ARTERIOSCLEROSIS OBLITERANS

T. SHERRARD · 2022 · Case ID: 22049202

GRANTED

Summary

The veteran, who served from February 1975 to January 1978, appeals the denial of higher disability ratings for peripheral vascular disease (PVD) in both his left and right lower extremities (LLE and RLE). The Board found that the criteria for a 40 percent disability rating for both LLE and RLE PVD were met. The veteran reported subjective complaints of leg cramping, pain, swelling, and trophic changes, limiting his ability to walk or stand for extended periods. Medical evidence, including VA examinations and treatment notes, confirmed bilateral PVD, venous insufficiency, and post-phlebitic syndrome. Specifically, the evidence showed claudication on walking between 25 and 100 yards, trophic changes, diminished peripheral pulses, and an ankle/brachial index of 1.0, which supported the 40 percent rating under diagnostic codes 7111, 7114, 7115, 7120, and 7121. The Board found the medical opinions from VA examiners to be highly probative, outweighing the veteran's subjective complaints of increased symptomatology. The Board denied higher ratings, as the evidence did not meet the criteria for more severe claudication or persistent edema. Service connection for both LLE and RLE PVD is granted at 40 percent.

Rationale

Met criteria for 40% rating; Claudication on walking 25-100 yards; Trophic changes and diminished pulses

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7114

Docket No.

20-18 001

Full Decision Text

Citation Nr: 22049202
Decision Date: 08/30/22 Archive Date: 08/30/22

DOCKET NO. 20-18 001
DATE: August 30, 2022

ORDER

A 40 percent disability rating, but no higher, for peripheral vascular disease (PVD) of the left lower extremity (LLE) is granted.

A 40 percent disability rating, but no higher, for PVD of the right lower extremity (RLE) is granted.

FINDINGS OF FACT

1. The Veteran had active service from February 1975 to January 1978.

2. For the entire period on appeal, the Veteran's LLE and RLE PVD have been characterized by subjective complaints of shiny, hairless legs, and bilateral lower extremity (BLE) cramping, pain and swelling limiting his ability to walk or otherwise be on his feet for extended periods of time; objective findings include BLE varicose veins and post-phlebitic syndrome with persistent stasis pigmentation and intermittent edema, and BLE PVD characterized by claudication on walking between 25 and 100 yards on a level grade at 2 miles per hours, trophic changes, diminished peripheral pulses, and ankle/brachial indices measured, at worst, at 1.0.

CONCLUSIONS OF LAW

1. The criteria for a disability rating of 40 percent for LLE PVD have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A (2012); 38 C.F.R. §§ 4.1 4.2, 4.3, 4.7, 4.104, Diagnostic Codes (DCs) 7111 7115, 7120 7121 (2021).

2. The criteria for a disability rating of 40 percent for RLE PVD have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A (2012); 38 C.F.R. §§ 4.1 4.2, 4.3, 4.7, 4.104, DCs 7111 7115, 7120 7121 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

As an initial matter, in September 2020, the Veteran requested a higher-level review (HLR) of the claims on appeal under the Appeals Modernization Act (AMA). However, the claims on appeal were already before the Board at the time he submitted his HLR request. As such, they were no longer eligible for adjudication under the AMA and the Board proceeded accordingly.

To this end, in November 2021, the Board remanded the claims under the "legacy" appeals process for additional development, to include obtaining a new VA examination assessing the current status of the Veteran's disabilities. The case has now been returned to the Board for further appellate action.

Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities.

The Veteran's LLE and RLE PVD have been rated under DC 7114 for arteriosclerosis obliterans. The Board will consider all relevant diagnostic codes. In order to warrant higher ratings, the medical evidence must show:

Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and either: (a) trophic changes (such as thin skin, absence of hair, dystrophic nails), or (b) an ankle/brachial index of 0.7 or less (40 percent rating under DCs 7111, 7114, 7115); or

Persistent edema and either: (a) stasis pigmentation or (b) eczema, with or without intermittent ulceration (40 percent rating under DCs 7120 7121).

Turning to the evidence, the Veteran reported in an August 2018 VA examination that he developed deep venous thrombosis (DVT) in 2003 and a superficial right leg clot in April 2017. The examiner found that he had PVD, to include an aneurysm of any larger artery, arteriosclerosis obliterans, and Buerger's disease, but did not assess the severity of the disorder.

s 7111, 7114, 7115); or

Persistent edema and either: (a) stasis pigmentation or (b) eczema, with or without intermittent ulceration (40 percent rating under DCs 7120 7121).

The examiner reported that the Veteran did not have an aortic aneurysm, aneurysm of a small artery, Raynaud's syndrome, an arteriovenous (AV) fistula, or soft tissue sarcoma in his BLEs. The examiner ultimately diagnosed bilateral DVT and venous insufficiency, noting that the ankle/brachial index was 1.12 in both his left and right ankles.

In an October 2018 statement, the Veteran described BLE cramping and pain and asserted that his symptoms constituted a claudication of his obstructed arteries. He said that as a result of his cramping pain, he was issued support stockings to help ease the pain in his BLEs. In subsequent December 2018 and May 2019 medical treatment notes, he described increasing aching pain that radiated into his BLEs. He denied experiencing falls, acute traumas, numbness, tingling, weakness, nausea, vomiting, and abdominal pain, and was diagnosed with chronic bilateral PVD. He noted that he underwent an angioplasty of his left leg and asserted that his LLE claudication had improved.

In a February 2020 VA examination, the Veteran described experiencing leg pain when walking. He said that he wore below-the-knee compression stockings and had no recent episodes of deep vein thrombosis. Upon examination, the examiner noted that he had PVD, to include an aneurysm of any larger artery, arteriosclerosis obliterans, and Buerger's disease.

The examiner reported that the Veteran had undergone venous ablations in May and September 2019 and found that his PVD was characterized bilaterally by claudication on walking more than 100 yards. The examiner further determined that he did not have varicose veins, an aortic aneurysm, aneurysm of a small artery, Raynaud's syndrome, an AV fistula, or soft tissue sarcoma. Ultimately, the examiner diagnosed bilateral DVT, venous insufficiency, and peripheral artery disease.

In April 2020, the Veteran described experiencing BLE pain when climbing a flight of stairs or walking a block, explaining that his legs got heavy and tired. He said that he additionally had swelling in his calves, as well as swelling and numbness in his feet. He finally reported that his legs were shiny and hairless. In a separate April 2020 buddy statement, his wife reinforced that he experienced leg pain and became out of breath after climbing a flight of stairs.

More recently, a January 2022 imaging report determined that the Veteran's bilateral ankle/brachial indices were within normal limits at rest. In a subsequent February 2022 VA examination, he described persistent pain and swelling in his BLEs, noting that he was unable to walk for more than 5 minutes without having to sit down and that after a few hours on his feet, the areas from his knees to his feet throbbed and swelled up. He finally reported waking at night due to pain in his feet, explaining that his feet went from being numb to being in severe pain and were very cold.

Upon examination, the examiner determined that he had bilateral varicose veins and post-phlebitic syndrome, characterized by aching and fatigue in his legs after prolonged standing and walking. The examiner additionally noted persistent stasis pigmentation and intermittent edema of his BLEs.

The examination further diagnosed the Veteran with a peripheral arterial disease, noting that he underwent an ablation in 2019 to treat the condition. The examiner reported that the peripheral arterial disease was characterized by trophic changes, numbness, and paresthesia at the tips of the fingers, and pain in his hands during physical activity. The examiner finally determined that he did not have an aneurysm of any large or small artery, Raynaud's disease, an AV fistula, angioneurotic edema, erythromelalgia, tumors, or neoplasms.

The examiner diagnosed bilateral varic
The examiner additionally noted persistent stasis pigmentation and intermittent edema of his BLEs.

The examiner diagnosed bilateral varicose veins, post-phlebitic syndrome, and peripheral arterial disease. The examiner noted that the Veteran had also been diagnosed with PVD and offered that he had claudication of his BLEs on walking between 25 and 100 yards on a level grade at 2 miles per hour. The examiner reported trophic changes and diminished peripheral pulses of his BLEs. Finally, the examiner found that his ankle/brachial indices were measured at 1.0 bilaterally.

Based on the above, 40 percent disability ratings, but no higher, are warranted for the Veteran's LLE and RLE PVD. In this regard, the Veteran reported persistent BLE cramping, pain and swelling that prevented him from walking or otherwise being on his feet for extended periods of time. Moreover, the medical treatment notes and examinations found that he had varicose veins characterized by persistent stasis pigmentation and intermittent edema of his BLEs. Finally, the evidence established that he had BLE PVD characterized, at worst, by claudication present on walking between 25 and 100 yards on a level grade at 2 miles per hour, trophic changes, diminished peripheral pulses, and an ankle/brachial index of 1.0. Thus, two of the criteria for 40 percent ratings are met claudication present on walking between 25 and 100 yards on a level grade at 2 miles per hour and trophic changes, as confirmed by the February 2022 VA examiner.

The criteria for an even higher rating have not been met at any time. Namely, while persistent stasis pigmentation was noted, the medical evidence did not find that the Veteran's varicose veins were characterized by persistent edema. Moreover, claudication on walking less than 25 yards or an ankle/brachial index of 0.5 or less is not shown by the evidence.

The Board has considered the lay statements submitted by the Veteran and his wife regarding the current severity of his LLE and RLE PVD. Lay witnesses are competent to report symptoms because this requires only personal knowledge as it comes to them through their senses. However, they are not competent to identify a specific level of disability according to the appropriate diagnostic codes.

Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disabilities are evaluated.

Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the Veteran's disabilities and had sufficient facts and data on which to base their conclusions, the Board affords the medical opinions great probative value. As such, to the extent that the Veteran seeks a rating in excess of 40 percent for his disabilities, these records are more probative than the subjective complaints of increased symptomatology submitted by the Veteran and his wife.

Consideration has been given to assigning staged ratings for the Veteran's LLE and RLE PVD. However, at no time during the periods in question have the disabilities warranted higher schedular ratings than those assigned herein. Hart v. Mansfield, 21 Vet. App. 505 (2007).

T. SHERRARD

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Spigelman, 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.

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