Citation Nr: 21024067 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 18-41 602 DATE: April 22, 2021 ORDER Service connection for varicose veins, right leg, is denied. Service connection for varicose veins, left leg, is denied. REMANDED Service connection for a right hip disorder. Service connection for a left hip disorder. Service connection for a right knee disorder. Service connection for shortening of right leg with pelvic tilt. Service connection for a back disorder. FINDINGS OF FACT 1. The Veteran served on active duty from December 1964 to January 1969. 2. Varicose veins of the legs were not shown in service and are not causally or etiologically related to service. CONCLUSIONS OF LAW 1. Varicose veins, right leg, were not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 2. Varicose veins, left leg, were not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In September 2020, the Veteran testified at a virtual hearing held before the undersigned Veterans Law Judge. A transcript of the hearing is of record. He contends that service connection is warranted for varicose veins of the legs because they are due to long periods of standing in the Navy. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). A review of the claims file reflects a diagnosis of varicose veins of both lower extremities. As such, the first element of service connection is met. As to an in-service incurrence, service treatment records (STRs) do not document any complaint, treatment, or diagnosis regarding varicose veins. Further, the January 1969 separation report noted normal clinical evaluation of the lower extremities. Therefore, the medical evidence does not support the second element of service connection. To the extent that the Veteran assets a medical nexus between his varicose veins and service, the VA treatment records noting a diagnosis and treatment for varicose veins do not reflect a connection to service. Of note, an August 2016 VA treatment record specifically indicated that the varicose veins were “new onset,” suggesting an onset more than 45 years after discharge. As such, the medical evidence does not support a nexus between service and varicose veins. The Board has considered the Veteran’s lay statements that his varicose veins were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records and clinical evidence obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. The Board notes that the Veteran has not been provided an examination with respect to his claims for service connection for varicose veins; however, as noted above, the record does not contain any competent and credible lay or medical evidence that can be said to even “indicate” that the current varicose veins “may be associated” with service. Notably, aside from the Veteran’s November 2015 statement that he believes his varicose veins are related to long periods of standing in service, there is no evidence linking varicose veins to service. At the hearing, he indicated that he would submit such evidence; however, he has not submitted any nexus evidence related to these claims. Therefore, remand for a medical opinion is not warranted. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND The Veteran contends that repeated injuries to his right lower extremity aboard ship in service resulted in the shortening of his right leg/pelvic tilt, which in turn caused right and left hip disorders, a right knee disorder, and a back disorder. An October 2016 private treatment record from Dr. T. reflected the Veteran’s report of back pain that had been present for 25 years what was related to previous injuries. The record also contains a July 2016 VA treatment record which noted that the Veteran reported knee problems. A February 2021 letter from a VA nurse practitioner stated that the Veteran had a long history of leg length inequality resulting in abnormal gait and back pain. The nurse practitioner opined that it is as least as likely as not that this occurred while he was in the Navy. Unfortunately, there is no rationale accompanying the February 2021 VA opinion or the October 2016 private medical opinion that the Veteran had lumbar disability based upon previous injuries. As such, a remand is required in order to obtain a medical opinion with a rationale regarding the etiology of the claimed disorders. The matters are REMANDED for the following actions: 1. Obtain updated clinical records not already associated with the claims file. 2. Provide Dr. T. with an opportunity to clarify the October 2016 opinion with a rationale. 3. Direct the claims file to a clinician to address the etiology of the Veteran’s right leg, right hip, left hip, back, and right knee disorders. 4. The clinician is asked to address the following: • it is at least as likely as not (50 percent or greater probability) that a right leg, right hip, left hip, back and right knee disorders had their onset during service or are causally or etiologically related to service, to include the Veteran’s multiple reported right leg injuries aboard ship during service. • If the clinician determines that shortening of the right leg with pelvic tilt is causally or etiologically related to service, the clinician is asked to address whether right hip, left hip, back and right knee disorders were caused or aggravated by the shortening of the right leg with pelvic tilt. The examiner is asked to consider Dr. T.’s October 2016 opinion that the Veteran had a lumbar disability for 25 years and the February 2021 VA nurse practitioner’s opinion that the Veteran’s long history of leg length inequality resulting in abnormal gait and back pain occurred during service. For the purposes of this opinion, the clinician should accept the Veteran’s statements regarding right lower extremity injuries despite no documentation in the service treatment records. In addition, the clinician should note that a disorder may exist even in the absence of a specific diagnosis, and that pain can constitute disability if it causes functional impairment. A complete rationale should accompany all stated opinions.   5. If the clinician determines that an examination is necessary in order to provide the requested opinions, then one should be scheduled. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Redman, 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.