Citation Nr: 21029240 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 20-28 528 DATE: May 13, 2021 ORDER As new and material evidence sufficient to reopen the claim for Raynaud's disease of the left foot, has been received, the claim to reopen is granted. As new and material evidence sufficient to reopen the claim for Raynaud's disease of the right foot, has been received, the claim to reopen is granted. As new and material evidence sufficient to reopen the claim for Raynaud's disease of the left hand, has been received, the claim to reopen is granted. As new and material evidence sufficient to reopen the claim for Raynaud's disease of the right hand, has been received, the claim to reopen is granted. Entitlement to service connection for Raynaud's disease of the left foot is granted. Entitlement to service connection for Raynaud's disease of the right foot is granted. Entitlement to service connection for Raynaud's disease of the left hand is granted. Entitlement to service connection for Raynaud's disease of the right hand is granted. REMANDED Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. In a rating decision dated August 2017, the Regional Office (RO) denied the Veteran's claim for service connection for Raynaud's disease of the left foot the basis that the disability was neither incurred in or caused by service. The Veteran did not appeal this decision and the decision became final. 2. Evidence received since the August 2017 rating decision is neither cumulative nor redundant of evidence already of record and raises a reasonable possibility of substantiating the claim of entitlement to service connection for Raynaud's disease of the left foot. 3. In a rating decision dated August 2017, the RO denied the Veteran's claim for service connection for Raynaud's disease of the right foot the basis that the disability was neither incurred in or caused by service. The Veteran did not appeal this decision and the decision became final. 4. Evidence received since the August 2017 rating decision is neither cumulative nor redundant of evidence already of record and raises a reasonable possibility of substantiating the claim of entitlement to service connection for Raynaud's disease of the right foot. 5. In a rating decision dated August 2017, the RO denied the Veteran's claim for service connection for Raynaud's disease of the left hand the basis that the disability was neither incurred in or caused by service. The Veteran did not appeal this decision and the decision became final. 6. Evidence received since the August 2017 rating decision is neither cumulative nor redundant of evidence already of record and raises a reasonable possibility of substantiating the claim of entitlement to service connection for Raynaud's disease of the left hand. 7. In a rating decision dated August 2017, the RO denied the Veteran's claim for service connection for Raynaud's disease of the right hand the basis that the disability was neither incurred in or caused by service. The Veteran did not appeal this decision and the decision became final. 8. Evidence received since the August 2017 rating decision is neither cumulative nor redundant of evidence already of record and raises a reasonable possibility of substantiating the claim of entitlement to service connection for Raynaud's disease of the right hand. 9. Resolving reasonable doubt in the Veteran's favor, his Raynaud's disease of the left foot is at least as likely as not related to cold weather exposure during service. 10. Resolving reasonable doubt in the Veteran's favor, his Raynaud's disease of the right foot is at least as likely as not related to cold weather exposure during service. 11. Resolving reasonable doubt in the Veteran's favor, his Raynaud's disease of the left hand is at least as likely as not related to cold weather exposure during service. 12. Resolving reasonable doubt in the Veteran's favor, his Raynaud's disease of the right hand is at least as likely as not related to cold weather exposure during service. CONCLUSIONS OF LAW 1. The August 2017 rating decision denying the claim for service connection for Raynaud's disease of the left foot is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2020). 2. New and material evidence sufficient to reopen the Veteran's claim of entitlement to service connection for Raynaud's disease of the left foot has been submitted; the application to reopen a claim for service connection for Raynaud's disease of the left foot is granted. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2020). 3. The August 2017 rating decision denying the claim for service connection for Raynaud's disease of the right foot is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2020). 4. New and material evidence sufficient to reopen the Veteran's claim of entitlement to service connection for Raynaud's disease of the right foot has been submitted; the application to reopen a claim for service connection for Raynaud's disease of the right foot is granted. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2020). 5. The August 2017 rating decision denying the claim for service connection for Raynaud's disease of the left hand is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2020). 6. New and material evidence sufficient to reopen the Veteran's claim of entitlement to service connection for Raynaud's disease of the left hand has been submitted; the application to reopen a claim for service connection for Raynaud's disease of the left hand is granted. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2020). 7. The August 2017 rating decision denying the claim for service connection for Raynaud's disease of the right hand is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2020). 8. New and material evidence sufficient to reopen the Veteran's claim of entitlement to service connection for Raynaud's disease of the right hand has been submitted; the application to reopen a claim for service connection for Raynaud's disease of the right hand is granted. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2020). 9. The criteria for service connection for Raynaud's disease of the left foot are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 10. The criteria for service connection for Raynaud's disease of the right foot are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 11. The criteria for service connection for Raynaud's disease of the left hand are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 12. The criteria for service connection for Raynaud's disease of the right hand are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Air Force from June 1964 to August 1968. New and Material Evidence Where service connection for a disability has been denied in a final decision, a subsequent claim for service connection for that disability may be considered on the merits only if new and material evidence has been received since the time of the prior adjudication. New evidence means evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). 1. New and material evidence sufficient to reopen the claims for Raynaud's disease of the bilateral hands and feet The Veteran's claims for service connection for Raynaud's disease of the bilateral hands and feet were denied in August 2017. The RO determined there was no evidence of a nexus linking the current condition to service. The Veteran did not appeal this decision. In January 2019, the RO reopened of the Veteran's claims for service connection for Raynaud's disease of the bilateral hands and feet on the basis that the evidence submitted was new and material. In particular, evidence since the last final denial showed a history of Raynaud's disease, and included an opinion linking Raynaud's disease to service. The Board finds that the evidence submitted since the August 2017 rating decision establishes a reasonable possibility of substantiating the Veteran's claims for service connection. Thus, the claims were properly reopened. 38 C.F.R. § 3.156(a). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). 2. Entitlement to service connection for Raynaud's disease of the left foot 3. Entitlement to service connection for Raynaud's disease of the right foot 4. Entitlement to service connection for Raynaud's disease of the left hand 5. Entitlement to service connection for Raynaud's disease of the right hand Due to the similar nature of the claims, the Veteran's claims for entitlement to service connection for Raynaud's disease of the bilateral feet and hands will be discussed together herein. In regard to a present disability, the December 2018 found the Veteran had a current diagnosis of Raynaud's disease. Further, a letter from the Veteran's private physician stated he had as diagnosis of Raynaud's disease. Thus, the first element of service connection has been established. With regard to the in-service element, the Veteran's service treatment records (STRs) do not show any treatment for cold weather injuries to the hands or feet. The Veteran's military personnel records indicate he served as a security guard for approximately 10 months in Lincoln, Nebraska. At the February 2021 Board hearing, the Veteran testified that while working as a security guard for B47 bombers in Nebraska he would be outside in weather that went down to 20-22 degrees below zero with 22 inches of snow. He would be outside for 15-20 minutes, warm up in a bus with a heater for 15-20 minutes, and then go back outside. Affording the Veteran the benefit of the doubt, the Board finds that Veteran was exposed to hazardous cold during service. Thus, the second element of service connection has also been established. As to the nexus element, the evidence conflicts. In January 2018, the Veteran's private primary care provider opined that the Veteran's Raynaud's disease is likely a result of his service in Nebraska in 1964 as extreme cold weather is a factor associated with the development of Raynaud's Phenomenon. In December 2018, a VA examiner opined that the Veteran's hand and foot condition was less likely than not related to military service. The examiner noted the Veteran was never treated for a cold injury and that the Veteran stated his symptoms started three years after he was stationed in Nebraska when he returned to Erie, Pennsylvania and cold weather. The examiner also noted the symptoms of Raynaud's could not be replicated on examination. The Board affords the December 2018 VA examiner's opinion less probative weight. At the February 2021 Board hearing, the Veteran testified that he did not experience Raynaud's symptoms or seek treatment following his extreme cold weather exposure in Nebraska for several years because he was subsequently stationed in Vietnam and Florida, which are both warm weather environments. It is not clear that the VA examiner considered the Veteran's warm weather postings and credible explanations as to why treatment was not sought until three years after being stationed in Nebraska. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current Raynaud's disease of the bilateral hands and feet is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for Raynaud's disease of the bilateral hands and feet is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. During the course of the appeal, the Veteran was last afforded a VA examination for his service-connected PTSD in November 2018. The Veteran's testimony at the February 2021 Board hearing suggests that his service-connected PTSD has worsened since he was last evaluated. In light of such evidence, additional development is needed to properly adjudicate the issue on appeal. See 38 U.S.C. § 5103A(a); 38 C.F.R. § 3.159; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Entitlement to a TDIU is remanded. The issue of entitlement to a TDIU was not certified for appeal. However, when evidence of unemployability is submitted during the course of an appeal from an assigned disability rating, a claim for a TDIU will be considered part of the claim for benefits for the underlying disability. Rice v. Shinseki, 22 Vet. App. 447 (2009). As the evidence presented at the February 2021 Board hearing suggests that the Veteran is unemployable due to symptoms of his service-connected disabilities, the issue of entitlement to a TDIU has been raised and is within the jurisdiction of the Board. While the Board remands the issues of entitlement to a higher rating for service-connected PTSD for additional evidentiary development, as discussed above, that decision may impact this claim for TDIU. As such, these issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Undertake all notice and evidentiary development needed to resolve the issue of entitlement to a TDIU. This should include sending the Veteran a letter advising him of the information and evidence needed to award a TDIU. The letter should also request that he complete a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, in order to provide the information needed to substantiate the claim for a TDIU. 2. Schedule the Veteran for an examination with an appropriate clinician to determine the current severity of his service-connected PTSD. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. Although an independent review of the claims file is required, the Board calls the examiner's attention to the following: (a.) The Veteran's February 2021 Board hearing testimony in which he described difficulties maintaining relationships and with employment. The examiner is also asked to provide a statement regarding the impact of the Veteran's PTSD on his employability. The examiner must provide all findings, along with a complete rationale for any opinions provided. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laura C. Owens 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.