Citation Nr: 21077646
Decision Date: 12/30/21	Archive Date: 12/30/21

DOCKET NO. 16-07 220
DATE: December 30, 2021

REMANDED

Entitlement to service connection for varicose veins of the legs is remanded.

REASONS FOR REMAND

The Veteran served honorably in the United States Navy on active duty from October 1985 to March 2008. 

This appeal comes to the Board of Veterans' Appeals (Board) from an August 2015 rating decision by the Veterans Benefits Administration (VBA).  The Board remanded this matter to VBA in April 2019 to afford the Veteran an examination of his varicose veins to assist in determining whether this condition is related to in-service events.  The Board remanded the appeal again in August 2021 because the January 2021 VA examiner's negative nexus opinion focused on a lack of a diagnosis of varicose veins during the Veteran's service without addressing the Veteran's statements about the onset and continuity of relevant symptoms over time.  

The Veteran contends his symptoms manifested during his service as a cramping pain.  See November 2021 Correspondence.  The September 2021 VA examination opinion that VBA obtained on remand cites post-service treatment records indicating the Veteran describes his varicose vein symptoms as a cramping pain.  It also cites "achy legs" as an early warning sign and symptom of varicose veins, and it notes people who experience cramping and achy legs after physical activity are more likely to develop varicose veins.  However, the examiner provided a negative opinion based largely on an assessment that the service treatment records contained no complaints of relevant symptoms.  The examiner failed to address documented reports of achy legs or cramps in the Veteran's service records.  See, e.g., April 1993 Report of Medical History in the Veteran's service treatment records.  On remand, VBA should obtain an addendum opinion addressing all reports of relevant symptoms noted in the service records.  

The Board REMANDS this matter for the following actions:

VBA should obtain an addendum medical opinion to address whether it is at least as likely as not (at least an approximate balance of negative and positive evidence) that the Veteran's varicose veins first manifested during, or were otherwise caused by, the Veteran's military service.  The examiner's opinion should address the following important pieces of evidence:

(a.) The Veteran's contention that his varicose veins manifested during his military service as cramping pain and his statements about continuity of relevant symptoms over time.  See November 2021 Correspondence.  

(b.) The September 2021 VA examiner's assessment that achy legs and cramps are early warning signs and symptoms of varicose veins including supporting medical literature.   

(c.) Documented reports of achy legs or cramps in the Veteran's service records.  See, e.g., April 1993 Report of Medical History; Service Treatment Records.

If the examiner is unable to provide an opinion on this matter, he/she must state whether the inability to render an opinion is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

 

 

K.A. KENNERLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Michael Duffy

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.