Citation Nr: 21012045 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 16-31 547 DATE: March 3, 2021 ORDER Entitlement to service connection for a vein disability is denied. FINDING OF FACT The preponderance of the competent evidence is against finding that the Veteran’s vein disability began during service, is otherwise related to service or to an incident of service origin or was caused or aggravated by his service-connected left tibia fracture. CONCLUSION OF LAW The criteria for service connection for a vein disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1958 to February 1962, September 1962 to June 1979 and from February 1991 to April 1991. This matter came before the Board of Veterans Appeals (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A March 2018 Board decision remanded the issues on appeal. A December 2019 Board decision then denied an increased rating for the left knee, granted an increased rating for the left ankle, and remanded the issue of service connection for a vein disability for further development. Entitlement to service connection for a vein disability The Veteran contends that his vein disability is secondary to his service-connected left tibia fracture. For the reasons below, the Board concludes that the Veteran’s bilateral vein disability is not related to service or to his service-connected left tibia fracture. Service connection is therefore not warranted. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For benefits to be denied, “the preponderance of the evidence must be against the claim.” Id. at 54. The Board’s review indicates that service treatment records are silent for complaints, treatment or diagnosis of a vein disability. VA treatment records show treatment for bilateral venous insufficiency and peripheral vascular disease, with complaints of bilateral lower extremity edema. January 2008, January 2010 and January 2011 primary care records are silent for a history of vein disabilities or joint swelling and the lower extremity examinations noted that there was no palpable or pretibial edema. October 2013 records noted edema for the past 4 to 5 months. The provider stated that it may have been due to heart failure rather than venous insufficiency. July 2014 records noted lower extremity swelling present for the past year, painful at the end of the day. The provider stated that it was likely due to venous insufficiency, noting normal cardiac testing. July 2014 venous ultrasound imaging was normal with no evidence of deep venous thrombosis. August 2014 records noted bilateral lower extremity edema and the provider stated that she would order compression hose for venous insufficiency. A November 2015 venous evaluation also found no evidence of deep venous thrombosis. The provider noted that the study was consistent with normal venous duplex. March 2016 records noted darkening of the lower extremities consistent with chronic venous insufficiency. April 2016 records noted bilateral chronic lower extremity edema. November 2016 records noted a diagnosis of peripheral vascular disease and show a treatment plan of continuing an antiplatelet regimen and a prescription for Lipitor. February 2017 records noted chronic bilateral edema, worsening. The provider noted that the Veteran had tried compression and elevation without improvement and planning to restart a prescription for Lasix. April 2019 records show a diagnosis of peripheral vascular disease and edema was found on lower extremity examination. May 2019 records noted edema June 2020 VA treatment records noted a DVT in the right lower extremity after suffering trauma to the shin from a metal object. A November 2014 VA examination diagnosed bilateral lower extremity venous insufficiency. The provider opined that venous insufficiency was not likely due to the left tibia fracture as it was bilateral, affecting both lower extremities, and there was no evidence that the tibia injury resulted in vascular compromise or injury. The examiner then provided a February 2015 addendum opinion stated that the record did not contain evidence showing aggravation of the Veteran’s current venous insufficiency by the 1960 left tibia fracture. A June 2019 VA examination diagnosed venous insufficiency and noted that the Veteran also had a diagnosis of peripheral vascular disease. The examiner noted the Veteran’s reports of a broken leg in service and loss of feeling in both legs below the knee, with diminished blood flow worse in the left leg. The examiner found that the Veteran’s peripheral vascular disease and vascular insufficiency were both not due to service, including the Veteran’s service-connected tibia fracture. As a rationale, the examiner noted that the tibia fracture was only on the left lower extremity, and therefore unlikely to be the cause of the vein disabilities which were present in both lower extremities. A July 2020 VA examination diagnosed venous insufficiency, which the examiner found was not be caused or aggravated by the service-connected left tibia fracture. As a rationale, the examiner stated that the left tibia fracture was unilateral but both lower extremities suffer the same vein disability. The examiner further noted that the record did not show that the vein disability had been aggravated beyond its natural progression. The Veteran submitted a January 2016 statement asserting that his bilateral venous insufficiency was secondary to his broken left leg, stating that he did not understand how the examiner could find that they were not related. He reported that the condition had been ongoing for years and that his feet and legs turned blue and that he had been issued support hose with little relief. The Board notes that the Veteran is competent to report lay-observable symptoms he experiences such as leg swelling and accords those statements significant probative weight. However, as a layperson, he does not possess the medical expertise required to provide a nexus opinion, and the Board therefore assigns his statement regarding etiology no probative weight. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). While the record shows current vein diagnoses of bilateral lower extremity venous insufficiency and peripheral vascular disease, the Board finds that the competent evidence of record does not support the conclusion that the Veteran’s bilateral vein disabilities were related to active service. The record does not show, and the Veteran does not contend, that his vein disabilities began in service. Service treatment records are silent for a vein diagnosis, symptoms or treatment and the record indicates that the Veteran’s symptoms began over 20 years after service. The Veteran was discharged from service in 1991, January 2008, January 20010 and January 2011 VA primary care records are silent for history or diagnosis of vein disability or edema, and October 2013 VA treatment records indicate that symptoms of leg swelling had begun 4 to 5 months prior. July 2014 records also noted symptoms beginning in the past year. There is simply no competent evidence of record that establishes either an earlier onset or a relationship between the Veteran’s vein disability and his active service. The Board also finds that the record does not support the conclusion that the Veteran’s vein disability was caused or aggravated by his service-connected left tibia fracture. All of the VA examiners consistently found that the bilateral vein disability was not caused by the tibia fracture, basing the conclusion that the two conditions were unrelated on the fact that the vein disability was present in both legs but the tibia fracture was only in the left leg. The July 2020 examination stated that this fact also meant that the left tibia fracture had not aggravated the bilateral vein disability, additionally noting that there were no signs that the disability had been worsened beyond its natural progression. This is consistent with the findings of the February 2015 addendum opinion, which also found that there were no signs of aggravation. The Board also finds that the record is negative for any evidence, other than the Veteran’s assertion that the vein disability is due to his left leg fracture, of a relationship between the left leg fracture and the later diagnoses of venous insufficiency and peripheral vascular disease. While VA treatment records noted edema due to right leg trauma in 2020, they are silent for similar reports regarding the tibial fracture. There is simply no basis on which the Board can conclude that the Veteran’s bilateral vein disability was caused or aggravated by his service-connected left tibia fracture. While the Veteran contends that his bilateral vein disability is related to his left leg fracture, as noted above, he does not possess the medical expertise required to provide a nexus opinion. The Board therefore finds that the preponderance of the competent and reliable evidence indicates that the Veteran’s vein disability, to include bilateral venous insufficiency and peripheral vascular disease, was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303, 3.310. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Arnold 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.