Citation Nr: 21074908 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 19-24 166 DATE: December 16, 2021 ORDER Reopening of service connection for right hand cold injury residuals is granted. Reopening of service connection for left hand cold injury residuals is granted. Reopening of service connection for right foot cold injury residuals is granted. Reopening of service connection for left foot cold injury residuals is granted. Service connection for right hand cold injury residuals is granted Service connection for left hand cold injury residuals is granted. Service connection for right foot cold injury residuals is granted Service connection for left foot cold injury residuals is granted. Service connection for coronary artery disease (CAD) is denied. Service connection for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. In an unappealed March 2016 rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for right and left hand cold injury residuals and redenied service connection for right and left foot cold injury residuals on the basis that the evidence did not have any tendency to show a nexus to service; evidence received since the March 2016 rating decision relates to the unestablished fact of a nexus to service, which is necessary to substantiate claims for service connection. 2. The currently diagnosed bilateral hand and foot cold injury residuals had their onset during service. 3. The Veteran is currently diagnosed with CAD. 4. There was no cardiovascular injury, disease, or event during service. 5. Symptoms of CAD were not chronic in service, were not continuous after service separation, and did not manifest to a compensable degree within one year of separation from service. 6. CAD did not have its onset during service and are not otherwise related to service. 7. The Veteran is not currently diagnosed with PTSD. CONCLUSIONS OF LAW 1. The March 2016 rating decision denying service connection for right hand, left hand, right foot, and left foot cold injury residuals became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. New and material evidence has been received to reopen service connection for right hand, left hand, right foot, and left foot cold injury residuals. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right hand, left hand, right foot, and left foot cold injury residuals have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326. 4. Coronary artery disease was not incurred in active service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 5. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from April 1952 to March 1954. In April 2021, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. A September 7, 2021 statement reflects the representative requested an additional 90 day extension. Subsequently, September 2021 lay statements from the Veteran's brother and granddaughter were added to the claims file. The 90-day extension period would have expired on December 6, 2021. As the extension has since expired, the instant issues are now ripe for adjudication. 1. Reopening Service Connection for Right Hand Cold Injury Residuals is Granted. 2. Reopening Service Connection for Left Hand Cold Injury Residuals is Granted. 3. Reopening Service Connection for Right Foot Cold Injury Residuals is Granted. 4. Reopening Service Connection for Left Foot Cold Injury Residuals is Granted. In a March 2016 rating decision, the AOJ denied service connection for right and left hand cold injury residuals and again denied service connection for right and left foot cold injury residuals on the basis that the evidence did not have any tendency to show a nexus to service. Because the Veteran did not submit a Notice of Disagreement, and no additional evidence was received within one year of the notice of the rating decision, the rating decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103. Since the March 2016 rating decision, VA has received additional lay and medical evidence that raises a reasonable possibility of substantiating claims for service connection for cold injury residuals to all extremities. Specifically, the May 2019 Board hearing transcript reflects the Veteran testified to experiencing symptoms of frostbite to the hands and feet during service, to include numbness and skin discoloration, and that the symptoms have been continuous since service separation. Such evidence relates to the unestablished fact of a nexus to service, which is necessary to substantiate a claim for service connection. For these reasons, the Board finds that new and material evidence has been received to reopen service connection. See 38 C.F.R. § 3.156(a). 5. Service Connection for Right Hand Cold Injury Residuals is Granted. 6. Service Connection for Left Hand Cold Injury Residuals is Granted. 7. Service Connection for Right Foot Cold Injury Residuals is Granted. 8. Service Connection for Left Foot Cold Injury Residuals is Granted. Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. The Veteran contends that the currently diagnosed bilateral hand and foot cold injury residuals first manifested during service and have continued since service separation. At the April 2021 Board hearing, the Veteran testified to experiencing symptoms of frostbite, to include numbness and skin discoloration, due to extreme cold, and that these symptoms have continued since service separation. First, the evidence of record demonstrates that the Veteran has currently diagnosed bilateral hand and foot cold injury residuals. See VA treatment records. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether there was onset of symptoms of bilateral hand and foot frostbite in service and since service separation that was later diagnosed as bilateral hand and foot cold injury residuals, that is, whether bilateral hand and foot cold injury residuals were "incurred in" service. The evidence weighing in favor of the claim includes an April 1954 original claim for service connection, filed within a month of service, asserting that frostbite of the feet was due to service in Korea. Additional favorable evidence includes the Veteran's consistent lay statements demonstrating bilateral hand and foot cold injury residual symptoms since service, to include the April 2021 Board hearing testimony reflecting self-reports of frostbite to the hands and feet first manifesting during service, and that bilateral hand and foot cold injury residuals have continued since service. Various VA treatment records also reflect treatment for bilateral hand and foot cold injury residuals. See VA treatment records. While cold injury residuals are not a chronic disease listed under 38 C.F.R. § 3.309(a), the Board is granting the service connection claim based on evidence, including that pertinent to service, which establishes that frostbite residuals began in service and so was directly "incurred in" service. The finding that the Veteran has had frostbite symptoms in service and since service is supportive of the direct service connection theory of the claim overall because it tends to show that the symptoms that began in service were the basis for the later diagnosed cold injury residual disabilities. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms - dizziness, loss of balance, hearing trouble, stumble and fall, and tinnitus - that were later diagnosed as Meniere's disease). For these reasons, and after resolving reasonable doubt in the Veteran's favor, the Board finds that bilateral hand and foot cold injury residuals were incurred in active service; thus, the criteria for direct service connection have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Service Connection for CAD CAD is considered a chronic disease under 38 C.F.R. § 3.309(a). As such, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). In addition, the law provides that, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of ten percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that a cardiovascular injury or disease occurred during service, or that chronic symptoms of CAD were manifested during service. The service treatment records, which are complete, show no complaints, findings, diagnoses, or treatment related to CAD. Further, the March 1954 service separation examination report reflects the cardiovascular system was clinically evaluated as normal. Because the service treatment records are complete, and the Veteran sought treatment for various other symptoms during service, clinical testing including blood pressure monitoring was conducted during service, the Board finds that CAD is a condition that would have ordinarily been recorded during service had they been present during service. As the service treatment records are complete and show complaints and treatment for other disorders, the Veteran similarly would have reported or complained of cardiovascular disability symptoms, had such occurred during service. Additionally, routine blood tests and blood pressure testing, which includes physical pressing on the pulse, would have noted such irregularities had they been present during service. For these reasons, the lay and medical evidence generated contemporaneous to service, which showed no in-service cardiovascular injury or disease and no chronic symptoms of CAD, is likely to reflect accurately the Veteran's physical condition, so is of significant probative value and provides evidence against a finding of cardiovascular disorder symptoms during service. Accordingly, the criteria for presumptive service connection under 38 C.F.R. § 3.303(b) based on "chronic" symptoms in service are not met. The Board next finds that the weight of the evidence shows that symptoms CAD were not continuous since service, including not to a degree of 10 percent within one year of service separation. The VA and private treatment records do not show symptoms of CAD were continuous since service, including not to a degree of 10 percent within one year of service separation. See VA and private treatment records. As the weight of the evidence demonstrates no "continuous" CAD symptoms since service, including to a compensable degree within the first post-service year, the criteria under 38 C.F.R. § 3.303(b) for presumptive service connection based on "continuous" symptoms or symptoms manifested to a degree of 10 percent within one year of service separation are not met. 38 C.F.R. §§ 3.307, 3.309. The Board further finds that the weight of the evidence demonstrates that CAD, which first manifested years after service, was not caused by or otherwise related to service. As discussed above, the weight of the evidence demonstrates no in-service injury or disease or even event to which a heart disorder could be related. While the Veteran is competent to relate some symptoms of CAD, he is not competent to opine on whether there is a link between the current heart disorder and active service under the facts of this case, which include no cardiovascular injury, disease, or event during service. Such a conclusion regarding causation requires specific, highly specialized, medical knowledge and training regarding the unseen and complex processes of the cardiovascular system, knowledge of the various causes of unobservable symptoms of CAD, and would involve objective clinical testing that the Veteran is not competent to perform. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). For these reasons, the Board finds that the preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for CAD; consequently, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 10. Service Connection for PTSD With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). The Veteran contends generally that PTSD is due to various in-service stressors. At the April 2021 Board hearing the Veteran indicated that the claimed PTSD was due to seeing friends killed during service. The Veteran also indicated that the claimed PTSD was due to racism during service. See April 2021 Board hearing transcript. Upon review of all of the evidence of record, lay and medical, the Board finds that the weight of the evidence shows no current diagnosis for PTSD. The VA treatment records do not contain a confirmed or even a purported diagnosis of PTSD. The July 2019 VA examiner also specifically assessed that the Veteran did not have PTSD. See 38 C.F.R. § 4.125. While the Veteran has requested a new VA PTSD examination, the Veteran's general assertations are insufficient to overcome the presumption that the July 2019 VA PTSD examination was adequately conducted. See Miley v. Principi, 366 F.3d 1343, 1346-47 (Fed. Cir. 2004) ("The presumption of regularity provides that, in the absence of clear evidence to the contrary, the court will presume that public officers have properly discharged their official duties."); Rizzo v. Shinseki, 580 F.3d 1288, 1292 (Fed. Cir. 2008) (applying the presumption of regularity to VA examinations); see also Sickels v. Shinseki, 643 F.3d 1362, 1366 (Fed. Cir. 2011). At the July 2019 VA examination, the VA examiner explicitly assessed that the Veteran's symptoms did not meet the diagnostic criteria for PTSD under DSM-5 criteria. While the Veteran is competent to report events that happened in service and symptoms experienced at any time, he is not competent to diagnose PTSD. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that "PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify"); Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (holding that a claimant without medical expertise cannot be expected to precisely delineate the diagnosis of his mental illness). Accordingly, the Board finds that the weight of the evidence is against finding that the Veteran is currently diagnosed with PTSD; therefore, the appeal for service connection for PTSD must be denied. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Tenney, 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.