Citation NR: 9612366	
Decision Date: 05/06/96		Archive Date: 05/16/96
DOCKET NO.  94-13 937	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Buffalo, 
New York


THE ISSUES

1.  Entitlement to service connection for varicose veins of 
the right lower extremity.

2.  Entitlement to an increased evaluation for 
psychoneurosis, anxiety state, currently evaluated as 10 
percent disabling.


REPRESENTATION

Appellant represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

Suzie St. Vil, Counsel



INTRODUCTION

The veteran had active military service from September 1943 
to December 1944.  He has been represented throughout his 
appeal by the Disabled American Veterans.  

This matter came before the Board of Veterans’ Appeals 
(hereinafter Board) on appeal from a rating decision of 
November 1993, by the Buffalo, New York Regional Office (RO), 
which increased the evaluation for the veteran’s service-
connected varicose veins of the left leg, from a 10 percent 
rating to a 20 percent rating, effective December 1, 1992; 
however, this rating action denied the claims for service 
connection for varicose veins of the right leg, and an 
increased rating for psychoneurosis, anxiety state.  The 
notice of disagreement with the denial of the veteran’s 
claims for service connection for varicose veins of the right 
leg and an increased rating for a psychiatric disorder was 
received in January 1994.  The statement of the case, with 
respect to the above issues, was issued in March 1994.  The 
substantive appeal was received in March 1994.  

Following the receipt of additional medical records, a rating 
action of May 1994 confirmed the previous denial of the 
veteran’s claim for service connection for varicose veins of 
the right leg, as well as a claim for an increased rating for 
his service-connected psychiatric disorder.  A Department of 
Veterans Affairs (VA) compensation examination was conducted 
in April 1995.  Thereafter, a rating action of May 1995 
confirmed the previous denial of the veteran’s claim for 
service connection for varicose veins of the right leg, as 
well as a claim for an increased rating for his service-
connected psychiatric disorder.  A rating action of August 
1995 confirmed the previous denials of the veteran’s claims.  
The appeal was thereafter received at the Board.  


CONTENTIONS OF APPELLANT ON APPEAL

The veteran essentially contends that he is entitled to 
service connection for varicose veins of the right leg.  The 
veteran maintains that he had bilateral varicose veins in 
service.  The service representative asserts that medical 
evidence of record confirms the findings of varicose veins in 
the veteran’s right lower extremity.  In addition, it is 
maintained that the veteran’s service-connected psychiatric 
disorder is more severe than reflected by the 10 percent 
rating currently assigned.  The veteran indicates that he has 
problems with tension, nightmares, loss of sleep, and 
anxiety.  Therefore, it is argued that the veteran’s 
psychiatric disorder has become worse and, as such, an 
increased rating is warranted.  It is requested that the 
veteran be accorded the benefit of the doubt.  


DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1995), has reviewed and considered 
all of the evidence and material of record in the veteran's 
claims file.  Based on its review of the relevant evidence in 
this matter, and for the following reasons and bases, it is 
the decision of the Board that the preponderance of the 
evidence is against the claims for service connection for 
varicose veins of the right lower extremity, and a rating in 
excess of 10 percent for the veteran’s service-connected 
psychoneurosis, anxiety state.  


FINDINGS OF FACT

1.  All relevant evidence necessary for an equitable 
disposition of the veteran’s claim has been obtained by the 
RO.  

2.  Service medical records are negative for any complaints, 
findings or manifestations of varicose veins in the right 
lower extremity.  

3.  Varicose veins in the right lower extremity were first 
shown many years after service, and are not shown to be 
related to military service.  

4.  The veteran's service-connected psychoneurosis, anxiety 
state, is manifested primarily by mild to moderate anxiety, 
depression, complaints of stomach problems, and complaints of 
difficulty sleeping.  His symptoms are not productive of more 
than mild social and industrial impairment.  


CONCLUSIONS OF LAW

1.  Varicose veins of the right lower extremity were not 
incurred in or aggravated by service.  38 U.S.C.A. §§ 1110, 
5107 (West 1991); 38 C.F.R. § 3.303 (1995).  

2.  The criteria for an evaluation in excess of 10 percent 
for psychoneurosis, anxiety state have not been met.  38 
U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 
4.132, Part 4, Code 9400 (1995).  


REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The veteran's claims are "well-grounded" within the meaning 
of 38 U.S.C.A. § 5107(a) (West 1991).  That is the claims are 
plausible.  Moreover, all relevant facts have been properly 
developed.  Therefore, no further assistance to the veteran 
is required to comply with the duty to assist as mandated by 
38 U.S.C.A. § 5107(a).  

The pertinent facts in this case may be briefly described.  
The records reflect that the veteran entered active duty in 
September 1943.  An enlistment examination, conducted in 
September 1943, was negative for any varicose veins of the 
right leg.  The records show that the veteran was diagnosed 
with varicose veins in the left leg in February 1944; he 
underwent high and low ligation of the left leg.  Among the 
records is the report of a Medical Board survey, dated in 
October 1944, indicating that the veteran was admitted to the 
hospital because of complaints of pain in the left side and 
stomach, constipation, headaches and nervousness.  It was 
reported that, since August 1944, the veteran had been in and 
out of hospitals with loin pain; it soon became obvious that 
the veteran was highly nervous, and a diagnosis of 
psychoneurosis anxiety neurosis was established in September 
1944.  It was also reported that his illness started by a 
buzz bomb exploding near his ship; that night, he went on 
liberty and became acutely ill with flank pain, nervousness, 
and restlessness.  Following the evaluation, it was the 
opinion of the board that the veteran was suffering from 
psychoneurosis, anxiety neurosis, and he was no longer fit to 
continue in service.  

At the time of the veteran’s initial examination by the VA in 
September 1945, he stated that when he was in the Navy in 
England, a bomb dropped near his ship and he got nervous.  
The veteran reported that he went to a doctor once in 
February 1945, because he was feeling upset, weak, and 
nervous.  The veteran also reported that he had pains in his 
left side and back, with cramps in the abdomen and nausea.  
The veteran further reported that he suffered from insomnia 
and nightmares.  He indicated that he trembled when he got 
upset.  The veteran related that noise of motors or airplanes 
were upsetting to him, and he was unable to tolerate 
unexpected noises and arguments.  Following a mental status 
evaluation, the examiner reported a diagnosis of 
psychoneurosis, anxiety state, chronic.  In the blank on the 
examination report for findings regarding varicose veins, the 
examiner wrote “no.”  According to a report of a VA 
compensation of March 1946, the findings with regard to 
varicose veins were “none.”  Regarding the psychoneurosis,  
the examination report included findings and a diagnosis 
similar to the report of 1945.  

Received in November 1946 was a social worker report, dated 
in August 1946, which consisted of an evaluation of the 
veteran in his home.  The veteran reported that he was not 
feeling well.  He indicated that he became nervous when he 
was with a group of people.  He complained of stomach pains, 
cramps, constipation and dizziness.  The social worker 
reported that the veteran was very reluctant to talk about 
his war experiences.  The social worker observed that the 
veteran was in need of out-patient psychotherapy.  

Medical evidence of record in the 1950’s, including VA as 
well as private treatment records, reflect that the veteran 
continued to receive clinical evaluation for symptoms of 
psychoneurosis, including headaches, nervousness, insomnia, 
and a host of somatic complaints.  These records also show 
treatment and evaluation for varicose veins.  An orthopedic 
examination, conducted in March 1952, was essentially 
negative.  Among these records is a certificate of attending 
physician from Kenneth F. Gale, M.D., dated in March 1953, 
indicating that the veteran recently began experiencing pain 
and cramping in his legs.  Dr. Gale reported findings of 
recurrent varicose veins in both legs; he noted that the 
veteran was treated with multiple high and low ligation of 
the right leg and religation of the left leg.  Also of record 
was a lay statement, dated in March 1953, certifying to the 
fact that the veteran had operations in the fall of 1943 and 
spring of 1944 at the Sampson Naval base.  During a VA 
compensation examination in April 1953, the veteran 
complained of varicose veins in both legs.  He indicated that 
he had one operation in 1940’s and another in 1953.  
Examination and X-rays revealed varicose veins in both legs.  
A subsequent VA examination in March 1958 reported the 
diagnoses of anxiety reaction, severe, tenseness, and 
restless with many somatic complaints; and, recurrent 
varicose veins, symptomatic.  It was recommended that the 
veteran be fitted for a pair of elastic stockings.  

Received in June 1965 was a VA treatment summary, dated in 
May 1965, indicating that the veteran continued to be 
occupied in the somatic field; he complained of gassy spells, 
and he was subject to pain in his left upper abdominal 
quadrant.  It was reported that the veteran was also subject 
to spells of constipation and diarrhea.  It was further 
reported that he had chronic phlebitis, which could be a 
contributing factor to his tiredness.  The examiner noted 
that the veteran was subject to headaches, pain in the neck, 
and so forth.  

The veteran was afforded a VA compensation examination in 
August 1965, at which time he continued to have complaints 
referable to his lower extremities; he indicated that they 
became tired after standing.  The veteran reported that the 
veins were becoming more prominent.  The pertinent diagnosis 
was status post multiple operations of varicose veins with 
residual symptoms, residual varicose veins of mild nature.  
The veteran was also afforded a psychiatric examination, at 
which time he indicated that he felt nervous and was all 
shook up.  The veteran further indicated that he had 
headaches, blurred vision, stomach pains and butterflies in 
his stomach.  The veteran also complained of irregular bowel 
function, chest pain, insomnia, and tightening of the cords 
in his neck.  The veteran reported that he dreamt a lot and 
was quite restless; as a result, he was often tired in the 
morning.  The veteran was described as somewhat shy and 
bashful.  It was noted that he suffered from chronic fatigue.  
The pertinent diagnosis was anxiety reaction, chronic.  

Received in February 1993 were VA medical records covering 
the period from July 1987 to January 1993, which essentially 
show that the veteran continued to receive clinical attention 
for multiple somatic complaints, including headaches and 
stomach problems.  

The veteran was afforded a VA compensation examination in 
March 1993, at which time he reported that he had had 
persistent difficulties with his lower extremity.  He 
indicated that he occasionally noticed some swelling of his 
legs.  The veteran related that he had noted recurrent 
varicose veins at both lower extremities.  He stated that he 
felt unsteady on his lower extremity and had some problems 
with balance.  On examination, it was noted that the veteran 
walked somewhat unsteadily without the use of a cane.  He had 
scars from previous surgery.  The examiner noted that there 
were scattered varicose veins in both lower extremities above 
and below the knees anteriorly and posteriorly; the varicose 
veins were irregular in distribution.  There was no evidence 
of persistence in the greater saphenous or lesser saphenous 
veins, but rather small areas of varicosities of both lower 
extremities which were associated with some pigmentation of 
the skin.  Pedal pulses were of good volume and there was no 
evidence of arterial insufficiency from the clinical point of 
view.  The conclusion was persistent symptomatic varicose 
veins of both lower extremities, following surgery treatment 
of the varicose veins on two occasions in the past.  

The veteran was also accorded a psychiatric examination in 
March 1993, at which time he complained of fatigue, being 
worried and depressive sympatric symptoms; he also complained 
of marital discord, headaches, and insomnia because of bad 
dreams about his service experiences.  It was noted that the 
veteran had never been psychiatrically hospitalized.  The 
veteran reported that he was last employed 10 years ago, but 
he became unemployed when he injured his back.  On mental 
status evaluation, the veteran’s verbal style was tense and 
uneasy.  He complained constantly about things wrong with his 
wife.  He exhibited a halting speech pattern and was 
extremely circumstantial.  He was oriented in all spheres; 
consortium was clear.  There was no evidence of thought 
blocking.  He did not exhibit any hallucinations or delusions 
or schizophrenia trends.  Judgment and reasoning were 
adequate.  The diagnosis was generalized anxiety disorder; 
and dependent personality disorder.  It was recommended that 
the veteran continued in supportive therapy.  

Of record is a medical statement from Dr. Kenneth E. Gale, 
dated in May 1993, who reported that the veteran was first 
seen in his office in 1953 for recurrent varicose veins and 
was last seen in 1963 for an unrelated complaints.  

Received in April 1994 were VA outpatient treatment records 
for the period from October 1992 to November 1993, showing 
that the veteran continued to receive clinical attention for 
multiple somatic complaints, including headaches and stomach 
problems.  The veteran complained of difficulty sleeping, and 
problems associated with marital discord.  These records 
continue to show a diagnosis of anxiety neurosis.  Received 
in March 1995 were VA outpatient treatment reports for the 
period from July 1993 to November 1994, which show that the 
veteran continued to be seen and evaluated for somatic 
concerns.  In July 1994, the veteran complained of headaches, 
increasing dreams and nightmares, and upset stomach on 
medications.  The veteran was prescribed a new medication.  
When seen in August 1994, the veteran reported feeling more 
irritable.  It was noted that his symptoms remained 
unchanged; they included anxiety, somatic complaints, and 
marital discord.  

The veteran was afforded a VA compensation examination in 
April 1995, at which time he reported that his symptoms 
remained the same; he indicated that he had a chronic sense 
of being worried, depressed, difficulty sleeping, anxious and 
feeling in the morning of electric shocks to his head.  It 
was reported that the veteran was in a chronically 
dysfunctional marriage, but mutually dependent.  It was also 
reported that the veteran had never been psychiatrically 
hospitalized.  It was further noted that he was last employed 
as a laborer in the early 1980’s, but he retired because of 
back problems.  

On mental status evaluation, the veteran was described as 
whinny, complaining and tense.  He was very circumstantial in 
his verbalization and only wanted to discuss his physical and 
emotional problems.  There was no evidence of hallucinations, 
delusions or thought blocking or thought disorder.  There was 
no evidence of psychotic symptoms.  His insight and judgment 
were poor.  He was oriented in all spheres.  He continued to 
be maintained on Valium.  The pertinent diagnoses were 
generalized anxiety disorder, and dependent personality 
disorder.  The examiner recommended that the veteran 
continued his supportive treatment.  It was noted that the 
veteran was administered the Beck Depression Inventory, on 
which he received a score of 16, which was consistent with 
mild clinical depression.  He was also administered the 
Minnesota Multiphasic Personality Inventory (MMPI), which 
portrayed a picture of a man suffering from a 
psychophysiological reaction with somatic complaints and a 
passive dependent orientation of the world around him.  He 
was described as an immature, dependent, egocentric, 
suggestible and demanding man.  

Received in August 1995 were VA medical records for the 
period from April 1993 to July 1994, most of which were 
previously discussed above.  The records essentially show 
treatment and evaluation for disabilities unrelated to those 
currently on appeal.  

I.  Service connection for varicose veins in the right lower 
extremity.

In order to establish service connection for a disability, 
the evidence must show the presence of the disability and 
that it resulted from disease or injury incurred in or 
aggravated by active service.  38 U.S.C.A. §§ 1110, 1131 
(1995).  

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, as distinguished from 
merely isolated findings or a diagnosis including the word 
"chronic."  Continuity of symptomatology is required where 
the condition noted during service is not, in fact, shown to 
be chronic or where the diagnosis of chronicity may be 
legitimately questioned.  When the fact of chronicity in 
service is not adequately supported, then a showing of 
continuity after discharge is required to support the claim.  
38 C.F.R. § 3.303(b) (1995).  

Based on the evidence of record and the above legal criteria, 
service connection is not warranted for varicose veins of the 
right leg.  There is no contemporaneous evidence of varicose 
veins in the right leg either in service or in the immediate 
years thereafter.  Although the veteran now contends that he 
had varicose veins in both legs in service, the written 
medical records dating from the 1940s are far more persuasive 
than the veteran’s recollections of events that occurred 
fifty years ago.  On the VA examination reports of September 
1945 and March 1946, there were explicit findings that no 
varicose veins were observable.  On the report dated in 
September 1945, the examiner wrote “no” in the blank for 
varicose veins; and on the report dated in March 1946, the 
examiner wrote “none” in the blank for varicose veins.  Thus, 
the written medical reports weigh heavily against the 
veteran’s claim; they are not simply silent as to the 
question of the presence of varicose veins on the right side, 
but instead include direct statements that no varicose veins 
were found in 1945 and 1946.  The first medical evidence of 
varicose veins in the right leg was reported by an attending 
physician who was examined the veteran in February 1953, and 
discovered varicose veins in his right leg.  Accordingly, the 
preponderance of the evidence of record provides no basis on 
which to associate the currently diagnosed varicose veins of 
the right leg with the veteran’s military service.  


II.  Increased rating for psychoneurosis, anxiety state.

The Board notes that the level of compensation benefits 
awarded for psychiatric disorders depends upon the degree of 
severity which is based upon the actual symptomatology as it 
affects the social and industrial adaptability.  In 
evaluating the impairment caused by the psychiatric disorder, 
we are required to evaluate primarily those symptoms of 
abnormalities of conduct, judgment, and emotional reaction 
which produce impairment of earning capacity.  38 C.F.R. 
§ 4.129 (1995).  

The evaluation assigned for the veteran's anxiety disorder is 
established by comparing the manifestations indicated in the 
recent medical findings with the criteria in the VA's 
Schedule for Rating Disabilities, 38 C.F.R. Part 4 (1995).  
The veteran's current 10 percent disability evaluation 
reflects that there is emotional tension or other evidence of 
anxiety productive of mild social and industrial impairment.  
A 30 percent disability evaluation requires definite 
impairment in the ability to establish or maintain effective 
and wholesome relationships with people and the 
psychoneurotic symptoms result in such reduction in 
initiative, flexibility, efficiency, and reliability levels 
as to produce definite industrial impairment.  Diagnostic 
Code 9400 (1995).  

In Hood v. Brown, 4 Vet.App. 301 (1993), the United States 
Court of Veterans Appeals stated that the term "definite," 
the rating description for a 30 percent disability evaluation 
under 38 C.F.R. § 4.132 (1995) was "qualitative" in 
character, whereas the other terms were "quantitative" in 
character, and invited the Board to construe the term 
"definite" in a manner that would quantify the degree of 
impairment for purposes of meeting the statutory requirement 
that the Board articulate "reasons or bases" for its 
decision.  38 U.S.C.A. § 7104(d)(1) (West 1991).  

In a precedent opinion, dated November 9, 1993, the General 
Counsel of the VA concluded that "definite" is to be 
construed as "distinct, unambiguous, and moderately large in 
degree."  It represents a degree of social and industrial 
inadaptability that is "more than moderate but less than 
rather large." VA O.G.C. Prec. 9-93 (Nov. 9, 1993).  The 
Board is bound by this interpretation of the term "definite."  
38 U.S.C.A. § 7104(c) (West 1991).  With these considerations 
in mind, the Board will address the merits of the increased 
rating claim at issue.

In this regard, the Board notes that, while the record 
reflects multiple somatic complaints, anxiety and difficulty 
sleeping, the veteran has never been psychiatrically 
hospitalized.  During the mental status examination in April 
1995, the examiner reported that the findings of a Beck 
Depression inventory was consistent with “mild” clinical 
depression.  In addition, while the veteran was described as 
complaining, whinny and tense, it was noted that he was 
oriented in all spheres and there was no thought disorder; he 
did not exhibit any hallucinations or delusions.  While it is 
reported that the veteran is currently unemployed; it is also 
reported that he retired because of a back injury.  Moreover, 
although the veteran is reported to be in a dysfunctional 
marriage, it is attributed to his personality disorder, and 
not his anxiety disorder.  

In light of the foregoing, the Board concludes that the 
record does not demonstrate that the veteran’s anxiety 
disorder produces social and industrial inadaptability which 
is “more than moderate but less than rather large.”  As such, 
a schedular evaluation above the currently assigned 10 
percent is not warranted.  In arriving at this result, the 
Board was mindful of the provisions of 38 C.F.R. § 4.7, but 
did not find it applicable to the facts of this case.  
Moreover, the record does not show an exceptional or unusual 
disability picture such as to render impractical the 
application of the regular schedular standards.  38 C.F.R. 
§ 3.321(b).  


ORDER

1.  Entitlement to service connection for varicose veins of 
the right leg is denied.  

2.  A rating above 10 percent for psychoneurosis, anxiety 
state, is denied.  



		
	G. H. SHUFELT
	Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures 
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 
(1994), permits a proceeding instituted before the Board to 
be assigned to an individual member of the Board for a 
determination.  This proceeding has been assigned to an 
individual member of the Board.

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 &  Supp. 1995), a decision of the Board of Veterans' 
Appeals granting less than the complete benefit, or benefits, 
sought on appeal is appealable to the United States Court of 
Veterans Appeals within 120 days from the date of mailing of 
notice of the decision, provided that a Notice of 
Disagreement concerning an issue which was before the Board 
was filed with the agency of original jurisdiction on or 
after November 18, 1988.  Veterans' Judicial Review Act, 
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988).  The 
date which appears on the face of this decision constitutes 
the date of mailing and the copy of this decision which you 
have received is your notice of the action taken on your 
appeal by the Board of Veterans' Appeals.
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