Case A26032943

Summary

The Veteran served on active duty from July 2003 to September 2018. The Veteran appealed the denial of a compensable rating for hypertension and sought service connection for varicose veins on a secondary basis to hypertension. During the appeal process, the Veteran withdrew the appeal for hypertension, leading to its dismissal. Regarding varicose veins, the Board reviewed VA treatment records showing symptoms as early as January 2020 and private records from 2021-2023. The Veteran is service-connected for hypertension. A private medical opinion from Dr. R.P. in June 2025 concluded that the varicose veins are at least as likely as not due to hypertension, citing a multifactorial pathophysiological process. The Board found this opinion highly probative due to its thorough rationale and citation of medical literature, supporting a secondary service connection. Therefore, service connection for varicose veins secondary to hypertension was granted.

Full Decision Text

Citation Nr: A26032943
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 210716-172583
DATE: April 9, 2026

ORDER

Entitlement to a compensable rating for hypertension is dismissed.

Entitlement to service connection for varicose veins on a secondary basis is granted.

FINDINGS OF FACT

1. On March 17, 2025, prior to the promulgation of a decision on appeal, the Board received notification from the Veteran and his representative at the Board hearing that a withdrawal of the appeal for a compensable rating for hypertension is requested.

2. The Veteran's varicose veins are caused by his service-connected hypertension.

CONCLUSIONS OF LAW

1. The criteria for dismissal of the claim for a compensable rating for hypertension have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for secondary service connection for varicose veins have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 2003 to September 2018.

This matter comes before the Board on appeal from a rating decision issued in January 2021 by a VA Regional Office (RO), the Agency of Jurisdiction (AOJ). 

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held in March 2025.  Therefore, the Board may only consider the evidence of record at the time of the January 2021 decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

The Veteran appeared for a Board hearing in March 2025 before the undersigned Veterans Law Judge (VLJ).  A copy of the transcript is associated with the record.

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  If the positive and negative evidence is in approximate balance or nearly equal-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt.  Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply.  Id. at 781-82.

1. Entitlement to a compensable disability rating for hypertension.

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed.  38 U.S.C. § 7105.  An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. § 20.205.  Withdrawal may be made by the appellant or by his or her authorized representative.  38 C.F.R. § 20.205.  

In the present case, the Veteran has withdrawn his appeal for a compensable disability rating for hypertension and, hence, there remain no allegations of errors of fact or law for appellate consideration on the issue of hypertension.  An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant.  DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018).  The Veteran appeared at the March 2025 Board hearing and requested to withdraw the issue of a compensable disability rating for hypertension.  The
 fact or law for appellate consideration on the issue of hypertension.  An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant.  DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018).  The Veteran appeared at the March 2025 Board hearing and requested to withdraw the issue of a compensable disability rating for hypertension.  The undersigned explained the consequences of withdrawing the appeal for that issue and the Veteran affirmed that he understood the consequences.  Accordingly, the Board does not have jurisdiction to review the appeal, and it is dismissed.

2. Entitlement to service connection for varicose veins.

The Veteran and his representative contend entitlement to service connection for varicose veins, including as secondary to service-connected hypertension. 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1131, 5107; 38 C.F.R.     § 3.303.  The three-element test for direct service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

In order to establish entitlement to service connection on a secondary basis, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability.  See Wallin v. West, 11 Vet. App. 509, 512 (1998).  Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition.  38 C.F.R. § 3.310.

The Board must determine whether the Veteran's varicose vein disability is related to service on a secondary basis.  

VA treatment records show treatment for symptoms of varicose veins as early as January 2020, and private treatment records also show a diagnosis for varicose veins between 2021 and 2023.  Additionally, the Veteran is service-connected for the asserted primary disability, hypertension, effective September 29, 2018.  Thus, the question turns to whether there is medical evidence establishing a nexus between the service-connected disability and the current disability.

The Veteran provided a private medical opinion in June 2025 from Dr. R.P., who concluded that the Veteran's varicose veins are at least as likely as not due to his service-connected hypertension.  Dr. R.P. explained how hypertension contributes to the development and progression of varicose veins through a multifactorial pathophysiological process that involves increased venous pressure, endothelial dysfunction, and vascular remodeling.  The clinician provided citations to medical literature supporting the clinician's opinion. 

The Board affords the private clinician's opinion high probative value.  In particular, the reports show the clinician contemplated the relevant evidence of record and provided a thorough rationale and a clear conclusion citing relevant studies and medical literature.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").  

In sum, the Board finds that the probative evidence of record supports the conclusion that the Veteran's varicose vein disability is secondary to his service-connected hypertension.  Consequently, the benefit of the doubt doctrine is not for application and service connection for varicose vein disability is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.310.

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scherba, Heather L.

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
").  

In sum, the Board finds that the probative evidence of record supports the conclusion that the Veteran's varicose vein disability is secondary to his service-connected hypertension.  Consequently, the benefit of the doubt doctrine is not for application and service connection for varicose vein disability is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.310.

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scherba, Heather L.

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.