Citation Nr: 21013952 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-34 337A DATE: March 11, 2021 ORDER Entitlement to service connection for varicose veins on the lower extremities is denied. FINDING OF FACT Varicose veins of the lower extremities were not shown in service or for many years thereafter; and, the preponderance of the evidence is against a finding that the Veteran’s diagnosed varicose veins of the bilateral lower extremities is the result of his active service or a service connected disability. CONCLUSION OF LAW The criteria for service connection for varicose veins are not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty military service from December 1983 to December 1986, as well as additional service in the Army National Guard. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Previously, in a July 2018 decision, the Board remanded the matter to obtain all the Veteran’s VA treatment records, to request the Veteran’s private treatment records, and to schedule the Veteran for an examination to determine the nature and etiology of any varicose vein conditions to include left varicocele. Since then, a June 2020 rating decision from the RO granted service connection for the left varicocele. As such, the decision before the Board is limited to the question of service connection for lower extremity varicose veins. Entitlement to Service Connection for Varicose Veins. The Veteran contends his varicose veins are etiologically related to his service. Alternatively, the Veteran contends his varicose veins are etiologically related to his service-connected shin splints, stress fractures, or his service-connected varicocele. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established for any disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Compensation may be established for any incremental increase in disability any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence. Ward v. Wilkie, 31 Vet. App. 233, 239 (2019 If there is at least an approximate balance of positive and negative evidence regarding any issue material to the claim, the Veteran shall be given the benefit of the doubt in resolving such issue. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran’s medical treatment records show he currently has a diagnosis of bilateral lower extremity chronic symptomatic superficial venous insufficiency. Therefore, the first Shedden element necessary to establish direct service connection, as well as the first Wallin, element necessary to establish secondary service connection, have been met. With respect to the second element of Shedden, service incurrence, service treatment records (STRs) do not reflect complaints, treatment, or diagnosis of varicose veins in the lower limbs. The Veteran does not necessarily argue the contrary. Rather, in a general sense, he seems to suggest that his left varicocele represented the initial onset of his varicose veins. Such is sufficient to meet the requirements of Shedden. The Veteran is service connected for shin splints, stress fractures, and a left varicocele. The second element of Wallin has also been met. To establish direct service connection, the Board must now determine whether there is a connection, or nexus, between the Veteran’s active service and his currently diagnosed varicose veins.   The Veteran’s STRs are absent complaints of varicose veins. Rather, the Veteran’s lower extremity varicose veins are first reported in private treatment records from Vascular Surgery Associates in 2007, roughly 20 years after the Veteran’s service. Such was noted by the VA examiner in a June 2020 report. That examiner explained that the symptoms of varicose veins would have been observed in service if such a disability had been present at time, and that the 20-year gap between service discharge and the initial diagnosis of varicose veins represented evidence against a finding of service. The examiner also stated that varicose veins and the Veteran’s left varicocele are distinct and unrelated conditions that were separated by 20 years. The Board interprets to mean that the development of a varicocele in service could not represent the initial manifestations of varicose veins. The examiner provided a detailed explanation of the anatomical differences and causes of both conditions. Consideration has been given to the Veteran’s opinion that his varicose veins had their initial onset in service. However, notwithstanding the finding that the Veteran does not have the competence to render such opinion, this opinion is outweighed by the negative VA examination. Thus, as there is no probative, competent, and credible evidence finding the Veteran’s varicose veins are caused by, due to, or incurred in his military service, the Board finds that the third Shedden element necessary to establish service connection has not been met. As noted above, the first two elements necessary to establish secondary service connection have been met. What is left for the Board to determine is whether the Veteran’s lower extremity Varicose veins are due to, or aggravated beyond the natural progression of the condition, by his service-connected left varicocele, shin splints, or stress fractures. In the Veteran’s March 2019 Statement in Support of Claim he wrote “the right lower varicose vein problem started after the groin varicose vein injury and could be a direct relation to that original problem.” According to the Veteran the right lower leg varicose vein “should be a secondary condition to the varicose veins in my groin which is the problem from my service.” While the Veteran is competent to report his observable symptoms, he is not competent to determine such issues as diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The development of a chronic vascular disorder is an internal pathology beyond a layperson’s capacity to observe, sense, or feel. Its development is a complex medical question. See Woehlart v. Nicholson, 21 Vet. App. 456, 462 (2007). On this complex question, the lay evidence is of no probative value. The Veteran was afforded a June 2020 VA examination to assess the nature and etiology of the Veteran’s varicocele and varicose veins. The VA examiner explained the Veteran’s service-connected varicocele and his varicose veins of the lower extremities are distinct conditions. According to the examiner, the Veteran’s service-connected varicocele is neither a cause, nor an aggravating factor of the Veteran’s lower extremity varicose veins. In the June 2020 examination, the examiner explained the Veteran’s varicose veins of the lower extremities are the result of incompetent valves causing blood pooling that can cause pain. Such a condition could develop after a traumatic injury. However, while the Veteran is service-connected for shin splints and stress fractures, the examiner explained varicose veins are less likely than not related to the Veteran’s service-connected shin splints and stress fractures. The examiner emphasized that there is no anatomic connection between lower leg veins and the bone pains from stress fractures or shin splints. Furthermore, according to the examiner, the weight of medical literature does not support that shin splints or stress fractures of the legs cause or aggravate varicose veins of the legs. While there are multiple risk factors for the development of varicose veins, including lower limb trauma such as a complicated fracture, crush injury or other traumatic injury, the Veteran’s shin splints and stress fractures are uncomplicated injuries and would not contribute to the development of varicose veins. The probative, competent, and credible evidence shows that the Veteran’s service-connected disabilities have not caused, or aggravated beyond the natural progression, his varicose veins. Therefore, the third Wallin element necessary to establish secondary service connection has not been met. Based on the above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for varicose veins, on both a direct and secondary basis. As the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Entitlement to service connection for varicose veins is denied. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.N. Bush, Associate 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.