Citation Nr: 18153082 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 15-17 793 DATE: November 27, 2018 ORDER New and material evidence has been submitted and the claim to reopen service connection for sciatica of the left lower extremity, to include left foot drop and left side weakness (neurologic disorder) is granted. Secondary service connection for a lumbar spine disability, which is proximately due to the service-connected left knee and/or cervical spine disabilities, is granted. Secondary service connection for a neurologic disorder in the left extremity, which is proximately due to the service-connected left knee and/or cervical spine disabilities, is granted. Compensation under 38 C.F.R. § 1151 for a neurologic disorder is denied. Compensation under 38 C.F.R. § 1151 for a left hip disability is denied. Compensation under 38 C.F.R. § 1151 for a lumbar spine disability is denied. REMANDED The service connection claim for a left hip disability, to include as secondary to the service-connected disabilities of the left knee and/or cervical spine is remanded. The claim for entitlement to automobile and adaptive equipment is remanded. FINDINGS OF FACT 1. Evidence received since the last, final February 2004 rating decision includes a nexus opinion that establishes a correlation between the Veteran’s neurologic conditions and his service-connected cervical spine disability. 2. Resolving all reasonable doubt in his favor, the Veteran’s lumbar spine disability is proximately due to his service-connected left knee and/or cervical spine disabilities. 3. Resolving all reasonable doubt in his favor, the Veteran’s neurologic disorder in the left extremity is proximately due to his service-connected left knee and/or cervical spine disabilities. 4. The Veteran’s neurologic disorder was not caused or aggravated by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, during his treatment at the Memphis VA Medical Center (VAMC). 5. The Veteran’s left hip disability was not caused or aggravated by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, during his treatment at the Memphis VAMC. 6. The Veteran’s lumbar spine disability was not caused or aggravated by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, during his treatment at the Memphis VAMC. CONCLUSIONS OF LAW 1. Evidence received since the last February 2004 rating decision is new and material and the service connection claim for a neurologic disorder is reopened. 38 U.S.C. §§ 5108, 7104 (West 2012); 38 C.F.R. §§ 3.104, 3.156, 20.1103 (2017). 2. The criteria for secondary service connection for a lumbar spine disability, due to the service-connected left knee and/or cervical spine disabilities, have been met. 38 U.S.C. § 5107 (West 2012); 38 C.F.R. §§ 3.102, 3.310 (2017). 3. The criteria for service connection for a neurologic disorder in the left extremity, due to the service-connected left knee and cervical spine disabilities, have been met. 38 U.S.C. § 5107 (West 2012); 38 C.F.R. §§ 3.102, 3.310 (2017). 4. The criteria for compensation under 38 C.F.R. § 1151 for additional disabilities, to include a neurologic disorder, have not been met. 38 U.S.C. § 1151 (West 2012); 38 C.F.R. § 3.361 (2017). 5. The criteria for compensation under 38 C.F.R. § 1151 for additional disabilities, to include left hip disability, have not been met. 38 U.S.C. § 1151 (West 2012); 38 C.F.R. § 3.361 (2017). 6. The criteria for compensation under 38 C.F.R. § 1151 for additional disabilities, to include a lumbar spine disability, have not been met. 38 U.S.C. § 1151 (West 2012); 38 C.F.R. § 3.361 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1968 to February 1971; and June 1974 to April 1980. This appeal comes before the Board of Veterans’ Appeals (Board) from February 2013 and April 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Offices (RO) in Seattle, Washington and St. Paul, Minnesota. In the February 2013 rating decision, the RO denied the claims for entitlement to automobile and adaptive equipment; and secondary service connection for the disabilities of the lumbar spine, left hip, left foot drop/left-sided weakness, and sciatica of the left lower extremity, due to the service-connected cervical spine disability. In the April 2015 rating decision, the RO denied the claims for compensation under 38 U.S.C. § 1151 (1151 claims) for a lumbar spine disability, left hip disability, left foot drop/left-sided weakness, and sciatica of the left lower extremity. Given that the secondary service connection and 1151 claims for left foot drop/ left-sided weakness and sciatica of the left lower extremity are all neurologic conditions that are ratable under the same diagnostic code, 8520, for paralysis of the sciatic nerve, these claims encompass one another and therefore, have been merged as one disability, referred as a neurologic disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 – 6 (2009) (holding that the scope of a claim includes any disorder that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record). In May 2017 the Veteran and his aid assistant/caregiver, A.B., testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. Although, the Veteran indicated on the record that he was withdrawing issues the remaining issues on appeal and would follow up with written notice of such; no such written notification was received. As such, these issues remain in appellate status. In a September 2018 appellate brief, the Veteran requested that his claim for entitlement to special monthly compensation at the aid and attendance/housebound rate be restored as an issue on appeal because testimony was received on those issues at the hearing. However, even though the Veteran filed a timely notice of disagreement in May 2015, the Board finds that the Veteran failed to perfect his appeal with a Form VA 9/Board Appeal after the RO issued a statement of the case in March 2016. In addition, it was not certified on appeal by the RO. Accordingly, this issue has not been certified for appeal, and thus, the Board has no jurisdiction to review it. Should the Veteran wish to reopen those claims, he is free to contact the VA Regional Office. New and Material evidence to Reopen Claim for Neurologic Conditions VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a Veteran. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. § 3.156(a) (2017); Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). New evidence is evidence not previously submitted to agency decision makers. Material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the prior final denial is new. New evidence is that which was not of record at the time of the last final disallowance on any basis of the claim, and is not merely cumulative of other evidence that was then of record. 38 C.F.R. § 3.156(a). That analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The Board must review all evidence submitted by or on behalf of a claimant since the last, final denial on any basis to determine whether a claim must be reopened. Evans v. Brown, 9 Vet. App. 273 (1996). For purposes of determining whether new evidence is material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 510 – 513 (1992). New and material evidence is not required as to each previously unproven element of a claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). The Veteran’s service connection claim for the sciatic nerve (neurologic disorder) was last denied in a February 2004 rating decision. In this decision, the RO denied the claim because it found that there was no medical evidence to establish that the Veteran’s neurologic disorder began in service, or that it was related to the cervical spine disability. Since the Veteran did not perfect an appeal of the decision within one year, this rating decision became final. 38 U.S.C. § 7105(c) (West 2012); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2017). Evidence received since this February 2004 rating decision includes, and is not limited to, a May 2012 VA nexus opinion indicating that the Veteran’s left sided neurologic disorder is most likely related to his service-connected left knee and cervical spine disabilities. This evidence is “new” because it had not been previously submitted and considered by VA. It is material because it is medical evidence of a correlation between the Veteran’s neurologic disorder and his service-connected left knee and cervical disabilities, and specifically, the previously unestablished, unproven element from the February 2004 rating decision. The Board recognizes that this additional piece of evidence is presumed to be credible for the purpose of reopening the claims. Justus, 3 Vet. App. at 512 – 513. Therefore, this additional piece of evidence, when considered in conjunction with the record as a whole, raises a reasonable possibility of substantiating the Veteran’s claim. Accordingly, since new and material evidence has been received, the service connection claim for a neurologic disorder is reopened. Secondary Service Connection A claim for secondary service connection requires medical evidence that connects the asserted secondary disability to the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). In order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See id. A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (2017). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2017); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). The disabilities that are pertinent to the claims on appeal, for which the Veteran has been service-connected, are post-operative left medial meniscus tear and degenerative joint disease with scar (left knee disability) and degenerative disc disease of the cervical spine, with intervertebral disc syndrome (cervical spine disability). The medical evidence of record reflects that the Veteran has diagnoses of osteoarthritis of the lumbar spine, osteoarthritis of the hip/thigh, and left side weakness, which includes a sciatic nerve injury. 1. Lumbar Spine In a January 2012 statement in support of claim and March 2013 notice of disagreement (NOD), the Veteran asserts that his lumbar spine disability is secondary to his left knee and cervical spine disabilities. In December 2003, a VA examiner, Dr. T.E.G., explained that the Veteran has had quadricep weakness on the left side, since suffering from a knee injury in service. He additionally explained that some component of the Veteran’s lumbar spine disability is likely attributable to the Veteran’s history of left leg give-way and subsequent falls. Thus, he opined that it is likely that his lumbar condition is related to the left knee disorder and attendant leg weakness. In October 2012, the Veteran underwent a VA examination for his lumbar spine. The VA examination report reflects a diagnosis of lumbar spine osteoarthritis. The VA examiner, Dr. J.R.B., noted that the Veteran’s service treatment records (STRs) did not reveal a neck or back injury, and that in a signed SF 93 form, the Veteran did not mention back or neck injury or pain; or any neurologic injury or problem in April 1980 and January 1970. However, the VA examiner clarified that the Veteran drove into a telephone pole in Japan, on or about June 1978; and that although he had a completely normal neurological assessment by a neurosurgeon at that time, in July 1978, he had no focal neurological deficits, but rather, was diagnosed with muscle spasm; and that in November 1978, he complained of intermittent neck stiffness, and was diagnosed with left shoulder myofascitis. At the VA examination, the Veteran, however, reported that he fractured his neck and was placed in a HALO traction splint. The Veteran further reported that in the 1970s, while he was on active duty, he would wake up and find that he was unable to move his neck, secondary to pain in his upper back, and that he received shots to his upper back, which helped. He further indicated that after his separation from service in 1980, he was no longer receiving shots and that after this, he began to have falls. He further reported that in the 1990s, at some point after 1992, when he was in Memphis, the chief of rehabilitation medicine undertook an MRI of his spine and informed him that he found “remnants of an old fracture to his neck” and that this was the cause of his falls. He additionally reported that he first noticed left sided weakness when he was running to catch a bus in the 1980s, when his left side gave out, and that he was informed, at that time, that he fell because of a torn meniscus to the left knee. He further explained that he began to have lower back pain in the 1990s, and that it would start with upper back pain on the left, which would radiate down to his lower left back, and that he could push on his left lumbar spine to make the pain go away. The VA examiner opined that the Veteran’s lumbar spine disability was less likely than not proximately due to or the result of the Veteran’s service-connected condition. As a rationale, the VA examiner explained that a bulging or painful disc in the cervical spine does not cause bulging disc in the lumbosacral spine. Nonetheless, the VA examiner failed to discuss and provide an opinion on whether the Veteran’s lumbar spine disability was caused by his service-connected left knee disability; and additionally, whether the Veteran’s lumbar spine disability was aggravated by his service connected cervical spine and/or left knee disabilities. In an October 2014 VA opinion, another VA examiner, Dr. G.F.C., after reviewing the Veteran’s claims file, indicated that he was unable to determine a baseline severity of the Veteran’s lumbar spine condition, based on medical evidence available, prior to aggravation of the earliest medical evidence following aggravation by a left knee. However, he opined that him lumbar spine disability is less likely than not aggravated beyond its natural progression by his cervical spine. As the rationale for this opinion, the VA examiner explained that there is no medical evidence or experience that the degenerative processes in the lumbar spine can be aggravated beyond its natural progression by degenerative processes in the left knee, and that there is no medical evidence that any given degenerative process of an area of a body has pathophysiologic or mechanical influence beyond its immediate locality bearing a severe limb length discrepancy of at least several inches. However, given that parts of the lumbar spine are in close proximity to the cervical spine, the VA examiner still failed to explain why the Veteran’s lumbar spine was not aggravated beyond its natural progression by his cervical spine. Rather, as a rationale to support his opinion that the Veteran’s lumbar spine was not aggravated by his cervical spine, he explained why the Veteran’s lumbar spine disability was not aggravated by his left knee, without any discussion of how or why the lumbar spine disability was not aggravated by (nor proximately due to) the cervical spine disability. As a matter of fact, the VA examiner failed to provide an opinion and rationale on whether the Veteran’s lumbar spine disability was proximately due to his left leg disability, despite acknowledging that the Veteran had a fall, post-service, which led to left knee surgeries. In an additional October 2014 VA opinion, the same VA examiner, Dr. G.F.C., also provided an opinion about conflicting medical evidence on the previous findings and opinions about the Veteran’s disabilities, including and not limited to, his lumbar spine disability. He indicated that the Veteran suffered an acute injury early in 1979, but that by the time of his separation from service nearly 14 months later, the record was clear that his acute left knee injury had resolved without residual. He further indicated that based on his review of an August 1986 VA examination, there was an interceding, intervening left knee injury event in 1982. He also indicated that the 1986 VA examination noted the 1979 knee injury, but that the VA examiner failed to recognize the significance of the separation examination, and that chronicity and nexus had not been established, given that an intervening, interceding event had occurred. As part of the medical evidence he reviewed, the VA examiner referenced this August 1986 VA examination and stated that this examination “notes knee hurts with walking. [The Veteran] has had arthroscopy since separation from service. The examiner notes the in-service motorcycle accident and peri-accident sequalae for knee, but does not note the subsequent [s]eparation exam 14 months later.” However, Dr. G.F.C. misstated the facts and findings from the August 1986 VA examination, and additionally, failed to discuss other pertinent findings from that August 1986 VA examination. For example, the August 1986 VA examination reflects that the Veteran complained that he hurt his knee on the inside whenever he was walking. The August 1986 VA examiner, Dr. F.A.M., then noted that the Veteran had a knee injury in 1975 or 1976 when he stepped in a hole, and that a bit later, the Veteran had a motor cycle accident, and he had swelling and an inability to move his knee. Dr. F.A.M. further noted that the Veteran had hurt knee earlier that year, in 1986, when it gave way and he fell one night; and crucially, that the Veteran underwent arthroscopies in 1980 and 1986. First, the October 2014 VA examiner, Dr. G.F.C., provided a rationale that is in conflict with his findings and his opinion. As noted above, he explained that there was no chronicity of injury and that the Veteran suffered an acute injury early in 1979, but that by the time of his separation from service nearly 14 months later, the record was clear that his acute left knee injury had resolved without residual. However, he particularly omitted Dr. F.A.M.’s (the August 1986 VA examiner) finding that the Veteran underwent an arthroscopic surgery in 1980, which suggestively refutes the VA examiner’s determination that the Veteran’s left knee resolved without residual upon separation from service in 1980. Rather, the VA examiner vaguely remarked that the Veteran “had arthroscopy since separation from service.” Thus, Dr. G.F.C.’s opinion is wholly based on a number of inaccurate factual premises, and accordingly, lacks probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (“If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely.”) (citing Reonal). In support of his claim the Veteran also submitted a May 2015 letter (private opinion) from a friend, Dr. W.P.P., who is also a physician who specializes in osteopathic medicine. Dr. W.P.P. indicated that he has known the Veteran for more than 18 years, he is a close personal friend of the Veteran, and that he has treated him on various occasions, even though he is not formally and officially the Veteran’s treating physician. He additionally explained that he has been familiar enough with the Veteran’s conditions over the past 18 years, also indicating that during a period of time, prior to his formal medical training, he witnesses and assisted the Veteran regularly in various ways, thereby becoming very familiar with health challenges he faced. Dr. W.P.P. opined that having injured his cervical spine, there is a greater probability than not that the Veteran’s spinal issues can and should be directly associated with the cervical spine injuries sustained while on active duty. As part of the rationale for his opinion, he explained that the cervical spine disease is highly correlated with the development and a presence of a lumbar spine disease. After a review of all pertinent evidence of record, the Board finds that the evidence is in at least relative equipoise, as the evidence of record reflects an approximate balance of positive and negative probative evidence, including and not limited to, competent, credible statements from the Veteran and medical evidence of a positive nexus opinion from a private and VA physician. Thus, by resolving all reasonable doubt in favor of the Veteran, his lumbar spine disability was caused by his service-connected left knee and cervical spine disabilities. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107 (West 2012); 38 C.F.R. § 3.102 (2017). 2. Neurologic Disorder In January 2012 and September 2012 statement in support of claim forms, the Veteran asserts that his neurologic disorder is secondary to his left knee and cervical spine disabilities. A December 2003 VA examination reflects that the Veteran “had had quadriceps weakness on the left side since suffering his knee injury in service”; he has had numerous episodes of left leg giving way and falling; and that his claim files documented spinal injury during these falls. The VA examiner, however, clarified that the exact etiology of his sciatic nerve injury was not completely clear from claims file review only. A May 2012 VA examination for the cervical spine reflects that the Veteran had a history loss of use of left lower extremity, post-operative left meniscus tear. At the VA examination, the Veteran reported that his condition began in 1982, in which his left side gave out, causing him to fall while crossing a freeway entrance. He reported that the original injury was related to the neck, and that he was diagnosed with drop foot in 1982. The VA examination report additionally reflects that the Veteran has radicular pain or other signs or symptoms due to radiculopathy, with constant mild pain in the left upper extremity, and intermittent moderate pain in the left upper extremity. A VA examiner, Dr. S.J.P., opined that the Veteran’s overall left side weakness, including loss of use of left lower extremity and left hand, was at least as likely as not (50 percent probability or greater) proximately due to his service-connected cervical spine disability. As the rationale for this opinion, the VA examiner explained that the Veteran’s left sided neurologic condition is most likely related to the fractured cervical spine, which the Veteran stated, occurred in 1969. He further explained that the cervical spine fracture caused the Veteran’s degenerative disc disease of the cervical spine, which was diagnosed in 1979. Additionally, he explained that the Veteran’s left knee degenerative arthritis is most likely related to a fall that occurred due to drop foot on the left side; the drop foot was the result of the cervical spine fracture; and that the left-hand paralysis is most likely related to the cervical spine fracture because of the impingement on the nerve during healing. In an October 2014 VA opinion, another VA examiner, Dr. G.F.C., opined that the Veteran’s sciatica (neurologic disorder) was less likely than not due to the Veteran’s service-connected condition. As a rationale, the VA examiner explained that there is no medical evidence or experience that sciatica can be proximately due to or the result of degenerative processes in the cervical spine, and that there is no medical evidence that any given degenerative process of an area of the spine has any pathophysiologic or mechanical influence beyond its immediate locality. Additionally, despite evidence on the record suggesting that his neurologic conditions and/or lumbar spine and cervical disabilities had worsened, without undertaking a VA examination of the sciatic nerve, the VA examiner speculatively casted the Veteran’s diagnosis of a sciatica injury in doubt. Rather, in support of his speculation that the Veteran likely did not have sciatica, he relied on medical evidence that was at least two years old, including an October 2012 VA examination for his lumbar spine, which indicated that the Veteran had a negative left leg raise and that thus, this was strongly suggestive that the Veteran did not have sciatica; and a June 2009 EMG. Additionally, Dr. G.F.C. failed to discuss and opine whether the Veteran’s sciatica and/or any neurologic condition was proximately due to or aggravated by his service-connected left knee disability. Thus, summarily, this opinion is inadequate for determining this issue. In an accompanying October 2014 VA opinion on left sided weakness/left foot drop, Dr. G.F.C. also opined that this “condition was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition.” As a rationale for this opinion, Dr. G.F.C. explained that there was no medical evidence that any given degenerative process of an area of the body has any pathophysiologic or mechanical influence beyond its immediate locality barring a severe limb length discrepancy of at least several inches. No opinion as to whether the Veteran’s left-sided weakness/left foot drop was aggravated by his cervical spine was provided. Additionally, he failed render an opinion on proximate causation and aggravation due to the service-connected left knee disability. Further, Dr. G.F.C, provided an explanation for the discrepancy between his finding and opinion and the finding and opinion from a December 2003 VA examination on the Veteran’s left sided weakness and drop foot. Specifically, Dr. G.F.C. explained that the December 2003 VA examination, Dr. T.E.G., relied heavily on erroneous finding that there was left leg weakness found in-service, and that this was not supported by a careful review of the STRs. He further explained that Dr. T.E.G., relied on this apparent weakness to discuss the falls the Veteran was suffering from, and that he extended these into spinal injury, “which supposedly led to the left sided weakness and foot drop.” However, Dr. G.F.C. (October 2014 VA examiner) misstated the facts and misinterpreted Dr. T.E.G.’s (December 2003 VA examiner) findings. Dr. T.E.G. never indicated that there was a left leg weakness found in service. Rather, he stated that “since suffering from his knee injury [while he was in service, h]e has had numerous episodes of left leg giving way and falling”, and that “the claims file has documented spinal injury during these falls.” In other words, Dr. T.E.G. made a general statement that since/after he suffered from his knee injury in service, the Veteran has had numerous episodes of his left leg giving way and falling. Thus, Dr. G.F.C.’s rationale is based on an inaccurate factual premise, and accordingly, this October 2014 VA opinion lacks any probative value. See Reonal, 5 Vet. App. at 461 (A medical opinion based on an inaccurate factual premise has no probative value.). In a third October 2014 VA opinion, Dr. G.F.C. also provided an opinion about conflicting medical evidence on the findings and opinions about the Veteran’s disabilities, including and not limited to, his neurologic disorder. He indicated that the Veteran suffered an acute injury early in 1979, but that by the time of his separation from service nearly 14 months later, the record was clear that his acute left knee injury had resolved without residual. He further indicated that based on his review of an August 1986 VA examination, there was an interceding, intervening left knee injury event in 1982. He also indicated that the 1986 VA examination noted the 1979 knee injury, but that he failed to recognize the significance of the separation examination, and that chronicity and nexus had not been established, given that an intervening, interceding event had occurred. As part of the medical evidence he reviewed, Dr. G.F.C. (October 2014 VA examiner) referenced this August 1986 VA examination and stated that this examination “notes knee hurts with walking. [The Veteran] has had arthroscopy since separation from service. The examiner notes the in-service motorcycle accident and peri-accident sequalae for knee, but does not note the subsequent [s]eparation exam 14 months later.” However, Dr. G.F.C. misstated the facts and findings from the August 1986 VA examination, and additionally, failed to discuss other pertinent findings from that August 1986 VA examination. For example, the August 1986 VA examination reflects that the Veteran complained that he hurt his knee on the inside whenever he was walking. The August 1986 VA examiner, Dr. F.A.M. then noted that the Veteran had a knee injury in 1975 or 1976 when he stepped in a hole, and that a bit later, the Veteran had a motor cycle accident, and he had swelling and an inability to move his knee. Dr. F.A.M. (August 1986 VA examiner) further noted that the Veteran had hurt his knee earlier that year, in 1986, when it gave way and he fell one night; and crucially, that the Veteran underwent arthroscopies in 1980 and 1986. Dr. G.F.C.’s (October 2014 VA examiner) rationale is in conflict with his findings and his opinion. As noted above, he explained that there was no chronicity of injury and that the Veteran suffered an acute injury early in 1979, but that by the time of his separation from service nearly 14 months later, the record was clear that his acute left knee injury had resolved without residual. However, he particularly omitted Dr. F.A.M.’s finding that the Veteran underwent an arthroscopic surgery in 1980, but rather, vaguely remarked that the Veteran “had arthroscopy since separation from service.” As a matter of fact, the Dr. G.F.C.’s opinion is wholly based on a number of inaccurate factual premises. See Reonal, 5 Vet. App. at 461 (A medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo, 26 Vet. App. 97, 107 (2012) (“If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely.”) (citing Reonal). Summarily, after a review of all pertinent evidence of record, the Board finds that the evidence is in at least relative equipoise, as the evidence of record reflects an approximate balance of positive and negative probative evidence, including and not limited to, the Veteran’s competent, credible statements and a positive nexus opinion from a VA examiner about his left foot drop/left sided weakness. Thus, by resolving all reasonable doubt in favor of the Veteran, his neurologic disorder in the left extremity was caused by his service-connected left knee and/or cervical spine disabilities. See Gilbert, 1 Vet. App. at 53; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Compensation for a Neurologic Disorder, Left Hip Disability, and Lumbar Spine Disability Under 38 U.S.C. § 1151 A veteran disabled as a result of VA medical treatment may receive compensation for a qualifying additional disability in the same manner as if such additional disability were service-connected. An additional disability is a qualifying disability if: (1) it was not the result of the veteran’s willful misconduct; (2) the disability was caused by VA hospital care, medical or surgical treatment, or examination furnished the Veteran under any law administered by the VA; and, (3) the proximate cause of the disability was carelessness, negligence, lack of proper skill, error in judgment, or similar instance on the part of the VA in furnishing the hospital care, medical or surgical treatment, or examination, or the proximate cause of the disability was an event not reasonably foreseeable. 38 U.S.C. § 1151(a). To establish actual causation, the evidence must show that the VA treatment at issue resulted in the Veteran’s additional disability. Merely showing that a Veteran received care, treatment, or examination and that the Veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c). In his March 2013 NOD, the Veteran asserts that his secondary conditions of a neurologic disorder, and his left hip and lumbar spine disabilities are a result of neglected service-connected disabilities, which led to these secondary conditions, and which have exacerbated due to neglect. The Board first notes that according to an April 2014 VA 21-820 Report of General Information form, the Veteran informed VA that he underwent treatment at the Memphis VAMC from 1989 to 1995, and that during that time, he also underwent treatment at the VA orthopedic clinic on a monthly basis. The RO undertook several searches to locate the Veteran’s treatment records via letter correspondences and telephone calls to the Memphis VAMC, Salt Lake City VAMC and Northern California VAMC. In April 2015, VA contacted the VAMC in Memphis and Salt Lake City, and both facilities indicated that medical records from the period of 1989 to 1995, for the Veteran, did not exist at those facilities. In an April 2015 rating decision, the Veteran was notified that Memphis VAMC indicated that they did not have the Veteran’s medical records, but rather, they were sent to both Salt Lake City and Northern California VAMCs. The rating decision further explained that although Salt Lake City VAMC indicated that they did not have the Veteran’s medical records, Northern California VAMC was only able to provide treatment records for the period of March 31, 1993 to October 26, 1994. Additionally, the Veteran has not provided any copies of treatment records for the pertinent period. Therefore, the Board finds that these treatment records are unavailable, and accordingly, the Board shall review the claims based on all available medical evidence of record. To determine whether compensation is warranted under 38 C.F.R. § 1151 for a neurologic disorder, left hip disability and lumbar spine disability, VA obtained a VA medical opinion in April 2015. With respect to the neurologic disorder, a VA examiner opined that there is no evidence that the Veteran’s treatment at Memphis VAMC has in any way caused the Veteran’s disabilities of sciatica, or that they have been aggravated by care, and that no evidence or any event not reasonably foreseeable proximately caused the Veteran’s additional disability. In this April 2015 VA opinion on the sciatica, while the VA examiner disclosed that no old records were available for review, her rationale, in pertinent part, indicated that the Veteran was seen at Memphis VAMC for left knee pain in June 1989, he was treated with a knee brace and medication; and that an arthrogram was noted to be negative for meniscal pathology. She also noted that in December 1989, the Veteran was discharged from the orthopedic clinic because he had undergone extensive work up, undertook exercises and multiple medication, but since there was no improvement, “[i]t was felt that they had no more to offer him.” She further explained that in December 1990, the Veteran was admitted to a rehabilitation unit to increase strength in the left leg; he increased his strength, but needed a left knee brace and use of a cane; and that he was also ordered a left ankle foot orthosis. She explained that at the time, left leg strength was noted to be 3-4/5. However, she stated that the Veteran suffered a work-related injury in 1993, and underwent evaluation by an orthopedic, including an MRI, which found no abnormality. She further stated that the Veteran was ordered to in-patient and follow-up outpatient rehabilitation. The VA examiner additionally explained that the Veteran was found to have had lacunar strokes and that a March 1996 physical therapy assessment found no corresponding myotome weaknesses in his extremities. She additionally explained that recent EMG did not find a clear etiology for his left leg/foot drop, and that he has evidence of EMG abnormality single left lower leg muscle that could represent old left L5 radiculopathy or peroneal mononeuropathy. However, the VA examiner clarified that there is no way to link this EMG finding to the standard of care the Veteran had at Memphis VAMC from 1989 to 1995. Also encompassing the neurologic disorder, the same VA examiner opined that there is no evidence that the Veteran’s treatment at Memphis VAMC has in any way caused the Veteran’s disabilities of left foot drop/left-sided weakness, or that they have been aggravated by care, and that no evidence or any event not reasonably foreseeable proximately caused the Veteran’s additional disability. In her April 2015 VA opinion on left foot drop/left-sided weakness, her rationale, in pertinent part, reiterated the same observations as her VA opinion on the Veteran’s sciatica, as indicated above, but additionally explained that the Veteran was treated for quad atrophy prior to his treatment at VAMC, and had extensive rehabilitation at VAMC in March 1996. She explained that he was prescribed “AFO at exit from inpatient” rehabilitation, and that this was for weakness evaluated during his rehabilitative treatment, and thus, there was no evidence of any incident caused by care. With respect to the Veteran’s lumbar spine disability, the VA examiner opined that there is no evidence that the Veteran’s treatment at Memphis VAMC has in any way caused the Veteran’s disabilities of a lumbar spine condition, or that they have been aggravated by care, and that no evidence or any event not reasonably foreseeable proximately caused the Veteran’s additional disability. In this April 2015 VA opinion on the Veteran’s lumbar spine disability, her rationale, in pertinent part, reiterated the same observations as her VA opinion on the Veteran’s sciatica, as indicated above, but additionally, noted that the Veteran currently has minimal degenerative changes in the lumbar spine, on CT. In her April 2015 VA opinion on the sciatica, however, she noted that the Veteran had mild degenerative changes of the lumbar spine many years after his care. With respect to the Veteran’s left hip disability, the VA examiner opined that there is no evidence that the Veteran’s treatment at Memphis VAMC has in any way caused the Veteran’s disabilities of a left hip condition, or that it has been aggravated by care, and that no evidence or any event not reasonably foreseeable proximately caused the Veteran’s additional disability. In this April 2015 VA opinion on the left hip disability, the VA examiner reiterated the same observations as her VA opinion on the Veteran’s sciatica, as indicated above, but additionally, noted that the Veteran had degenerative joint disease of the left hip noted on a CT scan for the pelvis in 2011. Particularly, the VA examiner’s rationale makes it clearly apparent that the Veteran’s diagnosis of degenerative joint disease of the left hip was approximately sixteen years after and well beyond the scope of the period of the alleged negligence at Memphis VAMC from 1989 to 1995. Based on a review of all pertinent medical evidence of record, the Board finds that there is no competent medical evidence to refute the VA examiner’s above-mentioned opinions. The Board has also considered all the statements made by the Veteran, in support of his 1151 claims. However, he has not demonstrated any specialized knowledge or expertise to indicate that he is capable of rendering a competent medical opinion on causation and/or aggravation of his disabilities. Although a lay person is competent to provide an opinion about some medical issues, such as, for example, observable symptoms of a medical condition, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), a lay person is not competent to provide an opinion on complex matters, such as, for example, the etiology of a neurologic disorder, left hip degenerative arthritis, or lumbar spine degenerative arthritis. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Summarily, the overall weight of the evidence is against a finding that the Veteran’s neurologic disorder, left hip disability, and lumbar spine disability are due to an instance of fault on the part of VA or an unforeseeable event. Although the Board is grateful for the Veteran’s Honorable service, and sympathizes with the Veteran for his disabilities, compensation under 38 U.S.C. § 1151 for a neurologic disorder, and the left hip and lumbar disabilities must be denied. REASONS FOR REMAND The Board regrets further delay but finds that additional development is necessary before a decision can be rendered on the remaining issues on appeal. 1. Secondary Service Connection Claim for a Left Hip Disability In January 2012 and September 2012 statement in support of claim forms, the Veteran asserts that his neurologic conditions are secondary to his left knee and cervical spine disabilities. None of the left hip/thigh VA examinations, of record, are adequate for determining this claim. Specifically, a October 2012 VA examination for hip and thigh conditions reflects a diagnosis of osteoarthritis of the left hip. However, a VA examiner opined that the Veteran’s left hip is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. As a rationale for this opinion, the VA examiner merely indicated that the Veteran’s hip does not appear to have failed, that he has mild osteoarthritic changes; the Veteran’s left hip was inconsistent on exam; and that a degenerated cervical spine disk or painful cervical spine disk would not cause a hip derangement. However, the VA examiner failed to address and provide an opinion as to whether the Veteran’s left hip arthritis was aggravated by his cervical spine disability. Additionally, given that the Veteran has also contended that his left hip disability is secondary to his service-connected left knee disability, the VA examiner failed to address and provide a secondary opinion based on causation or aggravation by his service-connected left knee disability. Therefore, this opinion is inadequate for lack of a complete opinion, as well as sufficient rationale. Subsequently, in an October 2014 VA opinion for the left hip, another VA examiner opined that the Veteran’s left hip is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. As a rationale for this opinion, the VA examiner explained that there is no medical evidence or experience that degenerative processes in the left hip can be proximately due to or the result of degenerative processes in the left knee. He further explained that there is no medical evidence that any given degenerative process of an area of the body has any pathophysiologic or mechanical influence beyond its immediate locality barring a severe limb length discrepancy of at least several inches. However, the VA examiner failed to discuss and provide an opinion as to whether the Veteran’s left hip disability was aggravated by his left knee disability. Furthermore, no opinion on whether the Veteran’s left hip disability was caused by or aggravated by his cervical spine injury was provided, despite instructions from the RO, in the VA examination report, to do so. Therefore, this opinion is inadequate for lack of a complete opinion, and a sufficient rationale. 2. Claim for Entitlement to Automobile and Adaptive Equipment At his May 2017 videoconference hearing, the Veteran asserted that as a result of his neurologic disorder, namely, neuropathy of the left side, he cannot feel his left side. He further indicated that he is now in a wheelchair. Thus, with respect to his claim for entitlement to automobile and adaptive equipment, at issue is whether his service-connected disabilities, including and not limited to, a neurologic disorder, have resulted in the loss or loss of use of his left extremities. Given that the Board has now granted secondary service connection for a neurologic disorder of his left extremities in this decision, supra, a disability rating evaluation is now pending. This rating evaluation for the neurologic disorder of the left extremities is inextricably intertwined with the automobile and adaptive equipment claim because it is predicated on a determination of the loss of use of the left extremities. Thus, the adjudication of the claim for entitlement to automobile and adaptive equipment is deferred, pending additional development on the rating evaluation for the neurologic disorder of the left extremities, including the extent and degree of loss of use to his left extremities. The matters are REMANDED for the following action: 1. Schedule the Veteran for a new VA examination with an orthopedist or appropriate qualified physician (VA examiner), who has not yet examined the Veteran, to determine the nature and etiology of his left hip disability. A copy of this remand must be made available to the VA examiner. Additionally, the VA examiner must review the claims file and must note that review in the report. All necessary tests and studies should be accomplished and all clinical findings reported in detail. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left hip disability is caused by his service-connected cervical spine disability. b. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left hip disability has been aggravated by his service-connected cervical spine disability. c. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left hip disability is caused by his service-connected left knee disability. d. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left hip disability has been aggravated by his service-connected left knee disability. “Aggravation” means an increase in severity of the disorder beyond any medically established baseline. The appropriate section of the Disability Benefits Questionnaire pertaining to aggravation opinions should be filled out for this purpose, if possible. e. In rendering an opinion, consider all lay statement from the Veteran about onset and symptomatology. f. If it is determined that there is another likely etiology for his left hip disability, please indicate and provide a clear, detailed explanation. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, the VA examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. 2. Also, schedule the Veteran for an examination by a neurologist or appropriate qualified physician (VA examiner) who has not yet examined the Veteran. The VA examiner must review a complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. All necessary tests and studies should be accomplished and all clinical findings reported in detail. The VA examiner must undertake the following: a. Opine whether the Veteran’s service-connected disabilities, including and not limited to, the neurologic disorder of the left extremity, left knee disability, lumbar spine disability, and cervical spine disability, have resulted in the loss or loss of use of his left extremities. b. Determine whether the Veteran has ankylosis in the left foot. c. Indicate whether the extent and severity of his service-connected disability/disabilities is such that no effective function remains other than that which would be equally well served by an amputation stump at the site of election below knee with use of a suitable prosthetic appliance. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. Matthew Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V-N. Pratt, Associate Counsel