Citation Nr: 21069861 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 17-00 673 DATE: November 22, 2021 ORDER Entitlement to service connection for cold weather injury of the hands, knees, and feet, to include gout, advanced degenerative changes, and cryopathy is granted. Entitlement to service connection for depressive disorder with alcohol use disorder, secondary to service-connected cold weather injury of the hands, knees, and feet on a causation basis is granted. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran's cold weather injury of the hands, knees, and feet is related to service. 2. The Veteran's depressive disorder with alcohol use disorder is caused by service-connected cold weather injury of the hands, knees, and feet. CONCLUSIONS OF LAW 1. The criteria for service connection for cold weather injury of the hands, knees, and feet, to include gout, advanced degenerative changes, and cryopathy, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for depressive disorder with alcohol use disorder, secondary to service-connected cold weather injury the hands, knees, and feet, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1976 to January 1980. This matter came to the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) which, inter alia, denied service connection for residuals of frostbite of the hands, feet, and knees, and depressive disorder with alcohol use disorder. The Veteran disagreed with the RO's determination and a Statement of the Case (SOC) was issued in December 2016 addressing the matter. The Veteran timely appealed. In light of the Veteran's reported symptoms and contentions and to encompass all disorders that are reasonably raised by the record, the Board has re-characterized the claim of service connection for residuals of frostbite, hands, feet, and knees (also claimed as neuropathy- loss of feeling in fingertips) as a claim of service connection for cold weather injury of the hands, knees, and feet, to include gout, advanced degenerative changes, and cryopathy. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (a claim should not be limited to the disorder as characterized by the Veteran but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in the active military, naval, air, or space service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). 1. Cold weather injury of the hands, knees, and feet The evidence of record demonstrates that the requirement for a current disability has been met. Specifically, a January 2015 VA examination report shows diagnoses of gout of hands, feet, and knees due to cold weather, and advanced degenerative changes of hands, feet, and knees. Also, a March 2015 VA addendum medical opinion shows a cold weather injury diagnosis of cryopathy of bilateral hand, bilateral knee, and bilateral feet. Thus, the first element of service connection has been met. The evidence of record also supports a finding that an in-service cold injury requirement has been met. As a preliminary matter the Veteran's service treatment records are negative of complaints, treatment, and diagnosis of cold weather injury of hands, knees, and feet. At the Veteran's January 1980 separation examination, no pertinent abnormalities were noted. In a September 2014 statement, the Veteran reported that he was a member of the 82nd Airborne as a signal corp. serviceman while stationed in Germany, and his job was to manage microwave communication connection. His duties required him to daily ascend a 120 foot tower to setup and maintain communications. The Veteran asserted that during the performance of his duties, he developed severe frostbites on his hands, knees, and feet. He noted that following the frostbite problems, he began to develop grossly severe growths on his hands, feet, knee joints, and body. In his December 2016 substantive appeal (VA Form 9), the Veteran reported that the time he spent in Germany being on a 110 microwave tower for 33 months, precipitated his current condition. He further noted that these conditions include joint pain and nerve damage in his hands, feet, and knees. Here, the Veteran has indicated that he had symptoms during service and his statements in this regard are competent, credible, and consistent with the circumstances of his service. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a) (each disabling condition for which a veteran seeks service connection must be considered based on factors including the basis of places, types, and circumstances of service as shown by service records). This is sufficient to establish the second element of his service connection claim. In January 2015, the Veteran was afforded a VA examination. The examiner opined that the Veteran's claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale was that the Veteran has had progressive degenerative changes as a result of cold weather exposure 40 years ago, as documented in the records. In a March 2015 VA medical opinion, the examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran has had progressive degenerative changes in hands, knees and feet, however, there is no evidence to show that this is related to cold exposure that occurred in service. The examiner opined that the Veteran's cold weather injury diagnosed as cryopathy of bilateral knees, feet, and hand was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran served in Germany for two years in very low temperatures that can cause a cold weather injury. The examiner further explained that within the records, the Veteran marked "don't know" on the separation examination for swollen/painful joints. The examiner indicated that there is no evidence that the Veteran's symptoms are due to service and the Veteran was not sure of complaints upon separation. In this case, the evidence of record includes conflicting January 2015 and March 2015 VA opinions as to the etiology of the Veteran's cold weather injury. Both the January 2015 and March 2015 VA examiners provided a thorough rationale for the basis of their medical opinions. Thus, the Board can find no basis upon which to assign greater probative weight to either medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Under the benefit-of-the-doubt rule, for the appellant to prevail, there need not be a preponderance of the evidence in his favor, but only an approximate balance of the positive and negative evidence. In other words, the preponderance of the evidence must be against the claim for the benefit to be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Given the evidence set forth above, such a conclusion cannot be made in this case. Under these circumstances, the record is sufficient to award service connection for cold weather injury of the hands, knees, and feet. Thus, the Board finds that service connection for cold weather injury of the hands, knees, and feet, to include gout, advanced degenerative changes, and cryopathy is warranted. 2. Depressive disorder with alcohol use disorder The Veteran contends that his depressive disorder with alcohol use disorder is secondary to service-connected disabilities. For the following reasons, service connection for depressive disorder with alcohol use disorder, secondary to cold weather injury the hands, knees, and feet is warranted In this case, the evidence of record demonstrates that the requirement for a current disability has been met. Specifically, a January 2015 VA examination report shows a diagnosis of depressive disorder with alcohol use disorder. The Veteran underwent a VA examination in January 2015. The examiner opined that the Veteran's depressive disorder with alcohol use disorder is at least as likely as not proximately due to or the result of the Veteran's service-connected cold weather injury the hands, knees, and feet. The examiner explained that the Veteran's cold weather injuries were due to working on a 120 foot pole in sub-zero temperature. The examiner further explained that the Veteran's hands are especially affected due to having to work in those condition without his gloves on while stationed in Germany. The examiner indicated the Veteran's gout, arthritis, and nerve damage to his hands, feet, and knees got progressively worse over the years after military service, such that he had to quit his job in 2004, and he has been very depressed (along with the associated anxiety symptoms) over the severely debilitating effects of his cold weather injuries. The Board finds that the VA opinion indicating that the Veteran's depressive disorder with alcohol use disorder, is caused by his service-connected cold weather injury the hands, knees, and feet, provide a sufficient basis to grant service connection for depressive disorder with alcohol use disorder. Thus, service connection for depressive disorder with alcohol use disorder, secondary to cold weather injury the hands, knees, and feet is warranted on a causation basis. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.