Citation Nr: 21064486 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 15-40 444 DATE: October 20, 2021 REMANDED Entitlement to service connection for Raynaud's syndrome, claimed as a right- hand disability, is remanded. REASONS FOR REMAND The Veteran had active military service from March 1979 to April 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, the Veteran testified via videoconference before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the file. This matter was previously before the Board in April 2019 and September 2020. In April 2019, the Board remanded the claim for additional development, including a VA examination. Following the evidentiary development, the Board denied the Veteran's claim of service connection for Raynaud's syndrome, claimed as a right-hand disability, in September 2020. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC) and in August 2021, CAVC issued a Joint Motion for Remand (JMR) after finding the Board did not provide an adequate statement of reasons or bases of its denial of the aforementioned claim. Entitlement to service connection for Raynaud's syndrome is remanded. Although the Board regrets additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran contends he is entitled to service connection for Raynaud's syndrome due to serving as an aircraft mechanic for over ten years on active duty that consisted of exposure to cold temperatures. In August 2021, the Court, based on a Joint Motion for Remand, vacated the Board's denial of entitlement to service connection. According to the Court, the Board erred when it failed to adequately address lay statements by the Veteran and others regarding the continuity of his symptoms as well as potentially favorable evidence. It was noted the Board failed to address the adequacy of the October 2019 VA opinion, the opinion upon which the denial was based, as it also did not consider the Veteran's or his mother's statements regarding his symptomatology. Post-service, records show the Veteran has a diagnosis of Raynaud's syndrome. A medical record from March 2013 indicated the Veteran complained of pain in his fingertips when cold. An Initial Pain Screening was completed in August 2013 and the Veteran noted pain in his hand at an 8 out of 10. He reported the pain in his fingertips has been continual for years. It was noted he has been unable to tolerate coldness to his fingers since 1991. A medical record from January 2014 indicated the Veteran reported the pain in his hands was more severe now, and he experiences numbness in his fingertips on both hands. A Nursing Telephone Care note from February 2014 noted the Veteran reported still having pain from Raynaud's disease in his hands and that his pain is worse in the winter time. The Veteran was afforded an examination to assess his hand disability in October 2019. The Veteran reported he began to seek treatment for throbbing hand and fingertip pain in 1991. He noted active duty service in Florida, as well as Norfolk, VA and Norway. No flare-ups were noted. The examiner opined that it was less likely than not that the Veteran's right hand disability was incurred in or caused by working on aircraft during cold weather. The rationale provided was that there was no evidence of a chronic hand condition, including cold injury/Raynaud's syndrome during active service and his separation history was negative for any extremity conditions, with the exception of recurrent back pain which he is service connected for. Records also showed that most of his service was in Florida, which is a warm climate area. The examiner further opined that his Raynaud's syndrome occurred more than one year following service. The Board finds that further medical development is necessary to comply with the August 2021 CAVC JMR. The October 2019 VA examination is not adequate for the Board to make an assessment on the issue of service connection. A medical opinion based solely on the absence of documentation in the record is inadequate and a medical opinion is also inadequate if it does not take into account the Veteran's reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). Here, the October 2019 examiner's conclusions were based on an absence of documentation of Raynaud's syndrome in the service treatment records and the examiner failed to accurately acknowledge the Veteran's post service treatment records which possibly showed reports of (ongoing) pain. Further, the examiner did not adequately address all the Veteran's lay statements regarding onset and continuity, such as in his July 2014 Notice of Disagreement where he noted treatment for his condition as early as 1991. In his December 2018 Board testimony, he testified he was exposed to a lot of cold weather while working on aircraft in Norfolk, Virginia and also during detachments overseas to Norway. See Hearing Transcript, Page 5-6. Nor did the examiner address the testimony from the Veteran's mother, a registered nurse, indicating that he has suffered from issues with his hand since leaving the service, including discoloration and pain. See Hearing Transcript, Page 9. Therefore, remand for an adequate medical opinion regarding the etiology of the Veteran's right-hand disability is necessary. Moreover, given the several post-service notations of hand issues, the Board must ensure that an opinion adequately contemplates the Veteran's medical history. On remand, the examiner is required to address the nature and etiology of the Veteran's Raynaud's syndrome, claimed as a right-hand disability, including consideration of the testimony made by both the Veteran and his mother during the December 2018 Board hearing. The matter is REMANDED for the following action: 1. Obtain a supplemental medical opinion on the nature and etiology of the Veteran's Raynaud's syndrome, claimed as a right-hand disability. Further in-person examination of the Veteran is left to the discretion of the clinician providing the opinion. If the clinician deems a new examination is necessary for providing an opinion, then such an examination should be scheduled. The examiner is to review the entire file, including a copy of this Remand and the August 2021 CAVC order. 2. After reviewing the claims file, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran's right-hand disability had its onset during a period of active service, or is related to an in-service injury, event, or disease. In providing the above opinion, the examiner is advised to address the Veteran's contentions regarding post service complaints of continuity of hand pain, including medical documentation from a March 2013 VA Clinic Note that reported pain in his fingertips when cold; an August 2013 VA Clinic Note that indicated the Veteran described his hand pain as an 8 out of 10 and the pain has been continual for years; a January 2014 medical record noting pain in his hands is more severe now and he experiences numbness in fingertips in both hands; and the February 2014 VA Nursing Telephone Note that reported the Veteran was still experiencing pain from Raynaud's syndrome in his hands that is worse in the winter. A complete rationale for the opinions rendered must be provided. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Krista Johnson, 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.