Citation Nr: 22015484 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 18-14 040 DATE: March 17, 2022 ORDER Service connection for residuals of frostbite of the hands and feet is denied. FINDINGS OF FACT 1. The Veteran served on active duty from January 1951 to January 1954, with periods of duty with the Army National Guard of New York; he has been 100 percent disabled based on unemployability since August 2016. 2. Cold injury residuals were not shown in service and current complaints related to cold injury residuals are not causally or etiologically related to service. CONCLUSION OF LAW Residuals of frostbite of the hands and feet were not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION In May 2019, the Board denied the appeal. The Veteran appealed to the Veterans Claims Court. In February 2021, the Court vacated the Board's decision. The Board then remanded the issue in July 2021 for additional development. There has been substantial compliance with the remand directives, and there is no bar to proceeding with the appeal. Stegall v. West, 11 Vet. App. 268, 271. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Turning to the evidence, a January 2017 VA examiner diagnosed a cold weather injury to the hands and feet based only on the history reported by the Veteran but found no residuals upon examination with the exception of some discoloration and numbness. Available clinical records likewise show the Veteran reporting cold injury residuals, but there was no evidence of treatment or diagnosis. Therefore, while the Veteran asserts that he experienced a cold injury in the 1950s, the medical evidence does not show any current residuals. Nonetheless, as the January 2017 VA examiner noted numbness and discoloration, symptoms have been shown. Next, with respect to an in-service incurrence, the service treatment records (STRs) do not show complaints of, or treatment for, a cold injury or any symptoms reasonably attributable to a cold injury (such as numbness and discoloration described above). Further, the January 1954 separation examination reflects that his upper and lower extremities, vascular system, and skin were all clinically normal. Additionally, the Veteran underwent multiple examinations during his Reserve service in the National Guard without any indication of cold injury residuals or symptoms of numbness or discoloration. Specifically, in April 1979, May 1981, March 1986, September 1987, and October 1991 examinations, the upper and lower extremities and skin were repeatedly noted to be clinically normal. While the Veteran contends that his records were destroyed in a fire (presumably the fire at the National Personnel Records Center in 1973), the fact that he had a clinical evaluation which was normal upon discharge, as well as numerous Reserve examinations thereafter which revealed no residuals, weighs against the finding of an in-service incurrence. The Board acknowledges the Veteran's statements of extreme cold in service, as well as a photograph which revealed that he was wearing gloves in service; however, these statements must be weighed with the remaining evidence of record. In this regard, while he is credible and competent to attest to the cold conditions during service, these statements must be weighed against the multiple examinations during and after service which revealed normal skin and extremities. These findings weigh against the finding of an in-service incurrence. To the extent that the Veteran asserts a medical connection between his current complaints and service, a January 2017 VA examiner, after examining the Veteran and reviewing the available records, opined it was less likely than not that cold injury residuals were incurred in, or caused by, service. The examiner noted that the Veteran reported experiencing a cold injury in 1951/1952 while stationed in Japan and participating in mountain training. He noted that it began to rain on an ascent up the mountain which later turned to snow. He noted that he was wearing new boots and believed he sustained frostbite. He also stated that his fingers got so cold, but that he did not seek care due to the military culture. He reported that since that time, for the past 65 years, every time it hit 40 degrees or less, his fingers and toes got cold and started burning. He noted that he had to wear gloves if the temperature dropped below 40 degrees and socks to bed. The examiner noted that the Veteran had cold sensitivity and color changes with numbness on both hands. His fingers were warm, dry, and pink, with radial and ulnar pulses at 2+ with brisk capillary refill. His feet were also displaying color changes, cold sensitivity and numbness, and his toes were cold, dry, and pink with posterior tibial and dorsalis pedal pulses at 1+, with brisk capillary refill. The examiner opined that after a careful review of the records, interview, and examination of the Veteran, as well as a search of the literature for current understanding of the condition under investigation, it was less likely than not that any residuals of a cold injury were due to service. The examiner noted that the Veteran dated the condition to Japan, and that medical records did not suggest a cold injury residual during combat. The examiner reasoned that frostbite, if treated early, is reversible by simple warning. The examiner noted that recovery was most often complete if not complicated by infection or gangrene. Early return of sensation and healthy skin color were signs of a favorable outcome. The examiner noted that peristent blue discoloration, noted as cyanosis, or blood blisters were signs of necrosis and less favorable of an outcome. Long-term effects were noted to be altered sensation of the affected area, damage to sweat glands, cracking skin, and loss of nails, abnormal color changes of area, cold sensitivity, joint stiffness, tremor, and osteoporosis. A reasonable reading of this opinion is that the Veteran's symptoms were not related to service. The Board finds that the examination was adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion, including conducting medical research. Further, there is no contradicting medical evidence of record. Therefore, the Board finds the VA examiner's opinion to be of great probative value. Additionally, the clinician evidence, consisting of newly obtained VA clinical records failed to show any treatment for residuals of cold injury. Therefore, the medical evidence does not support the appeal. The Board has also considered the newly-submitted evidence, to include the Veteran's statements describing his cold injury during service, the picture submitted of him wearing gloves in uniform, and the treatment records which were the subject of the Court and Board remands. His statements support cold exposure during service but that is not the end of the inquiry. Importantly, the medical evidence, including the newly-obtained VA treatment records, did not show treatment for any cold residual injuries. Specifically, no examining or treating provider has indicated that there is a nexus between any cold injury residual and active duty service. The Board has considered the Veteran's lay statements that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, 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.