Citation Nr: 20003575 Decision Date: 01/16/20 Archive Date: 01/15/20 DOCKET NO. 11-19 122 DATE: January 16, 2020 ORDER Entitlement to service connection for varicose veins on the lower extremities is denied. FINDINGS OF FACT 1. The evidence does not indicate that the Veteran incurred varicose veins during service. 2. The evidence does not indicate that service-connected disability caused or aggravated the Veteran’s varicose veins. CONCLUSION OF LAW The criteria for service connection for varicose veins have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Air Force from June 1965 until April 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U. S. Department of Veterans Affairs (VA) Regional Office (RO). In February 2017 and May 2018, the Board remanded this matter for additional development. The case is again before the Board for appellate review. In the May 2018 remand, the Board requested that a VA compensation examination be conducted into the claim on appeal. The record indicates that the RO notified the Veteran of the requested examination and its scheduled date, but that the Veteran did not appear for the examination. The Veteran has not provided good cause for his failure to report to the examination. As such, the claim will be decided based on the evidence of record. See 38 C.F.R. § 3.655. Service Connection The Veteran claims that he incurred varicose veins on his legs during service, and that he developed them as the result of service-connected disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during active service – the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The evidence in this matter consists of lay statements from the Veteran, service treatment records (STRs), and private and VA treatment records. This evidence establishes that the Veteran has varicose veins in his legs. This is demonstrated in an April 2015 VA examination report addressing service-connected diabetes mellitus type 2 (diabetes) and in VA treatment records dated in 2015 and 2016. The record indicates, however, that the Veteran did not incur varicose veins during service or develop them as the result of service-connected disability. The STRs are negative for varicose veins. The March 1969 discharge report of medical examination indicates a normal vascular system and normal lower extremities. An April 1969 Medical Board report addressing chronic otitis media is negative for vascular problems. A January 1969 discharge report of medical history notes complaints of leg cramps but is otherwise negative for lower extremity problems and is negative for complaints related to vascular problems. There is no evidence indicating a vascular problem in the years following service, moreover. In fact, the earliest evidence of record of varicose veins in the lower extremities is dated in the 2010s, over 40 years after service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of years between discharge from active service and the medical documentation of a claimed disability may be considered in evaluating a claim of service connection). In short, the objective record does not document the existence of a chronic vascular disorder in the legs during service or for many years following service. Rather, the preponderance of the evidence indicates that, for approximately 40 years following service, the Veteran did not have characteristic manifestations sufficient to identify a chronic disease entity. See 38 C.F.R. § 3.303. Moreover, the record lacks medical evidence drawing a nexus between service and current disorder, or between current disorder and service-connected disability. As indicated earlier, the Board attempted to obtain a VA compensation examination into these issues but the Veteran did not appear for the examination. As such, the current record as it stands contains no medical evidence supporting either theory of causation. See 38 C.F.R. §§ 3.303, 3.310. In assessing this claim, the Board has considered the Veteran’s lay assertions. He is competent to report observable symptoms such as discoloration of the skin on his legs or protruding veins. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Veteran is not competent to determine issues such as diagnosis and etiology. The development of a chronic vascular disorder is an internal pathology beyond a layperson’s capacity to observe, sense, or feel. Its development is a complex medical question. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). On this complex question, the lay evidence is of no probative value. As the preponderance of the evidence is against the claim to service connection, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. JEREMY J. OLSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher McEntee 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.