Citation Nr: 21070157 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 14-32 362A DATE: November 23, 2021 ORDER Entitlement to service connection for left leg vein circulation disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that a left leg vein circulation disorder began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for a left leg vein circulation disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from June 1976 to June 1979. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in March 2020. A transcript of the hearing has been associated with the claims file. This issue was remanded by the Board in April 2020 and April 2021 for further development. The issue has since returned to the Board for appellate review. Entitlement to service connection for left leg vein circulation disorder is denied. The Veteran asserts that he is entitled to service connection for a left leg vein circulation disorder on a direct basis. However, as outlined below, the preponderance of the evidence of record demonstrates that the Veteran's left leg vein circulation disorder did not manifest during, within the year following, or a result of active service. As such, service connection cannot be established on a direct basis. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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 service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran's service treatment records (STRs) are silent for any complaints or treatment of the left lower extremity, swelling, or findings of a vein disorder. On the June 2014 notice of disagreement (NOD), the Veteran stated that he was a cook in the Navy, and he was assigned 12-hour shifts. He stated that he stood on non-protected decks in the galley. He stated he always experienced circulation and vein problems. He stated that during those times he did not know this may have been a problem, so he would take medication to ease the pain. He stated that after separation he was treated for blood clots by VA. On the November 2014 substantive appeal, the Veteran stated he experienced symptoms in the left leg with poor circulation in 1978. He stated he was serving on a ship. He stated he sought treatment with medical staff. He stated he was treated with aspirin and long socks to help with circulation. He stated that he experienced a blood clot in 1999. At the March 2020 Board hearing, the Veteran testified that he was a cook in the Navy, which required him to be on his feet for 16- and 17-hour shifts. Board Hearing Transcript (T.) at 2. He stated that during that time he experienced swelling in the leg. Id. He stated he sought treatment and he was treated with aspirin. Id. The Veteran stated that the vein disorder became very serious in 1998 when it became a blood clot. T. at 3. He said he then experienced soreness and wounds and then sought treatment with VA. Id. On the September 2020 VA artery examination, the examiner indicated the Veteran has a diagnosis of deep vein thrombosis. The Veteran stated he was stationed in California in 1978. He reported experiencing pain the left leg. He stated that the symptoms worsened in 1998, when his left leg started swelling with blood clots. He stated he sought medical treatment in 1999 and was prescribed blood thinners. The Veteran stated he experiences pain and occasional swelling in the left leg. The September 2020 VA examiner opined that the Veteran's deep vein thrombosis is less likely than not caused by service. The examiner reasoned that after conducting a review of the Veteran's medical records, there is insufficient evidence in the STRs that show complaints of vein circulatory disorder in the left leg. The examiner stated there is no evidence of chronicity of care. The examiner stated that the Veteran was first diagnosed with deep vein thrombosis in 1998. The examiner concluded there is no nexus. On the June 2021 VA artery examination, the examiner indicated the Veteran has diagnoses of left lower extremity vein thrombosis, left lower extremity chronic venous insufficiency, and left lower extremity venous stasis ulcer that is resolved. The Veteran stated that he served in the Navy as a cook. He stated he would stand on his feet 10- to 18- hours a day. He reported that he developed pain and swelling in the left lower extremity in the 1970s associated with working long hours. He stated that he initially experienced symptoms for two weeks with swelling from the foot to the knee and tenderness over the shin. The Veteran denied having any trauma or color or temperature changes to the left leg. The Veteran stated he continued to work as a cook after separation from service and he experienced increased swelling in the 1980s. He stated that in 1998 he had severe swelling and pain in the left leg and sought treatment. The Veteran stated he continues to have symptoms in the left leg and treats the leg with compression hose and elevation. He stated he also stated he has had open wounds, which he self-treated and they have since resolved. The June 2021 VA examiner opined that the Veteran's vein disorder is less likely than not caused by service, to include pain and swelling during prolonged standing during service. The examiner reasoned that after considering the Veteran's statements, STRs, and discrepant historical details in objective records and medical literature, they found the objective evidence to carry more weight. The examiner noted there are no clinical treatment records for any left leg disorder until 1995. The examiner found the Veteran's onset of a vein disorder to be in 1998, which was related to lower left extremity trauma. The examiner also found there to be inconsistencies in the Veteran's historical details provided over time which led the examiner to question the reliability of the Veteran's recall of remote events. The examiner stated that based on the temporal relationship between the Veteran's vein disorder diagnosis in 1998, credible medical literature, and the discrepancies of the Veteran's report, the examiner gives more probative value to the objective records. The examiner cited medical literature in reaching this conclusion. Based on the foregoing, the Board concludes that there is no evidence that the Veteran's left leg vein circulation disorder was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for a left leg vein circulation disorder on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from a left leg vein circulation disorder continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's left leg vein circulation disorder is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his left leg vein circulatory disorder to service. The only competent evidence in the record that addresses this question is the June 2021 VA medical opinion, which stated that the Veteran's left leg vein circulatory disorder was not related to his service. As there is no other evidence to the contrary, and the June 2021 VA medical opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive. Further, the Veteran's own statements relating his left leg vein circulatory disorder to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether a vein circulatory disorder, in the absence of credible evidence of continuity, as here, is related to an incident in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, a vein circulatory disorder is a disease of the circulatory system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a left leg vein circulatory disorder. Accordingly, it must be denied. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, Counsel 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.