Citation Nr: 20047062 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 16-30 118 DATE: July 14, 2020 ORDER Service connection for a lower left extremity disability, to include as secondary to the Veteran’s service-connected right ankle disability, is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that the Veteran has a current diagnosis for a left ankle disability. 2. The weight of the evidence is against a finding that the Veteran’s diagnosed left leg radiculopathy or peripheral vascular disease (PVD) is due to his service-connected right ankle disability, or is otherwise related to his active duty service. CONCLUSION OF LAW The criteria for service connection for a lower left extremity disability have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1980 to February 1983. The Veteran testified at an August 2019 Board hearing before the undersigned Veterans Law Judge. A complete transcript is of record. As an initial matter, the Veteran sought to claim a TDIU rating in his May 2016 Form 9. A TDIU claim is only part and parcel of increased rating claims, not of service connection claims. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board notes that the Veteran submitted a VA 21-8940, Application for Increased Compensation based on Unemployability, in January 2014, which was denied in a March 2014 rating decision. The Veteran did not disagree with that decision. The Veteran’s claim file does not contain an application for a TDIU after January 2014. As such, in the absence of either a TDIU application or a Rice TDIU, there is no valid TDIU claim currently before the Board. Here, the only claim before the board is the Veteran’s service connection claim for a left leg disability. This appeal was previously before the Board in November 2019. The Board remanded the appeal because additional relevant evidence was associated with the record, subsequent to the most resent supplemental statement of the case (SSOC), regarding the claim for service connection for his left leg. The Veteran explicitly declined to waive agency of original jurisdiction (AOJ) review of the additional evidence. The AOJ has reviewed the additional relevant evidence and provided a May 2020 SSOC, which denied the Veteran’s service connection claim for a left leg condition. As such, the Board finds that there has been substantial compliance with the November 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection requires competent evidence showing: (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, 1167 (Fed. Cir. 2004). Service connection may also be 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). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Service connection for a lower left extremity disability, to include as secondary to the Veteran’s service-connected right ankle disability, is denied. The Veteran asserts that his left leg condition is due to his service-connected right ankle disability. Specifically, he asserts that his service-connected right ankle causes him to have an altered gait, which has led to a left leg condition. A review of the Veteran’s service treatment records (STRs) shows that he sprained his left ankle. See STR dated September 9, 1981. The Veteran appeared to have had a VA examination in November 2011 for his ankles. However, the examination report is unreadable, as it looks as though something went wrong in the scanning process. A subsequent January 2012 rating decision denied the claim for service connection because the evidence did not show his left leg condition was related to his service-connected right ankle disability, nor was there evidence of a left leg disability during his military service. The Veteran provided a medical opinion from his private physician in April 2012. The physician stated that the Veteran had ongoing issues with his right ankle since his active duty service. He opined that the Veteran developed left ankle pain, which is more than likely a result of the “wobble” effect when walking with pain from the right ankle. The Veteran was afforded a VA examination in August 2012. The examiner reported that the Veteran’s left ankle examination was normal, with the exception of complaints of pain. An x-ray of the left ankle was interpreted as showing a normal left ankle and the examiner stated that there was no chronic left ankle disability. The examiner opined that the Veteran’s left ankle pain was less likely than not due to his service-connected right ankle disability. The examiner reviewed the private physician’s statement from April 2012, but disagreed with the positive nexus opinion. The examiner noted that the private physician prescribed the Veteran gabapentin, which is usually reserved for neuropathic pain. The examiner explained that his left ankle pain is not secondary to his service-connected right ankle disability because his symptoms most likely represent a neuropathic condition. The Veteran was afforded a VA examination in February 2014. After an in-person examination, the examiner noted that the Veteran exhibited normal range of motion of the left ankle and had no painful motion. Imaging studies were conducted, which showed normal results of the left ankle. The examiner found that the Veteran had left ankle pain, without objective evidence of a chronic left ankle disability. The Veteran provided a medical opinion from his private physician in June 2014. It is from the same physician, who wrote the April 2012 medical statement. The 2014 report is basically the same statement provided in April 2012. The physician stated that he developed left ankle pain because of the “wobble” effect. However, there is nothing in the report that suggests he is diagnosed with a chronic left ankle or left leg disability. The Veteran provided a medical opinion from his treating VA nurse practitioner (NP) in September 2018. The NP noted that the Veteran has lower extremity radiculopathy related to a low back condition. The NP opined that it was more likely than not that the Veteran’s condition and collateral physical maladies are caused by events during his time in the military. The Veteran provided a medical opinion from his chiropractor in November 2018. After a review of the Veteran’s military records, VA treatment records, and MRI, the chiropractor opined that his left ankle malady was directly related to his service-connected right ankle. The chiropractor reviewed the April 2012 private physician statement and the NP’s September 2018 statement and concurred with both reports. The Veteran was afforded a VA examination in November 2018 for his ankles and his spine. After his ankle examination, there was no diagnosis for a left ankle condition. Regarding his spine, the examiner noted that the Veteran was diagnosed with degenerative disc disease (DDD) of the lumbar spine. After a review of the Veteran’s claims file, the examiner opined that it was less likely than not that the Veteran’s lumbar DDD was related to his service-connected right ankle disability. The examiner explained that there was no definite correlation between an altered gait and development of DDD; DDD is mostly a factor of genetics and the fact that it is at multiple levels in his lumbar spine corroborates this. The Veteran provided testimony at his August 2019 Board hearing. He testified that his left leg started giving him problems about 25 years earlier. He stated that he had damage in his back, which caused sciatic problems that caused problems from his waist to his feet. The Veteran was afforded a VA examination for his ankles in November 2019. After an in-person examination and imaging studies, the examiner found that there was no arthritis of the left ankle, or any other left ankle disability. The Veteran’s VA treatment records show that he has been diagnosed with peripheral vascular disease (PVD), a blood circulation disorder. See VA Treatment Record dated May 25, 2018. An October 2019 VA treatment record showed that he was diagnosed with chronic low back pain with lower extremity radiculopathy. See VA Treatment Record dated October 17, 2019. After a careful review of the Veteran’s VA treatment records, there did not appear to be any other diagnoses for any other left leg conditions. Here, the Veteran has two diagnosed conditions in his left leg, PVD and radiculopathy related to his lumbar DDD. The Veteran has been consistently found to not have a left ankle disability; at the latest VA examination in November 2019, after an in-person examination and an imaging study, he was found to not have any disabilities of the left ankle. He has been found to have arthralgia of the left ankle; however, pain itself is generally not considered to be a disability unless it causes functional impairment. The Board will first address the Veteran’s left ankle condition. The Veteran has provided two medical opinions that state his left ankle condition is due to his service-connected right ankle disability. They both opined that his altered gait caused his left ankle condition. However, these medical opinions are deficient because they do not show what the actual diagnosis was felt to be for the left ankle disability. Here, there are three medical opinions of record, each provided by credible sources, as to the Veteran’s left ankle condition. The Veteran has provided two positive nexus medical opinions that stated his left ankle condition is due to his service-connected right ankle condition and a medical opinion that states his condition and collateral physical maladies, to include a left leg condition, were caused by events or incidents during his time in the military. However, as previously stated, the Veteran does not have a diagnosis for any left ankle condition, at any time during the period on appeal. The August 2012 VA examiner provided a negative nexus opinion and explained that the Veteran’s left ankle pain was being treated with a medication usually reserved for neuropathic pain and did not appear to be an orthopedic condition. Here, although the Veteran has provided two positive nexus opinions as to his left ankle pain, he does not have a current diagnosis for a specific left ankle disability, even if he was experiencing pain in that anatomical region as a result of either back or neurologic problems. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Here, the evidence fails to support a diagnosis for a left ankle condition, at any time during the appeal period. Without a diagnosis, the Veteran fails to meet the requirements of service connection. Further, the Veteran’s testimony at the August 2019 Board hearing, suggested that the problems with his lower left extremity were due to his sciatic problem. The Board notes that he did not describe any symptoms or problems with his left ankle. As such, service connection for a left ankle disability is denied. Turning to his lower extremity radiculopathy, the November 2018 VA spine examiner provided a negative nexus opinion as to the Veteran’s low back disability. The examiner found that the Veteran’s low back disability was less likely than not related to his service-connected right ankle disability. The examiner explained that lumbar DDD is mostly a factor of genetics and the fact that it is at multiple levels in his lumbar spine corroborates this. Here, The Veteran’s sciatic problem has been attributed to his lumbar DDD. As the Veteran has received a negative nexus opinion in regard to his low back disability, the chain of causation has been broken, and the lower extremity radiculopathy has been shown that it is not a result of his service-connected right ankle disability. Turning to his PVD, there has been no suggestion that a blood circulation disorder is related to his service-connected right ankle disability, or is otherwise related to his active duty service. Here, there are two medical opinions of record, each provided by credible sources, as to the Veteran’s left leg conditions. The Veteran provided a positive nexus opinion from his treating VA NP that stated his collateral physical maladies were due to his service-connected right ankle disability. The November 2018 VA examiner provided a negative nexus opinion and explained that there was no definite correlation between an altered gait and the development of lumbar DDD, and that it was mostly a factor of genetics. The Board affords more probative weight to the VA examiner’s opinion because it the examiner provided a sound rationale along with their nexus opinion. Conversely, the NP simply stated that the Veteran had a service-connected right ankle disability, has since developed low back pain with radiculopathy and concluded that it was more likely than not that the Veteran’s collateral physical maladies were caused by the events or incidents during the Veteran’s time in the military. The NP did not explain how the Veteran’s service-connected right ankle disability caused the Veteran’s collateral physical maladies, to include his lower extremity radiculopathy. Because the November 2018 VA examiner’s opinion provided a sound rationale along with their nexus opinion, it is afforded greater weight, meaning that the weight of the evidence is against a finding that the Veteran’s service-connected right ankle disability was the cause of his left leg radiculopathy or PVD. The Board is sympathetic to the Veteran’s claim and does believe that his left leg does cause impairment. Unfortunately, the weight of the evidence is against the Veteran’s claim.   Accordingly, service connection for a lower left extremity disability is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, 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.