Citation Nr: 21021622 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-45 603 DATE: April 13, 2021 ORDER Prior to January 18, 2021, entitlement to an initial disability rating in excess of 10 percent for left lower extremity deep venous thrombosis (DVT) is denied. From January 18, 2021, entitlement to a disability rating of 20 percent, but no higher, for left lower extremity deep venous thrombosis (DVT) is granted. FINDINGS OF FACT 1. Prior to January 18, 2021, the Veteran’s left lower extremity DVT has been manifested by aching and fatigue in both legs after prolonged standing or walking with symptoms relieved by elevation of extremity and compression hosiery. 2. From January 18, 2021, the Veteran’s left lower extremity DVT has been manifested by aching and fatigue in his left leg after prolonged standing and walking with symptoms relieved by elevation of extremity and compression hosiery, but with persistent stasis pigmentation, intermittent edema, and persistent subcutaneous induration; ulceration was not shown. CONCLUSIONS OF LAW 1. Prior to January 18, 2021, the criteria for entitlement to an initial disability rating in excess of 10 percent for left lower extremity DVT have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7121. 2. From January 18, 2021, the criteria for entitlement to a disability rating of 20 percent, but no higher, for left lower extremity DVT have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7121. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2006 to November 2007. This matter comes before the Board of Veterans’ Appeals (Board) from a November 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. During the hearing, the Veteran’s representative indicated they wished to waive RO consideration of additional medical evidence added to the claims file. Increased Rating 1. Entitlement to an increased rating for left lower extremity DVT Service connection for left lower extremity deep venous thrombosis (DVT) was established in a November 2015 rating decision with a 10 percent rating assigned, effective September 23, 2011. The Veteran asserts that his DVT warrants a higher rating because he has unpredictable swelling and leg fatigue, persistent tenderness, and patchy skin discoloration. Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA evaluates DVT under the General Rating Formula provided in 38 C.F.R. § 4.104, Diagnostic Code 7121. Under Diagnostic Code 7121, a noncompensable rating is warranted for asymptomatic palpable or visible varicose veins. A 10 percent rating is warranted for intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery. A 20 percent rating is warranted for persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. A 40 percent rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent rating is warranted for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. Lastly, a 100 percent rating is warranted when there is a massive board-like edema with constant pain at rest. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If different disability ratings are warranted for different periods of time over the life of a claim, “staged” ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Upon review of the record, the Board finds that a disability rating in excess of 10 percent is not warranted at any time prior to January 18, 2021. The Veteran underwent a VA examination in August 2013, during which he reported a history of leg pain and cramps with long trips. The examiner noted that the Veteran was diagnosed with DVT in March 2011 and was subsequently prescribed the medication warfarin. Physical examination did not reveal any current signs or symptoms related to the Veteran’s condition. On VA examination in November 2015, the Veteran reported left lower thigh pain, with a pins and needles sensation that can extend to his calf. The Veteran also reported that he continued to take warfarin and has been wearing compression hosiery since 2011. The examiner indicated that the functional impacts of the Veteran’s DVT include limitations to prolonged sitting and using compression stockings constantly. During a January 2021 VA examination, the Veteran was noted as having symptoms of aching and fatigue in his left leg after prolonged standing and walking, which are relieved by elevation of extremity and compression hosiery. The examiner indicated that the Veteran had persistent stasis pigmentation, intermittent edema of extremity, and persistent subcutaneous induration. Ulceration was not shown. The examiner further indicated the Veteran’s condition impacted his ability to work in that he was unable to do prolonged standing or walking. VA treatment records throughout the period on appeal document the Veteran’s complaints of left leg pain, swelling, and his use of compression hosiery. Specifically, a June 2011 VA treatment record reveals the Veteran complained of left leg pain and the Veteran reported left calf pain that radiated to his groin. He denied swelling or tenderness of the leg in September 2011. A February 2012 VA treatment record reveals the Veteran complained of pain, tenderness, and tightness in the left lower extremity. In March 2012, the Veteran reported continued use of compression hosiery and experiencing pain and a feeling of swelling in his lower left extremity. An April 2013 VA treatment record indicates the Veteran was experiencing lower left extremity edema. Additionally, a September 2018 VA treatment record reveals the Veteran was not experiencing any unusual bruising, bleeding, or thrombotic symptoms. Upon review of the record, the Board finds that prior to January 18, 2021, the Veteran’s DVT more nearly approximates the criteria for a 10 percent rating. In this regard, prior to January 18, 2021, the Veteran’s DVT did not result in persistent edema, stasis pigmentation or eczema, subcutaneous induration, or persistent ulceration. After considering the record before it and resolving all doubt in the Veteran’s favor, the Board finds that from January 18, 2021, the Veteran’s left lower extremity DVT more nearly approximates the criteria for a 20 percent rating. The VA examination on that date revealed the Veteran experienced persistent stasis pigmentation but had only intermittent edema of the leg. The Board acknowledges that the examiner also noted persistent subcutaneous induration. However, a rating higher than 20 percent is not warranted as he has only intermittent edema, there was no evidence of ulceration, and his symptoms were relieved by elevation of the extremity and compression hosiery. As such, the Board finds that the disability picture more nearly approximates the criteria for a 20 percent rating than a higher rating. As a final matter, the Board notes the Veteran reported that his DVT impacted his ability to work because he is unable to do prolonged standing or walking. However, he has not indicated that he is unemployable, the medical evidence does not suggest he is unemployable, and the record reflects the Veteran has been employed during the appeal period. As such, a claim for total disability based on unemployability has not been reasonably raised. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In sum, the most probative evidence of record reflects that a rating in excess of 10 percent is not warranted prior to January 18, 2021, and that a rating of 20 percent, but no higher, is warranted from that date. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lance, 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.