CHRONIC VENOUS INSUFFICIENCY

Summary

The veteran served in the U.S. Army from March 1995 to September 1995. The veteran appeals the denial of service connection for several conditions, including bilateral venous disability, acquired psychiatric disability (depression and PTSD), erectile dysfunction, hiatal hernia, left knee disability, left shoulder disability, right shoulder disability, and cervical spine disability. The Board denied service connection for all these conditions, finding that the evidence persuasively weighed against the claims and that the benefit of the doubt doctrine was not applicable. For the acquired psychiatric disability, the Board noted the absence of any mental health complaints or diagnoses in the record. For erectile dysfunction, the VA examiner found no diagnosis, and the record lacked evidence of treatment or diagnosis. For the musculoskeletal and venous conditions, the Board found no evidence of in-service complaints or treatment, nor any medical evidence linking the current conditions to service. The claim for hypertension was dismissed without prejudice as it was deferred by the Regional Office and not ripe for appellate review. The Board remanded claims for headache disability and right testicle disability due to pre-decisional duty to assist errors, specifically the inadequacy of VA opinions and the need to verify active duty status for Reserve/National Guard periods. The headache remand requires a new opinion addressing nexus to service, considering verified duty status and in-service complaints. The right testicle remand requires obtaining records related to diagnosis and follow-up appointments, and a new opinion addressing nexus to service, considering verified duty status.

Rationale

No in-service complaints or treatment for venous conditions; No medical evidence linking current diagnosis to service; Evidence persuasively weighs against the claim

Full Decision Text

Citation Nr: A26029005
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 251210-622935
DATE: March 31, 2026

ORDER

Entitlement to service connection for a bilateral venous disability is denied.

Entitlement to service connection for an acquired psychiatric disability is denied.

Entitlement to service connection for erectile dysfunction is denied.

Entitlement to service connection for a hiatal hernia is denied.

Entitlement to service connection for a left knee disability is denied.

Entitlement to service connection for a left shoulder disability is denied.

Entitlement to service connection for a right shoulder disability is denied.

Entitlement to service connection for a cervical spine disability is denied.

Entitlement to service connection for hypertension is dismissed.

REMANDED

Entitlement to service connection for a headache disability is remanded.

Entitlement to service connection for a right testicle disability is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that a bilateral venous disability began during active service or is otherwise related to an in-service injury or disease.

2. The evidence of record persuasively weighs against finding that the Veteran has had an acquired psychiatric disability at any time during or approximate to the pendency of the claim.

3. The evidence of record persuasively weighs against finding that the Veteran has had erectile dysfunction at any time during or approximate to the pendency of the claim 

4. The evidence of record persuasively weighs against finding that a hiatal hernia disability began during active service or is otherwise related to an in-service injury or disease.

5. The evidence of record persuasively weighs against finding that a left knee disability began during active service or is otherwise related to an in-service injury or disease.

6. The evidence of record persuasively weighs against finding that a left shoulder disability began during active service or is otherwise related to an in-service injury or disease.

7. The evidence of record persuasively weighs against finding that a right shoulder disability began during active service or is otherwise related to an in-service injury or disease.

8. The evidence of record persuasively weighs against finding that a cervical spine disability began during active service or is otherwise related to an in-service injury or disease.

9. In December 2025, a Veterans Affairs (VA) Regional Office (RO) issued a rating decision deferring the issue of service connection for hypertension. That decision was not final.

CONCLUSIONS OF LAW

1. The criteria for service connection for a bilateral venous disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for an acquired psychiatric disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a hiatal hernia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The appeal regarding the deferred issue of service connection for hypertension, contains no current allegations of error of law or fact and is not ripe for appellate consideration. Therefore, the criteria for dismissal of the claim without prejudice have been met.  38 U.S.C. § 7105
 been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The appeal regarding the deferred issue of service connection for hypertension, contains no current allegations of error of law or fact and is not ripe for appellate consideration. Therefore, the criteria for dismissal of the claim without prejudice have been met.  38 U.S.C. § 7105; 38 C.F.R. § 20.104.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from March 1995 to September 1995.

The rating decision on appeal was issued in December 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the December 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of service connection for a headache disability and right testicle disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). 

The claims of service connection for PTSD and depression have been combined, and the scope has been construed more broadly to include any acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). The Board has recharacterized the issue accordingly.

Service Connection

To establish service connection a Veteran must generally show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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).

The term "active military, naval, or air service" includes active duty, and any period of active duty for training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred or aggravated in line of duty, and any period of INACDUTRA during which the individual concerned was disabled from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a).

Service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing ACDUTRA or an injury incurred or aggravated during INACDUTRA, but presumptive periods do not generally apply to ACDUTRA or INACDUTRA. See Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991).

ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). INACDUTRA is part-time duty in the Armed Forces performed
 from disease or injury incurred or aggravated while performing ACDUTRA or an injury incurred or aggravated during INACDUTRA, but presumptive periods do not generally apply to ACDUTRA or INACDUTRA. See Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991).

ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). Active service also includes authorized travel to or from such duty or service. 38 U.S.C. § 106 (d); 38 C.F.R. § 3.6 (e).

A member of the National Guard serves in the federal military only when formally called into the military service of the United States. At all other times, a member of the National Guard serves solely as a member of the State militia under the command of a state governor. To have basic eligibility as a veteran based on a period of duty as a member of a state Army National Guard, a National Guardsman must have been ordered into Federal service under 38 U.S.C. §§ 316, 502, 503, 504, 505; 38 C.F.R. § 3.6 (c), (d); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

1. Entitlement to service connection for a bilateral venous disability

Private medical treatment records submitted by the Veteran show that in October 2022 he was diagnosed with chronic thrombosis of the left superficial femoral vein and the left peroneal veins. The etiology of these conditions was not noted. 

The Veteran has indicated that he believes these diagnoses to be related to his service-connected degenerative arthritis with intervertebral disc syndrome. However, there is no medical evidence of record suggesting any such link. Further, there is no evidence of complaints or treatment related to chronic thrombosis of the left superficial femoral vein or left peroneal veins during the Veteran's service. 

Accordingly, the Board finds that service connection for a bilateral venous disability is not warranted. 

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for an acquired psychiatric disability

The Veteran seeks service connection for an acquired psychiatric disability, claimed as depression and PTSD. Review of the record does not show any complaints or treatment for any mental health symptoms or any mental health diagnosis. Therefore, the evidence weighs against a finding that the Veteran has any acquired psychiatric disability.

In the absence of proof of a present disability there can be no valid claim. 38 U.S.C. § 1110; Brammer v. Derwinski, 3 Vet. App. 223 (1992).

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for erectile dysfunction

The Veteran seeks service connection for erectile dysfunction. He received a VA examination in November 2025. The examiner indicated that the Veteran did not have erectile dysfunction. Review of the record does not show diagnosis or treatment for erectile dysfunction. Therefore, the evidence weighs against a finding that the Veteran has erectile dysfunction.

In the absence of proof of a present disability there can be no valid claim. 38 U.S.C. § 1110; Brammer v. Derwinski, 3 Vet. App. 223 (1992).

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

4. Entitlement to service connection for a hiatal hernia

The Veteran seeks service connection for a hiatal hernia. Private medical records show that he was diagnosed with a large hiatal hernia in December 2021. The etiology of the hiatal hernia was not noted. 

Service treatment records do not show any treatment or complaints for hiatal hernia. Nor has the Veteran provided any other medical evidence suggesting a link
 Derwinski, 3 Vet. App. 223 (1992).

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

4. Entitlement to service connection for a hiatal hernia

The Veteran seeks service connection for a hiatal hernia. Private medical records show that he was diagnosed with a large hiatal hernia in December 2021. The etiology of the hiatal hernia was not noted. 

Service treatment records do not show any treatment or complaints for hiatal hernia. Nor has the Veteran provided any other medical evidence suggesting a link between his hiatal hernia and his service. 

Accordingly, the Board finds that service connection for a hiatal hernia is not warranted. 

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

5. Entitlement to service connection for a left knee disability

The Veteran seeks service connection for a left knee disability. He has reported experiencing pain in his left knee. 

Service treatment records do not show complaints or treatment for the left knee. Nor has the Veteran provided any other evidence supporting a link between his claimed left knee pain and his active service. 

Accordingly, the Board finds that service connection for a left knee disability is not warranted. 

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

6. Entitlement to service connection for a left shoulder disability

The Veteran seeks service connection for a left shoulder disability. He has reported experiencing pain in his left shoulder. 

Service treatment records do not show complaints or treatment for the left shoulder. Nor has the Veteran provided any other evidence supporting a link between his claimed left shoulder pain and his active service. 

Accordingly, the Board finds that service connection for a left shoulder disability is not warranted. 

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

7. Entitlement to service connection for a right shoulder disability

The Veteran seeks service connection for a right shoulder disability. He has reported experiencing pain in his right shoulder. 

Service treatment records do not show complaints or treatment for the right shoulder. Nor has the Veteran provided any other evidence supporting a link between his claimed right shoulder pain and his active service. 

Accordingly, the Board finds that service connection for a right shoulder disability is not warranted. 

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

8. Entitlement to service connection for a cervical spine disability

The Veteran seeks service connection for a cervical spine disability. He has reported experiencing pain in his neck. 

Service treatment records do not show complaints or treatment for the neck. Nor has the Veteran provided any other evidence supporting a link between his claimed neck pain and his active service. 

Accordingly, the Board finds that service connection for a cervical spine disability is not warranted. 

The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

9. Entitlement to service connection for hypertension

On the Veteran's December 2025 Notice of Disagreement he listed the issue of hypertension, referencing a December 2025 rating decision. That rating decision did not adjudicate the issue of service connection for hypertension but deferred the issue for further development. Accordingly, the Board does not have jurisdiction to review the appeal for service connection for hypertension, and it is dismissed.

The Board thus finds there is no valid appeal for the appeal of deferred issue, and as such, lacks the jurisdiction to consider the Veteran's issue.  Pursuant to 38 C.F.R. § 20.104, previously codified pre-AMA as 38 C.F.R. § 20.101, regarding jurisdiction of the Board, the Board may dismiss any case of which it determines it does not have jurisdiction.  Where the law is dispositive, the claim must be denied on the basis of absence of legal merit.  Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

The Board notes that a rating decision denying the Veteran service connection for hypertension was issued in February
.

The Board thus finds there is no valid appeal for the appeal of deferred issue, and as such, lacks the jurisdiction to consider the Veteran's issue.  Pursuant to 38 C.F.R. § 20.104, previously codified pre-AMA as 38 C.F.R. § 20.101, regarding jurisdiction of the Board, the Board may dismiss any case of which it determines it does not have jurisdiction.  Where the law is dispositive, the claim must be denied on the basis of absence of legal merit.  Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

The Board notes that a rating decision denying the Veteran service connection for hypertension was issued in February 2026.  As such, the Veteran may file a new Notice of Disagreement for that rating decision.  The Board encourages the Veteran to do as soon as possible if he wishes to pursue his appeal.

The Board emphasizes that this dismissal is without prejudice and the Veteran is not precluded from appealing the issue. Since there remains no allegation of error of fact or law for appellate consideration regarding the issue, the criteria for the dismissal of the issue is met. 38 U.S.C. § 7105; 38 C.F.R. § 20.104.

REASONS FOR REMAND

1. Entitlement to service connection for a headache disability is remanded.

Remand is necessary to correct pre-decisional duty to assist errors.  Service treatment records show complaints of headache during drill periods in December 1993 and July 1997. 

The Veteran's periods of ACDUTRA and INACDUTRA have not been verified. Unlike INACDUTRA, service connection may be granted for a disability due to a disease during ACDUTRA. As such, dates during which the Veteran was in ACUDTRA and INACDUTRA must be verified.

The Veteran received a VA examination in November 2025. The examiner opined that the Veteran's current migraines were less likely than not related to his service because his active service was 50 years ago and his headaches began only a few years ago. The opinion did not address the December 1993 or July 1997 reports of headache and is therefore inadequate. Remand is necessary for a new opinion. 

2. Entitlement to service connection for a right testicle disability is remanded.

Service treatment records show a clinic note from December 1993 where the Veteran complained of pain in his right testicle. As noted above, it is unclear if this is from a period of ACDUTRA or INACDUTRA.

The Veteran received a VA examination in November 2025. The examiner stated that there was no diagnosis because no imaging had been performed but that the Veteran had a follow-up appointment the next day. The examiner then provided a negative nexus opinion based on a lack of definitive diagnosis. It does not appear that the records of the Veteran's follow-up appointment have been obtained or that any efforts have been made to do so. Remand is necessary to attempt to obtain any private medical records regarding diagnosis of the Veteran's right testicle condition. 

The matters are REMANDED for the following action:

1.  Contact the appropriate entity to verify the Veteran's duty status (i.e. ACDUTRA or INACDUTRA) during the Veteran's U.S. Army Reserve and National Guard service. If payroll records are needed to verify service, they should be requested as well. All records and/or responses received should be associated with the claims file.

All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e).

2. Ask the Veteran to complete a VA Form 21-4142 for any private medical records that may contain further treatment and/or diagnosis for his right testicle.  Make two requests for the authorized records from, unless it is clear after the first request that a second request would be futile.

3. After the Veteran's active-duty service is reasonably determined and/or verified, obtain an addendum medical opinion for the Veteran's headaches, providing the verified dates of any periods of ACDUTRA and INACDUTRA for the Veteran's Reserve service to the examiner. The examiner should review the claims file and respond to the following:

(a.) State whether any current headache disability was at least as likely as not incurred due to a disease or injury
. Ask the Veteran to complete a VA Form 21-4142 for any private medical records that may contain further treatment and/or diagnosis for his right testicle.  Make two requests for the authorized records from, unless it is clear after the first request that a second request would be futile.

3. After the Veteran's active-duty service is reasonably determined and/or verified, obtain an addendum medical opinion for the Veteran's headaches, providing the verified dates of any periods of ACDUTRA and INACDUTRA for the Veteran's Reserve service to the examiner. The examiner should review the claims file and respond to the following:

(a.) State whether any current headache disability was at least as likely as not incurred due to a disease or injury or aggravation in the line of duty during verified active duty or ACDUTRA, or due to an injury or aggravation in the line of duty during verified INACDUTRA.

The examiner is advised that general wear and tear may be considered an injury during a period of active duty, but not during ACDUTRA or INACDUTRA. Rather, a specific injury is required for those types of service. A complete rationale must be provided for all opinions.  If the examiner cannot provide the requested opinion without resorting to speculation, he or she should provide an explanation as to why speculation is the only possible response.

4. After all appropriate attempts have been made to obtain private medical records involving the Veteran's right testicle, obtain an addendum medical opinion for the Veteran's right testicle, providing the verified dates of any periods of ACDUTRA and INACDUTRA for the Veteran's Reserve service to the examiner. The examiner should review the claims file and respond to the following:

(a.) State whether any current right testicle disability was at least as likely as not incurred due to a disease or injury or aggravation in the line of duty during verified active duty or ACDUTRA, or due to an injury or aggravation in the line of duty during verified INACDUTRA.

The examiner is advised that general wear and tear may be considered an injury during a period of active duty, but not during ACDUTRA or INACDUTRA. Rather, a specific injury is required for those types of service. A complete rationale must be provided for all opinions.  If the examiner cannot provide the requested opinion without resorting to speculation, he or she should provide an explanation as to why speculation is the only possible response.

 

 

Christopher Seppanen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Creegan, A.

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.