Citation Nr: 21030159 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 16-38 129 DATE: May 18, 2021 REMANDED Entitlement to an effective date prior to April 24, 2015, for the award of a 40 percent for Raynaud's syndrome is remanded. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for neuropathy of the left upper extremity is remanded. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for neuropathy of right upper extremity is remanded. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for cold weather injury to the left hand, to include arthritis with Raynaud's syndrome, is remanded. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for cold weather injury to the right hand, to include arthritis with Raynaud's syndrome, is remanded. Entitlement to a rating in excess of 40 percent from April 24, 2015, to July 9, 2015, for Raynaud's syndrome is remanded. Entitlement to an initial rating in excess of 30 percent for neuropathy of the left upper extremity is remanded. Entitlement to an initial rating in excess of 40 percent for neuropathy of the right upper extremity is remanded. Entitlement to an initial rating in excess of 30 percent for cold weather injury to the right hand, to include arthritis with Raynaud's syndrome, is remanded. Entitlement to an initial rating in excess of 30 percent for cold weather injury to the left hand, to include arthritis with Raynaud's syndrome, is remanded. Entitlement to an initial compensable rating for eczema of the bilateral hands is remanded. Entitlement to service connection for an acquired psychiatric disorder, other than service-connected posttraumatic stress disorder (PTSD), to include as secondary to service-connected Raynaud's syndrome, later characterized as cold injury residuals of the bilateral hands, to include arthritis with Raynaud's syndrome, and neuropathy of the bilateral upper extremities, is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1986 to August 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in July 2015, October 2015, January 2017, and May 2017 by a Regional Office of the Department of Veterans Affairs (VA). In February 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, he waived Agency of Original Jurisdiction (AOJ) consideration of the evidence associated with the record since the AOJ last adjudicated his claims. 38 C.F.R. § 20.1305(c). 1. Entitlement to an effective date prior to April 24, 2015, for the award of a 40 percent for Raynaud's syndrome. 2. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for neuropathy of the left upper extremity. 3. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for neuropathy of right upper extremity. 4. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for cold weather injury to the left hand, to include arthritis with Raynaud's syndrome. 5. Entitlement to an effective date prior to July 9, 2015, for the award of service connection for cold weather injury to the right hand, to include arthritis with Raynaud's syndrome. 6. Entitlement to a rating in excess of 40 percent from April 24, 2015, to July 9, 2015, for Raynaud's syndrome. 7. Entitlement to an initial rating in excess of 30 percent for neuropathy of the left upper extremity. 8. Entitlement to an initial rating in excess of 40 percent for neuropathy of the right upper extremity. 9. Entitlement to an initial rating in excess of 30 percent for cold weather injury to the right hand, to include arthritis with Raynaud's syndrome. 10. Entitlement to an initial rating in excess of 30 percent for cold weather injury to the left hand, to include arthritis with Raynaud's syndrome. 11. Entitlement to an initial compensable rating for eczema of the bilateral hands. By way of history, the Veteran developed Raynaud's syndrome of his hands, which is a disorder manifested by impaired circulation of the extremities that results symptoms of pain, numbness, and tingling in the hands, due to exposure to cold weather during service. He was subsequently awarded service connection for Raynaud's syndrome the day after his separation from service with an initial 20 percent rating pursuant to Diagnostic Code (DC) 7117, which pertains to the evaluation of such disease. The Veteran most recently filed a claim for an increased rating for Raynaud's disease that was received by VA on April 24, 2015. At such time, he also sought service connection for bilateral hand arthritis secondary to such disability. Additionally, on July 9, 2015, VA received the Veteran's claims for service connection for degenerative joint disease/arthritis and neuropathy of the bilateral hands as due to his original in-service cold weather injury. In the July 2015 rating decision, the AOJ increased the rating for the Veteran's Raynaud's syndrome to 40 percent, effective April 24, 2015, and, in an October 2015 rating decision, awarded service connection with four separate 20 percent ratings for cold weather injuries and neuropathy of the bilateral hands, evaluated pursuant to DCs 7122 and 8513, pertaining to cold injury residuals and paralysis of all radicular groups, respectively, effective July 9, 2015. However, as pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is prohibited, the AOJ discontinued the 40 percent rating assigned for the Veteran's Raynaud's syndrome as of July 9, 2015, in an April 2017 rating decision. 38 C.F.R. § 4.14. Such also recharacterized the Veteran's service-connected disabilities of cold weather injuries to the bilateral hands to include arthritis with Raynaud's syndrome, and increased such ratings to 30 percent, effective July 9, 2015. Similarly, increased ratings of 40 and 30 percent for neuropathy of the right and left upper extremities, effective July 9, 2015, were awarded. Additionally, in a January 2017 rating decision, the AOJ awarded service connection for eczema associated with the Veteran's Raynaud's syndrome with a noncompensable rating, effective September 23, 2016. Thereafter, the Veteran appealed with respect to (1) the propriety of the effective dates assigned for (a) the award of the 40 percent rating for Raynaud's syndrome and (b) the award of service connection for (i) bilateral upper extremity neuropathy and (ii) cold weather injuries to the bilateral hands, to include arthritis with Raynaud's syndrome. He also appealed with regard to (2) the propriety of the ratings assigned for his (a) Raynaud's syndrome, (b) bilateral upper extremity neuropathy, (c) cold weather injuries to the bilateral hands, to include arthritis with Raynaud's syndrome, and (d) eczema. With respect to the termination of the Veteran's rating for Raynaud's syndrome, the Board notes that, pursuant to 38 C.F.R. § 3.400(o), while a retroactive increase or additional benefit will not be awarded after basic entitlement has been terminated, such as by severance of service connection, service connection for such disability has not been terminated; rather, the AOJ found that it was proper to rate such disability under alternative DCs. Butts v. Brown, 5 Vet. App. 532, 539 (1993); Pernorio v. Derwinski, 2 Vet. App. 625 (1992). The Board also observes that the foregoing service-connected disabilities were last evaluated at VA artery and vein conditions and hand and finger conditions performed in June 2015, a VA cold injury residuals examination performed in October 2015, and VA peripheral nerves and skin diseases examinations performed in December 2016. However, during his recent Board hearing in February 2021, the Veteran testified that the manifestations associated with his Raynaud's syndrome had increased in severity in the last five to six years in that he experiences increased attacks of Raynaud's syndrome with loss of circulation, color changes, numbness, tingling, burning, constant pain, cold sensitivity, digital ulcers, loss of skin of the joints between his fingers, and loss of strength and dexterity in his hands. Therefore, as the evidence suggests that the Veteran's symptomatology may have increased in severity since the most recent VA examinations, a remand is necessary in order to schedule him for appropriate VA examinations in order to assess the current nature and severity of such service-connected disabilities. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). Additionally, the Veteran testified that he has twice applied for disability benefits from the Social Security Administration (SSA) on the premise that his Raynaud's syndrome renders him unemployable and, at the time of his hearing, he was pursuing an appeal of his second denial. Consequently, as such records may be relevant to the instant claims, a remand is necessary in order to obtain any determination pertinent to the Veteran's claim for SSA benefits, as well as any medical records relied upon concerning that claim. Murincsak v. Derwinski, 2 Vet. App. 363 (1992) (where VA has actual notice of the existence of records held by SSA which appear relevant to a pending claim, VA has a duty to assist by requesting those records from SSA). Likewise, given the Veteran's testimony that he currently receives all medical treatment from VA providers, his updated VA treatment records dated from October 2019 to the present should be obtained for consideration in his appeal. Finally, as the separate ratings assigned for the Veteran's Raynaud's syndrome, neuropathy of the bilateral upper extremities, and cold weather injuries to the bilateral hands, to include arthritis with Raynaud's syndrome, are assigned for the manifestations of a single disability, the effective date claims are inextricably intertwined with the increased rating claims, requiring the Board to defer adjudication of the related earlier effective date claims pending the foregoing development. 12. Entitlement to service connection for an acquired psychiatric disorder, other than service-connected PTSD, to include as secondary to service-connected Raynaud's syndrome, later characterized as cold injury residuals of the bilateral hands, to include arthritis with Raynaud's syndrome, and neuropathy of the bilateral upper extremities. The Veteran is seeking service connection for an acquired psychiatric disorder, other than his service-connected PTSD, which he asserts is secondary to his service-connected Raynaud's syndrome, which was later characterized as cold injury residuals of the bilateral hands, to include arthritis with Raynaud's syndrome, and neuropathy of the bilateral upper extremities. Specifically, he asserts that he experiences anxiety, panic, and depression as a result of functional impairment related to his Raynaud's syndrome, such as when he cannot successfully complete simple tasks because of his lack of dexterity, coupled with his worry triggered by the continued progression of his symptoms. In conjunction with his claim, the Veteran was afforded a VA psychiatric examination in October 2015, during which he was diagnosed with a panic disorder. However, in a contemporaneous medical opinion, the VA examiner opined that it was less likely than not that such disorder is proximately due to or the result of his Raynaud's syndrome. In this regard, he noted that, while the Veteran alleged that his symptoms had their onset in the late 1980's around the same time he was diagnosed with Raynaud's, the record was void of any treatment for psychiatric symptoms until 2009, at which time it was noted that he had anxiety and stress as a result of marital problems. However, as such opinion does not address whether the Veteran's panic disorder is aggravated by his service-connected Raynaud's syndrome, an addendum opinion addressing such matter must be obtained. 13. Entitlement to service connection for bilateral hearing loss. In connection with his claim for service connection for bilateral hearing loss, the Veteran was afforded a VA audiological examination in June 2015; however, he was noted to have normal hearing for VA purposes at such time. 38 C.F.R. § 3.385. However, during his recent February 2021 Board hearing, the Veteran testified that his hearing acuity has decreased since such VA examination. Consequently, the Board finds that a remand is necessary in order to afford the Veteran a new VA examination so as to determine whether he currently has a bilateral hearing loss disability as defined by VA and, if so, whether such is related to his military service. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records dated from October 2019 to the present. 2. Any determination pertinent to the Veteran's claim for SSA benefits, as well as any medical records relied upon concerning that claim, should be obtained from SSA and associated with the record. 3. Schedule the Veteran for appropriate VA examinations so as to determine the nature and severity of all manifestations of his cold injury residuals of the bilateral hands, to include arthritis with Raynaud's syndrome, neuropathy of the bilateral upper extremities, and eczema of the bilateral hands. In this regard, such may require examinations evaluating artery and vein conditions, hand and finger conditions, cold injury residuals, peripheral nerves, and skin diseases. The record, to include a complete copy of this remand, must be made available for review in connection with the examinations, and all indicated tests and studies should be undertaken. The examiner should then describe the nature and severity of all manifestations of the Veteran's disabilities, to include those affecting the circulatory, orthopedic, neurologic, and dermatologic systems. He or she should also indicate whether the Veteran's disabilities more nearly approximate loss of use of the bilateral hands. A rationale for any opinion offered should be provided. 4. Obtain an addendum opinion from an appropriate clinician as to whether the Veteran's panic disorder, diagnosed during his October 2015 VA examination, is at least as likely as not (i.e., a 50 percent or greater probability) aggravated by his service-connected Raynaud's syndrome, which was later characterized as cold injury residuals of the bilateral hands, to include arthritis with Raynaud's syndrome, and neuropathy of the bilateral upper extremities. When rendering this opinion, the clinician is asked to consider the Veteran's reports of experiencing anxiety, panic, and depression as a result of functional impairments related to his Raynaud's syndrome, such as when he cannot successfully complete simple tasks because of his lack of dexterity, coupled with his worry triggered by the continued progression of his symptoms. A rationale for any opinion offered should be provided. 5. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his claimed bilateral hearing loss. The record, to include a complete copy of this remand, must be made available for review in connection with the examination, and all indicated tests and studies should be undertaken. Thereafter, the examiner should address the below inquiries: (A) Indicate whether the Veteran has left and/or right ear hearing loss as defined by VA regulations. (B) If so, is it at least as likely as not (i.e., a 50 percent or greater probability) that such diagnosed hearing loss is related to the Veteran's military service, to include his in-service noise exposure as a radar repairperson. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Northcutt, 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.