Citation Nr: 21020757 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-07 049 DATE: April 8, 2021 ORDER Entitlement to service connection for a left leg disability, to include left leg swelling, is DENIED. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s left leg condition was incurred while on active duty in the United States Army. CONCLUSION OF LAW The criteria for entitlement to service connection for a left leg disability have not been satisfied. 38 U.S.C. §§ 1101, 1131, 1133, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2020).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1959 to December 1962. In April 2019, July 2020, and November 2020, the Board addressed the Veteran’s claim for service connection for a left leg disability. On each occasion, the Board remanded the Veteran’s claim to the agency of original jurisdiction (AOJ) for additional development. Entitlement to service connection for a left leg disability, to include left leg swelling, is denied. In May 2012, the Veteran submitted a VA Form 21-526. Thereby, the Veteran initiated a claim for service connection for a left leg disability, which was identified as swelling. Service connection may be established for disability resulting from personal injury suffered or disease contracted while in the active military, naval, or air service. 38 U.S.C. § 1110. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). In order to establish service connection for the claimed disorder on a direct basis, generally there must be probative evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). In each case where service connection for any disability is sought, due consideration shall be given to the places, types, and circumstances of the Veteran’s service as shown by the Veteran’s service record, the official history of each organization in which the Veteran served, the Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154 (a). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In September 2012, the Veteran’s service treatment records (STRs) were associated with the claims file. During the October 1962 separation examination, the Veteran relayed that he endured bilateral leg cramps. However, the military examiner reported normal lower extremities after the clinical evaluation. In November 2012 the Veteran submitted a VA Form 21-4138. Therein, the Veteran reported that within a week or two after discharge, he was getting into the bathtub and noticed that his leg was swollen. The Veteran relayed that, “(t)he swelling did not feel painful so I did nothing. When my leg swells it’s easy to tear open. After hitting my ankle with a hammer, I was unable to walk for four months. This happen in 1964. I went to VA Hosp. in Los Angeles . . .. He advised me to stay off my leg until healed keep it elevated and wear a support hose.” In May 2015, the Veteran supplied testimony to a decision review officer (DRO). At that time, the Veteran testified that, “one afternoon after . . . after work we were recreation out in the . . . in . . . on the field and somehow I got tangled up in some barbwire and cut one on my leg . . . my left leg on the back side of it I got hung on the barbwire and it slashed it. It wasn’t real bad, but I didn’t think it was nothing. So, I didn’t really do anything about it. It healed up in about four days, but I believe that somehow with that open wound and in that laundry room is where the problem started.” The Veteran testified that, “I was discharged I was home for maybe a week and I got in the tub I had not tooken [sic] a bath in probably three years and I got in the tub with soap and I raised my legs up while I was laying back and I . . . that’s when I looked at my legs. I hadn’t really looked at my leg ‘cause I hadn’t had any pain there, so there was no reason for me to be examining my leg, I didn’t feel anything. So . . . but then the swelling was there. I noticed it and . . . but there was nothing I could do about it. It didn’t hurt, so I said, ‘Well, it will probably just go away.’” The Veteran testified that, “I don’t recall ever having that problem before going in service or during basic training I didn’t have a problem with it. And it’s only after I was discharged coming back from Europe when I got back being in New York and got back home was about a week before I realized that the swelling was even a problem.’ In November 2017, the Veteran’s treatment notations from the Tulsa Outpatient Clinic were associated with the claims file. Therein, in July 2009, it was reported that, “(l)eft lower leg swelling started about time of discharge. Then was involved in accident that FX ankle. VA gave him support hose which helped swelling. Has been wearing support hose since. In the last year has not been able to find any that help.” In July 2015, it was reported that, “Veteran is demanding that he get his compression socks order placed. He said he's requested this 10 days ago and that if he has to wait much longer for these, his legs ‘are going to blow’.” The Veteran relayed that, “his left leg is double the size of normal from ‘It feels like a bunch of needles are sticking in my ankles’.” In January 2019, the Veteran provided sworn testimony to the undersigned Veterans’ Law Judge (VLJ). When asked when he first injured his left leg, the Veteran responded that, “I don’t recall . . .. He got to looking at my leg, and I showed him the back of my leg, there was a mark down the back of it. He asked me where did I get that at . . .. The barbed wire was --and we --and we was out there playing ball one day, and somehow I got --my leg got tangled up in it, and --and just cut the back of my leg open. But then they had me working in that laundry room at the time, and what disease I was exposed to, I don’t know . . ..” When questioned by the undersigned, the Veteran testified that, “(t)hey didn’t stitch it up. It was --it was --it was open wound, but it was not that deep enough to where it would require stitches. But it was an open wound and I was working in that laundry room, I don’t know what I was exposed to.” The Veteran testified that the swelling is specific to his left leg, constant, and he first recognized the swelling during his first bath (instead of the typical shower) after separation from the United States Army. In April 2019, the Board considered the Veteran’s entitlement claim for service connection for a left leg disability. At that time, the Board relayed that, “the Board requires a competent medical provider’s opinion, addressing the etiology of any current swelling of the left lower appendage endured by the Veteran. Specifically, a competent provider must consider and opine whether any current left lower appendage numbness endured by the Veteran is etiologically related to the exposure of an open five-to six-inch laceration to laundry agents.” In October 2019, the Veteran’s treatment records from the Tulsa Outpatient Clinic were associated with the claims file. An October 2019 notation reported that, “(h)ad significant problem 25 years ago with ulcer on left ankle associated with edema--it took 6 mo. Sore on left ankle swells and burst open in 1974; hasn't happened in 25 years but is careful to keep compression stockings on and change when needed.” The VA provider reported that, “left ankle swells with compression socks; edema present.” The VA provider reported that, “Veteran states previous traumatic injury to left ankle. States has had swelling since active duty. Also states the inner ankle area has ‘opened’ up on a few occasions. Veteran wears compression stockings with ‘good results’.” In November 2019, the Veteran underwent a VA examination that considered the nature and etiology of any currently endured left leg muscle injuries. The VA examiner relayed that the Veteran had never been diagnosed with a left leg muscle injury. The VA examiner relayed that, “1) At the time of the exam, there is insufficient objective evidence to support a diagnosis for the claimed CONDITION. 2) At the time of the exam, Veteran reports no significant complaints to his MUSCLES that would meet any diagnosis within this DBQ. 3) At the time of the exam, Veteran’s MUSCLE exam is also unremarkable for any findings would meet any diagnosis within this DBQ.” The VA examiner remarked that, “(t)here was no objective evidence found on exam to warrant a diagnosis of a muscle injury condition.” In November 2019, the Veteran underwent a VA examination that considered the nature and etiology of any currently endured knee and lower leg conditions. The VA examiner relayed that the Veteran does not have a current diagnosis associated with left leg swelling. The VA examiner relayed that, “1) At the time of the exam, there is insufficient objective evidence to support a diagnosis for the claimed CONDITION. 2) At the time of the exam, Vet reports no significant complaints to his KNEE & LOWER LEG that would meet any diagnosis within this DBQ. 3) At the time of the exam, Vet's KNEE & LOWER LEG exam is also unremarkable for any findings would meet any diagnosis within this DBQ.” In November 2019, the VA examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner supplied the following rationale: “(t)here was no objective evidence found on examination to warrant a diagnosis for the veteran’s claimed Left Leg Swelling. At the time of the exam, there is insufficient objective evidence to support a diagnosis for the claimed condition. At the time of the exam, the veteran reports no significant complaints to his KNEE & LOWER LEG that would meet any diagnosis. At the time of the exam, the veteran’s Muscle Injuries and Knee & Lower Leg exams are also unremarkable for any findings that would meet any diagnosis.” The Board notes that the VA examiner was directed to answer whether any current swelling is etiologically related to a five to six-inch scar on the Veteran’s left lower appendage. The VA examiner replied with, “(t)he Veteran does not have any swelling during the exam.” In July 2020, the Board considered the Veteran’s claim for service connection for a left leg disability. At that time, the Board observed that, “(t)he prescription of compression socks during the appeal period suggests that the Veteran may have had a disabling condition of the left leg that either resolved or was not symptomatic at the time of the November 2019 examination.” The Board remanded the Veteran’s claim to obtain an addendum opinion on whether the Veteran has had a disability manifested by left leg swelling or edema at any time during the course of the appeal, and if so, whether such disability is related to his military service. In August 2020, a Disability Benefits Questionnaire was associated with the claims file. After review of the electronic claims file, the VA examiner opined that a left leg disability, to include left leg swelling, was less likely than not (less than 50 percent probability) incurred in or caused by an injury, event, or illness the Veteran endured while serving in the United States Army, to include complaints of cramping in October 1962. The VA examiner relayed that, “it is in my opinion that the information is less likely as not sufficient to opine that Veteran has any complaints of left leg swelling or the use of compression socks are indicative of a disabling left knee condition at the time of that exam on 11/21/2019. As for the status of his LEFT LEG after 11/21/2019, I am not able to determine the status of Veteran’s Left Leg since I have not examined veteran. As stated previously, the opinions rendered herein are provided solely based on the medical records available.” In November 2020, the Board addressed the Veteran’s claim for service connection for a left leg disability. At that time, the Board noted that the November 2019 and August 2020 VA examiner failed to address the competent medical notations of left leg swelling and/or edema during the claim period. The Board directed the AOJ to secure an examination report that addressed the etiology of the Veteran’s left leg swelling and/or edema, which was reported by VA providers during the claim period. In December 2020, the Veteran’s treatment records from the Jack C. Montgomery VAMC were associated with the claims file. Important to this analysis, the VA providers reported that the Veteran has worn support hose since 1966 to keep his legs from swelling (emphasis added). In December 2020, a VA examination report was associated with the claims file. Therein, the VA examiner opined that the Veteran’s claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner also opined that, “based upon review of records, the information is less likely as not sufficient to support ANY etiological relationship to the exposure of an open five- to six-inch laceration on the Veteran’s left leg to laundry agents and the VA-documented left ankle edema in October 2019.” The VA examiner supplied the following rationale: “(a)t the time of the exam, there is insufficient objective evidence to support a diagnosis for the claimed CONDITION. 2) At the time of the exam, Vet reports no significant complaints to his KNEE & LOWER LEG that would meet any diagnosis within the KNEE LOWER LEG DBQ. 3) At the time of the exam, Vet's KNEE & LOWER LEG exam is also unremarkable for any findings that would meet any diagnosis within the KNEE LOWER LEG DBQ.” During the January 2019 Board hearing, the Veteran testified that he currently endured swelling that was specific to the left leg. However, the November 2017 and December 2020 VA treatment notations identified bilateral leg swelling, and compression socks were utilized on both legs. Nevertheless, the VA notations indicate that the Veteran endures swelling of the left leg. Consequently, the first requisite element for service connection has been substantiated. See Hickson, 12 Vet. App. at 253. Throughout the appellate period, the Veteran has repeatedly reported that he endured a cut to his left leg while on active duty in the United States Army. The Veteran also competently reported that the cut was open during his service in the military laundry. The Board finds that these competent reports align with the circumstances of the Veteran’s service. See 38 U.S.C. § 1154 (a). Consequently, the in-service injury element for service connection has been substantiated. See Hickson, 12 Vet. App. at 253. The Board notes that, while the Veteran is competent to testify about the symptoms he has observed during the course of his claimed disability, he is not competent to identify the etiology for left leg swelling. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992)). The Board notes that the December 2020 VA examiner specifically opined that there was not any etiological relationship between the Veteran’s in-service exposure of a laceration to laundry agents and the VA-documented left leg swelling. The Board concludes that there is not a competently identified nexus between the Veteran’s active duty service and the current left leg swelling. Consequently, the final requisite element for service connection has not been substantiated. See Hickson, 12 Vet. App. at 253. Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s claim for service connection for a left leg disability. Since the preponderance of the evidence is against this claim, the provisions of 38 U.S.C. § 5107(b), regarding reasonable doubt, are not applicable. The Veteran’s claim for service connection for a left leg disability must be denied because the preponderance of the evidence weighs against his claim. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, 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.