VARICOSE VEINS

Summary

The Veteran, a veteran who served from July 1989 to July 1993, appeals the denial of a compensable rating for his service-connected left testicle varicocele. The Board of Veteran's Appeals (Board) previously denied a higher rating, and the case has been remanded multiple times. The Veteran sought a rating for his left varicocele, which he described as causing pain with any exertion, such as prolonged standing or sitting. The Board reviewed multiple VA examinations from 2016, 2020, and 2021, which noted similar findings of enlargement and pain, though some noted voiding dysfunction related to unrelated prostatitis. The Veteran's private and VA treatment records consistently showed complaints of pain and discomfort from the varicocele. The Board found that the Veteran's symptoms, while acknowledged as causing pain and discomfort, did not meet the criteria for higher ratings under Diagnostic Code 7120 due to the absence of persistent edema, stasis pigmentation, or ulceration, and the pain being managed by treatment. The Board also considered and rejected other diagnostic codes for atrophy or removal of the testicle. After resolving all doubt in the Veteran's favor, the Board found the evidence supported a 10 percent rating under DC 7121 for the varicocele, granting the claim to that extent.

Rationale

Veteran reported pain with exertion, throbbing, and sharp shooting sensations.; VA examinations noted enlargement and pain, but no voiding dysfunction or urinary frequency.; Pain and discomfort did not meet criteria for higher ratings under DC 7120 due to lack of persistent edema/ulceration and pain management.

Full Decision Text

Citation Nr: 22047602
Decision Date: 08/22/22	Archive Date: 08/22/22

DOCKET NO. 15-06 764A
DATE: August 22, 2022

ORDER

A 10 percent rating, but no higher, for a left varicocele disability is granted, subject to the laws and regulations governing the payment of monetary awards.

FINDING OF FACT

The Veteran's left varicocele disability results in constant pain, throbbing, and pain with any exertion such as prolonged standing or walking, with symptoms relieved by pain management.

CONCLUSION OF LAW

The criteria for a rating of 10 percent, but no higher, or a left varicocele disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.115b, Diagnostic Code (DC) 7120.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 1989 to July 1993.

The Board of Veteran's Appeals (Board) denied the claim in June 2018, and the appellant appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2019 Memorandum decision, the Court vacated and remanded the Board's decision. This matter was most recently remanded in April 2021 and returns to the Board for further adjudication. 

The Veteran seeks a compensable rating for his service-connected left testicle varicocele. 

The Veteran is currently rated by analogy for his left varicocele under DC 7527. Diagnostic Code 7527 rates prostate gland injuries, infections, hypertrophy and postoperative residuals as voiding dysfunction or urinary tract infection, whichever is predominant. Voiding dysfunction is rated under the three subcategories of urine leakage, urinary frequency, and obstructed voiding. 38 C.F.R. § 4.115a.

For urine leakage a 20 percent rating is warranted when there is continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, such that the Veteran is required to wear absorbent materials which must be changed less than two times per day. A 40 percent rating is warranted when the Veteran is required to wear absorbent materials that must be changed two to four times per day. A 60 percent disability rating is warranted with the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day. 38 C.F.R. § 4.115a.

With regard to urinary frequency, a daytime voiding interval between one and two hours or awakening to void three to four times per night warrants a 20 percent rating, and daytime voiding interval less than one hour, or awakening to void five or more times per night warrants a 40 percent rating. 38 C.F.R. § 4.115a. For obstructed voiding, a 30 percent rating requires urinary retention requiring intermittent or continuous catheterization. 38 C.F.R. § 4.115a.

Under Diagnostic Code 7120, a noncompensable evaluation for varicose veins is warranted when it is asymptomatic, palpable or there are visible varicose veins. A 10 percent evaluation is warranted for intermittent edema of the extremity or aching and fatigue in the leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery. A 20 percent evaluation is warranted for persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. A 40 percent evaluation is assigned for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent evaluation is assigned for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration, and a 100 percent evaluation is warranted for massive board-like edema with constant pain at rest. 38 C.F.R. § 4.104, Diagnostic Code 7120.

The Veteran was afforded a VA examination in June 2021. The Veteran reported that he has pain with any exertion such as prolonged walking or standing or sitting for more than one or two hours. Current symptoms were noted as a throbbing or aching pain but can increase to a "sharp shooting like sensation." The examiner noted the Veteran did not have a voiding dysfunction or any issues with urinary frequency or obstruction. The Veteran's left teste was noted to be considerably harder than normal and had a mild to moderate enlargement of the vein. April 2016 VA Examination, August 2020 VA Examination, January 2021 VA Examination had
 at rest. 38 C.F.R. § 4.104, Diagnostic Code 7120.

The Veteran was afforded a VA examination in June 2021. The Veteran reported that he has pain with any exertion such as prolonged walking or standing or sitting for more than one or two hours. Current symptoms were noted as a throbbing or aching pain but can increase to a "sharp shooting like sensation." The examiner noted the Veteran did not have a voiding dysfunction or any issues with urinary frequency or obstruction. The Veteran's left teste was noted to be considerably harder than normal and had a mild to moderate enlargement of the vein. April 2016 VA Examination, August 2020 VA Examination, January 2021 VA Examination had similar findings. April 2016 and January 2021 VA examinations reported voiding dysfunction but noted the etiology of the dysfunction is related to unrelated prostatitis in 2015. The Veteran has not contended this finding. VA and private treatment records continually show the Veteran complained of pain and discomfort caused by his left varicocele. 

During the period on appeal, the Veteran has not presented evidence that his left varicocele testicle has caused continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, such that the Veteran is required to wear absorbent materials which must be changed less than two times per day due to his left varicocele testicle. There is no evidence that the Veteran's left varicocele has manifested to daytime voiding interval between one and two hours or awakening to void three to four times per night. While the Board acknowledges the Veteran has chronic pain and discomfort due to his left varicocele, it finds the pain and discomfort does not warrant a higher 20 percent rating under diagnostic code 7120 as there is no evidence of persistent edema or swelling and the pain and discomfort is managed by treatment.

The Board has considered other diagnostic codes related to the Veteran but finds them unwarranted. A higher rating under DC 7523 would require the equivalent of complete atrophy of both testicles and DC 7524 would require the equivalent of removal for both testicles. The Veteran's left varicocele testicle does not appear to have manifested to this point.

The Board further notes that although the examiners did not report edema, induration, stasis pigmentation, or eczema, the Veteran has consistently reported that his symptoms include pain and discomfort to include after prolonged standing, sitting and walking. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that the relevant medical and lay evidence in this case supports a rating of 10 percent under DC 7121, but no higher, for the Veteran's service-connected left varicocele disability for the entire period on appeal. To this extent, the claim is granted.

 

 

Carole R. Kammel

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Jarman, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.