Citation Nr: 21024491 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-54 246 DATE: April 22, 2021 ORDER Service connection for a blood circulation disorder affecting the left lower extremity (previously claimed as peripheral vascular disease and varicose veins), hereinafter referred to as a blood circulation disorder, is denied. FINDINGS OF FACT 1. The Veteran has a current blood circulation disorders affecting the left lower extremity, diagnosed as peripheral vascular disease and varicose veins. 2. Symptoms of the peripheral vascular disease in the left lower extremity specifically were not chronic in service, were not continuous after service separation, and did not manifest to a compensable degree within one year of separation from service. 3. The current blood circulation disability did not have its onset in service and is not otherwise etiologically related to service. CONCLUSION OF LAW The criteria for service connection for the blood circulation disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1954 to August 1956. This matter is on appeal from a December 2013 rating decision issued by the Regional Office (RO). The Veteran filed a notice of disagreement (NOD) in December 2013, a statement of the case (SOC) was issued in August 2016, and the Veteran filed a substantive appeal in October 2016. This matter was before the Board in February 2018. The Board remanded in order to obtain outstanding VA and private treatment records. A November 2019 supplemental statement of the case (SSOC) denied the claim. This matter was before the Board again in January 2020. The Board remanded the claim again for outstanding VA and private treatment records and to conduct a VA examination. A VA examination was conducted in December 2020. A SSOC was issued in January 2021, denying the claim. Duties to Notify and Assist The Board finds that the duties to notify and assist the Veteran in this case have been fulfilled. Neither the Veteran nor the representative has raised any further issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). LEGAL AUTHORITY FOR SERVICE CONNECTION Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). In this case, the disorder at issue, peripheral vascular disease in the left lower extremity, is an organic disease of the nervous system and, as such, listed as a “chronic diseases” under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. See 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258, 271 (2015). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as peripheral vascular disease in the left lower extremity, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Service Connection for the Blood Circulation Disability The Veteran contends that the blood circulation disability is related to service and proffers two different theories. The Veteran claims that when he was an infantryman during service, his legs were in constant pain from walking with a full backpack. The Veteran also claims that he experienced a June 1955 in-service left clavicle injury, which caused him to feel pain down the left side of his body. The Veteran contends that the infantryman duties and June 1955 in-service injury caused the current blood circulation disability. After a review of the evidence, both lay and medical, the Board finds that the Veteran has a current blood circulation disorder affecting the left lower extremity, diagnosed as peripheral vascular disease (with no obstruction) and varicose veins. See December 2020 VA Examination (diagnosing peripheral vascular disease with no obstruction and varicose veins). Upon review of the record, the Board finds that the Veteran had a military occupational specialty (MOS) of infantryman and experienced a June 1955 in-service left clavicle injury. According to the DD Form 214, the MOS was light weapons infantryman. Service treatment records indicate that the Veteran fell down barracks steps in June 1955 while he was stationed in Germany and fractured the left clavicle. The military medical examiner noted no artery or nerve involvement, but did find acute neuritis in the median nerve after he wore a plaster body cast. The Board notes that the diagnosed peripheral vascular disease in the left lower extremity is a chronic disease listed under 38 C.F.R. § 3.309(a). The weight of the evidence is against finding that the symptoms of the peripheral vascular disease in the left lower extremity were not chronic in service. The service treatment records do not contain a complaint of or treatment for symptoms associated with peripheral vascular disease in the left lower extremity, or any other circulatory symptoms during service in the left lower extremity. The June 1956 service separation examination indicates that the Veteran separated from service with a normal heart and a normal vascular system. The weight of the evidence is against finding that the Veteran experienced continuous symptoms of the peripheral vascular disease in the left lower extremity after service separation and against finding that the symptoms of the peripheral vascular disease in the left lower extremity manifested to a compensable degree within one year of separation from service. The first report of peripheral vascular disease symptoms of record was in an April 1991 correspondence, approximately 34 years after service separation. The Board also notes that the Veteran pursued claims for service connection for the left shoulder, increased rating for the left shoulder, and service connection for the lower back for over a period of several years before pursuing a claim for service connection for peripheral vascular disease in the left lower extremity. The weight of the evidence shows that the current blood circulation disorder did not have its onset in service and is not otherwise etiologically related to service. The Veteran submitted to a VA examination in January 2021. The Veteran was diagnosed with peripheral vascular disease with no obstruction and varicose veins, both in the lower left extremity. The VA examiner opined that it was less likely than not that the peripheral vascular disease (PVD) in the left lower extremity is related to the in-service June 1955 neuritis associated with the left clavicle injury or leg pain associated with the Veteran’s MOS. The VA examiner in January 2021 reasoned that the PVD was caused by the non-service-connected diabetes. The VA examiner explained that the PVD “is increased in diabetic patients, occurs earlier and is often more severe and diffuse.” The VA examiner also explained that “endothelial dysfunction, vascular smooth muscle cell dysfunction, inflammation and hypercoagubility are the key factors in diabetic arteriopathy.” The VA examiner concluded that there is no history to support that PVD was caused during service. The VA examiner also opined that it was less likely than not that the varicose veins is related to the in-service June 1955 neuritis associated with the left clavicle injury or leg pain associated with the Veteran’s MOS. The VA examiner opined that the varicose veins were caused by the non-service-connected diabetes. The VA examiner explained that patients with diabetes can develop varicose veins due to levels of blood glucose which damage the veins and can delay blood passing through some smaller blood vessels in the legs and feet. The VA examiner concluded that there is no history to support that varicose veins was caused during service. For these reasons, the Board finds that the criteria for service connection for the blood circulation disorders, diagnosed as peripheral vascular disease and varicose veins, have not been met. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Costantino, 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.