Citation Nr: 20042377 Decision Date: 06/23/20 Archive Date: 06/23/20 DOCKET NO. 12-09 056 DATE: June 23, 2020 ORDER The claim of entitlement to an initial, compensable rating prior to March 26, 2012, and a rating greater than 40 percent from that date, for service-connected Raynaud’s syndrome is denied. FINDINGS OF FACT 1. Prior to March 26, 2012, the Veteran’s Raynaud’s syndrome was manifested by characteristic attacks of such symptoms as his fingers turning white and feeling a burning sensation in cold temperatures; however, the attacks did not occur at least one to three times per week. 2. Since March 26, 2012, the Veteran’s Raynaud syndrome has been manifested by characteristic attacks of similar symptoms (to now include fingers turning from white to red) that occur daily, but is not manifested by two or more digital ulcers and autoamputation of one or more digits. CONCLUSIONS OF LAW 1. The criteria for an initial, compensable rating for Raynaud’s syndrome, prior to March 26, 2012, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3-4.7, 4.31, 4.104, Diagnostic Code (DC) 7117. 2. The criteria for a rating greater than 40 percent for Raynaud’s syndrome, from March 26, 2012, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3-4.7, 4.104, DC 7117. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1984 to June 2004. This appeal to the Board of Veterans’ Appeals (Board) arose from an August 2010 rating decision in which a Department of Veterans Affairs (VA) Regional Office (RO), inter alia, awarded service connection for Raynaud’s syndrome, assigning a zero percent (noncompensable) rating, effective January 6, 2010. The Veteran filed a timely notice of disagreement (NOD) in August 2011. In October 2011, the RO issued a Statement of the Case (SOC), which continued the noncompensable rating. In March 2012, the Veteran filed a timely substantive appeal (via a VA Form 9, Appeal to the Board of Veterans’ Appeals). In March 2014, a supplemental SOC (SSOC) was issued. In July 2015, the Board, inter alia, remanded the claim to the agency of original jurisdiction (AOJ) to afford the Veteran a Board video-conference hearing. In June 2016, the Veteran testified during a Board video-conference hearing before the undersigned Veterans Law Judge. A hearing transcript has been associated with the claims file. In August 2016, the Board remanded the claim on appeal for further action, to include additional development of the evidence. In May 2017, the Veteran missed his scheduled VA examination. In March 2018, the Board found good cause for his missed VA examination, and remanded the claim on appeal to the AOJ for additional development, to include arranging for the Veteran to undergo a new VA examination. After accomplishing further action, in a March 2020 rating decision, the AOJ granted a 40 percent rating for Raynaud’s syndrome, effective March 26, 2012. However, the AOJ denied any higher rating (as reflected in a March 2020 SSOC) and returned this matter to the Board for further appellate consideration. As the Veteran has not been granted the maximum rating available for Raynaud’s syndrome (which he is presumed to seek) before or after March 26, 2012, the Board has now characterized the claim to reflect the staged ratings assigned. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Evaluation of Raynaud’s Syndrome At the onset, the Board is now satisfied that all notification and development actions needed to fairly resolve the claim for higher ratings on appeal have been accomplished. An August 2010 pre-rating letter provided notice of what was needed to substantiate the claim and who was responsible for obtaining what evidence, and October 2011 SOC and March 2014 and March 2020 SSOCs set forth the criteria for higher ratings. The Board also finds that VA has fulfilled its duties to assist the Veteran in the development of his claim. Prior to the March 2018 remand, the record included service treatment records, service personnel records, VA and private treatment records, reports of VA examination, and the transcript of the lay statements. Pursuant to the development requested in the remand, the AOJ requested that the Veteran provide, or provide appropriate authorization to obtain any outstanding, pertinent private (non-VA) records, and obtained a VA examination in February 2020, the report of which includes sufficient information for evaluation of the disability, resolve the claim. Significantly, there is no identified evidence for which appropriate authorization to obtain has been provided, and the Veteran has not alleged any error or omission in the assistance provided. Hence, the Veteran is not prejudiced by the Board proceeding to a decision on the claim on appeal, at this juncture. Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. A veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). While the Veteran’s entire history is reviewed when assigning a disability rating, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, in evaluating a claim for a higher initial rating or increased rating, staged rating is appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007) (for increased rating claims); Fenderson v. West, 12 Vet. App. 119, 126 (1999) (for initial rating claims); Here, the Veteran’s service-connected Raynaud’s syndrome has been assigned a noncompensable initial rating prior to March 26, 2012 and a 40 percent rating from that date. As the AOJ has already assigned staged ratings for the disability, the Board will consider the propriety of the rating assigned at each stage, as well as whether any further staged rating is warranted. Under DC 7117, a 10 percent rating is warranted when characteristic attacks occur one to three times per week; a 20 percent rating is warranted where there are characteristic attacks occurring four to six times per week; a 40 percent rating is warranted where there are characteristic attacks occurring at least daily; a 60 percent rating is warranted where there are two or more digital ulcers and a history of characteristic attacks; a maximum, 100 percent rating is warranted where there are two or more digital ulcers plus autoamputation of one or more digits and a history of characteristic attacks. 38 C.F.R. § 4.104, DC 7117. Under DC 7117, characteristic attacks consist of sequential color changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. These evaluations are for the disease as a whole, regardless of the number of extremities involved or whether the nose and ears are involved. Notably, the rating schedule authorizes the assignment of a 0 percent (noncompensable) rating in every instance in which the rating schedule does not provide for such a rating and the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Turning to the relevant evidence of record, in the report of the July 2010 VA examination, the examiner noted a diagnosis of the Veteran’s Raynaud’s syndrome. The examiner also notes the Veteran’s symptoms per his own report, such as that his fingers would sometimes turn white and that he felt a burning sensation in cold temperatures. He stated that his hands would return to a normal color when placed in warm water and the symptoms would resolve. The examiner indicated that there were no limitations or functional impact on the Veteran’s occupation and daily activities. There was no evidence of a recurrent pattern. VA treatment records dated in March 2018 and January 2019 note that the Veteran reported that his characteristic attacks, which are manifested by a burning sensation in his hands when exposed to cold weather, are more bothersome in the winter months, particularly when he needs to work outside and when he is unable to wear his gloves at work. Pursuant to the March 2018 Board remand, the Veteran was afforded a new VA examination for evaluation of his Raynaud’s syndrome. The February 2020 examiner noted the Veteran’s disability was manifested by characteristic attacks of symptoms such as burning sensation in his fingers, and color changes in his fingers from white to red occurring at least daily. The Veteran reported his symptoms occur only when the weather is cold or wet. The examiner stated that the Veteran does not have two or more digital ulcers, nor does the Veteran have autoamputation of one or more digits. Regarding the functional impact on the Veteran’s ability to work, the examiner noted the Veteran’s reports that, at times, he needs to work outside in the cold weather with his tools and he is unable to use gloves at that time and his fingers can become painful and numb. Considering the pertinent evidence in light of the applicable rating criteria and rating considerations noted above, the Board finds that an initial, compensable rating prior to March 26, 2012, and a rating greater than 40 percent from that date, for Raynaud’s syndrome must be denied. For the period prior to March 26, 2012, the competent medical evidence of record shows that the Veteran’s Raynaud’s syndrome was manifested by characteristic attacks of such symptoms as the Veteran’s fingers would occasionally turn white and that he felt a burning sensation in cold temperatures. The Veteran stated that his hands would return to a normal color when placed in warm water and the symptoms would resolve. The July 2010 examiner reported that there were no limitations or functional impact on the Veteran’s occupation and daily activities and there was no evidence of a recurrent pattern. Notably, the disability was not shown to be manifested by characteristic attacks occurring, at least, one to three times per week—which is required for the minimum, compensable 10 percent disability rating for Raynaud’s syndrome. Thus, a compensable rating prior to March 26, 2012 is not warranted. For the period from March 26, 2012, during VA treatment and on examination, the Veteran has reported similar symptoms, such as burning sensation in his fingers, and that color changes in his fingers from white to red. He also has stated that his fingers become numb when it is very cold outside. In addition, he has reported that his symptoms occur any day when he is out in the cold or he is exposed to cold and wet weather; once he returns inside, his symptoms will last from a few minutes to a few hours. The February 2020 VA examiner confirmed that the Veteran has characteristic attacks manifested by the above-noted symptoms, which occur daily. However, that examiner also explicitly found that the Veteran did not have two or more digital ulcers or autoamputation of one or more digits, which is required for the next, higher, 60 percent disability rating, as well as the maximum, 100 percent disability rating. Thus, for the period from March 26, 2012, no rating higher than 40 percent for the disability is warranted. In evaluating the claim for higher ratings for the Veteran’s service-connected Raynaud’s syndrome, the VA examiners and the Board have considered the Veteran’s assertions regarding his symptoms, which he is certainly competent to provide. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). As noted, however, the criteria needed to support higher ratings require medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). Here, such findings do not support any rating than those assigned for the Veteran’s Raynaud’s syndrome at any pertinent point. For all the foregoing reasons, the Board finds that there is no basis for any further staged rating of the Veteran’s Raynaud’s syndrome, and that an initial, compensable rating prior to March 26, 2012 and a rating greater than 40 percent from March 26, 2012 for the disability must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, as the preponderance of the evidence is against assignment of any higher rating at any pertinent point, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53- 56 (1990). JACQUELINE E. MONROE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kovacs, 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.