Source: https://va-claim.com/2019/06/03/fibromyalgia-hypertension-left-leg-varicose-veins-right-leg-varicose-veins-diabetes-mellitus-denied-citation-nr-18160451/?shared=email&msg=fail
Timestamp: 2019-06-20 05:57:07
Document Index: 189461043

Matched Legal Cases: ['§ 1110', '§ 3', '§ 1110', '§ 3', '§ 1110', '§ 3', '§ 1110', '§ 3', '§ 1110', '§ 3', '§ 3', '§ 1112', '§ 3', '§ 3', '§ 3', '§ 3', '§ 3', '§ 5107', '§ 3', '§ 5107', '§ 3', '§ 3', '§ 1110', '§ 5107', '§ 3', '§ 3', '§ 5107', '§ 3']

Fibromyalgia; hypertension; left leg varicose veins; right leg varicose veins; diabetes mellitus; [DENIED] Citation Nr: 18160451 – VAClaims.org ~ A Non-Profit Non Governmental Agency
Citation Nr: 18160451
DOCKET NO. 12-14 264
Entitlement to service connection for fibromyalgia, to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus is denied.
Entitlement to service connection for hypertension, to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus is denied.
Entitlement to service connection for left leg varicose veins (claimed as left leg seizures), to include as due to asbestos exposure, herbicide exposure, and secondary to diabetes mellitus is denied.
Entitlement to service connection for right leg varicose veins (claimed as right leg seizures), to include as due to asbestos exposure, herbicide exposure, and secondary to diabetes mellitus is denied.
1. The Veteran’s fibromyalgia was not present during active service, was not manifest to a compensable degree within one year of separation from service, and the most probative evidence establishes that his current fibromyalgia is not causally related to an in-service disease or injury, to include exposure to asbestos or herbicide agents, and is not caused or aggravated by his service-connected diabetes mellitus.
2. The Veteran’s hypertension was not present during active service, was not manifest to a compensable degree within one year of separation from service, and the most probative evidence establishes that his current hypertension is not causally related to an in-service disease or injury, to include exposure to asbestos or herbicide agents, and is not caused or aggravated by his service-connected diabetes mellitus.
3. The Veteran’s right and left leg varicose veins were not present during active service, were not manifest to a compensable degree within one year of separation from service, and the most probative evidence establishes that his current varicose veins are not causally related to an in-service disease or injury, to include exposure to asbestos or herbicide agents, and are not caused or aggravated by his service-connected diabetes mellitus.
1. The criteria for entitlement to service connection for fibromyalgia have not been met.  38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.
2. The criteria for entitlement to service connection for hypertension have not been met.  38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.
3. The criteria for entitlement to service connection for left leg varicose veins have not been met.  38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.
4. The criteria for entitlement to service connection for right leg varicose veins have not been met.  38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.
The Veteran had active service from March 1961 to March 1965, including service in the Republic of Vietnam.
These matters come before the Board of Veterans’ Appeals (Board) from a December 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).
In November 2014 and May 2017, the Board remanded the issues set forth above for additional evidentiary development.
Also in May 2017, the Board remanded the issue of entitlement to an initial rating in excess of 20 percent for diabetes mellitus for the issuance of a Statement of the Case.  See Manlincon v. West, 12 Vet. App. 238 (1999) (holding that where a claimant has submitted a notice of disagreement, but a Statement of the Case has not yet been issued, a remand to the RO is necessary).
Pursuant to the Board’s remand instructions, the RO issued a Statement of the Case in September 2018 addressing the issue of entitlement to a rating in excess of 20 percent for diabetes mellitus.  The Veteran, however, did not thereafter perfect an appeal within the applicable time period.  Thus, this issue is not before the Board.
Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304.  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 C.F.R. § 3.303(d).
Service connection for certain chronic diseases, including an organic disease of the nervous system and cardiovascular-renal disease, may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. § 1112;  38 C.F.R. §§ 3.307(a) (3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service.  38 C.F.R. § 3.307(a).
To establish service connection under this provision, there must be:  evidence of a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307), and subsequent manifestations of the same chronic disease; or if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology after service.
Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a).
The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b).  Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary.  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  Id; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  “It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran.”  Gilbert, 1 Vet. App. At 54.
The Veteran’s service treatment records are silent for complaints or findings of hypertension, fibromyalgia, or varicose veins.  At his February 1965 military separation medical examination, no pertinent abnormalities were identified.  His lower extremities and musculoskeletal system were examined and determined to be normal and his blood pressure was 122/71.  On a report of medical history, the Veteran denied having or ever having had high blood pressure, cramps in his legs, and bone, joint or other deformities.
The Veteran’s service personnel records are entirely negative for any indication that he served in the Republic of Vietnam.  However, in a November 2014 decision, the Board determined that the Veteran’s assertions that he went TDY to Vietnam in December 1964 and January 1965 were sufficient to establish that he set foot in Vietnam.  The Board notes that the Veteran’s service treatment and personnel records are entirely negative for any indication that he was exposed to asbestos during his period of active duty.
In pertinent part, the post-service record on appeal shows that in May 2003, the Veteran was seen at a private medical facility and was diagnosed with hypertension.  At the same facility, he was diagnosed with diabetes in August 2005.
In November 2006, the Veteran’s private medical provider, Dr. R.C., stated that he diagnosed the Veteran with diabetes “in July of 2005, when he started having some noticeable side affects[sic].”
In November 2009, the Veteran was seen at a VA medical center with multiple complaints, including leg cramps.  The assessments included hypertension, diabetes mellitus, leg cramps and diabetic neuropathy.
In an August 2010 statement submitted in support of his claim, the Veteran stated that he was diagnosed with hypertension “in 1966 during a routine pre-employment physical.”  He indicated that he “blew it off as just part of becoming a civilian.”
In September 2010, the Veteran stated that he had been exposed to asbestos during service and that the nature of his service “would raise anyone’s blood pressure.”  In the same month, he also stated that he had been diagnosed with “diabetic mellitus in 2005,” and that his “leg seizures and fibromyalgia” were “direct proven result[s] of the diabetic mellitus” caused by his herbicide agent exposure.  He stated that he was also diagnosed with fibromyalgia in 2005.
Also in August 2010, the Veteran’s private medical provider, Dr. R.C., stated that he diagnosed the Veteran with diabetes mellitus in June 2005 after a routine yearly physical examination.  He also stated that the Veteran was “already being treated for hypertension prior to his first visit.”
In April 2012, the Veteran stated that he did not receive a medical examination upon discharge from the Air Force.  He also stated that he was “nervous and jittery all the time” during service, which he contends was a sign of hypertension.  He also contended that asbestos exposure causes hypertension.
In April 2014, the Veteran sought treatment at a VA clinic and reported a history of a fibromyalgia, diabetes, hypertension, and restless leg syndrome.  The examiner noted that the Veteran’s active medical problems included hypertension, diabetes, and diabetic neuropathies.  Examination of the extremities showed no distal pedal edema or other deformities.  His gait was normal.  The assessments were diabetes, controlled; hypertension; hyperlipidemia, and erectile dysfunction.
In August 2015, the Veteran was afforded a series of VA medical examinations.
With respect to hypertension, the Veteran reported that he had first been diagnosed as having hypertension in 1972.  The examiner concluded that it was less likely than not caused by or otherwise etiologically related to service, including the purported asbestos exposure “because of hypertension first being diagnosed in 1972 and because of lack of medical nexus to exposure to asbestos.”  The examiner also concluded that it is less likely than not that that the Veteran’s hypertension was caused or aggravated by a service-connected disability, to include diabetes, because the Veteran’s renal function was normal.
With respect to fibromyalgia, the examiner opined that the condition was not due to military service because the medical records are silent for the condition until more than 40 years after separation and because of neither herbicide agents or asbestos were medically recognized causes of fibromyalgia.  The examiner also determined that the fibromyalgia was not caused by or secondary to any service connected disability, to include diabetes mellitus, as diabetes was not a medically recognized cause of fibromyalgia.  He indicated that it was not aggravated by diabetes mellitus because there was no evidence to support worsening beyond the natural progression.
With respect to varicose veins, the examiner noted that the August 2007 diagnosis of varicose veins reported by the Veteran was for restless leg syndrome.  The examiner opined that varicose veins was not caused by military service because it was first identified in 2007 and because of lack of nexus.  Additionally, the examiner determined that the condition was not caused or aggravated by the Veteran’s service-connected disabilities, to include diabetes, because of a lack of a medical nexus.
In May 2017, the Board found the medical opinions inadequate and remanded the matter for additional evidentiary development.
While the matter was in remand status, in September 2017, the Veteran submitted an article referencing a study showing higher rates of hypertension among service members who handled Agent Orange compared to those who did not.  He also submitted an article showing that 80 percent of people with diabetes mellitus had hypertension and indicated that having diabetes raises one’s risk for heart disease, stroke, kidney disease and other medical problems.
In January 2018, the VA physician provided a supplemental opinion regarding the questions at issue in this appeal.  He opined that it was not at least as likely as not that the Veteran’s bilateral varicose veins were caused by exposure to herbicide agents, exposure to asbestos, or by the Veteran’s diabetes.  The examiner noted that the Veteran was first diagnosed with varicose veins in August 2015.  The examiner also reasoned that exposure to herbicide agents and asbestos, as well as diabetes mellitus, were not medically recognized causes of leg varicose veins.  On the question of aggravation of bilateral leg varicose veins due to diabetes, the examiner stated that there is no medical knowledge that determine the precise natural progression of bilateral leg varicose veins in an individual, and therefore that there was no evidence to support any worsening beyond natural progression.  The examiner opined that, rather, the Veteran’s bilateral leg varicose veins were caused by defective structure and function of the leg vein valves, intrinsic weakness of the vein wall, high intraluminal pressure, aging, obesity and or incompetent perforating veins that cause enlargement of superficial veins as they were recognized causes of varicose veins of legs.
On the issue of service connection for the Veteran’s fibromyalgia, the January 2018 physician opined that it was less likely than not that it was caused by the Veteran’s active service, or was the result of exposure to asbestos, exposure to herbicide agents, or due to diabetes.  The rationale was that the Veteran’s diagnosis of fibromyalgia was more than 40 years after discharge in August 2015, with no evidence of record during the Veteran’s service.  Also, the physician stated that diabetes or exposures to herbicide agents or asbestos were not medically recognized causes of fibromyalgia.  On the question of aggravation of fibromyalgia due to diabetes, the physician stated that there was no medical knowledge that can precisely determine the natural progression of fibromyalgia in an individual, and thus no evidence existed to support worsening beyond natural progression.  Instead, the physician indicated that the etiology of the Veteran’s fibromyalgia was genes associated with metabolism, transport and receptors of serotonin and other monoamines as such genes associated with pathways involved in pain transmission had been described as vulnerability factors of fibromyalgia.
The January 2018 physician also opined that the Veteran’s hypertension was not caused by, or was the result of active service, exposure to herbicide agents or asbestos, or due to diabetes.  The examiner noted that the Veteran’s reported diagnosis of hypertension in 1972 preceded his diabetes diagnosis in 2005, but was after his discharge in 1965.  Thus, he reasoned that diabetes, diagnosed after hypertension, could not have caused hypertension.  He also stated that exposures to herbicide agents and asbestos were not recognized causes of hypertension.  On the question of aggravation of hypertension due to diabetes, the examiner stated that medical knowledge could not determine the precise natural progression of hypertension in an individual and, as such, evidence supporting aggravation did not exist.  He instead opined that the nature and etiology of the Veteran’s hypertension were his history of tobacco use, obesity, family history of hypertension, and vitamin D deficiency, which were all recognized risk factors for hypertension.
1. Entitlement to service connection for fibromyalgia, to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus
After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for fibromyalgia.
As a threshold matter, the Board finds that fibromyalgia is not a disease subject to the presumptive provisions related to Agent Orange exposure under 38 C.F.R. § 3.309(e), and therefore may not be presumptively service-connected pursuant to the above on the basis of herbicide exposure.
Although fibromyalgia is not a disease presumptively related to herbicide agent exposure, it may nonetheless be considered on a direct basis.  Combee v. Brown, 34 F.3d 1039, 1044–45 (Fed. Cir. 1994).  Here, service treatment records are silent for any complaints, diagnosis, or treatment of fibromyalgia.  The Veteran also does not contend that he had fibromyalgia in service or within one year of discharge from active duty.
The first diagnosis of fibromyalgia of record is the August 2015 VA examination, although the Veteran contends that he was first diagnosed with fibromyalgia in 2005.  Regardless, the evidence is clear that the condition did not develop in service nor was it manifest to a compensable degree within one year of service and the Veteran has not argued otherwise.
Moreover, the Board finds that the most probative evidence establishes that fibromyalgia is not otherwise causally related to active service or any incident therein.  As discussed above, a VA physician has provided a medical opinion to the effect that the Veteran’s fibromyalgia is not causally related to the Veteran’s active service or any incident therein, to include presumed herbicide agent exposure and reported asbestos exposure.  The physician’s opinion is highly probative as it was based on a review of the relevant evidence of record, reflects consideration of the Veteran’s contentions, is consistent with the evidence of record, and contains a rationale.
The Board has considered the Veteran’s assertions to the effect that there is a relationship between his fibromyalgia and exposure to asbestos or herbicide agents, but finds that such assertions do not provide persuasive evidence in support of the claim.  The matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals.  Jones v. Brown, 7 Vet. App. 134, 137–38 (1994).  Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the etiology of the Veteran’s fibromyalgia is a complex medical matter that falls outside the realm of common knowledge of a lay person.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Thus, lay assertions as to the etiology of the Veteran’s fibromyalgia have no probative value.  Questions of competency notwithstanding, the Board assigns more probative weight to the conclusion of the VA physician, given his medical training and the detailed rationale he provided.  In summary, the preponderance of the evidence is against the claim of service connection for fibromyalgia on a direct basis.
For the same reasons, the Board finds that the Veteran’s fibromyalgia was not caused or aggravated by his service-connected diabetes mellitus.  The January 2018 VA examiner supported his opinion against the finding of causation or aggravation with a rationale which included consideration of the evidence of record, the Veteran’s own statements, and the applicable medical literature which indicates that other medically recognized factors were more likely to have caused the Veteran’s fibromyalgia.
For all the foregoing reasons, the Board finds that the claim for service connection for fibromyalgia must be denied.  In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53–56 (1990).
2. Entitlement to service connection for hypertension, to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus
After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for hypertension, to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus (“hypertension”).
As a threshold matter, the Board finds that hypertension is not currently a disease subject to the presumptive provisions related to Agent Orange exposure under 38 C.F.R. § 3.309(e), and therefore may not be presumptively service-connected pursuant to the above on the basis of herbicide exposure.
With respect to direct service connection, as set forth above, the Veteran’s service treatment records show that hypertension was not present during the Veteran’s period of active duty.  His service treatment records, including his medical examination at discharge, are silent for any complaints, diagnosis, or treatment of hypertension, including high blood pressure.  His blood pressure was within normal limits at separation and the Veteran, at that time, specifically denied having or ever having had high blood pressure.  Indeed, the Veteran does not contend that his hypertension was present in service.
Rather, the Veteran contended in August 2010 that he was first diagnosed with hypertension in 1966 during a pre-employment physical examination with AT&T, but that he “blew it off,” suggesting that he received no treatment for the condition in 1966.  In August 2015, before a medical examiner, he stated that he was first diagnosed as having hypertension in 1972.  There is no contemporaneous clinical evidence to support either report.  Regardless, the Board finds that even if the Veteran was diagnosed as having hypertension before March 1966, within the one year of his discharge from active duty, the record still lacks any indication that such hypertension was disabling, as required for presumptive service-connection.  Indeed, the Veteran has not contended otherwise.  Therefore, the Board finds no basis upon which to award service-connection for hypertension on a presumptive basis.
The Board also finds that the most probative evidence establishes that the Veteran’s post-service hypertension is not otherwise causally related to his active service or any incident therein, to include herbicide agent exposure or asbestos exposure.  The January 2018 VA physician explained that the Veteran’s hypertension was not at least as likely as not related to his service, to include herbicide agent or asbestos exposure.  He supported his opinion against the finding of service connection with rationale based on the Veteran’s own statements, medical evidence of record, medical literature, and listed other medically recognized factors as more likely to have caused the Veteran’s hypertension.
The Board has considered that the National Academies of Sciences, Engineering and Medicine (NAS) recently upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence to “sufficient” evidence of an association with exposure to Agent Orange and other herbicides used during the Vietnam War.  The study states that this category “indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure.  The Board however, notes that evidence of an association or a correlation is not the same as evidence of causation, and the applicable statute requires that a disability result from an in-service injury.  See 38 U.S.C. § 1110.  Regardless, the Board assigns more probative weight to the conclusions of the January 2018 VA physician who considered the applicable medical literature in rendering his negative nexus opinion.
The Board has also considered the Veteran’s contentions that his hypertension is related to in-service asbestos or herbicide agent exposure.  However, the matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals.  Jones, 7 Vet. App. at 137–38.  Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana, 24 Vet. App. at 435), here, the etiology of the Veteran’s hypertension is a complex medical matter that falls outside the realm of common knowledge of a lay person.  See Jandreau, 492 F.3d 1372.  Thus, lay assertions as to the etiology of the Veteran’s hypertension have no probative value.
The Board has also considered whether service-connection may be granted on a secondary basis, but finds that the most probative evidence of record is against the claim.  As set forth in detail above, the VA physician concluded in January 2018 that the Veteran’s hypertension was not causally related to or aggravated by the service-connected diabetes mellitus.  For the reasons previously expressed, the Board finds that the opinion is highly probative and further notes that there is no other medical opinion evidence of record which contradicts the conclusion of the VA physician.
The Board has also considered the evidence submitted by the Veteran from his own internet research regarding the relationship between Agent Orange exposure and high blood pressure, and the relationship between diabetes and high blood pressure.  Although medical articles “can provide important support when combined with an opinion of a medical professional,” in this case, this evidence is general and does not raise a plausible causality between the Veteran’s current disability and his active service or his service-connected diabetes.  Mattern v. West, 12 Vet. App. 222, 228 (1999).  Moreover, this evidence is not accompanied by the opinion of any medical professional.  Rather, as explained above, the medical opinion of record weighs against the Veteran’s claim.  Given the record in its entirety, the Board assigns more probative weight to the medical opinion discussed above, which was based on a review of evidence and facts specific to the Veteran’s history, than to general internet articles.
In summary, the most probative evidence shows that hypertension was not present during active service, manifest to a compensable degree within one year of separation, and is not otherwise causally related to active service or any incident therein, to include legally presumed herbicide agent exposure or claimed asbestos exposure, nor is it causally related to or aggravated by a service-connected disability, to include hypertension.
For all the foregoing reasons, the Board finds that the claim for service connection for hypertension must be denied.  In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53–56.
3. Entitlement to service connection for left leg varicose veins (claimed as right leg seizures), to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus
4. Entitlement to service connection for right leg varicose veins (claimed as right leg seizures), to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus
After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for bilateral leg varicose veins, to include as due to asbestos exposure, herbicide agent exposure, and secondary to diabetes mellitus (“varicose veins”).
As a threshold matter, the Board finds that varicose veins do not constitute a disease subject to the presumptive provisions related to Agent Orange exposure under 38 C.F.R. § 3.309(e), and therefore may not be presumptively service-connected pursuant to the above on the basis of herbicide exposure.
Although varicose veins do not constitute a disease presumptively related to herbicide agent exposure, they may nonetheless be considered on a direct basis.  Combee, 34 F.3d at 1044–45.  Here, service treatment records are silent for any complaints, diagnosis, or treatment of varicose veins.  He does not contend otherwise.  The Veteran also does not contend that he had varicose veins in service or within one year of discharge from active duty.
The first medical diagnosis of varicose veins of record is the August 2015 VA examination.  The Veteran contends that he was first diagnosed with varicose veins in 2007.  Even after resolving doubt in the favor of the Veteran, the diagnosis is at least four decades after the Veteran’s discharge from active duty in March 1965.
Moreover, to the extent the Veteran asserts that a relationship exists between his varicose veins and his service, particularly exposure to asbestos or herbicide agents, the Board finds that such assertions do not provide persuasive evidence in support of the claim.  The matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals.  Jones, 7 Vet. App. at 137–38.  Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana, 24 Vet. App. at 435), here, the medical etiology of the Veteran’s varicose veins is a complex medical matter that falls outside the realm of common knowledge of a lay person, especially when the question is not the symptoms of varicose veins but the medical cause of them.  See Jandreau, 492 F.3d 1372.  Thus, lay assertions as to the medical etiology of the Veteran’s varicose veins have no probative value.
Rather, the Board finds that the most probative evidence establishes that the Veteran’s post-service varicose veins are not otherwise causally related to his active service or any incident therein, to include herbicide agent exposure or asbestos exposure.  The January 2018 VA physician explained that the Veteran’s varicose veins were not at least as likely as not related to his service, to include herbicide agent or asbestos exposure.  He supported his opinion against the finding of service connection with rationale based on the Veteran’s own statements, medical evidence of record, medical literature, and listed other medically recognized factors as more likely to have caused the Veteran’s varicose veins.  The Board assigns greater probative weight to the findings of the VA physician than to the lay assertions of the Veteran, given the examiner’s expertise and the rationale he provided to support his conclusions.
For the same reasons, the Board finds that the Veteran’s varicose veins were not caused nor aggravated by his service-connected diabetes mellitus.  The January 2018 VA physician explained that it was not at least as likely as not that the Veteran’s bilateral varicose veins were caused by exposure to herbicide agents, exposure to asbestos, or by the Veteran’s diabetes.  The physician explained that exposure to herbicide agents and asbestos, as well as diabetes mellitus, were not medically recognized causes of leg varicose veins.  Similarly, the physician indicated that there was no medical basis to support a conclusion that diabetes mellitus aggravated varicose veins.  Rather, the Veteran’s bilateral leg varicose veins were caused by defective structure and function of the leg vein valves, intrinsic weakness of the vein wall, high intraluminal pressure, aging, obesity and or incompetent perforating veins that cause enlargement of superficial veins as they were recognized causes of varicose veins of legs.
For all the foregoing reasons, the Board finds that the claim for service connection for varicose veins must be denied.  In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53–56.
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