Raynaud's / Cold Injury Claim. Need Help

[jlrith]

Good day all,

I am service connected for Raynaud's with no established etiology.
I have symptoms beyond those listed in the Raynaud's rating criteria.
I put in for increased compensation based on my private doctor's exam. The VA then conducted their own exam based on the Cold Injury Residuals DBQ.

Just received the decision and it came back with service connection for Chilblain's syndrome but no change in rating, stating that the evaluation criteria for Chilblains is so close to that of Raynaud's that it would be pyramiding to assign a separate rating. True enough. But it is quite obvious that my symptoms match the cold injury residuals much, much better than the Raynaud's criteria.

The catch is:
NOTE 2 of the cold injury residuals: "Separately evaluate other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud’s phenomenon, muscle atrophy, etc., unless they are used to support an evaluation under diagnostic code 7122"
and from the federal registry entry on the cold injury residuals change: "Simply because a condition could be the result of cold injury does not mean that it is the result of cold injury in a given claim. All of the conditions mentioned have other possible etiologies, and it will require a medical determination in each case to establish whether a condition claimed as a residual of a cold injury is the residual of a cold injury."

Does anyone know if it is possible to obtain a hyphenated or analogous rating for a disability that is not a cold injury but manifests as one?
Anyone have any advice as to how I should proceed with my appeal?


VA exam results:
Left hand: Cold sensitivity, color changes, hyperhidrosis.
Right hand: Cold sensitivity, color changes, hyperhidrosis.
Left foot: Cold sensitivity, color changes, hyperhidrosis.
Right foot: Cold sensitivity, color changes, hyperhidrosis.
Left ear: Cold sensitivity, color changes
Right ear: Cold sensitivity, color changes

Conclusion:
Chilblains is secondary to Raynaud's.
Color changes, cold sensitivity and hyperhidrosis are secondary to Raynaud's.

Basically I have cold injury symptoms due to damage caused by Raynaud's, but I did not sustain a cold injury while in the service.


Reference material:
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 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. These evaluations are for the disease as a whole, regardless of the number of extremities involved 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 abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) 30

Arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular 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 peripheral neuropathy, under other diagnostic codes. Separately evaluate other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud’s phenomenon, muscle atrophy, 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.

[jlrith]

Thank you for your assistance Berta. 

 

The VA ended up classifying my disability as "Raynaud's Syndrome with Chilblain's Syndrome" and based on "the evaluation criteria for chilblains being the so similar to the criteria for Raynaud's that a separate rating would be pyramiding" they rated the whole thing under the Raynaud's rating. 

The problem with that is that there is no specific chilblains evaluation criteria.  But, since chilblains are a type of cold injury with absolutley no other cause, the only rating that could be applied is the cold injury criteria. 

 

My rheumatologist who treats my Raynaud's was nice and reviewed my medical history, but came to the conclusion that although my symptoms could be caused by a cold injury, he was not competent to determine that as he lacks experience in cold injuries.  He wrote a letter to the VA stating that and that the VA should provide a cold injury expert to review my situation.  He also mentions the possibility of a cold injury causing my problems in all of his office visit notes. 

 

I have not yet found a cold injury expert who can help me.  Everyone so far is dead or retired; lots of cold injury work because of the Korean war, but not much since. 

 

I am employed, so I have no basis or desire to persue TDIU. 

 

One correction to my previous post:"Basically I have cold injury symptoms due to damage caused by Raynaud's, but I did not sustain a cold injury while in the service."

That line is wrong.  I had a period of training where I was went, cold and under clothed for about 3 days.  I'm pretty sure this caused a cold injury, but since I was not treated I can't prove it.