Citation Nr: 21013048 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 18-21 610 DATE: March 8, 2021 ORDER Entitlement to service connection for leg cramps, to include secondary to low back and left knee disability or caused by nerve pain medications, is denied. REMANDED Entitlement to service connection for a left ankle disability, to include as secondary to low back and left knee disabilities is remanded. FINDING OF FACT The competent evidence reflects that the Veteran’s leg cramps are part of the Veteran’s service-connected right lower extremity radiculopathy and not manifested by symptoms of a separate diagnosis. CONCLUSION OF LAW The criteria for service connection for leg cramps, to include as secondary to low back and left knee disabilities, or as caused by nerve pain medications, are not met. 38 U.S.C. §§ 11137, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1984 to November 1987. In October 2020, this appeal was remanded for further development. Service Connection Legal Principles and Regulations Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Analysis The Veteran contends that his leg cramps are secondary to his service-connected disabilities and also to his nerve pain medicine. Specifically, the Veteran contends that he experiences chronic “charlie horse” leg cramps in the right leg with progressive paralysis in the right leg. Here, in the Board’s October 2020 remand, the Board requested a VA medical opinion to determine whether the Veteran’s leg cramps were part and parcel of his service-connected right and left leg radiculopathy or whether the Veteran’s leg cramps are considered a separate and distinct disability. In a December 2020 VA examination report for peripheral nerve conditions, the VA examiner noted a diagnosis of bilateral radiculopathy. The Veteran reported symptoms of “instability of the legs, swelling, sharp pain in the back.” The Veteran also reported, “muscle spasms” and “Charlie horse” leg pain. His current symptoms were reported as “constant pain, half of right leg numb, instability.” In an associated December 2020 VA medical opinion, the VA examiner opined that the Veteran’s leg cramps are not separate and distinct from his right lower extremity radiculopathy. In other words, the Veteran’s leg cramps are a symptom of his right lower extremity radiculopathy. Therefore, the Veteran’s leg cramps are not a separate and distinct disability. Given such, the Board finds that the Veteran does not have a separate diagnosis related to leg cramps. Here, the evidence reveals that the Veteran’s leg cramp symptoms are part of his right lower extremity radiculopathy and the Veteran is already service connected for right lower extremity radiculopathy. Consequently, because a separate pathology does not exist, then service connection for his leg cramps, which encompass the same symptoms as his already service-connected right lower extremity radiculopathy, would not be warranted as this would constitute impermissible pyramiding. See 38 C.F.R. § 4.14 (the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided.); See also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (pyramiding is rating the same physical manifestations of a disability under two separate diagnostic codes). The Board concludes that the Veteran does not have a current separate diagnosis related to leg cramps and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). In light of the above, the Board finds that the probative evidence of record does not demonstrate that the Veteran has a separate diagnosis related to leg cramps, and that the first element of service connection has not been met. In the absence of evidence of a separate and distinct diagnosis, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223.225 (1992); 38 C.F.R. § 3.385 (2008) (for VA purposes, “impaired hearing will be considered to be a disability” only when hearing loss examination results reach certain auditory thresholds). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997). The evidence must show that the Veteran currently has the disability for which benefits are being claimed. Given that the Veteran does not have a separate diagnosis of leg cramps, which is the cornerstone of any service connection claim, the remaining elements of direct and secondary service connection will not be addressed. The Board considered the arguments presented by the Veteran’s representative. The representative contends that “VA denied [the Veteran’s] service connection for his leg cramps because he did not receive a formal diagnosis.” Then the representative cites to Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), citing “[p]ain alone is enough to establish a disability.” The Board is cognizant of the holding in Saunders v. Wilkie, which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. 886 F.3d 1356, 1368. In sum, pain alone resulting in functional impairment is in fact a disability and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. However, the Board notes the reason why service connection is not warranted for leg cramps is that the Veteran’s leg cramps are not a separate and distinct diagnosis from his radiculopathy. In other words, the Board is acknowledging that the Veteran’s has leg cramps; however, these symptoms are encompassed in his service-connected radiculopathy. Given such, Saunders is not applicable in this case. The Board has also considered the Veteran’s general lay statements that his leg cramps are a separate disability. However, finds that due to the complexity of the issue, where it encompasses a complex medical determination, the Veteran is not competent to make such a finding, especially where there is no evidence of record that he has the requisite medical background to make such a finding. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2010). Indeed, the Board had to remand this claim for an addendum opinion from a medical examiner in order to assess the Veteran’s disability. Essentially, the medical opinion is more probative than the Veteran’s lay statement. Accordingly, the Veteran’s claim for leg cramps is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. REASONS FOR REMAND The Board regrets the delay associated with this remand. However, based on a review of the evidence of record, the Board finds that a remand is necessary to allow the Agency of Original Jurisdiction (AOJ) to conduct additional development. Here, the Veteran contends that his left ankle disability is related to his service-connected disabilities. Thus, in October 2020, the Board requested a VA medical opinion to ascertain whether the Veteran’s left ankle disability is secondary to his service-connected disabilities. Specifically, the VA examiner was requested to opine whether the Veteran’s left ankle disability was (i) caused by or (ii) underwent any incremental increase in disability due to his lumbar spine or left knee disabilities. Subsequently, in a December 2020 VA medical opinion, the VA examiner opined that the Veteran’s left knee disability is less likely than not proximately due to or the result of the Veteran’s service-connected condition. The rationale provided was that “[t]he claimant has developed an antalgic gait due to his left knee condition, which has caused him to put more weight on his right knee and right ankle. While this accounts for his right knee and right ankle conditions, it does not account for the left ankle pathology.” The VA examiner also stated that an “[a]ltered gait from a back disability is directly due to weakness caused by radiculopathy. The gait abnormality that the claimant has is due to favoring his left knee condition.” Here, in a January 2021 correspondence, the Veteran’s representative argues that the December 2020 VA medical opinion is inadequate as the VA examiner did not provide an analysis as to the basis of this opinion. The Board agrees that this opinion is inadequate, but only to the extent that the VA examiner did not provide a sufficient rationale. A broad conclusory statement, as provided here, without a medical explanation, is not a rationale based on sufficient facts and data. Additionally, the Board notes that in the January 2021 correspondence, the Veteran’s representative contends that the Veteran’s left knee disability is secondary to all of his service-connected disabilities, not only the lumbar spine and left knee disabilities. Whereas, the December 2020 VA examiner only addressed secondary service-connection as it related to the Veteran’s service-connected lumbar spine and left knee disabilities. The Veteran is also service connected for sciatic lumbar radiculopathy of the right and left lower extremities, right and left hip disabilities, right ankle disabilities, and right knee disabilities. For the reasons discussed above, a remand is warranted to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain updated medical records, to include the Veteran’s comprehensive VA treatment records for the period from January 2021 to the present, to include from VA medical centers, clinics, counseling centers, hospitals, and outpatient treatment centers. See 38 C.F.R. § 3.159(c)(3) (2020). 2. Upon completion of the above to the extent possible, with respect to the Veteran’s claim for a left ankle disability, request an addendum opinion from a qualified medical professional that addresses the following: (a) Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s left ankle disability is i. proximately caused by or ii. underwent any incremental increase in disability, regardless of its permanence, due to the Veteran’s service-connected disabilities. • The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. • Any opinion expressed by the VA examiner must “contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). 3. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. (continued on the next page) YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Abdelbary, 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.