Rating Scheme For Cold Injury Residuals Secondary To Raynauds

[jlrith]

Hello all,

I am interested in opinions concerning a disability that could be rated under 2 separate codes.

I am rated 40% for Raynaud's, with my previous symptoms matching that rating spot on.
Over the last 2 years the Raynaud's has started to manifest with other problems such as nail abnormalities, hyperhidrosis, fungal infections, chilblains, loss of hair...
I submitted a claim for a rating increase based on the chilblains being a type of ulcer.
The VA came back with a C&P exam for cold injury residuals as secondary to Raynaud's.
I only recently had my C&P exam for this, so although I know what was discussed and the notes the doctor made, I do not know the content of the final report.
Depending on how the C&P report is written there is the possibility that I will fall into a gray area, namely that including Raynaud's could be rated under code 7117 as Raynaud's, or included in code 7122 as color changes. Since a 30 percent rating under 7122 requires 2 of the listed symptoms, of which color changes is one, the way this is rated could make a huge difference in the final outcome.

My question is this:
Would Raynaud's be automatically rated separately since the cold injury residuals are secondary to it, or would it be rolled into the 7122 code (analagous rating) which would result in a higher combined rating?

My ratings for this, based on my understanding:

Cold injury residuals only rating:
Hands, bilateral - 30% each
Feet, bilateral - 30% each
ears, bilateral - 20% each
Combined = 94%

Raynaud's rated separately:
Hands, bilateral - 20% each
Feet, bilateral - 20% each
ears, bilateral - 10% each
Raynaud's - 40%
Combined = 84%


For reference:

7117 Raynaud’s syndrome:
With two or more digital ulcers plus autoamputation of one or more digits and
history of characteristic attacks .................100

With two or more digital ulcers and history
of characteristic attacks .............................60

Characteristic attacks occurring at least
daily ...........................................................40

Characteristic attacks occurring four to six
times a week .............................................20

Characteristic attacks occurring one to three
times a week .............................................10

NOTE: For purposes of this section, characteristic at- tacks 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. These evaluations are
for the disease as a whole, regardless of the number of extremities in- volved or whether the nose
and ears are involved.


7122 Cold injury residuals:
With the following in affected parts:
Arthralgia or other pain, numbness, or cold sensitivity plus two or more of the following:
tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X-ray
abnormali- ties (osteoporosis, subarticular punched out lesions, or osteo-
arthritis) .......................................30

Arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail
abnormalities, color changes, locally impaired sensa- tion, hyperhidrosis, or X-ray ab- normalities
(osteoporosis, sub- articular punched out lesions, or
osteoarthritis) ...............................20

Arthralgia or other pain, numbness,
or cold sensitivity .........................10

NOTE (1): Separately evaluate amputations of fingers or toes, and complications such as squamous
cell carcinoma at the site of a cold injury scar or pe- ripheral neuropathy, under other diagnostic
codes. Separately evaluate other disabilities that have been diagnosed as the residual effects
of cold in- jury, such as Raynaud’s phenomenon, muscle at- rophy, etc., unless they are used to
support an evaluation under diagnostic code 7122.

NOTE (2): Evaluate each affected part (e.g., hand, foot, ear, nose) separately and combine
the ratings in accordance with §§ 4.25 and 4.26.

Edited April 3, 2013 by jlrith

[jlrith]

Looking through BVA decisions I found substaniation for including Raynauds as part of the cold injury residuals rating.

Citation Nr: 0520412:
"Using the Combined Rating Table and the bilateral factor, 30 
percent ratings for each hand warrant a combined rating of 60 
percent.  38 C.F.R. §§ 4.25, 4.26 (2004).  Therefore, the 
Board finds that a 60 percent rating is warranted for cold 
injury residuals under DC 7122.  Because Board has considered 
the symptoms associated with Raynaud's disease (cyanosis, 
pain, numbness) as part and parcel of cold injury residuals, 
separately rating Raynaud's disease (except to assess whether 
a higher rating could potentially be assigned under the 
relevant diagnostic code) is not warranted."

Citation Nr: 9911227:
"In the case at hand, the Board notes that the veteran is 
currently receiving the maximum schedular evaluation of 
30 percent for each hand and foot under the revised criteria 
for cold injuries.  In light of the four separate 30 percent 
evaluations under the criteria for residuals of cold injury, 
the Board notes that a higher evaluation is only available 
under the criteria for Raynaud's syndrome if the veteran 
meets the schedular criteria for a 100 percent evaluation.  
The revised criteria for Raynaud's syndrome provide that the 
evaluations are for the disease as a whole, regardless of the 
number of extremities involved.  38 C.F.R. § 4.104, 
Diagnostic Code 7117, Note (1998).  The Board notes that the 
final value for the combined degree of disability with 
respect to the four separate 30 percent evaluations is 
80 percent.  See 38 C.F.R. § 4.25 (providing a combined value 
of 76 percent) and § 4.26 (providing a bilateral factor of 
7.6 percent). "

[Berta]

WOW, you sure did some Homework on this. That is commendable!

Does this disability (or the meds you take for it) cause you to be unable to work?

Do you get SSDI benefits solely for this disability?

Did VA Voc Rehab ever turn you down for vocational rehab due solely to your SCs?

Reason I ask is I see 80% in your profile and wonder if the VA considered you for TDIU when you got the 80%,but denied it then, and whether you should apply for TDIU now.

TDIU Total Disability Due to Unemployability .......... paid at the 100% rate of comp.

[jlrith]

It wasn't much homework. The BVA does a good job of standardizing their decisions, its just a matter of finding the right terms to search for to weed out the desired results from the chaff.

I am fairly sure they will combine the ratings under 7122 as it encompasses all of my symptoms and results in the higher evaluation.

Even if they go with the separate ratings I have other rated disabilities that will put me up to 100%, assuming I am correct on the cold injuries residuals estimate I made.

Getting the combined rating will make a 100% permanent and total rating easy to justify. My Raynauds and symptoms are permanent and if the Raynauds is rated under 7122, thats a combined rating of 94%. I have enough in other permanent disabilities to get the last 1%, but maybe not enough for the 11% a 7117 / 7122 rating would require.

On the TDIU; I am gainfully employed and plan to stay so. I like my job.

That means no TDIU or SSDI, which I am fine with.