Citation Nr: 18157307 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 17-15 877 DATE: December 12, 2018 ORDER Entitlement to service connection for a left knee condition as secondary to service-connected disability of degenerative arthritis, lumbar spine, is denied. Entitlement to service connection for left leg spasms as secondary to service-connected disability of degenerative arthritis, lumbar spine, is denied. REMANDED Entitlement to service connection for right hip tendinitis as secondary to service-connected disability of degenerative arthritis, lumbar spine, is remanded. Entitlement to service connection for unspecified polyneuropathy bilateral distal legs as secondary to service-connected disability of degenerative arthritis, lumbar spine, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a presently existing diagnosis for a left knee condition. 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a presently existing diagnosis for left leg spasms. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for a left knee condition on a secondary basis are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for establishing service connection for left leg spasms on a secondary basis are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1980 to April 1987. This case comes before the Board of Veterans’ Appeals (Board) from a December 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a notice of disagreement in January 2017 and a statement of the case was issued in January 2017. The Veteran filed a timely notice of appeal to the Board in February 2017 and elected not to appear before the Board for an optional hearing. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection can also be established on a secondary basis for: (1) a disability that is proximately due to or the result of a service-connected disease or injury; or, (2) any increase in the severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease or injury. 38 C.F.R. §§3.310 (a)-(b); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993) (explaining 38 C.F.R. §3.310 (a)); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (explaining 38 C.F.R. §3.310 (b)). It is VA policy to administer the laws and regulations governing disability claims under a broad interpretation and consistent with the facts shown in every case. When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not prove or disprove the claim satisfactorily. It is a substantial doubt and one within range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. §3.102. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). Entitlement to service connection for a left knee condition as secondary to service-connected disability of degenerative arthritis, lumbar spine The Veteran is seeking service connection for a left knee condition as secondary to his service-connected disability of degenerative arthritis of the lumbar spine. The Veteran’s record includes private treatment records from October 2016 that show negative results for a left knee x-ray. The Veteran was provided with a VA knee examination in November 2016 where he reported the onset of symptoms such as muscle spasms, instability, and dull aching post-service. The VA examiner noted that the Veteran does not have a current diagnosis associated with his left knee and opined that it is therefore less likely than not related to his back condition. Upon review of the foregoing evidence, the Board concludes that the Veteran is not entitled to service connection for a left knee condition as secondary to his service-connected disability of degenerative arthritis lumbar spine. The Board finds that the Veteran does not have a presently existing disability diagnosed as a left knee condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). While the Veteran believes he has a current disability diagnosed as a left knee condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board assigns no probative weight to the Veteran’s assertions. Because the preponderance of the evidence is against the claim, service connection for a left knee condition as secondary to service-connected disability of degenerative arthritis lumbar spine is denied. Entitlement to service connection for left leg spasms as secondary to service-connected disability of degenerative arthritis, lumbar spine The Veteran is seeking service connection for left leg spams as secondary to his service-connected disability of degenerative arthritis of the lumbar spine. The Veteran was provided with a VA muscle injuries examination in November 2016 where he reported symptoms of muscle spasm, cold feeling, and tingling sensations since 1997. The VA examiner noted that the Veteran does not have a diagnosis for a muscle injury and therefore it is less likely than not related to his back condition. The record does not contain any competent evidence of a disability manifested by left leg spasm. Upon review of the foregoing evidence, the Board concludes that the Veteran is not entitled to service connection for left leg spasms as secondary to his service-connected disability of degenerative arthritis lumbar spine. The Board finds that the Veteran does not have a presently existing disability diagnosed with symptoms of left leg spasms and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). While the Veteran believes he has a current disability associated with symptoms of left leg spasms, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board assigns no probative weight to the Veteran’s assertions. Because the preponderance of the evidence is against the claim, service connection for left leg spasms as secondary to service-connected disability of degenerative arthritis lumbar spine is denied. REASONS FOR REMAND The Veteran contends that he suffers from right hip tendinitis and unspecified polyneuropathy bilateral distal legs, both as secondary to his service-connected disability of degenerative arthritis of the lumbar spine. The Veteran was provided with a VA hip and thigh conditions examination in November 2016 where he was diagnosed with right hip tendinitis. The VA examiner opined that the diagnosed right hip tendinitis is a separate condition unrelated to the diagnosed arthritis back condition. At a November 2016 VA peripheral nerve conditions examination, the Veteran was diagnosed with unspecified polyneuropathy of both distal legs. The VA examiner opined that the condition was not related to the back condition but indicated that additional testing was required to determine causality. The Board cannot make a fully-informed decision on the issues of entitlement to service connection for right hip tendinitis and unspecified polyneuropathy bilateral distal legs as secondary to service-connected disability of degenerative arthritis of the lumbar spine because no VA examiner has opined whether these conditions were aggravated by his low back condition. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate medical professional regarding the etiology of the Veteran’s right hip tendinitis and unspecified polyneuropathy bilateral distal legs. The examiner should address the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s right hip tendinitis is aggravated (i.e., permanently worsened beyond the natural progression) by the Veteran’s service-connected degenerative arthritis of the lumbar spine? (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s unspecified polyneuropathy bilateral distal legs is (1) caused, or (2) aggravated (i.e., permanently worsened beyond the natural progression) by the Veteran’s service-connected degenerative arthritis of the lumbar spine? The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. 2. After completing the above action, the claim must be readjudicated. If the claims remain denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Morrad, Associate Counsel