Citation Nr: 21029835 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 17-24 782 DATE: May 17, 2021 ORDER Service connection for bilateral lower extremities varicosities (bilateral leg varicose veins) is granted. FINDING OF FACT The Veteran's bilateral leg varicose veins are related to his active military service. CONCLUSION OF LAW The criteria for service connection for bilateral leg varicose veins are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army Reserve from October 2004 until his honorable discharge in December 2005, with service in Southwest Asia (Iraq) as a petroleum supply specialist. This appeal is being treated expeditiously on the Board of Veterans' Appeals' (Board) docket pursuant to 38 U.S.C. §§ 5109B, 7112 and 38 C.F.R. § 20.902(d). This case comes before the Board on appeal from an October 2016 decision a Regional Office of the United States Department of Veterans Affairs (VA), which denied service connection for the claimed disability. The Veteran filed a timely appeal and did not request to testify before the Board. In a March 2019 decision, the Board denied the Veteran's claim for service connection for bilateral leg varicose veins. The Veteran subsequently appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). The Court issued a Memorandum Decision in September 2020 vacating the Board's decision and remanding the case for readjudication. The Court held the June 2016 VA medical examination on which the Board relied was inadequate because the examiner relied on an inaccurate factual basis and did not have all factual information before him at the time prior to issuing his negative-nexus medical opinion. Evidentiary Standards In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 12829 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to be entitled to service connection there must be competent, credible evidence of (1) a current disability, (2) an in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). When these elements are satisfied, service connection may be granted on a direct basis. Analysis The Board recognizes that as part of the Court's Memorandum Decision it wrote, "Remand thus is warranted for the Board to order a new examination that considers the appellant's lay statements of continuing symptoms since service, and lay statements submitted in support of his appeal." Because the Board grants service connection for bilateral leg varicose veins, there is no resulting prejudice by not obtaining a new VA examination. First element: A current disability The Veteran has a current diagnosis of bilateral leg varicose veins. June 2016 VA Medical Examination. Therefore, the first element is satisfied. Second element: An in-service event, injury, or illness, or aggravation thereof The Veteran generally asserts his active military service in Iraq resulted in his bilateral leg varicose veins, particularly due to his repetitive carrying of heavy materials and prolonged periods of standings. May 2017 VA Form 9, Appeal to the Board. The Board finds the Veteran's assertions are credible and an in-service event occurred. Therefore, the second element is satisfied. Third element: A causal link The Board finds the medical and lay evidence of record is sufficient to establish a causal link between the Veteran's active military service and his bilateral varicose veins. While the Veteran's in-service treatment records are silent as to any leg issues that occurred during his active military service, he reported experiencing swollen, stiff, or painful joints, and muscle aches within his November 2005 post-deployment health assessment. During a June 2016 VA examination, the Veteran reported being diagnosed with bilateral leg varicose veins in 2007. The Veteran has submitted three relevant lay statements. First, his brother, T.Z., stated that they were in the same military Company and Platoon. Prior to being deployed to Iraq, T.Z. said the Veteran never complained about any leg pain and T.Z. never observed the Veteran to have varicose veins. While in Iraq together, following long periods of standing, the Veteran complained of leg pain to T.Z. During physical training, T.Z. said that he observed the Veteran to have varicose veins and small, dark purple veins around his ankles. He observed the Veteran repeatedly rub his legs to reduce the swelling and pain where the varicose veins appeared. Second, the Veteran submitted a statement from a fellow service member, T.F. They served in Iraq together. T.F. stated that when they were initially deployed, he never heard the Veteran complain of leg problems. During their time in Iraq, the Veteran began complaining of frequent pain in his legs. During physical training, T.F. observed "what looked like puffy raised veins" in the Veteran's legs. Following their daily duties, which included carrying heavy equipment, T.F. observed the Veteran needed to elevate his legs at the end of the day due to pain. He also witnessed the Veteran massage the area of his legs where the veins were puffy and painful. Third, the Veteran submitted a statement from a fellow service member, G.S., who knew the Veteran prior to both of them serving in Iraq together. G.S. said that prior to serving in Iraq, the Veteran never had pain or discomfort in his legs. Following their daily duties, the Veteran routinely complained of leg pain. G.S. observed what he thought were varicose veins on the Veteran's legs. The Board finds the Veteran is capable of reporting his physical sensations of pain and experiences associated with his varicose veins. He is also competent to report when he began experiencing symptoms. Jandreau v. Nicholson, 493 F.3d 1372, 1377 (Fed. Cir. 2007) (noting general competence of laypersons to testify as to symptoms but not medical diagnosis). Likewise, the Board finds the Veteran's brother and fellow service members are competent to report what they observed about the Veteran's legs and actions, what the Veteran reported to them, and when these events occurred. Id. The Board finds the Veteran, his brother, and fellow service members' statements are credible and probative. Symptoms of varicose veins, such as swelling, discoloration, pain, and location, are capable of lay observation. The lay statements indicate that prior to active service, the Veteran did not have leg issues, to include any symptoms associated with varicose veins. While in service, the Veteran developed symptoms of pain, swelling, and discoloration of his legs, particularly his veins. Following his separation from service, he stated he was diagnosed with varicose veins in 2007. This would reasonably indicate his symptoms continued following service and did not resolve. He has continued to experience varicose veins since 2007, as documented by the June 2016 VA examination. This evidence reasonably demonstrates a continuity of symptoms associated with leg issues since service. See Savage v. Gober, 10 Vet. App. 488, 497 (1997) (holding that lay evidence of continuing symptoms of a disability following service can be sufficient to demonstrate a medical nexus between a current disability and an in-service event or injury, even where there is no medical opinion establishing that nexus). The Veteran also submitted a June 2016 letter from a private physician, Dr. M.H., who wrote that the Veteran's prolonged standing in the military is at least as likely as not the cause of his varicose veins. An accompanying medical record indicates the private physician did consider the Veteran's reported medical history and lay statements in addition to conducting an examination of the Veteran. Although the opinion is unsupported by rationale, in light of the lay statements offered by the Veteran, his brother, and fellow service members, the Board finds the opinion is still credible and has some probative value. Jandreau, 492 F.3d at 137277 (stating the Board retains discretion to make competency and credibility determinations and otherwise weigh the evidence submitted). In the absence of contrary evidence, the Board finds there is sufficient lay and medical evidence, when viewed together, to establish a medical nexus between the Veteran's bilateral leg varicose veins and his military service. Therefore, the third element is satisfied. Accordingly, service connection for bilateral lower extremities varicosities (bilateral leg varicose veins) is warranted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, 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.