Citation Nr: 21072748 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 17-35 220 DATE: December 6, 2021 REMANDED Entitlement to service connection for a chronic right ankle disability is remanded. Entitlement to service connection for a chronic left ankle disability is remanded. Entitlement to service connection for right lower extremity circulatory impairment (toes), to include Raynaud phenomenon, is remanded. Entitlement to service connection for left lower extremity circulatory impairment (toes), to include Raynaud phenomenon, is remanded Entitlement to service connection for right upper extremity circulatory impairment (fingers), to include Raynaud phenomenon, is remanded. Entitlement to service connection for left upper extremity circulatory impairment (fingers), to include Raynaud phenomenon, is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 2012 to September 2015. REASONS FOR REMAND 1. Entitlement to service connection for a chronic right ankle disability is remanded. 2. Entitlement to service connection for a chronic left ankle disability is remanded. The Veteran seeks service connection for chronic right and left ankle disabilities. The Veteran reports bilateral ankle pain began after a ten-mile march with 60 pounds weight during service. He reports the right ankle and left ankle disabilities, described as pain and swelling, have been recurrent since that time and have worsened. See December 2014 ankle conditions examination. The December 2014 examiner provided a negative nexus opinion. The examiner reasoned that there was no diagnosis of an ankle condition in either ankle because there was no pathology to render a diagnosis. The Veteran's medical records document ongoing treatment and complaints of pain and swelling to both ankles. See October 2015 VA primary care note; see also February 2015, March 2015 treatment records. The Board finds that remand for another VA examination is necessary to determine whether the Veteran's right and left ankle impairment are caused or etiologically related to service, to include due to marching with heavy weights during service. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that pain resulting in functional impairment constitutes a disability as contemplated in 38 U.S.C. § 1110, even in the presence of a presently-diagnosed condition). 3. Entitlement to service connection for right lower extremity circulatory impairment (toes), to include Raynaud phenomenon, is remanded. 4. Entitlement to service connection for left lower extremity circulatory impairment (toes), to include Raynaud phenomenon, is remanded. 5. Entitlement to service connection for right upper extremity circulatory impairment (fingers), to include Raynaud phenomenon, is remanded. 6. Entitlement to service connection for left upper extremity circulatory impairment (fingers), to include Raynaud phenomenon, is remanded. The Veteran asserts that he developed bilateral lower extremity and bilateral upper extremity circulatory impairment, to include Raynaud phenomenon, after exposure to cold temperatures as numbness in his fingers and toes. See December 2014 artery and vein conditions examination. The Board notes that Raynaud disease is defined as "a primary or idiopathic vascular disorder characterized by bilateral attacks of Raynaud phenomenon." See Dorland's Illustrated Medical Dictionary 542 (32nd ed. 2012). Raynaud phenomenon is defined as "intermittent bilateral ischemia of the fingers, toes, and sometimes ears and nose, with severe pallor and often paresthesias and pain, usually brought on by cold or emotional stimuli and relieved by heat; it is usually due to an underlying disease or anatomical abnormality. When it is idiopathic or primary it is called Raynaud disease." See Dorland's Illustrated Medical Dictionary 1430 (32nd ed. 2012). The December 2014 VA examiner provided a negative nexus opinion for the Veteran's condition. Specifically, the examiner determined the Veteran did not have a diagnosis of Raynaud phenomenon because there was no pathology to render a diagnosis. Id. The Veteran's post treatment records reflect ongoing symptoms related to Raynaud phenomenon and the patient taking prescribed medication to treat the Veteran's diagnosed Raynaud phenomenon. See December 2012, December 2016 treatment records. The Board finds that a remand is necessary to obtain outstanding treatment records and a new VA examination with a new etiological opinion regarding the Veteran's bilateral lower extremity and bilateral upper extremity circulatory impairment, to include Raynaud phenomenon. The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge of any of his right ankle and left ankle problems and symptoms of his bilateral lower extremity and upper extremity circulatory impairment, to include Raynaud phenomenon, during and since service. 2. Ensure that all outstanding VA treatment records are associated with the claims file, including treatment records related to the treatment of the Veteran's chronic right ankle and left ankle impairment and circulatory symptoms, to include Raynaud phenomenon. 3. Schedule a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and etiology of his right and left ankle. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner is asked to address the following: (a) Provide a diagnosis for any right or left ankle disability found. If no such disability is diagnosed, the examiner must indicate whether the Veteran's reported right and left ankle disability causes any functional impairment. (b) For any right or left ankle disability/functional impairment diagnosed, please opine as to whether it is at least as likely as not that such disability/functional impairment had its onset or is otherwise related to the Veteran's active service, to specifically include in-service training or the use of training equipment during service. A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Schedule a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and etiology of his bilateral upper and lower extremity circulatory impairment. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner is asked to address the following: (a) Provide a diagnosis for any right and/or left upper/lower extremity circulatory impairment. If no such disability is diagnosed, the examiner must indicate whether the Veteran's reported right and/or left upper/lower extremity circulatory impairment causes any functional impairment. The examiner is also directed to address the diagnoses of Raynaud phenomenon in the medical records. (b) For any right and/or left upper/lower extremity circulatory impairment/disability diagnosed, please opine as to whether it is at least as likely as not that such disability/functional impairment had its onset or is otherwise related to the Veteran's active service, to specifically include in-service training or the use of training equipment during service. A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. Jarrette A. Marley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jordan, Jacquelynn 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.