Citation Nr: 21041118 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 08-09 835A DATE: July 8, 2021 ORDER A disability rating greater than 10 percent for varicose veins of the right leg for the period from April 14, 2006 to January 4, 2018 is denied. A disability rating greater than 10 percent for varicose veins of the left leg for the period from April 14, 2006 to January 4, 2018 is denied. A 40 percent rating effective January 4, 2018, for varicose veins of the right leg is granted. A 40 percent rating effective January 4, 2018, for varicose veins of the left leg is granted. FINDINGS OF FACT 1. Before January 4, 2018, the service-connected varicose veins of the right leg caused pain and fatigue in the leg after prolonged standing or walking. There was no edema and the symptoms were relieved by elevation of the extremity or use of compression hosiery. 2. Before January 4, 2018, the service-connected varicose veins of the left leg caused pain and fatigue in the leg after prolonged standing or walking. There was no edema and the symptoms were relieved by elevation of the extremity or use of compression hosiery. 3. Beginning January 4, 2018, the service-connected varicose veins of the right leg were manifested by persistent edema; pain, aching and fatigue in the leg; and stasis pigmentation. 4. Beginning January 4, 2018, the service-connected varicose veins of the left leg were manifested by persistent edema; pain, aching and fatigue in the leg; and stasis pigmentation. CONCLUSIONS OF LAW 1. The criteria for a rating of more than 10 percent for varicose veins of the right leg for the period from April 14, 2006 to January 4, 2018 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § §§ 3.102, 4.1, 4.2, 4.6, 4.7, 4.104, Diagnostic Code 7120. 2. The criteria for a rating of more than 10 percent for varicose veins of the left leg for the period from April 14, 2006 to January 4, 2018 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § §§ 3.102, 4.1, 4.2, 4.6, 4.7, 4.104, Diagnostic Code 7120. 3. The criteria for a 40 percent rating for varicose veins of the right leg for the period beginning January 4, 2018 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § §§ 3.102, 4.1, 4.2, 4.6, 4.7, 4.104, Diagnostic Code 7120. 4. The criteria for a 40 percent rating for varicose veins of the left leg for the period beginning January 4, 2018 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § §§ 3.102, 4.1, 4.2, 4.6, 4.7, 4.104, Diagnostic Code 7120. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1978 to August 1978; January 1982 to January 1990 and from October 1997 to May 2002. Effective May 2019, the Veteran's combined rating of service-connected disabilities is 100 percent. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from an October 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office. In February 2017, the Veteran testified at a video-conference hearing before the undersigned. A transcript of the hearing is included in the electronic case file. In the August 2017, the Board remanded the claims for further examination to evaluate the current severity and manifestations of his varicose veins. In April 2018 the RO increased the ratings for the Veteran's service-connected varicose veins of the right and left legs to 20 percent each, effective January 4, 2018. As higher ratings for varicose veins of the right and left legs are possible both before and after January 4, 2018, the claim for increased ratings remains pending. AB v. Brown, 6 Vet. App. 35 (1993). The Veteran contends that he is entitled to ratings in excess of 10 percent (prior to January 2018) and in excess of 20 percent (beginning January 2018), alleging that he experiences persistent swelling that was not completely relieved by elevation or compression hosiery, and discoloration or pigmentation and ulceration in his lower extremities. Because his symptoms were relieved by elevation and compression hosiery and there was no evidence of edema, the claims for increased ratings for his varicose veins of the legs will be denied for the period before January 4, 2018. For the period beginning January 4, 2018, because there is evidence of persistent edema and stasis pigmentation, 40 percent ratings for the varicose veins of the legs will be assigned. Increased Rating 1. Entitlement to a rating in excess of 10 percent for varicose veins of the right leg for the period from April 14, 2006 to January 4, 2018 2. Entitlement to a rating in excess of 10 percent for varicose veins of the left leg for the period from April 14, 2006 to January 4, 2008 3. Entitlement to a rating in excess of 20 percent for varicose veins of the right leg for the period beginning January 4, 2018 4. Entitlement to a rating in excess of 20 percent for varicose veins of the left leg for the period beginning January 4, 2018 Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Diagnostic Codes ("DC's) describe specific disabilities. The Court has held that "staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Where 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. See 38 C.F.R. § § 4.7. The rating for the Veteran's varicose veins of the right and left legs is assigned pursuant to Diagnostic Code 7120. A 10 percent rating is assigned for varicose veins with 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 assigned for varicose veins with persistent edema, incompletely relieved by elevation of extremity with or without beginning stasis pigmentation or eczema. A 40 percent rating is assigned for varicose veins with persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent rating is assigned for varicose veins with persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. A 100 percent rating is assigned for varicose veins with the following findings attributed to the effects of varicose veins: massive board-like edema with constant pain at rest. 38 C.F.R. § 4.104. During an August 2006 VA arteries, veins and miscellaneous examination, the Veteran complained of aching and tiredness of his legs with "peculiar feelings of sensation." There had been no swelling. He used compression stockings daily and they were somewhat effective in relieving his symptoms. He complained that if he stood for any length of time his legs would ache. He reported that if he was shopping with his wife, he would have to sit and relieve his pain. Objective examination showed large varicose veins anterior and posterior from the knee down to the ankles; above the knees there were small varicose veins. There was no phlebitis, post phlebitic syndrome, or edema. During an April 2011 VA arteries, veins and miscellaneous examination, the Veteran reported worsening pain and fatigue in his legs. Daily use of compression stockings alleviated the varicose veins to some degree. However, his varicose veins caused pain, even at rest and he described aching, fatigue, and throbbing after prolonged walking or standing. His symptoms were relieved by elevation or compression hosiery. Edema, skin discoloration and ulceration were not present. Objectively, there was stasis pigmentation or eczema in the lower extremities but no edema or ulceration. The examiner observed tortuous varicosities in the bilateral lower extremities and superficial blue varicosities in the left upper leg. During a May 2016 VA artery and vein conditions examination, the Veteran complained of pain and fatigue on both legs with prolonged walking and prolonged standing. He wore compression stockings and kept his legs elevated to prevent swelling. His varicose veins caused aching and fatigue in his legs after prolonged standing and prolonged walking and beginning stasis pigmentation in his legs. His symptoms were relieved by elevation and compression hosiery. Physical examination showed there was no edema; minimal skin changes on the distal legs; visible and palpable bluish tortuous veins along the anterior aspect of both legs; and, more pronounced, bigger veins on both calves. The varicosities were more pronounced when the Veteran stood. During a December 2017 VA artery and vein conditions examination, the Veteran complained of aching and heaviness in his legs and sharp pain in his posterior calves. He experienced fatigue with standing and walking. He elevated his legs and wore compression hosiery, but neither was effective in relieving his symptoms. He had undergone an ablation procedure in January 2017 that reduced the number of visibile varicosities but had no effect on his symptoms. Documented symptoms attributable to his varicose veins in his legs included aching and fatigue in his legs after prolonged standing and prolonged walking and beginning stasis pigmentation. A January 2018 private treatment statement reflects that the Veteran had varicose veins of both legs with edema. Current symptoms included persistent edema, painful, achy, heavy-feeling legs, and constant itching. The symptoms were not relieved by elevation of the legs, even though the Veteran had undergone ambulatory vein ablation surgery in January 2017. The Veteran's aching and fatigue in both legs after prolonged standing or walking was severe and affected his mobility in his occupation. In addition, the persistent edema and constant itching affected the Veteran's quality of life and required him to seek constant relief throughout the day. During an August 2018 VA artery and vein conditions examination, the Veteran complained of daily, constant itching from dry skin on both lower legs; discoloration from ablation on his right lower leg; and, occasional sharp, shooting pains with constant dull, achy heaviness on his lower legs due to his varicose veins. Compression stocking provided no relief for his leg pains and prescribed moisturizing lotion provided no relief for the dry skin on both lower legs. Documented symptoms attributable to his varicose veins included aching and fatigue in the legs after prolonged standing and prolonged walking and beginning stasis pigmentation. The Veteran worked as a security specialist and reported that both legs hurt due to swelling from prolonged standing and walking during work. A January 2020 VA treatment record documents that the Veteran's varicose veins of the bilateral lower legs was stable. The Veteran continued use of compression stockings as needed for treatment. During a November 2020 VA artery and vein conditions examination, the Veteran complained of intermittent, shooting pain when walking or standing for a prolonged period with discomfort at rest in his legs. He used compression stockings and elevated his feet when possible. Documented symptoms attributable to his varicose veins of the legs included aching in the legs after prolonged standing and prolonged walking and constant pain at rest. Before January 4, 2018, the symptoms attributable to the Veteran's varicose veins (i.e., pain, aching and fatigue in his legs after prolonged standing and prolonged walking) were relieved by elevation of the extremity or use of compression hosiery. This is shown in the reports of VA examinations in August 2006, April 2011, and May 2016. The Veteran also did not have edema when examined. Though the December 2017 VA examination found that elevation of his legs and use of compression hosiery was not effective in relieving his symptoms (i.e., aching and fatigue in his legs after prolonged standing and prolonged walking) and despite the demonstration of beginning stasis pigmentation, the Veteran did not have persistent edema. The preponderance of the evidence is therefore against ratings of more than 10 percent for varicose veins of the right and left legs for the period from April 14, 2006 to January 4, 2018. However, the January 2018 private treatment statement found that current symptoms of the Veteran's varicose veins of the bilateral legs included persistent edema; painful, achy, heavy-feeling legs; and, constant itching not relieved by elevation of the legs. The August 2018 VA examination found that current symptoms of the varicose veins of the bilateral legs included aching and fatigue in the legs after prolonged standing and prolonged walking and beginning stasis pigmentation and the Veteran reported that both legs hurt due to swelling from prolonged standing and walking. Because there is evidence of persistent edema and stasis pigmentation, 40 percent ratings are warranted for the varicose veins of the right and left legs beginning January 4, 2018. Because there is no evidence of ulceration (persistent or otherwise), the preponderance of the evidence is against assignment of ratings of more than 40 percent for varicose veins of the right and left legs for the period beginning January 4, 2018. The Veteran has not raised any other issues, nor has the record reasonably raised any other issues. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (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). Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Jackson 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.