Citation Nr: 20037526 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 14-13 483 DATE: June 2, 2020 ORDER Entitlement to service connection for Raynaud's disease is denied. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for prostate cancer is remanded. FINDING OF FACT The weight of the competent and probative evidence reflects that the Veteran does not have a current diagnosis of Raynaud’s disease that had its onset during service or is otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for Raynaud’s disease have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1966 to July 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision of a Regional Office (RO) for Department of Veteran Affairs (VA). In September 2015, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge and a transcript of the hearing is associated with the claims file. The appeal was remanded in January 2016 and December 2017 for additional development. 1. Entitlement to service connection for Raynaud's syndrome The Veteran asserts that he has Raynaud’s disease and that his Raynaud’s disease was incurred in or is otherwise causally related to his exposure to cold weather during service and his frost bite as a result of his exposure to cold weather. The Veteran testified at his September 2015 Board hearing that he began to notice symptoms in approximately 1972. He stated that he would have cold hands and toes. He indicated that a prior doctor had indicated that the condition sounded like Raynaud’s syndrome. Generally, to establish service connection, there must be lay or medical evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability. See 38 U.S.C. § 1110; Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. It is the Board’s responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. The Veteran’s STRs are silent for complaints of, or treatment for Raynaud’s disease. The Veteran was seen for a VA Primary Care initial evaluation in March 2012 at which time he reported a history of Raynaud’s syndrome. The Veteran’s VA treatment records contain reports of a past medical history of Raynaud’s phenomenon based. An April 2016 past medical history from Regional Orthopedic Professional Association also lists Raynaud’s Syndrome. The Veteran testified at his Board hearing that he had been diagnosed with this condition at a satellite of Cooper Hospital called Camcare but couldn’t afford to continue after he lost his job. He testified that he first noted the condition in approximately 1972, about three years following separation from service. The Veteran provided records from Camcare in November 2015 that do not contain a diagnosis of Raynaud’s syndrome. The Veteran also submitted an article regarding Raynaud’s Phenomenon from the US Department of Health and Human Services. The article indicated that for most individual with Raynaud’s syndrome, the symptoms are not associated with any blood or vessel damage and is not associated with any underlying disease. The Veteran had a VA examination for artery/vein conditions in February 2020. Following an in-person examination and review of the evidence of record, the examiner indicated that the Veteran did not have Raynaud’s syndrome or a vascular disease. The examiner noted the Veteran’s reports of frostbite in Germany during service and the Veteran’s reports that he had been diagnosed with the condition in approximately 2005. The examiner noted that the Veteran has not provided evidence to confirm a diagnosis of Raynaud’s syndrome and offered an opinion based on his review of the history, physical exam, review of the claims file, and medical literature that he was aware of that the Veteran’s claimed Raynaud’s syndrome was not due to, caused or otherwise aggravated by severe cold temperatures during service. The examiner formed this opinion based on the lack of evidence of the claimed condition. While the Board acknowledges the Veteran’s genuinely held beliefs that he has Raynaud’s disease, the weight of the evidence is against finding that the Veteran has Raynaud’s. The Veteran’s medical treatment records do not contain a diagnosis of Raynaud’s disease, although it is reported in his past medical history. While the Veteran is competent to report what prior physicians have told him regarding his diagnosis of this condition there is not competent medical evidence during the period on appeal that he has had a current diagnosis of this condition. The Board notes that the prior Board remand noted that the Veteran’s treatment records contained a diagnosis for this condition, however, as noted in the April 2020 Supplemental Statement of the Case this was only part of the past medical history and was not based on clinical assessment or laboratory testing. Accordingly, because the Veteran has not been diagnosed with Raynaud’s disease, service connection for Raynaud’s disease must be denied. Moreover, there is no indication that his symptoms began during active service or within one year of separation from service; therefore, even if a diagnosis of Raynaud’s is subsequently confirmed, the evidence fails to show any relationship to service.] REASONS FOR REMAND 1. Entitlement to service connection for hypertension is remanded. Regarding the Veteran’s claims for service connection of hypertension and prostate cancer the Board notes that the Veteran’s claims were last remanded in December 2017 to determine whether the Veteran had been exposed to herbicide agents and to provide him with a VA exam. A January 2020 VA Memorandum indicated that based on the responses received that there was no evidence of exposure to herbicide agents, but that exposure to chemicals related to vehicle operation, maintenance and repair was conceded based on the Veteran’s MOS. The Veteran was seen VA exams regarding his hypertension and prostate cancer in February 2020. The examiner indicated that the Veteran’s hypertension was due to elevated peripheral vascular resistance and there was no evidence to support the claim that hypertension was incurred in or caused by exposure to chemicals/herbicide agents during service. The examiner also indicated that there was no evidence to support the claim that the Veteran’s prostate cancer was due to exposure to chemicals during service. The Board notes that there is a positive finding of exposure to chemicals related to vehicle operations. The examiner’s opinion that there is no evidence to support the claim is unclear to the Board as to whether such exposure was considered and found not to be causally related or whether such exposure was not conceded. As the opinion offered regarding these conditions is unclear the Board will request an addendum opinion from the examiner. Additionally, regarding the Veteran’s hypertension, the examiner did not address the Veteran’s systolic reading at the time of separation as requested by the prior Board remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the examiner who provided the February 2020 VA prostate examination, or another appropriate medical professional if the examiner is unavailable. The examiner should answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s prostate cancer is causally related to the Veteran’s active service, to include his conceded exposure to chemical, including hydraulic fluid, diesel fuel, gasoline solvents, and PLL greases? A detailed rationale for the opinion must be provided. The examiner should specifically indicate that they have reviewed the January 2020 VA Memorandum regarding the Veteran’s exposure to chemicals. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. 2. Obtain an addendum opinion from the examiner who provided the February 2020 VA hypertension examination, or another appropriate medical professional if the examiner is unavailable. The examiner should answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s hypertension is causally related to the Veteran’s active service, to include consideration of his systolic readings at separation and his conceded exposure to chemicals, including hydraulic fluid, diesel fuel, gasoline solvents, and PLL greases? A detailed rationale for the opinion must be provided. The examiner should specifically indicate that they have reviewed the January 2020 VA Memorandum regarding the Veteran’s exposure to chemicals. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it] MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board John M. Middleton 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.