Citation Nr: 22014100 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 17-28 781A DATE: March 11, 2022 ORDER Entitlement to an initial rating of 40 percent, but not higher, for Reynaud's syndrome is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a rating in excess of 40 percent for Reynaud's syndrome is denied. FINDINGS OF FACT 1. Throughout the course of the appeal, the Veteran's disability exhibited characteristic attacks occurring at least daily. 2. The Veteran's disability does not exhibit digital ulcers or autoamputation. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating of 40 percent, but not higher, for Reynaud's syndrome have been met. 38 U.S.C. §§ 1110, 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7117. 2. The criteria for entitlement to a rating in excess of 40 percent for Reynaud's syndrome have not been met. 38 U.S.C. §§ 1110, 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7117. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 2009 to April 2014. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014rating decision by the Department of Veterans Affairs (VA). In July 2021, the Veteran testified at a Board hearing. The transcript of that hearing has been associated with the Veteran's claims file. In November 2021, the case came before the Board. The Board remanded the Veteran's claim for an additional VA examination in order to properly evaluate the severity of the Veteran's disability. In January 2022, the RO issued a rating decision that increased the Veteran's rating to 40 percent disabling effective from December 22, 2021. 1. Entitlement to an initial rating of 40 percent, but not higher, for Reynaud's syndrome 2. Entitlement to a rating in excess of 40 percent for Reynaud's syndrome The Veteran contends that his disability warrants an increased rating throughout the course of the appeal. A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In considering the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the most persuasive evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board notes that the Veteran is challenging his initial rating. The Veteran was awarded a noncompensable rating effective from April 22, 2014, which was the day after his discharge from active duty. The Veteran's disability was rated according to Diagnostic Code 7117. Diagnostic Code 7117 provides that a 10 percent rating is warranted when there are characteristic attacks occurring one to three times per week; a 20 percent rating is warranted when characteristic attacks occur four to six times per week; a 40 percent rating is warranted when characteristic attacks occur daily; a 60 percent rating is warranted when there are two or more digital ulcers and a history of characteristic attacks; and a 100 percent rating is warranted when there are two or more digital ulcers plus autoamputation of one or more digits and a history of characteristic attacks. Characteristic attacks consist of sequential color changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. The ratings are for the disease as a whole, regardless of the number of extremities involved or whether the nose or ears are involved. See Note following Code 7117. 38 C.F.R. § 4.104. The Board has considered if other Diagnostic Codes are available to evaluate the Veteran's disability; however, Diagnostic Code 7117 deals directly with the disability at hand and the medical evidence of record does not support consideration of any other codes. As to a current diagnosis, the Board notes that the Veteran's disability has been diagnosed as Reynaud's syndrome. As to the Veteran's lay statements, the Board notes that in November 2015, the Veteran reported to VA that he experiences daily attacks. The Veteran also reported that he experienced pain, numbness, tingling, and diminished senses. The Board further notes that the Veteran testified that he experiences numbness and pain on a daily basis. Turning to the medical evidence at hand, the Board notes that the Veteran attended a VA examination in May 2014. The Veteran reported that his symptoms were well-controlled. Upon examination, the examiner indicated that the Veteran exhibited characteristic attacks less than once a week. The examiner also indicated that the Veteran did not have digital ulcers or auto amputation of his digits. In December 2021, the Veteran attended a VA examination. Upon examination, the examiner indicated that the Veteran exhibits characteristic attacks at least daily with trophic changes. The Veteran does not have digital ulcers or auto-amputation of his digits. The examiner also indicated that the Veteran had no other issues related to this disability. The Board has also reviewed the Veteran's medical treatment records. The Board notes that the Veteran has reported pain and numbness in his hands and feet. In sum, the Board finds that the Veteran's disability has remained consistent and that an increased initial rating is warranted. The Board acknowledges that the Veteran's reports and the medical evidence of record demonstrate that the Veteran's disability exhibits characteristic attacks that occur on a daily basis. Accordingly, the Board finds that the Veteran's disability is best characterized by a 40 percent rating. The Board has considered a rating in excess of 40 percent; however, the evidence of record does not show that the Veteran's disability exhibits digital ulcers or autoamputation of one or more digits. Based on the foregoing and resolving all reasonable doubt in the Veteran's favor, the Board finds that an initial rating of 40 percent, but not higher, is warranted for the Veteran's Reynaud's syndrome. The Board additionally finds that the Veteran's disability has remained consistent effective from December 22, 2021, and that an increased rating is not warranted. Specifically, the Board notes that the record does not show evidence that the Veteran's disability exhibits digital ulcers or autoamputation of one or more digits. Thus, for the above stated reasons, the most persuasive evidence is against the claim, the benefit of the doubt doctrine does not apply, and the claim for entitlement to a rating in excess of 40 percent for the Veteran's Reynaud's syndrome, effective from December 22, 2021, must also be denied. Extra Considerations Lastly, the Board has considered the Court's holding in Rice v. Shinseki, 22 Vet. App. 447 (2009). However, the Board finds that Rice is not applicable to the current appeal because the Veteran does not claim, and the record does not show that his disabilities prevent the Veteran from securing or following a substantially gainful occupation at this time. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Rescan, 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.