BVA9504597 DOCKET NO. 93-10 951 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for varicose veins of the left leg. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Sandra L. Smith, Associate Counsel INTRODUCTION The veteran had active service from January 1945 to November 1946. This appeal is before the Board of Veterans' Appeals (the Board) from a January 1993 rating decision of the Regional Office (RO) which denied service connection for varicose veins of the left leg. The case is now ready for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for varicose veins of the left leg on a direct basis because he had varicose veins in both legs during service. In the alternative, he also contends that service connection is warranted on a secondary basis because the left leg disorder developed as a result of the service-connected varicose veins of the right leg or as a result of his service-connected pes planus. It is asserted that he did not make reference to the left leg when making reference to the right leg because it was well known that if you had varicose veins in 1 leg you would have them in the other. He asserts that prior to being accepted into service in 1945, he had previously been turned down and classified as 1-F due to bilateral varicose veins. 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 against the claim for service connection for varicose veins of the left leg. FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Varicose veins of the left leg were not present during service. 3. Varicose veins of the left leg were not demonstrated medically for more than 10 years after service discharge and are not shown to be due to any in-service occurrence or event. 4. Varicose veins of the left leg are not shown to be etiologically related to or the result of the service-connected varicose veins of the right leg or bilateral pes planus. CONCLUSIONS OF LAW 1. Varicose veins of the left leg were not incurred in or aggravated by the veteran's active service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). 2. Varicose veins of the left leg are not proximately due to or the result of the service-connected varicose veins of the right leg or bilateral pes planus. 38 C.F.R. § 3.310(a) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS A person who submits a claim for benefits has 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. After reviewing the evidence on file we conclude that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the claim presented is not inherently implausible. Furthermore, we conclude that all facts pertinent to the plausible claim have been developed and that as such, there is no further duty to assist in developing the claim as contemplated by 38 U.S.C.A. § 5107(a). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). In this regard, it is the policy of the VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, such doubt will be resolved in favor of the veteran. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. 38 C.F.R. § 3.102 VA regulations provide that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). In addition, service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. With chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 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). A review of the veteran's service medical records revealed no evidence of any left leg disorder or disability, including varicose veins during service. At the time of the physical examination for induction, it was noted that the veteran had been a student. It was indicated that he had never been sent to an induction station before. Varicose veins were not found on examination, and the veteran was qualified for general service. The service separation examination report, dated in October 1946, contained a no finding of no varicose veins. The veteran filed an application for VA compensation in October 1947 for varicose veins of the right leg which he stated began in service in approximately May 1945. Service connection for varicose veins was denied by rating decision of November 1947. Service connection was granted for pes planus, rated noncompensably disabling. Written statements from the veteran's private physician, dated in February 1950 and October 1962, indicated that the veteran was first treated for varicose veins of the right leg in 1949. There was no reference to varicose veins of the left leg. Written statements from the veteran, fellow servicemen and friends, dated in October 1962 indicated that the veteran had varicose veins in his right leg while in service and that the condition was present during a routine physical examination in April 1945. A statement from a private physician, dated in October 1962, indicated that he had treated the veteran in March 1962 for varicose veins of the right leg. He stated that examination revealed large varicose veins of the right leg with incompetent valves of the whole greater saphenous system and some communicating branches. He advised the veteran to have a saphenous ligation and vein stripping. The physician made no reference to any finding or complaint of varicose veins of the left leg. The veteran testified at a personal hearing held in March 1963 as to the problems he encountered in service and thereafter because of varicose veins in his right leg. During the hearing the veteran's legs were examined by a VA physician and it was noted that the veteran also had some varicose veins on the left foot. The veteran was afforded a VA medical examination in April 1963. The examination report noted that the veteran complained that his feet and legs hurt when he stood a lot. Physical examination revealed varicosities of the long saphenous vein on the right, extending through the leg and thigh. A large sacculation was also seen on the medial side of the right knee. There was also congestion and dark segmentation noted at the ankle secondary to venous insufficiency. No varicosities were seen on the left leg. The diagnoses were: varicose veins, right leg; degenerative joint disease, both knees; pes planus, bilateral. Additional lay statements, dated in 1963, indicate that the veteran had varicose veins in his right leg during service overseas and at his wedding in 1946. In a written statement, dated in October 1963, the veteran claimed that the evidence in his case clearly showed that he was entitled to service connection for varicose veins of both legs. The veteran was subsequently granted service connection for varicose veins of the right leg in a June 1964 rating decision (which was issued to comply with a June 1964 Board decision). The Board held that service connection was granted for the varicose veins of the right leg on a direct basis as they had been present during service and had been treated since service. No reference was made to varicose veins in the left leg. The veteran was afforded a VA medical examination in April 1965. The examination report noted complaints of swelling and pain in both legs and feet. during the physical examination an enlargement of the long saphenous vein on the right was seen and it was noted that the veteran should have a surgical excision and ligation of those veins. The examiner also found varicosities on the left leg in and around the left foot and ankle but not as great as on the right side. The report contained no clinical evidence or medical opinion as to the etiology of the left leg disorder. A written statement from a private physician, received in May 1977, showed a diagnosis of varicose veins of both legs. An additional doctor's statement, dated in November 1983, showed the veteran was examined and diagnosed to have varicose veins of both legs, worse on the right. The veteran was afforded a VA medical examination in December 1983. The examination report noted that there was obvious deformity of the venous drainage system, especially in the right leg. Varicose veins were noted on both legs, less extensive on the left. The report contained no clinical evidence or medical opinion as to the etiology of the varicose veins of the left leg. A written statement from the veteran, received in May 1984, indicated that at his first examination in service a doctor told the veteran he had bad feet and that bad feet cause varicose veins. A doctor's statement, dated in May 1989, showed that the veteran was examined and found to have severe varicosities in both legs and tenosynovitis of both feet. The statement contained no evidence as to etiology or causation. In June 1989 the veteran was afforded another VA medical examination. The examination report noted the veteran gave a history of severe varicose veins. Physical examination revealed moderate severe tortuous varicosities in the greater and lesser saphenous of the left leg. Severe markedly dilated tortuous sacculated varicosities were noted in the right leg. The diagnoses were: bilateral pes planus and severe varicose veins. The report contained no evidence of etiology or causation. The veteran submitted several written statements, dated in 1989, which indicated that during his 1963 VA examination the physician had told him that if he had good feet he'd be taller and that "[b]ad feet cause varicose veins." The veteran stated that he had varicose veins in both his feet while stationed in Japan and that is why he was put in charge of the laundry. A written statement from a private physician, dated in November 1992, indicated that the veteran was examined and diagnosed to have severe varicosities of both legs, bursitis of both feet, and collapsed pronated feet. In written statements, dated in November 1992, the veteran indicated service connection was warranted for his left leg as "an adjunct condition." He explained that he had had to put more weight on the left leg to take pressure off the right and this had "caused the left to go bad." The veteran also stated that varicose veins were present in both legs during service. He was allowed to oversee the laundry later in service because of his bilateral foot and leg disorders. A lay statement, dated in December 1992, from a former serviceman indicated that the veteran had varicose veins in both legs at the time of the service physical. (This individual had submitted a statement in 1963 that referred only to the veteran's right leg.) The veteran was afforded a VA medical examination in January 1993. The examination report noted that the veteran suffered from varicose veins and flat feet; the veteran wore support stockings to control the varicose veins. He complained of swelling and pain in both legs. After physical examination of the veteran's feet and legs the diagnoses were: Bilateral varicose veins, severe on right; and pes planus deformity of the feet. A written statement, dated in March 1993, from the VA physician who had examined the veteran in April 1963, indicated that the veteran had varicosities in both legs in 1963. However, it contained no information as to the etiology or cause of the varicose veins in the left leg. The veteran submitted several lay statements, dated in 1993, from former servicemen and personal friends who stated that the veteran had varicose veins in both legs during service in 1946. The veteran also submitted several written statements in 1993 to the effect that he had varicose veins in both legs in service. He explained that he did not pursue service connection for his left leg disorder earlier because he assumed that most people believed, as did he, that if he had varicose veins in one leg, they were in both. He further asserted that the earlier lay statements of his friends and comrades only mentioned the right leg because the individuals were only asked specifically about the right leg. The Board finds, based on the evidence of record and the above legal criteria, that service connection is not warranted for varicose veins of the left leg on a direct basis. There is no contemporaneous evidence of varicose veins in the left leg either in service or in the immediate years thereafter. The first medical evidence of varicose veins in the left leg occurred during a personal hearing in March 1963 when he was examined by a physician and noted to have varicose veins in his left foot. The Board notes that this is more than 15 years after the veteran's discharge from service. Thus, there is no medical evidence of continuity of symptomatology or other showing of varicose veins in the left leg immediately after service. In reaching its decision, the Board has also taken into consideration the recent statements of the veteran and fellow servicemen and friends as to the existence of varicose veins in the left leg during service. However, the Board finds more credible the early, more contemporaneous, statements of the veteran and some of these same individuals which specify varicose veins of the right leg. The Board also finds it significant that in the original application for compensation, dated in October 1947, the veteran specified varicose veins of the right leg. Thus, the Board concludes that varicose veins of the left leg were not present during service or for many years after service. There is no reason to suspect that if varicose veins were present in the left leg, some mention would have been made by the veteran in his claim, or by examining physicians in the treatment rendered. The evidence does not support the veteran's recollections that he was originally turned away from service due to varicose veins. The induction examination on file contains a notation that he had never presented to an induction center before (and therefore had not had an earlier examination--that part of the form is not filed out). Thus, there is no credible evidence to relate varicose veins of the left leg, first reported in 1963, to any in-service event or occurrence. The Board further finds that service connection for varicose veins of the left leg is not warranted on a secondary basis. The veteran has failed to present any competent evidence as to this issue. The Court of Veterans Appeals has held that the veteran's own bare opinion as to any medical relationship is not probative, inasmuch as there is no evidence that he has medical knowledge, training, or expertise to render a diagnosis or medical opinion as to such a relationship. Espiritu v. Derwinski, 2 Vet.App. 492 (1992); Grottveit v. Brown, 5 Vet.App. 91 (1993). The record does not otherwise contain medical evidence of the claimed relationship. Consequently, the claim must be denied as there is no evidence on file that the varicose veins of the left leg are the result of any service connected disability. Therefore, the Board finds the preponderance of the evidence is against the veteran's claim for service connection for varicose veins of the left leg. As such, the record does not present an approximate balance of positive and negative evidence with respect to the merits of the veteran's claim. Accordingly, the benefit of the doubt is not for application in this case. ORDER Service connection for varicose veins of the left leg is denied. MICHAEL D. LYON 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.