Citation Nr: 20042398 Decision Date: 06/23/20 Archive Date: 06/23/20 DOCKET NO. 14-38 022 DATE: June 23, 2020 ORDER Entitlement to an effective date earlier than June 30, 2011, for the award of service connection for peripheral artery disease of the right leg is denied. Entitlement to an effective date earlier than June 30, 2011, for the award of service connection for peripheral artery disease of the left leg is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran’s favor, his claim received by VA on June 17, 2009, encompassed a claim of entitlement to service connection for peripheral artery disease of the right and left legs. 2. The medical evidence first reflected a diagnosis of peripheral artery disease of the right leg on August 24, 2011. 3. The medical evidence first reflected a diagnosis of peripheral artery disease of the left leg on August 24, 2011. CONCLUSIONS OF LAW 1. The criteria for entitlement to an earlier effective date prior to June 30, 2011, for the award of service connection for peripheral artery disease of the right leg have not been met. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.102, 3.400. 2. The criteria for entitlement to an earlier effective date prior to June 30, 2011, for the award of service connection for peripheral artery disease of the left leg have not been met. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.102, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from April 1969 to January 1972. In June 2018, the Board issued a decision which, in pertinent part, denied entitlement to an effective date earlier than June 30, 2011, for the award of service-connection for peripheral artery disease of the bilateral lower extremities. The Veteran appealed the Board’s decision to the Court of Appeals for Veterans Claims (Court). In a November 2018 memorandum decision, the Court set aside that portion of the Board’s decision and remanded the case to the Board for further action. 1. Entitlement to an effective date earlier than June 30, 2011, for the award of service connection for peripheral artery disease of the right leg is denied. 2. Entitlement to an effective date earlier than June 30, 2011, for the award of service connection for peripheral artery disease of the left leg is denied. The Veteran maintains that an effective date earlier than June 30, 2011, is warranted for the awards of service connection for peripheral artery disease of the bilateral lower extremities. In general, the effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). The term “date entitlement arose” is not expressly defined. However, it has been interpreted as the date when the claimant met the requirements for the benefit sought. This is determined on a “facts found” basis. See 38 U.S.C. § 5110(a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). These “facts found” may include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See 38 C.F.R. § 3.400. After thorough consideration of the evidence of record, the Board concludes that an effective date of earlier than June 30, 2011 is not warranted for the awards of service connection for the Veteran’s peripheral artery disease of the bilateral lower extremities. A review of the record shows that a correspondence was received on June 17, 2009, in which the Veteran asserted worsening of his service-connected peripheral neuropathy of the bilateral lower extremities and complications of his service-connected diabetes, including his eyes, rectum, muscles, and arthritis in the shoulders, legs, and knees. As peripheral artery disease is a complication of diabetes and is characterized by pain, which is also a symptom of peripheral arthritis and neuropathy, the Board finds that the Veteran’s claim could have reasonably encompassed peripheral artery disease. See Clemons v. Shinseki, 23 Vet. App. 1, 3 (2009) (because a claimant generally is not competent to provide a medical diagnosis, a claim for benefits includes other conditions characterized by the same observable symptoms). The Board further notes that VA sent a letter to the Veteran following receipt of the correspondence indicating that development for a “bilateral leg condition secondary to diabetes mellitus, type II” would be undertaken. As peripheral neuropathy had already been service-connected and the claimed worsening of that condition was listed separately in the letter, logic dictates that the other diabetes-related leg condition identified was peripheral artery disease. Thus, the Veteran was given the impression that these other claimed disabilities of the legs were being processed by VA. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the correspondence received on June 17, 2009, included claims of entitlement to service connection for peripheral artery disease of the right and left legs. The Board now turns to the question of when entitlement to service connection for peripheral artery disease of the right and left legs arose. The Veteran avers that this condition existed as early as 2007. However, the Board finds that the competent, credible medical evidence of record does not support this assertion. None of the VA or private medical treatment records from 2007 or earlier indicate complaint, treatment, or diagnosis for peripheral artery disease. At the Veteran’s September 2003 VA examination, he described the complications associated with his service-connected diabetes mellitus. He indicated that he had diabetes ketoacidosis and had been hospitalized on average once a year. He denied problems with hypoglycemia. He reported visiting the doctor an average of six times per year for his diabetes. At that time, he had no restriction of activity, progressive weight loss, tingling, numbness, abnormal sensation, or bladder or bowel dysfunction. He endorsed some related issues with his vision. He denied problems with his skin, heart, arteries, or kidneys. Similarly, VA and private treatment records from 2007 through 2009 do not contain complaint, treatment, or diagnosis of peripheral artery disease. At the Veteran’s November 2009 VA examination, he reported having been diagnosed with a bilateral leg condition that had existed since 2007. He stated that it was not due to injury or trauma. He endorsed experiencing pain in the bilateral legs that occurred constantly and traveled to his feet. The Veteran explained that the pain was exacerbated by physical activity and stress and was relieved by rest. He stated that the bone condition was not currently infected; the last time it was actively infected was in 2007. He reported that he was never hospitalized, nor did he have surgery for the condition. He denied any current treatment for the condition. During a physical examination of the Veteran, the examiner noted that were no findings of complications related to several body systems, including the heart and peripheral arteries. Following the examination, the examiner determined that there was no diagnosis of a bilateral leg condition aside from the Veteran’s service-connected peripheral neuropathy, as there was no pathology to render another diagnosis. In August 2011, the Veteran attended another VA examination. There, he described cardiac symptoms, including shortness of breath and fatigue. He further discussed leg cramping and pain after walking twenty yards of level ground at two miles per hous. He stated that the symptoms were typically resolved with rest, but the Veteran still experienced calf pain at rest and did not feel persistent coldness in his extremities. Following the provision of a physical examination, the examiner diagnosed with Veteran with peripheral artery disease as secondary to his service-connected diabetes, mellitus type II, pointing to the Veteran’s subjective symptoms of leg pain and the objective factor of abnormal ankle-brachial index (ABI) test results as support for the diagnosis. The Board finds that the earliest date of a diagnosis of peripheral artery disease from a competent, credible source occurred on August 24, 2011, at the Veteran’s VA examination. While prior to that date the Veteran complained of bilateral leg pain, previous examiners specifically found no problem with the Veteran’s heart or arteries. The Board has also considered the tenets of Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018) wherein the United States Court of Appeals for the Federal Circuit (Court) held that a Veteran’s pain may be considered a disability if it results in functional impairment of earning capacity. However, the Board finds that the Veteran has never averred nor has the record reflected that the bilateral leg pain he experienced, independent from his service-connected peripheral neuropathy, caused functional limitation such that his earning capacity was adversely affected. Further, the Board has considered the Veteran’s lay statements that his peripheral artery disease disability arose prior to August 24, 2011. The Board, however, finds that the competent and probative evidence of record, namely, the objective medical tests, does not show that the Veteran’s disability arose prior to that date. The Veteran is competent to attest to his symptoms; however, he is not competent to diagnose peripheral artery disease, as such requires medical expertise in the cardiovascular field. For these reasons, the Board concludes the “date entitlement arose” is no earlier than August 24, 2011. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s claim of entitlement to service connection for peripheral artery disease of the bilateral extremities was received by VA on June 17, 2009. However, the competent, credible medical evidence of record shows that he was first diagnosed with peripheral artery disease of the right and left legs at the VA examination performed on August 24, 2011. As the disability first manifested after the date of claim, the Board finds that August 24, 2011, (the date entitlement arose) is the appropriate effective date for service connection. However, as the current effective date of June 30, 2011, is more advantageous to the Veteran, the Board will not disturb it. In summation, the Veteran’s claims of entitlement to an effective date earlier than June 30, 2011 for the award of service connection for peripheral artery disease of the right and left legs are denied. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Bush 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.