Citation Nr: 21004783 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-28 992 DATE: January 28, 2021 ORDER Entitlement to service connection for right lower extremity sensory motor axonal neuropathy, to include as secondary to service-connected pes planus, is denied. Entitlement to service connection for left lower extremity sensory motor axonal neuropathy, to include as secondary to service-connected pes planus, is denied. Entitlement to compensation under 38 U.S.C. § 1151 for a lumbar spine disability is denied. FINDINGS OF FACT 1. Right lower extremity sensory motor axonal neuropathy is not shown to be causally or etiologically related to any disease, injury, or incident in service, and did not manifest during service or within one year of the Veteran's discharge from service nor is it etiologically related to any service-connected disorder. 2. Left lower extremity sensory motor axonal neuropathy is not shown to be causally or etiologically related to any disease, injury, or incident in service, and did not manifest during service or within one year of the Veteran's discharge from service nor is it etiologically related to any service-connected disorder. 3. No additional lumbar spine disability has been shown to be caused by hospital care, medical or surgical treatment, or examination furnished the Veteran by VA or in a VA facility. CONCLUSIONS OF LAW 1. The criteria for service connection for right lower extremity sensory motor axonal neuropathy, to include as secondary to service-connected pes planus, have not been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2019). 2. The criteria for service connection for left lower extremity sensory motor axonal neuropathy, to include as secondary to service-connected pes planus, have not been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2019). 3. The criteria for compensation under 38 U.S.C. § 1151 for a lumbar spine disability have not been met. 38 U.S.C. §§ 1151, 5107 (2012); 38 C.F.R. § 3.361 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from September 1966 to February 1967. As to the issues of service connection for right and left lower extremity sensory motor axonal neuropathy and entitlement to compensation under 38 U.S.C. § 1151 for a lumbar spine disability, these matters were previously before the Board in May 2017. As it relates to these issues, a hearing was held before Veterans Law Judge (VLJ) Roberts in March 2013. In its May 2017 decision, the Board, in pertinent part, found the issues of service connection for right and left lower extremity sensory motor axonal neuropathy to be inextricably intertwined with the then not perfected claim of service connection for pes planus. The Board remanded the above claims for the issuance of a statement of the case with regard to the issue of service connection for pes planus. A statement of the case was issued in May 2017 and the Veteran filed a substantive appeal to perfect this issue for appeal that same month. In his substantive appeal, the Veteran checked the box indicating that he wished to be afforded a videoconference hearing as it related to this issue. The Veteran was afforded the requested hearing in September 2019 before VLJ Parakkal. At that time, the Veteran and his representative noted that the issue of service connection for pes planus was inextricably intertwined with the other service connection issues on appeal and provided testimony on all issues of service connection as well as the 1151 claim. Judge Parakkal informed the Veteran of the right to a third hearing, if so desired, and the Veteran waived his right to a third hearing. In a January 2020 decision, the Board granted service connection for pes planus and remanded the issues listed on the title page of this decision for further development. The requested development has been completed and the matter is now ready for appellate review. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be awarded on a presumptive basis for certain chronic diseases listed in 38 C.F.R. § 3.309(a) that manifest to a degree of 10 percent within 1 year of service separation or during service and then again at a later date. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed.Cir.2013). Organic disease of the nervous system is listed as a chronic disease. Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, at 448 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). To establish secondary service connection, the law states that there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between a service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The analysis herein focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a competent source. Second, the Board must determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). Third, the Board must weigh the probative value of the proffered evidence in light of the entirety of the record. The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Lay evidence can be competent and sufficient evidence of a diagnosis if (1) the 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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Veteran maintains that his current neuropathy either had its onset in service or is etiologically related to his service-connected pes planus. Service treatment records do not reveal any complaints or findings of neurological problems relating to the lower extremities. At the time of the Veteran’s June 1967 service separation examination, normal neurological findings and normal findings for the lower extremities were reported. On his June 1967 service separation report of medical history, the Veteran checked the ‘no” boxes when asked if he had or had ever had neuritis or paralysis. There were no reports or notations of lower extremity neuropathy at that time. VA outpatient treatment records reveal that the Veteran had complaints of radiating pain from his hips to his knees that began in 2008. A January 2009 treatment report noted that the Veteran had multilevel facet arthropathy with mild to moderate spinal canal stenosis. The examiner noted that the Veteran’s leg pain was probably radiculopathy related to his spine disability. A February 2010 treatment record noted that the Veteran had been diagnosed with sensory axonal neuropathy idiopathic right and left side. In conjunction with the January 2020 remand, the Veteran was afforded a VA examination in October 2020. Following examination of the Veteran and review of the file, the examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed inservice injury, event, or illness. The examiner cited to numerous medical findings in his report. The examiner indicated that after examination of the Veteran, including physical examination and the Veteran’s medical history, and review of the Veteran’s available medical records, it was his opinion that the Veteran’s left and right lower extremity sensory motor axonal neuropathy was less likely than not (less than 50 percent probability) to have had its onset in service, nor was it otherwise related to the Veteran's service. He noted that the Veteran stated that his bilateral foot "neurologic" pain began "many years ago," but was unable to provide more specific details in relation to time (even year) or place. Moreover, the Veteran himself claimed that he had experienced foot pain and problems "since I was a kid." The examiner noted the Veteran’s significant lumbar spine condition, with severe degeneration, most significantly at the L4-L5 level where there was severe facet arthropathy and mild anterolisthesis as well as severe spinal stenosis, severe at L4-5 and moderate at L3-4, as well as facet hypertrophy. He indicated that this lumbar spine condition was the most likely candidate for the Veteran’s pattern of radicular pain, particularly as he stated it had worsened considerably in the last three to four years. For these reasons, the opinion was written in the negative. The examiner also opined that the claimed condition was less likely than not proximately due to or the result of the Veteran’s service-connected condition. He stated that after examination of the Veteran, including physical examination and the Veteran’s medical history, and review of the Veteran’s available medical records, it was his opinion that the Veteran’s right and left lower extremity sensory motor axonal neuropathy was less likely than not (less than 50 percent probability) to be caused by pes planus. The Veteran stated that his bilateral foot "neurologic" pain began "many years ago," but was unable to provide more specific details in relation to time (even year) or place. Moreover, the Veteran himself claimed that he had experienced foot pain and problems "since I was a kid." The examiner did note the Veteran’s significant lumbar spine condition, with severe degeneration, most significantly at the L4-L5 level where there was severe facet arthropathy and mild anterolisthesis as well as severe spinal stenosis, severe at L4-5 and moderate at L3-4, as well as facet hypertrophy. He indicated that this lumbar spine condition was the most likely candidate for the Veteran’s pattern of radicular pain, particularly as he stated it had worsened considerably in the last three to four years. For these reasons the opinion was written in the negative. The examiner also opined that the claimed condition was not as likely as not aggravated beyond its natural progression by his service-connected condition. The examiner indicated that after examination of the Veteran, including physical examination and the Veteran’s medical history, and review of the Veteran’s available medical records, it was his opinion that the Veteran’s left and right lower extremity sensory motor axonal neuropathy was less likely than not (less than 50 percent probability) to be either caused or aggravated by pes planus. The Veteran stated that his bilateral foot "neurologic" pain began "many years ago," but was unable to provide more specific details in relation to time (even year) or place. Moreover, the Veteran himself claimed that he had experienced foot pain and problems "since I was a kid." The examiner did note the claimant's significant lumbar spine condition, with severe degeneration, most significantly at the L4-L5 level where there was severe facet arthropathy and mild anterolisthesis as well as severe spinal stenosis, severe at L4-5 and moderate at L3-4, as well as facet hypertrophy. The lumbar spine condition was the most likely candidate for the Veteran’s pattern of radicular pain, particularly as he stated it had worsened considerably in the last three to four years. For these reasons the opinion was written in the negative. Right and left lower extremity sensory motor axonal neuropathy After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence is against the conclusion that the Veteran's current right and left lower extremity sensory motor axonal neuropathy had its onset in service. At the time of the June 1967 separation examination, normal neurological and lower extremity findings were reported. There were also no reports, findings, or complaints of right or left lower extremity sensory motor axonal neuropathy on the Veteran's service separation report of medical history. Moreover, right and left lower extremity sensory motor axonal neuropathy was not diagnosed until many years following service. Given the foregoing, the weight of the evidence demonstrates that the Veteran did not sustain chronic right and left lower extremity sensory motor axonal neuropathy during active service. The Board next finds that the weight of the evidence is against a finding that right and left lower extremity sensory motor axonal neuropathy was continuously manifested since service, including to a degree of ten percent disabling within one year of service separation. The earliest evidence of right and left lower extremity sensory motor axonal neuropathy is many years after service. The absence of post-service findings of, diagnosis of, or treatment for right and left lower extremity sensory motor axonal neuropathy for years after service separation is one factor that tends to weigh against a finding of right and left lower extremity sensory motor axonal neuropathy in service or continuous symptoms after service separation, including to a compensable degree within the first post-service year. See Buchanan v. Nicholson, 451 F.3d 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible). See also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). The Veteran has attempted to establish a continuity of symptomatology of his right and left lower extremity sensory motor axonal neuropathy or a nexus through his own lay assertions. The Board finds, however, that the etiology of the Veteran's current right and left lower extremity sensory motor axonal neuropathy falls outside the realm of common knowledge of a layperson and the Veteran is, thus, not competent to provide evidence on the issue of causation. The evidence does not show clinical documentation of right and left lower extremity sensory motor axonal neuropathy until years after service. The Veteran's opinion that purports to establish continuity of symptomatology or relate his right and left lower extremity sensory motor axonal neuropathy to active service, is of little probative value. Next, service connection may be granted when the evidence establishes a nexus between active duty service and current complaints. The Veteran was afforded the opportunity to provide medical evidence and/or an opinion relating his current right and left lower extremity sensory motor axonal neuropathy to his period of service. He has not provided either medical evidence or an opinion to support this proposition. Significantly, there is also no competent, probative evidence or opinion of record that suggests a nexus between any incident in service and the Veteran's right and left lower extremity sensory motor axonal neuropathy. Moreover, the October 2020 VA examiner, following an examination of the Veteran and review of the record, opined that the claimed condition, right and left lower extremity sensory motor axonal neuropathy, was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner also provided rationale to support the opinion. Likewise, as to service connection under 38 C.F.R. § 3.310, the Board finds that the most probative evidence of record shows that the Veteran does not have current right and left lower extremity sensory motor axonal neuropathy that is caused or aggravated by his service-connected pes planus. See 38 C.F.R. § 3.310; Allen. To the extent that the Veteran has expressed his opinion that he currently has right and left lower extremity sensory motor axonal neuropathy that is related to his service-connected pes planus, this is an assertion as to an internal medical process, which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Moreover, the Board finds that diagnosing a link between any claimed right and left lower extremity sensory motor axonal neuropathy and the service-connected pes planus is a determination of medical complexity and is not capable of lay observation. See Davidson. Therefore, since laypersons are not capable of opining on matters requiring medical knowledge, the Board finds that the Veteran's opinion that he has right and left lower extremity sensory motor axonal neuropathy that was caused or aggravated by a service-connected disability is not competent evidence. In contrast, the Board obtained an opinion from a VA examiner as to the relationship, if any, between any right and left lower extremity sensory motor axonal neuropathy and his service-connected pes planus. The examiner rendered an opinion that any right or left lower extremity sensory motor axonal neuropathy was not caused or aggravated by his service-connected pes planus. The opinion was based upon a thorough examination of the Veteran and a comprehensive review of the claims folder. There was no indication that the VA examiner was not fully aware of the Veteran's past medical history, citing to it in the report, or that he misstated any relevant fact, or relied on any inaccurate fact. The Board notes that the VA examiner has indicated that the Veteran’s right and left lower extremity sensory motor axonal neuropathy is etiologically related to his low back disabilities. However, service connection is not currently in effect for a low back disorder. For the foregoing reasons, the preponderance of the evidence is against the claims for service connection for right and left lower extremity sensory motor axonal neuropathy. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1151 Claim Under VA laws and regulations, when a claimant suffers an injury or an aggravation of an injury resulting in additional disability or death as the result of VA training, hospitalization, medical or surgical treatment, or an examination furnished by the VA, disability compensation shall be awarded in the same manner as if such disability or death were service-connected. 38 U.S.C. § 1151; 38 C.F.R. § 3.361. For section 1151 claims, a claimant is required to show fault or negligence in medical treatment. Specifically, the claimant must show additional disability which was caused by VA hospital care, medical or surgical treatment or examination; and that the proximate cause of the disability was carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part in furnishing the hospital care, medical or surgical treatment, or examination. In the alternative, the claimant must show that he suffers from additional disability which was caused by VA hospital care, medical or surgical treatment or examination; and that the proximate cause of the additional disability was an event which was not reasonably foreseeable. 38 U.S.C. § 1151(a)(1)(A), (B). In determining whether an additional disability exists, VA compares the claimant's condition immediately before the beginning of the hospital care or medical or surgical treatment upon which the claim is based to his or her condition after such care or treatment. 38 C.F.R. § 3.361(b). To establish causation, the evidence must show that the hospital care or medical or surgical treatment resulted in the claimant's additional disability. Merely showing that a veteran received care or treatment and that a veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1). Hospital care or medical or surgical treatment cannot cause the continuance or natural progress of a disease or injury for which the care or treatment was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a veteran's additional disability or death, it must be shown that the hospital care or medical or surgical treatment caused additional disability or death; and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or (ii) VA furnished the hospital care or medical or surgical treatment without the claimant's informed consent. Determinations of whether there was informed consent involve consideration of whether the health care providers substantially complied with the requirements of 38 C.F.R. § 17.32. Minor deviations from the requirements of 38 C.F.R. § 17.32 that are immaterial under the circumstances of a case will not defeat a finding of informed consent. 38 C.F.R. § 3.361(d)(1). Whether the proximate cause of a claimant's additional disability or death was an event not reasonably foreseeable is determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of 38 C.F.R. § 17.32. 38 C.F.R. § 3.361(d)(2). The Veteran claims that treatment he received for a bilateral foot disability caused or aggravated a back disability. He contends that his back disorder is secondary to his flat feet due to continuous mistreatment, or misdiagnosis of the foot problems. In a March 2014 remand, the Board requested that the Veteran be scheduled for a VA examination with a specialist with expertise in treating disorders of the spine. The examiner was requested to provide the following opinions: (a) Was it is at least as likely as not (50 percent probability or greater) that the Veteran had any additional lumbar spine disability due to VA treatment. (b) If any additional disability was diagnosed, the examiner was to offer an opinion as to whether it was at least as likely as not (50 percent probability or greater) that the proximate cause of any identified additional disability was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the medical treatment from 2008 to the present. The examiner was also to discuss whether any failure on part of VA to timely diagnose and properly treat the lumbar spine disorder caused or contributed to the Veteran's development of any additional disability and whether VA failed to exercise the degree of care that would be expected of a reasonable health care provider or VA furnished the hospital care, medical or surgical treatment, or examination without informed consent. (c) If any additional disability was diagnosed, the examiner was then to offer an opinion as to whether it was at least as likely as not (50 percent probability or greater) that the proximate cause of any identified additional disability was an event which was not reasonably foreseeable, based on what a reasonable health care provider would have foreseen. (d) If the examiner determined that any additional lumbar spine disability was caused by VA treatment, the examiner was to state whether the claimed neuropathy of the lower extremities was caused or aggravated by the lumbar spine disability. In a May 2014 opinion, the examiner opined that it was less likely than not that the Veteran had any additional lumbar spine disability due to VA treatment. She noted that the Veteran's history, physical examination, and lumbar MRI demonstrated lumbar DDD, DJD, and spinal stenosis, all of which were consequences of aging. The examiner further stated that she could not estimate the additional loss of functionality during flare-ups objectively, as she would have to observe and measure range of motion/functionality for the Veteran both at baseline and during flares in the same visit in order to obtain this information. The Veteran would have to be both at a baseline level of limitation and have the range of motion/functionality be measured in that state; then sometime in the same encounter the Veteran would also have to be in a flared state and then have that range of motion and other functionality measured. She indicated that this could not be done objectively at the present time without resorting to mere speculation, as the Veteran was not presently in both of those states. She also stated that she was unable to provide an opinion beyond the documented information above regarding increased limitation of functionality when the joint was used repeatedly over a period of time. Such an opinion would require her to observe the Veteran over a period longer than the visit or for repetitions beyond three which were completed at the visit. She indicated that she could not render the opinion without resorting to mere speculation In a September 2014 addendum opinion, the examiner stated that as to the left lower extremity, she was unable to determine whether or not the proximate cause of the Veteran's left lower extremity radiculopathy was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the medical treatment from 2008 to the present without resorting to mere speculation. She further indicated that she was unable to determine, without resorting to mere speculation, whether any failure on the part of the VA to timely diagnose and properly treat the lumbar spine disorder caused or contributed to the Veteran's development of any additional disability, including left lower extremity radiculopathy, and whether VA failed to exercise the degree of care that would be expected of a reasonable health care provider or VA furnished the hospital care, medical or surgical treatment, or examination without informed consent. She also stated that she was unable to determine, without resorting to mere speculation, that the proximate cause of the Veteran's left lower extremity radiculopathy was an event which was not reasonably foreseeable, based on what a reasonable health care provider would have foreseen. She indicated that since she was unable to determine that the Veteran's left lower extremity radiculopathy was caused by VA treatment, she was unable to further comment on the question of whether the claimed neuropathy of the lower extremities was caused or aggravated by the lumbar spine disability. In its January 2020 remand, the Board noted the above May and September 2014 opinions. The Board found that additional development was necessary in the form of an additional opinion. The Board indicated that as it related to the rendered opinions, the examiner had to state whether the need to speculate was due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner did not have the knowledge or training. In an April 2020 report, a VA examiner opined that it was less likely than not (smaller than 50 percent likelihood) that the Veteran had any additional lumbar spine disability due to VA treatment. The examiner indicated that the Veteran had widespread DJD prior to initial VA encounter. This included the lumbar spine. There was no evidence the lumbar spine degeneration has progressed beyond its normal rate. With regard to the question of whether any additional disability was diagnosed, and the examiner offering an opinion as to whether it was at least as likely as not (50 percent probability or greater) that the proximate cause of any identified additional disability was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the medical treatment from 2008 to the present; with the examiner discussing whether any failure on part of VA to timely diagnose and properly treat the lumbar spine disorder caused or contributed to the Veteran's development of any additional disability and whether VA failed to exercise the degree of care that would be expected of a reasonable health care provider or VA furnished the hospital care, medical or surgical treatment, or examination without informed consent, the examiner provided the following answer. No additional disability is diagnosed. Treatment for plantar fasciitis and pes planus was appropriate - Veteran was wearing down lateral shoe prior to prescription of inserts. Varus inserts shift the load bearing medially to reduce lateral shoe wear. The Veteran's neurologic signs were due to idiopathic peripheral neuropathy, not due to the back. In response to the question of whether any additional disability was diagnosed, the with examiner then offering an opinion as to whether it was at least as likely as not (50 percent probability or greater) that the proximate cause of any identified additional disability was an event which was not reasonably foreseeable, based on what a reasonable health care provider would have foreseen; the examiner replied: Yes, because they are unrelated, there is no reason that a provider would anticipate the onset of idiopathic neuropathy in a patient presenting for plantar fasciitis and pes planus. Finally as to the question of if the examiner determined that any additional lumbar spine disability was caused by VA treatment, the examiner was to state whether the claimed neuropathy of the lower extremities was caused or aggravated by the lumbar spine disability; the examiner indicated that no additional lumbar spine disability arose from VA care. The idiopathic peripheral neuropathy of the sural nerve did not arise from the lumbar spine. To the extent that the appellant has argued fault on VA's behalf, the question of causation for purposes of 38 U.S.C. § 1151 claims is whether the proximate cause of the disability was carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable. There is no indication that the appellant possesses the requisite medical expertise to provide a competent opinion on this question. Cf. Jandreau, 492 F.3d 1372. The May 2014 and April 2020 VA medical opinions that it was less likely than not (smaller than 50 percent likelihood) that the Veteran had any additional lumbar spine disability due to VA treatment are persuasive in that they were based upon a complete review of the file with detailed rationale being provided for the rendered opinion. The weight of the evidence of record is against a finding of carelessness, negligence, lack of proper skill, error in judgment on the part of VA as it relates to this issue. Likewise, causation has not been attributed to an event not reasonably foreseeable. Thus, the criteria for compensation under 38 U.S.C. § 1151 have not been met. The Board finds that the preponderance of the evidence is against the appellant's claim for compensation under 38 U.S.C. § 1151 as it relates to the claim for a lumbar spine disorder. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals James L. March Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. S. Kelly, 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.