If Myers is in Tier 3 and open handed, is that always tombstone?

Got into an argument with someone about an open handed Myers in Tier 3 being Tombstone, so here it goes. If Tombstone (Judith’s Tombstone specifically) Myers is in Evil Within III and using other perks like ‘Play with Your Food’ his fist is more closed as he approaches survivors. Conversely, is there any other perk or add on that would make Myers’ hand appear open without Judith’s tombstone while in Evil Within III?

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