Citation Nr: 0005474 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 98-13 824A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to service connection for chronic venous insufficiency and superficial thrombophlebitis of the lower extremities. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and U. I. ATTORNEY FOR THE BOARD R. M. Panarella, Associate Counsel INTRODUCTION The veteran served on active duty from February 1941 to September 1944. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the May 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office in Lincoln, Nebraska (RO). FINDING OF FACT The preponderance of the evidence shows that the veteran's chronic venous insufficiency and superficial thrombophlebitis of the lower extremities are not related to his period of active service. CONCLUSION OF LAW Chronic venous insufficiency and superficial thrombophlebitis of the lower extremities were not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 5107 (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION A veteran may be granted service connection for disability resulting from injury or disease contracted in the line of duty or for aggravation of a preexisting injury or condition. 38 U.S.C.A. §§ 1110, 1131 (West 1991). The veteran carries the burden of "submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded." 38 U.S.C.A. § 5107(a) (West 1991). A well- grounded claim is one that is "a plausible claim, one which is meritorious on its own or capable of substantiation." Murphy v. Derwinski 1 Vet App. 78, 81 (1990). As a preliminary matter, the Board finds that the veteran has submitted a well-grounded claim and that VA has properly assisted him in the development of that claim. 38 U.S.C.A. § 5107(a) (West 1991). The veteran alleges that his current vascular symptomatology is due to cold exposure while serving on active duty in Alaska. The veteran's service personnel records show that he served in Alaska from January to December 1942 and in Amchitka from January 1943 to April 1944. The veteran's service medical records contain no complaints, findings, or diagnoses related to chronic venous insufficiency, superficial thrombophlebitis, or other cold exposure residuals. At VA examinations in November 1945 and January 1948, the veteran's vascular system was reported to be normal, and there was no abnormality of the lower extremities. At a VA neuropsychiatric examination in April 1972, a neurological examination of the extremities was normal, and there was no reference in the report of any history of venous insufficiency or thrombophlebitis. In an application for compensation which was received in April 1998, the veteran stated that he was seeking benefits for "Bad left leg. Began in 1990 became worse in 1992." The veteran stated in his claim that he first received medical care for left leg symptoms in 1992. Private medical records from 1993 through 1997 show that he received treatment for pedal edema, superficial thrombophlebitis, and chronic venous insufficiency of the lower extremities. An April 1998 letter from T.S. Robertson, M.D., stated that the veteran had significant problems with his left leg, including osteoarthritis of the left knee and severe venous insufficiency, for the past several years. The venous insufficiency caused swelling, pain, and a heavy feeling. The veteran related his symptoms to cold exposure in Alaska. An April 1998 letter from James A. Martin, M.D., stated that the veteran provided a history of working for two years in Alaska and spending three days without heat in the barracks. The veteran stated that, since that time, he had had cold intolerance, and that his left leg began to exhibit pain, swelling, and weakness in approximately 1990. Physical examination disclosed significant chronic pedal edema, multiple varicosities, and venous insufficiency. Dr. Martin opined that these symptoms were "possibly related to his cold exposure back in 1942." At a VA examination in June 1998, the veteran stated that his left leg pain started when he was exposed to cold in Alaska, and he now had daily pain and weakness of the left lower extremity. Upon physical examination, there was peripheral edema in association with the left knee, and the left knee was more distended than the right, with range of motion limited by pain. Diffuse telangiectatic vessels were present over the knee and the ankle, with 3+ peripheral edema of a nonpitting type on both extremities. The left ankle was significantly swollen, and deep tendon reflexes were 1/4 bilaterally. Peripheral vessels could not be felt due to the edema. The assessment was degenerative joint disease of the left knee with peripheral edema of unknown etiology. The veteran appeared for a personal hearing before the RO in June 1999. He testified that: when he was stationed in Alaska, he worked daily building airstrips; he lived in a hut with a stove, but no heating fuel, for a few nights; he had felt cold since his discharge from service; and he first received medical treatment for his left leg in the early 1990s. Evaluating the evidence of record, the Board finds that the preponderance of the evidence is against a finding that current chronic venous insufficiency and superficial thrombophlebitis of the lower extremities is related to cold exposure in the 1940s. With respect to questions involving medical causation, credible medical evidence is required. See Lathan v. Brown, 7 Vet. App. 359, 365 (1995). Although Dr. Martin's opinion is sufficient to well ground the veteran's claim, the Board finds that it is outweighed by the remaining evidence of record. See Hernandez-Toyens v. West, 11 Vet.App. 379, 382 (1998); Alemany v. Brown, 9 Vet.App. 518, 519 (1996). Dr. Martin's opinion has little probative value, because he did not review the reports of VA examinations in early postservice years, which are entirely negative for vascular abnormality, and he did not base the opinion on clinical findings. Dr. Martin's opinion speaks in terms of possibility rather than probability and is outweighed by the lack of any medical evidence of the relevant symptomatology for almost 50 years following discharge from service. The entire record is devoid of any documented complaint or treatment related to the veteran's lower extremity disabilities until the early 1990s. Most significantly, examinations in 1945 and 1948 showed no abnormality of the lower extremities. The Board, therefore, concludes that the greater weight of the evidence is against the claim, and the benefit sought on appeal must be denied. While the Board has considered the doctrine of affording the veteran the benefit of any existing doubt with regard to the issues on appeal, the record does not demonstrate an approximate balance of positive and negative evidence as to warrant resolution of this matter on that basis. 38 U.S.C.A. § 5107(b). ORDER Service connection for chronic venous insufficiency and superficial thrombophlebitis of the lower extremities is denied. JAMES A. FROST Acting Member, Board of Veterans' Appeals