Citation Nr: 21040300 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 17-02 633 DATE: July 3, 2021 ORDER Entitlement to service connection for right leg varicose veins is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's current right leg varicose veins are related to her active service. CONCLUSION OF LAW The criteria for entitlement to service connection for right leg varicose veins have not been met. 38 U.S.C. §§ 1110, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had a period of active duty for training (ACDUTRA) from January to June 1975 and had active service from January to May 1991 in the U.S. Air Force. She had additional ACDUTRA and INACDUTRA periods in the U.S. Air Force Reserve from January 1975 to January 2013. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, the Board remanded the claim for further development. There has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). In the December 2018 remand, the Board also remanded service connection claims for left shoulder disorder, left wrist disorder, and left wrist carpal tunnel. The Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a VA Form 10182, Decision Review Request: Board Appeal, in September 2020 for each of these claims. Thus, they are the subject of a separate AMA decision. The Veteran contends that she has a current diagnosis of right leg varicose veins that are related to her active service. The question for the Board is whether she has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As discussed below, the Board concludes that, although she has a current diagnosis of right leg varicose veins and she was treated for varicose veins during her Reserve service, the preponderance of the evidence weighs against finding that the current right leg varicose veins are related to her active duty service, a disease or injury incurred during a period of ACDUTRA, or an injury during INACDUTRA. Turning to the records, the Veteran was normal at the January 1975 enlistment exam without any indication of varicose veins. The service treatment records (STRs) during her active service period from January to June 1975 do not show any complaints of or treatment for varicose veins. In an October 1995 emergency room record, the clinician noted the Veteran presented with history of venous veins to the right leg. She noticed a bruise to back of calf. There was no injury or trauma. The bruise was hard and painful. Physical examination of the right leg revealed bruise on the calf with very superficial multiple varicose veins without swelling, tenderness, or cords. The assessment was right leg contusion. In a September 1997 medical record, she reported heavy feeling in the calves at the end of the day. Observation of the right leg noted tortuous dilated vessels across knee and medial part of calf, and telangiectasias at the knee. Observation of the left leg noted minimal dilation with few telangiectasias. The assessment was varicose veins. Surgical options were discussed and compression stockings were dispensed. A November 1997 medical record from Dr. T.H. noted symptoms of varicose veins. It noted relief of symptoms with Jobst stockings. It noted that the Veteran desired sclerotherapy for telangiectasias. The assessment was varicose veins. She was scheduled for sclerotherapy. A November 1997 request for administration of anesthesia noted "sclerotherapy." The nature of the procedure was "inject varicose veins." A December 1997 medical record from Dr. T.H. noted that the following risks of sclerotherapy were explained: bruising, ulceration, and allergic reaction. The Veteran voiced understanding and wished to proceed. It noted 0.2-0.4 milliliter of NA tetradecyl sulfate was injected into telangiectasis in the bilateral lower extremities. Total 2 milliliters were injected. A January 1998 medical record by Dr. T.H. noted status post sclerotherapy with mild pigmentation changes at injection site. It noted there were telangiectasias and varicosities, and excision of varicosities was offered. Prescription was deferred. It noted continue compression stockings daily. In a November 2008 private treatment record, the Veteran noted that she had varicose veins during the past 12 months. In a February 2010 private treatment record, she noted that she had varicose veins during the past 12 months. In an August 2010 private patient consultation form for sclerotherapy, the Veteran noted she has been treated for unwanted veins which was sclerotherapy. She noted her problem with veins began when she was 41 years old. She noted the veins occurred after pregnancy. She noted she has family members with a history of varicose or spider veins. She noted she is developing new veins. She noted the veins are getting bigger. She reported that her legs ache after prolonged standing or sitting. A September 2010 private treatment record shows informed consent form for sclerotherapy. It noted the Veteran understands that this is a procedure in which her unwanted varicose veins or spider veins are injected with a strong saline solution to destroy the vein walls and about 10 percent of the people are not happy with their results following this therapy. An October 2010 sclerotherapy patient consent forms noted that the Veteran consented to the sclerotherapy in her right leg for spider veins. In a March 2011 private x-ray, the clinician noted there was large varicose veins. In a February 2012 private treatment record, the Veteran noted she had varicose veins during the past 12 months. A September 2012 VA examination for artery and vein conditions noted a diagnosis of varicose veins as of 1997. The Veteran reported that she did not have varicose veins upon entering the service in 1975 when she was 19 years old. She reported she was diagnosed with a large varicosity of the right greater saphenous vein as well as bilateral spider veins (telangiectasias) in her bilateral lower extremities, more in the right than left. She was offered surgical treatment of the varicose veins, particularly the large varicosity of the greater saphenous vein of the right lower extremity, but deferred at that time and was treated with thigh high compression stockings. She reported that in December 1997, she underwent sclerotherapy for the smaller spider veins, and that she had another session of sclerotherapy 4-6 weeks later. She reported she eventually abandoned treatment for this issue until approximately 10 years later when she saw her civilian provider. She reported she was prescribed compression stockings, and had another attempt of sclerotherapy for the smaller spider veins which did not help much. She stated that the compression stockings did help, but she eventually abandoned using them due to inconvenience and irritation. She reported that ever since, she has been bothered by aching in both lower extremities when on her feet for any prolonged period of time. No nexus opinion was provided. In a March 2013 private record, the review of her cardiovascular system was positive for varicosities. In the February 2014 notice of disagreement (NOD), the Veteran asserted that she was treated for her varicose veins while on active duty. She stated she was a medical service specialist and emergency medical technician for 25 years, carried heavy patients in the field, and moved and transferred patients in and out of bed, wheelchair, gurney, etc. She believed that wearing combat boots for 38 years also caused further varicose veins damage in her right leg. An October 2019 VA treatment record noted right leg varicose vein stripping in January 2016. The Veteran underwent a VA examination for artery and vein conditions in March 2020. She was diagnosed with varicose veins as of 1995. She reported that her varicose veins started getting bad around 1980s. She stated she had varicose veins prior to active duty and she was treated for and had sclerotherapy during active service. She reported surgery in 2016 for stripping of the veins on the right. She reported she does not wear compression stockings. She stated she had sclerotherapy around 2001. The examiner noted that a May 1997 record noted right leg tortuous dilated vessel and a December 1997 record noted sclerotherapy. The examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that she reviewed the medical records and could not find that the Veteran was diagnosed with varicose veins while on active duty. The examiner noted that the records she was able to find for varicose veins are from 1997 and the record did not list Veteran on active duty at that time. The examiner concluded that varicose veins did not incur in military service. In an August 2020 addendum opinion, a VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that right leg varicose veins were initially noted in 1995, 4 years after the last active duty period in 1991. The examiner noted that the right leg varicose vein condition is chronic but there was no documentation of it during active duty service "at all." Given the above, the Board finds that service connection for right leg varicose veins is not warranted. The Veteran has asserted that she had the varicose veins prior to active duty and she had sclerotherapy while on active duty. The evidence of record does not show that the right leg varicose veins preexisted active service. She was normal at the entrance examination in 1975 and the first clinical record showing right leg varicose veins was in 1995. Thus, any claim based on aggravation during active service is not warranted. Further, she stated at the March 2020 exam that she was treated for and had sclerotherapy during active service. Her active duty STRs are silent as to any complaints or treatments related to right leg varicose veins. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). As noted, the first clinical record noting right leg varicose veins was in 1995 which was 4 years after her active service. The records show she first had her sclerotherapy in 1997 which was 6 years after her active service. The Board observes in this regard that evidence of a prolonged period without medical complaint, and the amount of time that elapsed since military service, can be considered as evidence against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Although she is competent to report having experienced symptoms related to right leg varicose veins, she is not competent to provide a diagnosis in this case or determine that her symptoms were manifestations of the current diagnosed right leg varicose veins. The issue is medically complex as it requires knowledge of interpreting complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, to the extent that the Veteran has attributed the currently diagnosed right leg varicose veins to active service, her statements are not probative. Moreover, when a claim for service connection is based only on a period of ACDUTRA or INACDUTRA, there must be evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during that period of ACDUTRA or INACDUTRA. See 38 U.S.C. §§ 101(2), (22), (24); 38 C.F.R. § 3.6(a). Here, the records do not include a line of duty determination for the claimed condition. And no other evidence is presented to support her assertion that her right leg varicose veins occurred or were aggravated in the line of duty. Furthermore, the March and August 2020 examiners opined that her right leg varicose veins are less likely than not caused by or the result of her active service. The March 2020 examiner explained that she could not find that the Veteran was diagnosed with varicose veins during active service. The examiner noted that the records showing varicose veins were from 1997 which was not an active duty period. The August 2020 examiner noted that the Veteran's right leg varicose veins were noted initially in 1995 which was 4 years after the last active duty period in 1991. The examiner noted that there is no documentation of right leg varicose veins during active duty service. The Board finds these opinions to be probative because they are based on accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board accepts these opinions as probative evidence that the Veteran's current right leg varicose veins are not related to her active service. There is no other competent medical opinion of record other than the Veteran's own assertions. In summary, the Board finds that service connection for right leg varicose veins is not warranted. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jake Choi, 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.