## Facts

- A U.S. Army veteran (served 1965–1967) sought VA service connection for painful varicose veins, asserting onset during service and post-service private treatment beginning shortly after discharge.
- A January 1997 VA examination diagnosed varicose veins and venous insufficiency but provided no medical opinion on whether the condition was related to service.
- The VA regional office denied the claim, and the veteran appealed to the Board of Veterans’ Appeals.
- The veteran submitted lay statements reporting visible varicose veins beginning in service and continuing afterward, with pain developing decades later.
- The Board denied service connection, finding no competent evidence linking the condition to service and rejecting the veteran’s lay statements as incompetent to establish diagnosis or causation.
- The veteran appealed to the United States Court of Appeals for Veterans Claims, challenging the Board’s handling of lay evidence and the adequacy of the VA examination.

## Issues

1. Whether the Board erred by treating the veteran’s lay testimony as categorically incompetent to identify varicose veins and report their presence and continuity since service.
2. Whether VA breached its duty to assist by relying on a VA examination that diagnosed varicose veins but did not provide an etiology (nexus) opinion.

## Decision

- The court held the Board erred by rejecting the veteran’s lay testimony as incompetent where the claimed condition (varicose veins) has readily observable features capable of lay identification.
- The court held the January 1997 VA examination was inadequate because it omitted a nexus opinion despite the claim and lay reports of in-service onset and continuity.
- The court vacated the Board’s decision and remanded for proper consideration of the veteran’s lay evidence (competence and credibility) and for an adequate medical examination/opinion addressing etiology.

## Legal Principles

- Lay evidence can be competent to identify a condition when it has unique, readily observable features; competency depends on the type of condition and the nature of the testimony.
- Competency (a legal admissibility question) is distinct from credibility (a factual weight determination); the Board must not conflate the two when evaluating lay statements.
- The absence of contemporaneous medical documentation does not, by itself, permit rejection of competent lay evidence; such evidence must be weighed with the full record.
- When VA undertakes to provide a medical examination or opinion, it must ensure the examination is adequate for adjudication, including consideration of the veteran’s history and sufficient medical detail to decide nexus.

## Conclusion

The court required the Board to treat varicose veins as a condition that may be competently identified through lay observation, to separately assess the credibility and weight of the veteran’s reports, and to obtain an adequate VA medical opinion on whether the diagnosed condition is related to service.


Barr v. Nicholson, 21 Vet. App. 303 (2007)