Citation Nr: 18161224 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 17-00 779 DATE: December 31, 2018 ORDER Service connection for residuals of a left leg fracture, claimed as secondary to service-connected left ankle disability, is denied. Service connection for nerve damage in left lower extremity, claimed as secondary to service-connected left ankle disability, is denied. FINDINGS OF FACT 1. The most probative evidence fails to link current residuals of a left leg fracture to the service-connected left ankle disability. 2. The most probative evidence fails to link the claimed nerve damage in his left lower extremity to the service-connected left ankle disability. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a left leg fracture, claimed as secondary to service-connected left ankle disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.310. 2. The criteria for service connection for nerve damage in left lower extremity, claimed as secondary to service-connected left ankle disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 2001 to December 2005. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing. A transcript of the hearing has been associated with the claims file. During the hearing, the VLJ held the record open an additional 30 days for the Veteran to submit evidence, to include a medical opinion. The Veteran has not submitted any additional evidence pertinent to the issues before the Board. Service Connection In his initial claim for VA benefits, the Veteran indicated that his left leg and nerve damage disabilities developed secondary to his service-connected left ankle disability. He clarified on multiple occasions, including during his May 2017 testimony, that he believes his left leg and nerve damage disabilities developed not as a direct result of service, but as secondary to his service-connected left ankle disability. Thus, the Board will address his claim for service connection for left leg and nerve damage disabilities on a secondary basis. Service connection may be granted for disability which is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may not be granted without medical evidence of a current disability and medical evidence of a nexus between the current disability and a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 488 (1995) (en banc). In relevant part, 38 U.S.C. 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). “[L]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). “Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.” Savage v. Gober, 10 Vet. App. 488, 496 (1997) (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. Service connection for residuals of a left leg fracture and nerve damage, claimed as secondary to service-connected left ankle disability During the October 2016 VA examination, the Veteran reported that he fractured his left tibia and fibula while roller skating in July 2009. The VA examiner indicated that based on the available evidence, as well as the separate locations of each fracture, it is her opinion that the residuals of fracture of the left tibia and fibula in July 2009 is less likely as not proximately due to, caused or aggravated by the service-connected residuals of Maisonneuve fracture, medial malleolus, left ankle. The examiner stated that the medial malleolus is the bump on the inner side of the ankle joint. She stated that this is the end of the tibia and forms the support for the inner side of the ankle joint. She concluded that because of the two different locations of the fractures, they are clearly independent of each other. Furthermore, she stated that the in-service fracture was well-healed prior to the comminuted distal tibia-fibula fracture sustained in July 2009. During the October 2016 VA nerve examination, the Veteran reported that he experienced numbness in his left foot and toes after suffering a fall in July 2009, in which he fractured his left tibia and fibula. Based on the Veteran’s report, the examiner essentially indicated that the nerve damage and numbness is less likely as not proximately due to or aggravated by residuals of the Maisonneuve fracture, medial malleolus, left ankle and more likely residuals from a fracture of the tibia/fibula sustained in July 2009. The Board finds the examination findings to be highly probative as the examiner reviewed the Veteran’s claims file, his post-service treatment records, and conducted an in-person examination, to include detailed physical examination of the left lower extremity, as well as to include a neurological examination. The Board notes that the VA examiner explained that the medial malleolus is the bump on the inner side of the ankle joint. She stated that this is the end of the tibia and forms the support for the inner side of the ankle joint. She concluded that because of the two different locations of the fractures, they are clearly independent of each other. Moreover, she noted that the service-connected left ankle disability had healed prior to the July 2009 left leg fracture. The VA examiner also found that the Veteran’s current nerve damage to the left lower extremity was not secondary to the left ankle disability. To the contrary, the claimed disorder is more likely related to the Veteran’s non-service-connected left leg fracture. For these reasons, these opinions are considered highly probative and given considerable weight. The Board observes the Veteran was provided additional time to obtain and submit a favorable medical opinion; however, he has not submitted any additional evidence pertinent to the left leg fracture and nerve damage. As such, there is no contrary opinion. The Board acknowledges that the VA examiner did not specifically address aggravation when rendering her secondary opinion as to both claimed disabilities. Read as a whole, and specifically considering her description of the left ankle fracture residuals being independent of the claimed secondary disabilities, the opinion adequately addresses secondary service connection. In other words, her opinion essentially addresses both causation and aggravation. The Board has considered the Veteran’s contention that his left leg with nerve damage disability is a result of or aggravated by his service-connected left ankle disability; however, as a layperson without the appropriate medical training and expertise, he is simply not competent to provide a probative opinion on a medical matter such as the etiology of his diagnoses. Thus, the Veteran is competent to report symptoms observable to a layperson, a diagnosis that is later confirmed by clinical findings, or a contemporary diagnosis, but he is not competent to independently opine as to the specific etiology of a condition on a medical question such as this. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Although the Veteran is competent to report the symptoms he experienced, his assertions and reported history were considered by the VA examiner who provided the opinion that his left leg and nerve damage disability is not the result of, or aggravated by, his service-connected left ankle disability. The Veteran’s own assertions as to the etiology of his left leg and nerve damage disability have little probative value, and are far outweighed by the VA opinions of record. The preponderance of the evidence is against a finding that the Veteran’s left leg and nerve damage disability is secondary to service-connected left ankle disability. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. McPhaull, Counsel