BVA9503014 DOCKET NO. 92-03 726 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to an increased (compensable) disability rating for venous insufficiency of the left leg. ATTORNEY FOR THE BOARD L. B. Wirt, Associate Counsel INTRODUCTION The veteran served on active duty from January 1960 to March 1963, from June 1963 to June 1966 and from November 1990 to May 1991. This appeal arises from a September 1991 rating decision of the Department of Veterans Affairs (VA) Montgomery, Alabama, Regional Office (RO), which granted a temporary total convalescent rating under 38 C.F.R. § 4.30 (1994), from June 27, 1991, through July 1991, for venous insufficiency of the left leg. That decision also denied the veteran entitlement to an increased (compensable) evaluation for that disorder. The case was remanded by the Board of Veterans' Appeals (Board) in June 1993. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his service-connected venous insufficiency of the left leg has become worse, and required him to have surgery in June 1991. He contends that the severity of the condition warrants a compensable evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), 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 in favor of the grant of entitlement to a disability rating of 10 percent for venous insufficiency of the left leg. FINDINGS OF FACT 1. The veteran is service connected for venous insufficiency of the left leg, heretofore assigned a noncompensable rating. 2. The veteran's status post vein ligation with venous insufficiency of the left leg is moderate in nature. The condition continues to cause the veteran pain on prolonged standing or walking, and requires the use of a cane. There is no deep circulation involvement, deep vein thrombosis or large varices currently. CONCLUSION OF LAW The criteria for a disability rating of 10 percent for venous insufficiency of the left leg have been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7120 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the statutory duty to assist mandated by 38 U.S.C.A. § 5107(a). The veteran has been service connected for venous insufficiency of the left leg with a noncompensable evaluation effective since August 1984. This condition has been evaluated under 38 C.F.R. Part 4, Diagnostic Code 7121 (1994), which is for phlebitis or thrombophlebitis. However, the Board finds that the veteran's current condition is more accurately described at 38 C.F.R. Part 4, Diagnostic Code 7120, designated for varicose veins. Under Code 7120, a 10 percent evaluation is provided for moderate conditions involving varicosities of the superficial veins below the knee, with symptoms of pain or cramping on exertion. A 20 percent evaluation is provided under Code 7120 for unilateral moderately severe conditions involving superficial veins above and below the knee, with involvement of the long saphenous, ranging in size from one to two centimeters in diameter, with symptoms of pain or cramping on exertion and no involvement of the deep circulation; a 30 percent evaluation is provided if these symptoms are bilateral. Severe conditions are to be assigned a 40 percent rating if unilateral and a 50 percent rating if bilateral, and pronounced conditions are to be assigned a 50 percent rating if unilateral and a 60 percent rating if bilateral. 38 C.F.R. Part 4, Diagnostic Code 7120. The veteran was examined in May 1991 at Fort McClellan, Alabama, immediately following his most recent period of active duty. He reported a history of a left thigh injury in Vietnam, with worsening varicose veins and pain in his left leg since that time. Physical examination revealed a competent deep vein system on the left by Doppler. Greater saphenous vein incompetence was found by Doppler at the saphenofemoral junction. Greater saphenous varicosity was noted to the ankle, with some incompetent perforations at the knee level. The veteran underwent a greater saphenous vein stripping procedure in June 1991. Following the surgery, the veteran was granted a temporary total rating for convalescence and was returned to a noncompensable evaluation thereafter. The pathology report completed after the surgery reveals that the excised specimen was 40 centimeters in length and .8 centimeter in "maximal diameter." The veteran underwent a VA examination in August 1991. He reported some continued discomfort in the area of the venous stripping. It was noted that his incisional scars were well-healed in the groin and medial aspect of the knee. He was able to stand on his toes and heels. He was unable to perform deep knee bends due to pain. His pulses were good, and there were no venous stasis changes. There was also no coolness of the feet, and sensation was good in the lower extremities. His cardiovascular system appeared intact and his blood pressure was normal. The relevant impression was history of left leg superficial varicose veins extending into the groin with persistent pain, with initial onset in Vietnam following severe lower leg injury with question of thrombophlebitis. It was noted that the veteran was still complaining of discomfort following his venous stripping procedure and walked with a cane. It was also noted that this interfered with his employment in that he had discomfort with prolonged standing of greater than one or two hours or walking greater than several blocks. Pursuant to the Board's June 1993 remand, the veteran underwent another VA examination in November 1993. He reported having pain in his left leg. On physical examination, multiple scars were noted on his left leg from the vein stripping. There were no pulsations felt. Skin appearance and temperature were normal. There was no paresthesia and no cardiac involvement. The diagnosis was post phlebitic syndrome. The examiner commented that the veteran had considerable pain when working as a mail carrier. A Doppler ultrasound test was performed pursuant to the examination, and revealed no evidence of deep vein thrombosis from the common femoral vein down through the popliteal vein. There was no evidence of large varices seen in the lower leg. The impression was no evidence of deep vein thrombosis or large varices. The Board is of the opinion that these findings are sufficient to warrant a 10 percent disability rating under 38 C.F.R. Part 4, Diagnostic Code 7120. Although the veteran underwent a June 1991 venous stripping of the left greater saphenous vein to ameliorate his superficial varicosities, he has continued to have pain and discomfort while walking or standing for long periods of time. No involvement of the deep circulation is currently shown. In addition, although his superficial varicosities prior to surgery involved veins both above and below his left knee, the pathology report following the June 1991 stripping procedure indicates that the excised specimen measured only .8 centimeter in diameter, which would not meet the size requirement (one to two centimeters in diameter) for a 20 percent evaluation. Currently, he has no large varices. The veteran has not required frequent hospitalizations, and there is no indication of marked interference with employment such as to warrant a higher (extraschedular) evaluation under 38 C.F.R. § 3.321 (1994). Nor do his symptoms more closely approximate the criteria for the next higher rating. See 38 C.F.R. § 4.7 (1994). ORDER Entitlement to a 10 percent evaluation, but no more, for venous insufficiency of the left leg, is granted, subject to the regulations governing the payment of monetary benefits. SAMUEL W. WARNER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (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), 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 (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.