Citation Nr: 22019554 Decision Date: 04/01/22 Archive Date: 04/01/22 DOCKET NO. 19-34 288 DATE: April 1, 2022 ORDER Entitlement to service connection for bilateral lower extremity peripheral vascular disease is denied. FINDING OF FACT Peripheral vascular disease of the bilateral lower extremities is not etiologically related to any event, injury, or disease in service, to include exposure to herbicide agents, and was not caused or aggravated by service-connected coronary artery disease. CONCLUSION OF LAW The criteria for service connection for bilateral lower extremity peripheral vascular disease are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1964 to December 1975. 1. Entitlement to service connection for bilateral lower extremity peripheral vascular disease is denied. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Generally, service connection requires: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be established for any disease diagnosed after separation from service when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For certain chronic diseases, such as cardiovascular-renal disease, presumption of service connection arises if the disease is manifested to a compensable degree within one year following discharge from service. That presumption is rebuttable by probative evidence to the contrary. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Service connection may be presumed due to an association with exposure to herbicide agents for certain diseases. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). The Veteran served on the ground in Vietnam during the Vietnam era and is presumed to have been exposed to herbicide agents. 38 C.F.R. § 3.307(a)(6)(iii). Unfortunately, while ischemic heart disease is a listed disability, peripheral arterial and peripheral vascular disease are not included on list of the diseases presumptively associated with herbicide exposure. 38 C.F.R. § 3.309(e). Rather, the applicable regulation specifically does not include peripheral manifestations of arterio-sclerosis as a disease that warrants presumptive service connection due to exposure to herbicide agents. The regulation states that the term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. 38 C.F.R. § 3.309(e), Note 2. The Board finds that service connection for peripheral vascular disease is not warranted on a presumptive basis. That disability is not considered to be presumptively related to herbicide agent exposure in service. On a direct basis, the Board finds that service connection for peripheral vascular disease is not warranted. The evidence does not show that the Veteran was diagnosed with peripheral vascular disease while in service or shortly after separation from service. Rather, the first indication of diagnosis of peripheral vascular disease is not until 2014, almost 40 years following service separation. While the Veteran has contended that he first started experiencing radiculopathy symptoms in the legs in service, he has not provided any specific contentions as to symptoms related to peripheral vascular disease beginning in service or shortly thereafter. There is no medical evidence or opinion to link the Veteran's peripheral vascular disease service or to exposure to herbicide agents in service. Accordingly, the Board finds no evidence of record to link the Veteran's peripheral vascular disease with service directly, to include as due to exposure to herbicide agents. On a secondary basis, the Veteran contends that peripheral vascular disease is related to service-connected coronary artery disease. Service connection may be established for a disability that is proximately due to, or aggravated by, service-connected disability. 38 C.F.R. § 3.310. The Board finds that the probative and competent evidence of record weighs against that contention. Specifically, two VA examiners have reviewed that assertion and have determined that it is less likely than not that the Veteran's peripheral vascular disease is proximately due to coronary artery disease. In September 2019, the VA examiner explained that peripheral vascular disease was not caused by coronary artery disease because coronary artery disease affected the heart and not the lower extremities. Peripheral vascular disease was caused by build up of fatty deposits in the lower extremities, whereas coronary artery disease was caused by build up of deposits in the heart. Therefore, while the two conditions occurred due to the same reason, coronary artery disease was not known to be a cause of peripheral vascular disease. In June 2020, a similar VA opinion was provided. The VA examiner stating that there was a lack of a pathophysiologic relationship to connect the two disabilities. While the two conditions shared common contributing risk factors, and having peripheral vascular disease could be an indication also of having coronary artery disease, it was less likely than not the coronary artery disease aggravated the left lower extremity peripheral artery disease for which the Veteran had surgery in 2014. The Board finds that those opinions are highly probative evidence against the Veteran's claim. Both opinions provided a well-explained rationale for the conclusion reached, and were based upon a review of the Veteran's records. The Board notes that the 2020 VA examiner provided the requested opinion under the wrong section of the Disability Benefits Questionnaire, listing this opinion under a section set aside for when a disability pre-exists service. However, despite that administrative error, the Board finds that the opinion is adequate for rating purposes and is responsive to the question of aggravation. The Board has considered the other evidence of record, to include an April 2017 medical opinion stating that the Veteran's coronary artery disease and bilateral aorta-iliac bypass do not occur in a vacuum and are related. However, as further explained by the two subsequent VA opinions, while coronary artery disease and peripheral vascular disease share similar risk factors, the evidence does not demonstrate that the service-connected coronary artery disease caused or aggravated peripheral vascular disease. Thus, the criteria for service connection on a secondary basis are not met. The Veteran believes his peripheral vascular disease is proximately due to or aggravated by service-connected coronary artery disease, or is due to service. The Veteran in this case is not competent to provide an etiology opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). Accordingly, the Board gives more probative weight to the two VA opinions obtained, and finds that the evidence is not in approximate balance. There is no reasonable doubt to resolve in favor of the Veteran. Therefore, as the evidence weighs against the claim for service connection for peripheral vascular disease, the claim must be denied. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals R. Erdheim, Attorney for the Board Department of Veterans Affairs 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.