P&T request: Appeal or new claim?

[jlrith]

I am in the midst of a form 9 appeal, waiting on the VARO to review and certify the appeal.  If the claim is granted I will hit 100% disability.  

If Permanent and Total is not granted by the VARO or BVA, but the claim is otherwise approved, is applying for P&T a new claim or an appeal?

My disability goes back 20 years and my claim is from February 2012, so I would obviously be looking to P&T status dated to the date of claim.  

[jlrith]

I will post up the denials when I get a change to redact them.

 

On the subject of my claim as a whole, here is the outline:

Was in Marine Combat Training (MCT) December 1997 to January 1998. MCT is almost all field work.

Suffered a non-freezing cold injury (NFCI) due to rain with 30-40 degree weather on the rifle range and below freezing weather at other times.  Did not see medical as the acute symptoms of NFCI are very similar to what you would expect from a few weeks of combat training; pain, swelling, redness, loss of sensation.  

I was in warm climates until the winter of 2000-2001 when I started having issues with my hands, feet and ears being sensitive to cold.  They would go purple, white and orange for periods of time when exposed to cool or cold temperatures, about 60 degrees or below.

Was diagnosed while in service with Raynauds.

Left the military.

Was service connected with Raynaud's back to my end of service.  All the exams I had continued the Raynaud's diagnosis since my symptoms were very similar to Raynaud's but also because I thought I had Raynaud's and described it as such.  

2012 - Started having additional symptoms, including Chilblains.  Submitted increase claim based on the 60% level for Raynaud's: 2 or more digital ulcers (Chilblains are a type of ulcer)

Had a C&P exam with Raynaud's and Cold Injury DBQs.  One of the questions was whether the symptoms began after an incident.  I answered no, believing I just had Raynaud's.

Claim was denied based on C&P exam; doctor stated the Chilblains was secondary to Raynaud's.

I got curious and looked into cold injuries;  found out my symptoms were consistent with a cold injury, not Raynaud's.  Made the connection with my experience in MCT.

Contacted and received an Independent Medical Opinion from Dr. Oakley, head of the UK Ministry of Defense's Thermal Medicine Division.  He is the world expert in cold injuries, including having treated many Korean War veterans and all of the British Falkland Island's Veterans.  He also wrote the VA manual on non-freezing cold injuries.  

Submitted a buddy statement from a friend concerning us having talked about MCT bak in the day, and the symptoms I had (wear and tear.)  

Submitted weather data, certified by the National Climatic Data Center showing cold, freezing cold and rain during my time in MCT.  

Denied by DRO based on the original DR stating I had had Raynaud's for 5 years, which would have been prior to service (violation of Presumption of Soundness 38 CFR 3.304 b) and the C&P exam DR stating it was Raynaud's.  Also denied on the basis that I wasn't seen by medical and it wasn't wartime, so I don't get the cold-injury wartime shortcut (you can establish service connection for a cold injury without medical treatment for the original injury or witness statements if you were in a cold climate during wartime.  Think Chosin reservoir.)

Rebutted each of the denial items with evidence; Presumption of Soundness argument, statements from my parents about me not having cold issues prior to service, Rheumatologist statement agreeing with Dr Oakley's report on my cold injury.  Additional Dr's IMO on my cold injury.  Statement from original C&P doctor about how my Raynaud's could have been caused by a cold injury, but that it was 'outside of the scope of his exam', buddy statement from a friend who attended MCT the class after me about the conditions at MCT,  and finally, in 2016, a C&P exam for Raynaud's where the doctor diagnosed me with cold injury sequelae.

The only evidence I am missing, and doesn't exist, would be medical records of the original cold injury or a witness statement documenting my original cold injury.  

Now waiting on VARO review of the above evidence.  

 

 

Symptoms:

Cold sensitivity in my hands, feet and ears;  they react to cold at 60 degrees as other people's would at -20.  Hands feet and ears turn dark purple-blue, white and orange.  On warming they go bright red.  

Contrast to Raynaud's where it's almost universally just the digits.  The digits completely blanch and have a very clear demarcation line.  

Pain on cold exposure to the point where I can't carry an item from the garage refrigerator to the kitchen with my right had.  It causes searing pain all the way to my shoulder.

Chilblains (little ulcers) following cold exposure.  I have hundreds over the course of a winter.  Some turn to open wounds and cause pitting and scaring. 

Hyperhidrosis.

Nail ridging.

Nail clubbing.

Loss of sensation, especially heat. 

Skin on the tips of my fingers breaks down. 

 

 

 

Raynaud's can be caused by a cold injury, auto-immune diseases or can be a primary affliction.