Citation Nr: 18150095 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-34 124 DATE: November 14, 2018 ORDER Entitlement to service connection for buttocks and left leg sciatic pain and numbness, diagnosed as left lower extremity radiculopathy, is denied. FINDING OF FACT Radiculopathy of the left lower extremity did not have its onset during service or within one year of active service discharge; and, the preponderance of the evidence fails to establish that the present left lower extremity sciatic pain is etiologically related to service or to a service-connected disability. CONCLUSION OF LAW The criteria for service connection for radicular/sciatic pain of the left lower extremity have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from June 1985 to November 1985 and the United States Army from May 1990 to August 1994. This matter comes before the Board from an April 2014 rating decision. 1. Entitlement to service connection for buttocks and left leg sciatic pain and numbness, secondary to lumbar strain Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012). Generally, the evidence must 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, 1166-67 (Fed. Cir. 2004). Certain chronic diseases, such as organic diseases of the nervous system (like neuropathy), are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). An alternative method of establishing the second and third Shedden elements for disabilities identified as chronic diseases in 38 C.F.R. § 3.309(a) is through a demonstration of continuity of symptomatology. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be shown if “the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology.” Savage v. Gober, 10 Vet. App. 488, 498 (1997). Service connection may be also established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a) (2018). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran contends that he has sciatic pain and numbness in the buttocks and left leg related to his service-connected lumbar strain. The Veteran has a current diagnosis of radiculopathy of the left sciatic nerve. Accordingly, the requirements of Shedden and Wallin element (1) have been met. Additionally, the Veteran is currently service-connected for a lumbar strain. As such, the requirements of Wallin element (2) have been met. The question for the Board is whether the Veteran’s current radiculopathy of the left sciatic nerve is proximately due to or the result of or is aggravated beyond its natural progress by his service-connected lumbar strain. The Board concludes that it is not. The Veteran cites to medical evidence from his physical therapy records documenting treatment for lumbago and thoraco-lumbar neuritis. Although the records indicate that the physical therapist is treating symptoms of both back and leg pain, a positive etiological opinion is not provided. The Veteran was afforded a VA examination in January 2014 in which the examiner opined that the Veteran’s radiculopathy of the left sciatic nerve was less likely than not related to service or proximately related to the Veteran’s service connected lumbar strain. The examiner’s rationale was that the Veteran’s radiculopathy of the left sciatic nerve did not develop until 2001 after a work-related fall. The examiner further explained that although the Veteran now has lumbar spondylosis, causing the left sciatic nerve neuritis, this condition developed following the injury in 2001 and is unrelated to the service-connected lumbar strain. The Veteran contends that the examiner did not have the Veteran’s complete medical record when making this determination and for that reason the opinion is inadequate. The examiner marked that she had reviewed the Veteran’s claim file. There is no indication that records were missing from the file at the time of the examination. Another Disability Benefits Questionnaire (DBQ) was completed in July 2016. Using the existing medical evidence of record, the examiner determined there was sufficient medical evidence on file to opine as to whether the Veteran’s bilateral radiculopathy of the sciatic nerve was related to his lumbar strain. The examiner determined that lumbar strain does not typically result in radiculopathy of the sciatic nerve and the Veteran’s bilateral lower extremity sciatica is less likely than not proximately due to or a result of service connected lumbar strain. The examiner’s rationale was that radiculopathy of the sciatic nerve is typically caused by degenerative changes in the spine that occur naturally as a result of aging resulting in disc protrusion and/or degenerative changes that compress the nerve roots. An additional VA examination and opinion were provided in July 2018. At that time, the examiner noted the Veteran’s diagnoses of L5-S1 sciatica to the bilateral lower extremities. The examiner opined that it was less likely than not that the Veteran’s lower extremity sciatica was proximately due to, a result of, or aggravated by his service-connected lumbar strain. The rationale was based on a review of the medical evidence showing the Veteran’s radiculopathy is related to a disc bulge, rather than a lumbar strain, and medical literature indicating lumbar radiculopathy most commonly associated with aging. Based on the above, the Board finds that service connection for the Veteran’s left lower extremity sciatica as secondary to his service-connected lumbar strain is not warranted. The VA examiner’s negative nexus opinions are highly probative in this regard. The opinions are based on a thorough review of the Veteran’s claims file, and the examiners considered the Veteran’s medical history and lay statements. Additionally, sound rationales are provided for the opinions offered. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consideration has been given to the Veteran’s statements that he has sciatic pain of the left lower extremity that is related to his service-connected lumbar strain. Specifically, the Board acknowledges the Veteran’s contentions that his sciatica is caused by the degenerative changes in his spine which are a progression of the service-connected lumbar strain. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issues in this case fall outside the realm of common knowledge of a lay person. The etiology of a neurological condition is medically complex and requires specialized medical knowledge the Veteran is not shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. The lay opinions are also outweighed by the medical evidence of record. Further, although service connection may be granted on a direct basis, the preponderance of the evidence is against finding that the Veteran’s left lower extremity sciatic pain is etiologically related to the Veteran’s active service. The Veteran’s service treatment records are absent of complaint or treatment for left leg or buttocks pain or radiculopathy. Moreover, the Veteran does not contend that he incurred sciatica during active service. Presumptive service connection is similarly not warranted. The first evidence of complaints of “shooting pain down left buttock” are noted in March 2001, over a year after service discharge. (Continued on the next page)   Because the weight of the evidence is against the Veteran’s claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Service connection for buttocks and left leg sciatic pain and numbness, diagnosed as left lower extremity radiculopathy, is denied. Lindsey M. Connor Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Rekowski, Associate Counsel