since the October 2014 statement of the case was issued. However, as the Board’s decision to grant the claims on appeal is entirely favorable to the Veteran, there is no prejudice in proceeding with adjudication at this time. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends he has residuals of frostbite to both his hands and feet due to a cold weather injury incurred in service. See March 2011 VA Form 21-526. The Board observes that in December 1975 service treatment records, the Veteran was diagnosed with cold weather injury to his hands and feet. In March 2011, the Veteran reported he had experienced bilateral hand and foot pain for the past 30 years due to frostbite incurred in service, and that the pain had increased in the previous five months, rating the pain as a five on a scale of one to ten. See March 2011 VA treatment records. The Veteran reported his hands, fingers, and toes would go numb, and turn a purple tint. The Veteran indicated the pain was worse in the winter months, and the symptoms were minimal in a warm environment. A VA cold injury protocol examination was conducted in June 2011. The Veteran reported that after participating in military night training during the winter in 1975 he could not feel his hands or feet and they had turned purple. He indicated the symptoms from frostbite to his hands and feet had become progressively worse. The examination indicated a history of Raynaud’s phenomenon, affecting the digits of his bilateral upper and lower extremities. The Veteran reported the attacks were precipitated by exposure to cold, lasted more than 60 minutes, occurred less than once per week, and resulted in pain and changes in skin coloration. The Veteran also reported severe cold sensitivity in both his hands and feet, with moderate tingling. Diagnostic studies of the hands and feet were performed, and revealed only mild degenerative joint disease of the first interphalangeal joint on the right, the right distal radioulnar joint and the left radiocarpal joint. The examination indicated there were no objective findings of frostbite residuals to the hands or feet, and no medical opinion was provided. In April 2011, the Veteran’s spouse reported witnessing a steady decline in the condition of the Veteran’s hands and feet, and that they had moved to a warmer environment in hopes of alleviating his symptoms. See April 2011 correspondence from the Veteran’s spouse. She also reported the Veteran often complained of pain, numbness, tingling, and sensitivity, especially when trying to warm the affected areas of his hands and feet. The Veteran’s spouse stated she had observed changes in coloration of the Veteran’s nails. In the February 2012 VA nursing note, the Veteran complained of cold, tingling, and pain in both his hands and feet, especially with cooler weather. The provider indicated an assessment of parasthesia of the hands and feet, and prescribed Neurontin. See also April 2012 VA primary care note. In the November 2015 VA orthopedic note, the Veteran reported bilateral hand and foot pain and paresthesias. The attending physician noted a complex past medical history, including frostbite to the bilateral hands and feet sustained in service, and treated nonoperatively. The Veteran reported significant pain in both hands, and described feeling constant pain in his fingers, as well as tingling sensation, and being very cold at baseline. The physician’s assessment was sequela of frostbite in the hands and feet. The Board finds probative value in the medical history reported by the Veteran, and confirmed in service treatment records that demonstrate assessment and treatment for frostbite of the bilateral hands and feet. Although the June 2011 VA cold injury protocol examination did not find objective evidence of residuals of frostbite to the hands or feet at the time of the examination, the examiner did not explain how he reached this conclusion, or reconcile this conclusion with the Veteran’s reported history of worsening symptoms. The Board finds probative value in the November 2015 orthopedic physician’s assessment that the Veteran has current residuals of frostbite of his hands and feet. Accordingly, the Board finds the evidence of record is in favor of a finding that the Veteran has a current diagnosis of residuals of frostbite of the bilateral hands and feet due to the cold weather injury to his hands and feet incurred in active service. Based on the probative evidence of record, and the Veteran’s competent and credible statements, entitlement to service connection for residuals of frostbite of the bilateral hands and feet is warranted. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Mask, Associate Counsel