Citation Nr: 22039331 Decision Date: 07/08/22 Archive Date: 07/08/22 DOCKET NO. 14-22 650 DATE: July 8, 2022 REMANDED Entitlement to service connection for Raynaud's syndrome, including as secondary to a service-connected chronic adjustment disorder, is remanded. Entitlement to a finding of total disability based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1981 to August 1985. He also had an additional period of service that is not honorable for VA purposes from August 1985 to January 1988. This matter comes before the Board of Veterans' Appeals (Board) from a September 2013 rating decision by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). This matter was previously remanded in an August 2019 Board decision. The Veteran contends that his Raynaud's disease is secondary to his service-connected adjustment disorder. In August 2019, the Board remanded this matter in order to obtain medical opinions to determine the etiology of the Veteran's Raynaud's disability. Specifically, the August 2019 remand directed the AOJ to obtain opinions to determine if the Veteran's Reynaud's syndrome had its onset in service or was otherwise caused or aggravated by service or a service-connected disability, to include adjustment disorder. The Board additionally remanded claims of service connection for keloid scars of the scalp and a related skin condition; these were granted by the AOJ in an April 2020 decision review officer decision. There remains no further question or controversy for consideration by the Board with regard to those matters. In January 2020, the Veteran underwent a VA examination. The examiner provided opinions related to direct service connection, and secondary service connection. However, the Board finds the VA examiner's opinion regarding whether the Veteran's service-connected adjustment disorder aggravated his Raynaud's disease is not adequate. The examiner opined that the Veteran's Raynaud's syndrome is less likely than not aggravated by the service-connected disability or medications taken for that disability. The cited rationale, however, simply repeats that offered for secondary service connection. He stated there was no diagnosis of record known to cause Raynaud's, such as atherosclerosis or Buerger's syndrome. Causation and aggravation are two separate theories of entitlement; while the Veteran's disabilities may not cause the Veteran's Raynaud's disease it does not mean such a disorder was not aggravated by the Veteran's service-connected disabilities. The examiner failed to opine to this issue. Moreover, the examiner did not discuss the Veteran's September 2014 submission of medical authorities supporting his allegation that psychiatric problems can trigger or aggravate Raynaud's. Therefore, the Board finds a remand is required for an addendum medical opinion to determine whether the Veteran's service-connected adjustment disorder aggravated his Raynaud's disease. Finally, the issue of entitlement to a TDIU is also remanded as inextricably intertwined with the remanded claim. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain an addendum opinion addressing the Veteran's claim for service connection for Raynaud's syndrome. The examiner must opine whether it is at least as likely as not that the Veteran's Raynaud's syndrome is aggravated by a service-connected disability, specifically, the Veteran's adjustment disorder. A complete medical rationale must be provided, and must discuss the 10/20/2011 Mayo Clinic statement and the Dr. Fredrick Wigley (Rheumatologist, Johns Hopkins Medical Center) excerpt cited by the Veteran in his September 2014 submission. 2. Then, readjudicate the claim. If the benefits sought remain denied, issue a supplemental statement of the case and return the matter to the Board if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert Batten 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.