James P. Barr v. R. James Nicholson
21 Vet. App. 303 (2007)
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Rule of Law:
A layperson is competent to provide testimony on the presence of a medical condition if the condition, such as varicose veins, has unique and readily identifiable observable symptoms, and such testimony cannot be dismissed as incompetent merely for lack of corroborating medical evidence.
Facts:
- James P. Barr served in the U.S. Army from September 1965 to September 1967.
- His induction medical examination noted no abnormalities of his vascular system or lower extremities.
- During the summer of 1966, while stationed at Fort Benning, Barr stated the veins in his left leg "erupted," causing visible bulges from his knee to his foot, which he attributed to daily training runs.
- While in service as a medical supply clerk, Barr discussed his condition with doctors and medical specialists in his company, but he did not file a formal complaint or receive official treatment as they did not deem it necessary at the time.
- His separation medical examination noted a history of leg cramps, but not varicose veins.
- Following his discharge, Barr's leg continued to have visible varicosities, and he occasionally mentioned the condition to private physicians during appointments for other issues.
- In October 1996, approximately 29 years after his service ended, Barr filed a claim for disability compensation for varicose veins, stating that the pain from the condition had only recently begun.
Procedural Posture:
- In October 1996, James P. Barr filed a claim with a VA regional office (RO) for disability compensation.
- In January 1997, a VA medical examiner diagnosed varicose veins but offered no opinion on their origin.
- The VA RO denied the claim.
- Barr filed a Notice of Disagreement with the RO's decision, initiating the appellate process.
- In October 2001, the Board of Veterans’ Appeals (Board) remanded the case to the RO.
- On February 17, 2004, the Board issued a final decision denying Barr’s claim for service connection for varicose veins.
- Barr, the appellant, appealed the Board's 2004 decision to the U.S. Court of Appeals for Veterans Claims.
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Issue:
Is a veteran's lay testimony competent evidence to establish the presence of varicose veins for the purpose of demonstrating continuity of symptomatology for a service-connection claim?
Opinions:
Majority - Greene, Chief Judge
Yes, a veteran's lay testimony is competent evidence to establish the presence of varicose veins. The Board erred by dismissing the veteran's statements as incompetent simply because he is a layman. The court reasoned that varicose veins possess unique, readily identifiable, and observable characteristics—such as being visibly dilated and tortuous—that do not require medical expertise to identify. Citing medical dictionaries which state that a diagnosis is often 'obvious to the patient,' the court held that identifying varicose veins is not a determination 'medical in nature.' Therefore, the Board was obligated to consider the veteran’s testimony regarding the onset and persistence of his symptoms and assess its credibility, rather than rejecting it outright as incompetent evidence. The failure to do so was a prejudicial error.
Analysis:
This decision significantly clarifies the scope of competent lay evidence in veterans' disability claims. It establishes that for conditions with distinct, externally observable symptoms, a veteran's own testimony can be sufficient to establish the presence of the condition and continuity of symptomatology, even without contemporaneous medical records. This holding lowers the evidentiary burden for veterans, particularly for claims filed long after service, by forcing the Board of Veterans' Appeals to evaluate the credibility of lay testimony rather than summarily dismissing it. The case reinforces the principle from Buchanan v. Nicholson that the absence of medical records cannot be the sole basis for rejecting a veteran's credible testimony.
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