Citation Nr: 21063861 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 17-62 199 DATE: October 18, 2021 ORDER Entitlement to service connection for right lower extremity meralgia paresthetica, secondary to service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction, on a causation basis, is granted. Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for a groin injury following cardiac catherization is dismissed. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran has right lower extremity meralgia paresthetica that is caused by his service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction. 2. The award of service connection for right lower extremity meralgia paresthetica constitutes a complete grant of the benefits sought on appeal. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right lower extremity meralgia paresthetica, as secondary to service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction, on a causation basis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The claim for compensation under the provisions of 38 U.S.C. § 1151 for a groin injury following cardiac catherization is moot. 38 U.S.C. §§ 1151, 7105; 38 C.F.R. § 3.361. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1980 to July 1984 and from January 2007 to August 2007. He had additional service with the Air Force Reserve, to include a period of active duty for training (ACDUTRA) in October 2010. These matters come before the Board of Veterans' Appeals (Board) from a July 2016 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a September 2021 hearing. A transcript of the September 2021 Board hearing has not yet been associated with the claims file. However, in light of the fact that the Board is awarding service connection for right lower extremity meralgia paresthetica (thus reflecting a full grant of the benefit sought) and the fact that there is no information in the hearing transcript that will affect the decision herein, the transcript is not necessary at this time. 1. As for characterization of the issues on appeal, the evidence reflects that the Veteran's claimed groin injury (diagnosed as right lower extremity meralgia paresthetica) is caused by treatment for his service-connected cardiac disability. Although the claim raised by the Veteran and adjudicated in the July 2016 rating decision is entitlement to compensation under the provisions of 38 U.S.C. § 1151 for a groin injury following cardiac catherization and the Board is cognizant of the fact that service connection and 1151 claims are separate and distinct claims for benefits, 38 C.F.R. § 3.155 (d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed; rather, VA must consider those "complications" in connection with the claim on appeal. Compare Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021) with Anderson v. Principi, 18 Vet. App. 371, 37677 (2004) ("A section 1151 claim 'constitutes a separate and distinct claim for VA benefits'"). As the evidence reflects that the Veteran has right lower extremity neurological disability that is caused by treatment for his service-connected cardiac disability, the Board has expanded the appeal to include the issue of entitlement to service connection for right lower extremity meralgia paresthetica, as secondary to service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction. I. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310. Entitlement to service connection for right lower extremity meralgia paresthetica, secondary to service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction The Board finds, for the following reasons, that the evidence is at least evenly balanced as to whether the Veteran has right lower extremity meralgia paresthetica that is caused by his service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction. An April 2019 VA pain note indicates that the Veteran has been diagnosed as having right lower extremity meralgia paresthetica. Thus, current right lower extremity disability has been demonstrated. The Veteran contends that he began to experience upper right lower extremity pain and numbness following a cardiac catherization performed in December 2010 for his cardiac disability, and that these symptoms have continued in the years since that time. As for whether the Veteran's claimed right lower extremity disability is caused by his service-connected cardiac disability, there are conflicting medical opinions. 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 Veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The Board may favor one medical opinion over another, provided an adequate statement of reasons or bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). The nurse practitioner who conducted a September 2017 VA artery and vein conditions examination opined that the Veteran's right groin pain was likely ("as least as likely as not") due to his cardiac catherization procedure. He reasoned that groin pain began after the catherization procedure and that lateral femoral cutaneous nerve entrapment can be a complication of cardiac catherization procedures. The physician who conducted a July 2018 VA hip examination explained, in pertinent part, that the Veteran's claimed right lower extremity symptoms were due to mild osteoarthritis of the right hip and that it was less likely that the Veteran's cardiac catherization produced symptoms of pain/meralgia paresthetica, which did not have its onset until 5 months following the cardiac catherization. The Veteran's symptoms of muscle weakness would not be due to any lateral femoral cutaneous nerve injury since that nerve is solely sensory. His complaints of feeling weakness and needing wall support when first getting up and getting better after walking, is much more characteristic for symptoms arising from osteoarthritis of the right hip. [The Board notes, parenthetically, that service connection for right hip osteoarthritis was denied in an October 2020 Board decision] The September 2017 and July 2018 opinions are based upon examination of the Veteran, a review of his treatment records, and consideration of his reported history, and they are accompanied by specific rationales that are consistent with the evidence of record. Therefore, the September 2017 and July 2018 opinions are adequate and entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). In light of the above medical opinions, the Board finds that the evidence is at least evenly balanced as to whether the Veteran has current right lower extremity meralgia paresthetica which is caused by treatment for his service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, service connection for right lower extremity meralgia paresthetica, secondary to service-connected coronary artery disease status post angioplasty, stable angina, and myocardial infarction, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. II. 1151 Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for a groin injury following cardiac catherization The Board may dismiss any appeal which fails to identify the specific determination with which the claimant disagrees. 38 U.S.C. § 7105 (d). In this case, the Veteran also seeks compensation under the provisions of 38 U.S.C. § 1151 for a groin injury following his 2010 cardiac catherization. Compensation pursuant to 38 U.S.C. § 1151 shall be awarded for a qualifying disability in the same manner as if such disability was service-connected. 38 U.S.C. § 1151. As discussed above, the Board is awarding service connection right lower extremity meralgia paresthetica. Hence, this is a complete grant of the benefit sought on appeal. The award of service connection for right lower extremity meralgia paresthetica is an equal benefit as that sought by the 38 U.S.C. § 1151 claim. Therefore, there remains no specific determination with which the claimant disagrees as regards the issue of entitlement to compensation under the provisions of 38 U.S.C. § 1151 for a groin injury following cardiac catherization. Hence, the section 1151 claim is moot, requiring dismissal of this aspect of the Veteran's appeal. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.