Citation Nr: 21032734 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 13-01 543 DATE: May 27, 2021 REMANDED Entitlement to service connection for a breathing disorder is remanded. Entitlement to service connection for a right-hand disability is remanded. Entitlement to service connection for a left-hand disability is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1970 to January 1992. In June 2019, he testified at a hearing before the undersigned Veterans Law Judge (VLJ). With respect to the Board hearing, the undersigned VLJ clarified the issues on appeal, identified potential evidentiary deficits, and clarified the type of evidence that would support the Veteran's claim. These actions complied with any duties owed during a hearing. 38 C.F.R. § 3.103. REASONS FOR REMAND 1. & 2. Left- and right-hand disorders The Veteran, at his Board hearing, reported that he had been found to have Reynaud's phenomenon (also known as Raynaud's disease) of the hands. The Veteran reported this was due to exposure to cold weather in service, which caused pain. He described the symptoms (coldness and tingling) started when he was stationed in Alaska, and indicated an unnamed medical provider endorsed this as a cause of the condition. A report of left-hand pain in service in 1980 prompted an X-ray which was negative for fracture or arthritis. An X-ray dated in May 2011 found no significant periarticular bone proliferative changes and/or erosions. Joint spaces appeared intact. Of incidental note is evidence of a 2-mm in diameter opaque density observed at the level of the distal diaphysis proximal phalanx fourth digit left hand. Findings were nonspecific. VA treatment records show the Veteran was diagnosed with Raynaud's syndrome in July of 2019. However, there are no reports of symptoms in the treatment records. For example, an August 2019 VA treatment record notes hand strength as 5/5. A VA examination dated in February 2021 noted the Veteran had flare-ups during the winter months of taking a long time (30 minutes) to warm hands and having some coldness and stiffness prior to warming. He cannot put nuts on bolts until his hands are warm. The Veteran's description of his functional impairment was that he could not put chains on a truck for driving. On testing, range of motion was not limited for any fingers of either hand. There was no evidence of pain or any other abnormality of either hand or any other factors causing functional loss. Muscle strength was normal with no other pertinent physical findings, complications, signs, symptoms, or scars. The remarks section notes no evidence to support a hand disorder; therefore, no diagnosis was warranted at this time. It is not clear that testing specific for Raynaud's was conducted. 3. Breathing disorder At his Board hearing, the Veteran contended his breathing difficulties are due to service, to include asbestos exposure, and he reported that he had chest pains since 1987, which he associated with his COPD. There is a report of medical examination with signature date of September 1990 or 1991the date is only partially readable. The report notes the Veteran had a history of chest pains with an overnight admission, MI (myocardial infarction) was ruled-out (R/O). A retirement report of medical history dated in October 1991 also notes chest pains and a prior hospitalization. Atypical chest pains were listed on his post-service treatment records from an U.S. Army hospital for the first time in July 2007, with the history of present illness stating intermittent chest pains (CP) for 20 years. The Veteran did not want further evaluation. These records also list intermittent substernal chest pain. See March 2008 Army treatment record. A December 2010 VA treatment note first reported shortness of breath (SOB). After this there were several attempts to determine the cause of the Veteran's chest pains without any success, including cardiac catherization, cardiac stress test, and chest X-rays. In September 2018, the Veteran told his VA primary care provider that he had a cough for years, had chronic chest pains for many years, and had been seen for shortness of breath. This note reports that the Veteran had chronic chest pain for many years, had an exhaustive workup, including cardiac, several times, and no etiology had been found. The note reports that the Veteran could have COPD. COPD was assessed in November 2018. The Board remanded for an examination on the matter and noted the in-service treatment records dated in 1990 or 1991. A VA examination dated in March 2021 states that the Veteran had a medical history of chest pains with onset in 1987 and a current diagnosis of COPD with dyspnea and chest pain. The VA opinion only notes a single isolated complaint of breathing disorder in 1981 (the document referenced here is dated in 1982 and reports cough and tightness in the chest) and there was no follow-up to indicate a chronic condition. However, this statement is not precisely correct, as a report of medical examination dated in 1990 or 1991 noted a history of chest pains with a hospital admission. This was specifically noted in the prior remand instructions. As a result, a remand is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of any breathing disorder (recently found as COPD with chest pain and dyspnea). The examiner is asked to provide an opinion regarding whether a breathing disorder is at least as likely as not (50 percent or greater likelihood) due to service. Rationale for all opinions offered should be provided. If the examiner finds that the Veteran's symptoms of chest pain are associated with a breathing disorder, he or she should address the chest pains documented in service medical records (see above). Chest pains of uncertain etiology are documented in the service medical records in 1982 and twice in the 1990s (medical examination in 1990 or 1991 and the separation report of medical history). 2. Schedule an examination of the hands. Testing specific for Raynaud's should be conducted unless contraindicated. If present, the examiner should determine whether the disorder is related to in-service complaints. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Yoffe, 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.