Citation Nr: 20034098 Decision Date: 05/15/20 Archive Date: 05/15/20 DOCKET NO. 11-26 247 DATE: May 15, 2020 ORDER Entitlement to an initial disability rating in excess of 10 percent for service-connected varicose veins, left lower extremity, is denied. Entitlement to an initial disability rating in excess of 10 percent for service-connected varicose veins, right lower extremity, is denied. FINDINGS OF FACT 1. During the period on appeal, the Veteran’s varicose veins of the left lower extremity have more nearly approximated aching and fatigue in the leg after prolonged standing or walking with symptoms relieved by compression of the extremity. 2. During the period on appeal, the Veteran’s varicose veins of the right lower extremity have more nearly approximated aching and fatigue in the leg after prolonged standing or walking with symptoms relieved by compression of the extremity. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for the Veteran’s left lower extremity varicose veins disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code (DC) 7120. 2. The criteria for a rating in excess of 10 percent for the Veteran’s right lower extremity varicose veins disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code (DC) 7120. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1977 to July 1983 and from May 1986 to May 2003. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in November 2018, it was remanded for additional development. Specifically, the RO was instructed to obtain an addendum from the October 2016 VA examiner in order to define what a “night clump” was, or if that examiner was unavailable, an opinion from another qualified examiner. The Veteran was provided with a December 2019 Vein and Artery Conditions examination where the examiner defined what a “night clump” was, in addition to an in-person examination. As such, the Board finds that the AOJ substantially complied with the directives in the November 2018 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of the two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise the lower rating will be assigned. See 38 C.F.R. § 4.7. In both initial rating claims and normal increased rating claims, the Board must discuss whether “staged ratings” are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must weigh against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. At 54). Bilateral Varicose Veins—Legal Criteria The Veteran contends that his service-connected varicose veins of his bilateral lower extremities warrant a higher disability rating than the 10 percent evaluations currently assigned. Varicose veins are rated under DC 7120. In pertinent part, a 10 percent disability rating is warranted for intermittent edema of the extremity or aching and fatigue in the leg after prolonged standing or walking with symptoms relieved by elevation of the extremity or compression hosiery. A 20 percent disability rating is warranted for persistent edema, incompletely relieved by elevation of the extremity with or without beginning stasis pigmentation or eczema. A 40 percent disability rating is warranted for varicose veins with persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. Varicose veins with persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration warrant a 60 percent disability rating. Finally, a maximum schedular disability rating of 100 percent is warranted for varicose veins with massive board-like edema with constant pain at rest. 38 C.F.R. § 4.104, DC 7120. Analysis The Board initially notes the Veteran’s outpatient treatment records show consistent treatment for varicose veins of his bilateral lower extremities throughout the period on appeal. The Veteran’s treatment notes show no ulcerations, edemas, stasis pigmentation, eczema, or subcutaneous induration. The Veteran was provided with an October 2016 VA artery and vein conditions examination. The examiner confirmed the Veteran’s diagnosis of bilateral varicose veins and indicated that the Veteran experienced aching/fatigue in his legs after prolonged standing and walking. Additionally, the examiner noted beginning stasis pigmentation, pain at rest, and reported a symptom of a “night clump.” No edemas, ulcers, or other symptoms were noted on the examination. The Board, in a November 2018 decision, found this examination required clarification, as the examiner did not define what a night clump was, and remanded the issue for an addendum opinion, or if needed a new examination. As part of the Board’s remand, the Veteran was provided a December 2019 VA artery and vein conditions examination. The examiner confirmed the Veteran’s diagnosis of varicose veins in his bilateral lower extremities. The examiner indicated that the Veteran’s condition was stable and that a “night clump” is a prominent of veins which are tender on palpitation and rest. The examiner indicated that the Veteran experienced aching in his legs after prolonged walking and standing. However, the examiner noted that the Veteran’s symptoms were relieved by compression hosiery. No edemas, ulcers, or other symptoms were noted on the examination. The Board finds that the Veteran’s bilateral lower extremity varicose veins disabilities warrant a 10 percent rating for each leg under DC 7120. The totality of the evidence demonstrates that the Veteran has experienced aching/fatigue in his legs after prolonged standing/walking which is relieved compression hosiery. Accordingly, the Veteran’s bilateral lower extremity varicose vein symptomatology more nearly approximate that contemplated by a 10 percent disability rating. The Board has carefully reviewed the Veteran’s outpatient treatment notes as well as the abovementioned VA examinations. At no time during the pendency of this appeal has the Veteran’s lower extremity varicose veins caused a persistent edema, stasis pigmentation, or ulceration; required for a higher rating. (Continued on the next page) For these reasons, the Board finds that a rating in excess of 10 percent for the Veteran’s lower extremity varicose veins disabilities is not warranted at any time during the appeal period. Therefore, the Board concludes that a preponderance of the evidence is against a rating in excess of 10 percent for the Veteran’s varicose veins disabilities. The claim is, therefore, denied. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Gresham 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.