Citation Nr: 20003262 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 17-05 570A DATE: January 14, 2020 ORDER Service connection for a sciatic nerve disorder is denied. A rating in excess of 10 percent for a right knee strain is denied. FINDINGS OF FACT 1. The Veteran had active service from October 1993 to June 1995. 2. A sciatic nerve disorder, diagnosed as sciatica, was not shown in service, is not causally or etiologically related to service, and was not caused by or permanently worsened in severity by a service-connected disability; sciatica was not shown to a compensable degree within one year of service and symptoms were not continuous since service. 3. A right knee disability has been manifested by subjective complaints of pain and difficulty running; objective findings include limited range of motion but no finding of ankylosis. CONCLUSIONS OF LAW 1. A sciatic nerve disorder was not incurred in service, is not proximately due to, aggravated by, or the result of a service-connected disability, and is not presumed to have been incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2018). 2. The criteria for a rating in excess of 10 percent for a right knee strain have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1-4.14, 4.21, 4.124, Diagnostic Code (DC) 5260 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In July 2019, the Veterans Claims Court vacated a January 2019 Board decision which denied service connection for sciatic nerve pain and an increased rating for a right knee disability. Further, the Court remanded the issues to obtain adequate medical examinations and opinions. The Veteran was scheduled for examinations but failed to report despite multiple attempts to reach him. Therefore, the issues will be decided on the evidence or record. Service Connection Sciatic Nerve Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a 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 Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran contends that sciatic nerve pain is related to service. Turning to the medical evidence, a private physician evaluated the Veteran in May 2016 and diagnosed ongoing sciatica. As such, the first element of service connection is met. As to an in-service incurrence, the service treatment records (STRs) do not reflect complaints of or treatment for the sciatic nerve or any symptoms reasonably attributed to sciatic nerve pain. Further, the May 1995 separation examination reflects a normal clinical evaluation of the lower extremities. As such, the medical evidence does not support the second element because there is no in-service incurrence. Next, sciatica is considered an organic disease of the nervous system under 38 C.F.R. § 3.309(a) and presumptive service connection will be considered. While sciatica has been shown, it did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology has not been established. While the Veteran’s active service ended in 1995, he contends that the onset of sciatic nerve pain came around 2008. Further, the medical treatment records do not support a finding of sciatic nerve pain until 2015. As such, sciatica did not manifest itself to a compensable degree in service or within the one-year presumptive period. Additionally, continuity of symptomatology has not been established. The May 1995 examination, one month prior to separation from service, did not show evidence of sciatic nerve pain. The medical evidence shows that the Veteran did not begin seeking treatment for sciatica until 2015, twenty years after separation from service. As such, continuity of symptomatology has not been established and the medical evidence does not support service connection on a presumptive basis. Next, the Veteran’s main contention is that sciatic nerve pain is due to his service-connected right knee disability. He has been diagnosed with sciatica and he is service-connected for a right knee strain. As such, the first two elements of secondary service connection are met. As to nexus, a May 2015 VA examiner found that sciatica was less likely than not due to or the result of a service-connected right knee disability because the examiner found no objective evidence of sciatica. In May 2016, the private physician who diagnosed the Veteran with ongoing sciatica opined that degenerative disk disease may be related to a right knee disability. He made no indication that sciatica was caused by a right knee disability. Further, the connection between degenerative disc disease, assuming that the physician by implication also meant sciatic nerve pain, and the right knee disability is speculative as the clinician indicating that it may be related, which also suggests that it may not be related. As such, the medical evidence does not support a nexus between the sciatica and the Veteran’s service-connected right knee disability. The Board has considered the Veteran’s lay statements that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Increased Rating Right Knee Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran is rated at 10% under DC 5260 for limitation of extension of the leg and 38 C.F.R. § 4.59 regarding painful motion. The Board will also consider all potentially relevant diagnostic codes. In order to warrant a higher rating, the evidence must show: • ankylosis of the knee with a favorable angle in full extension or in slight flexion between 0 and 10 degrees (30% under DC 5256); • moderate recurrent subluxation or lateral instability (20% under DC 5257); • dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint (20% under DC 5258); • flexion of the knee limited to 30 degrees (20% under DC 5260); • extension of the knee limited to 15 degrees (20% under DC 5261); or • impairment of the tibia or fibula with a moderate knee disability (20% under DC 5262). A July 2019 CAVC decision remanded this issue in order to obtain an additional medical examination. The RO made multiple attempts to contact the Veteran through mailed correspondence and telephone calls in order to schedule an examination, but he did not respond. As such, a new examination could not be scheduled. The Veteran contends that he is entitled to a higher rating due to pain which worsens with use and the inability to run. Turning to the medical evidence, VA examiners from May 2015 and September 2016 found no evidence of ankylosis, moderate recurrent subluxation, lateral instability, or dislocated semilunar cartilage of the right knee. As such, a higher rating is not warranted based on these criteria. Further, the Veteran’s right knee flexion was measured from 0 to 135 degrees and extension from 135 to 0 degrees in a May 2015 VA examination. In September 2016, right knee flexion was measured at 0 to 130 degrees and extension from 130 to 0 degrees. Normal flexion and extension range from 0 to 140 degrees. After repetitive use, he experienced pain but no additional loss of motion was noted. As such, a higher rating is not warranted based on limited range of motion of the right knee. Next, neither VA examiner found evidence of impairment of the tibia or fibula. Therefore, an increased rating is not warranted on this basis. Further, the Veteran’s clinical records, including VA records and a private treatment note, were reviewed and the evidence does not support a rating in excess of 10 percent based upon any of the criteria. The Board has also considered the Veteran’s lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s right knee strain has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiners have the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kokolas, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.