Citation Nr: 22052002 Decision Date: 09/13/22 Archive Date: 09/13/22 DOCKET NO. 18-20 176 DATE: September 13, 2022 ORDER Entitlement to service connection for a cracked pelvis is denied. Entitlement to service connection for a back disability, to include as secondary to a cracked pelvis is denied. Entitlement to service connection for a left leg disorder, to include as secondary to a cracked pelvis is denied. Entitlement to service connection for radiculopathy of the left lower extremity is denied. Entitlement to service connection for radiculopathy of the right lower extremity is denied. Entitlement to service connection for lymphedema is denied. FINDINGS OF FACT 1. The Veteran's claimed cracked pelvis is not related to her military service. 2. The Veteran's claimed back disability is not related to her military service. 3. The Veteran's claimed left leg disorder is not related to her military service. 4. The Veteran's claimed radiculopathy of the left lower extremity is not related to her military service. 5. The Veteran's claimed radiculopathy of the right lower extremity is not related to her military service. 6. The Veteran's claimed lymphedema is not related to her service. CONCLUSION OF LAW 1. The criteria for entitlement to service connection for a cracked pelvis, a back disability, a left leg disorder, radiculopathy of the left lower extremity, radiculopathy of the right lower extremity, and lymphedema have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from November 1985 to March 1986 with additional currently unverified service in the reserves until 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from April 2017 and November 2017 rating decisions of a Department of Veterans' Affairs (VA) Regional Office (RO). The Veteran presented testimony before the undersigned Veterans Law Judge at a June 2020 virtual hearing; a transcript of that hearing has been associated with the Veteran's file. During the hearing, the undersigned Veterans Law Judge granted the Veteran's request to have the record held open for 90 additional days for the submission of additional evidence to support her claim. In June 2020, additional evidence and argument was submitted. Initial agency of original jurisdiction consideration of this evidence was waived. In November 2020, the Veteran and her attorney were notified that an additional 90-day extension to submit evidence and argument had been approved. That notification was in error, given the Veteran's attorney's October 2020 notice that he had submitted final contentions to the Board. In November 2020, the Board remanded the issues for further development. All necessary development has been completed. In December 2020, the Veteran's attorney withdrew from representing the Veteran in her claim with good cause and notified the Veteran of such action. See December 2020 Third Party Correspondence. Thus, the Board finds that the Veteran is now unrepresented. 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. §§ 1131; 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). Secondary service connection is permitted based on aggravation, such that compensation is payable for the degree of aggravation of a nonservice-connected disability caused by a service-connected disability. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). Consequently, there exists two potential theories of entitlement to secondary service connection namely, causation under § 3.310(a) and aggravation under § 3.310(b). A disorder diagnosed after discharge may be service connected if all the evidence establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, to include arthritis, may be service-connected on a presumptive basis if manifested to a compensable degree within a specified period of time following separation. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). With a chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent cause. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the persuasive weight of the evidence is against the claim, in which case the claim is denied. Furthermore, it is the responsibility of the Board to assess the credibility and weight to be given to the evidence. Hayes v. Brown, 5 Vet. App. 60 (1993). 1. Entitlement to service connection for a cracked pelvis. 2. Entitlement to service connection for a back disability, to include as secondary to a cracked pelvis. 3. Entitlement to service connection for a left leg disorder, to include as secondary to a cracked pelvis. 4. Entitlement to service connection for radiculopathy of the left lower extremity. 5. Entitlement to service connection for radiculopathy of the right lower extremity. 6. Entitlement to service connection for lymphedema. The Veteran asserts that her lymphedema, cracked pelvis, left leg disorder, back disability, and radiculopathy of the left and right lower extremities are related to her military service. The Veteran asserts she injured her leg and cracked her pelvis while in the military. The Veteran asserts that her left leg disorder, back disability, and radiculopathy of the left and right lower extremities are secondary to her cracked pelvis. Service treatment records show that in a January 1986 radiologic consultation, it was noted that there were findings bilaterally of the pubic rami suggestive of possible early stress fractures. It was advised that a follow-up examination in 5 to 7 days be conducted to re-evaluate it. In March 2017, the Veteran was afforded a VA examination for hip and thigh conditions. The VA examiner concluded that the Veteran did not have a current diagnosis associated with any claimed condition. The VA examiner opined that the Veteran's claimed cracked pelvis was less likely than not incurred in or a continuation of the symptoms/complaints/treatment as shown in the service treatment records. The Veteran's service treatment record dated January 21, 1986, showed X-ray with possible early stress reaction of the left hip. Service treatment record dated January 28, 1986, for follow-up with "no fracture noted." Left hip x-ray in March 2017 showed no evidence of a cracked pelvis or fracture. In March 2017, the Veteran was afforded a VA examination for knee and lower leg conditions. The VA examiner noted that the Veteran was not diagnosed with a leg condition. The VA examiner acknowledged that the Veteran reported left leg symptoms flare-up after walking. The Veteran reported that she felt her muscles in her left leg were "pulling" when she bent the left leg or squatted. The VA examiner opined that that the Veteran's left leg condition was less likely than not proximately due to or the result of the Veteran's cracked pelvis. The Veteran's service treatment records and March 2017 X-ray did not support the claimed cracked or fractured pelvis. The Veteran's leg condition had been diagnosed as sciatica. In March 2017, the Veteran was afforded a VA examination for back conditions. The VA examiner opined that the claimed back condition was less likely than not proximately due to or the result of the Veteran's cracked pelvis. The Veteran's service treatment records and X-ray in March 2017 did not support the claimed cracked or fractured pelvis. The Veteran's back condition was not related to her cracked pelvis, but a result of DJD/DDD in her lumbar and sacral spine and supported by MRI results in September 2015. In a May 2017 private treatment record, it was noted that the Veteran was diagnosed with lymphedema of the lower extremity. The nurse practitioner stated that although she would like to review prior records and work up the history and examine the Veteran, it was classic for lymphedema. The Veteran had no history of radiation or surgery to this area. However, she did have a history of significant pelvic fracture, which was the most likely cause of her lymphedema. The Veteran would benefit from compression stockings and physical therapy. In October 2017, the Veteran was afforded a VA examination for lymphatic conditions. The Veteran stated that, about a year ago, her left leg swelled up and was painful. She was told that she had sciatica. The swelling worsened and was told that she had lymphedema. The VA examiner reported that the Veteran had been diagnosed with a lymphatic condition in the past. However, the current examination showed that everything was normal. The VA examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Veteran's claims file reflects that she complained of pelvic pain in January 1986. X-rays in January 1986 showed possible early stress reaction. X-rays of her pelvis, dated January 1986, were negative for a fracture. In February 1986, tenderness to palpation of the left pubic ramus was noted, but there was no edema. There was no further documentation regarding edema found in her records until May 2017 when she was seen at Craven County Health Department. No edema was seen the day of this VA examination. A nexus had not been established. In September 2018, the Veteran was afforded a VA examination for her hip and thigh condition. The Veteran was diagnosed with bilateral enthesitis of the hips and mild DJD with subchondral syst of the right hip. The VA examiner opined that it was less likely than not that the Veteran's claimed condition was related to her military service. The examiner explained that there was only 1 record from January 1986 found during military service describing groin/hip pain. No nexus of injury or complaint could be made to indicate persistence of such a complaint during military service. There was only one complaint found in the service treatment records provided for review from January 1986 at which time the Veteran noted "1 week" of groin pain. On the period exam of November 1986, there was no joint complaint. Thereafter, there was nothing in the records to indicate ongoing complaint of groin/hip pain. Therefore, no nexus of injury could be established. Therefore, the left hip condition was less likely than not a continuation from military service. The VA examiner opined that there were no records form the Veteran's military service describing right hip pain. If the right hip condition was due to the left hip/pelvis possible stress fracture from military service, there should have been a complaint of right hip pain during service. In September 2018, the Veteran was afforded a VA examination for his back condition. The Veteran was diagnosed with lumbar DDD and DJD, sciatic IVDS and thoracolumbar strain. The VA examiner noted that the Veteran had radiculopathy on the left side. The VA examiner opined that it was less likely than not that the Veteran's chronic antalgic gait alone due to bilateral hip and knee pain would cause lumbar DJD with DDD and IVDS. The Veteran's leg edema was less likely than not the cause of her back condition. There was no evidence in the Veteran's records that she had back pain in association with complaints of left groin/hip pain during military service. There was no mention of knee pain in the military service records reviewed. In July 2021, the Veteran was afforded VA examinations. The Veteran was only diagnosed with degenerative arthritis of the right hip, degenerative disc disease of the back, and left lower extremity radiculopathy. The reported lymphedema was not evidenced on the examination; however, the symptoms correlated with left lower extremity radiculopathy which had been diagnosed. Although private medical records showed diagnosis of lymphedema, physical examination did not show objective evidence of lymphedema, and the Veterans symptoms did not correlate with lymphedema. Instead, it correlated with left lower extremity radiculopathy that was supported with physical examination findings. Review of the Veteran's service treatment record did not show compelling evidence of injury that might have resulted in the Veterans lumbar degenerative disc disease, left knee strain, and left lower extremity radiculopathy. For this reason, it was less likely than not that the claimed right lower extremity radiculopathy was incurred in service. Radiographs, dated January 1986, noted that there were findings bilaterally of the pubic rami suggestive of possible early stress reactions, which correlated with the claimed pelvis disorder. However, this condition was not diagnosed as it had since resolved. This was proven by most recent pelvis X-rays, dated June 15, 2021, which did not show evidence of any other pelvis condition (pubic rami condition); however, demonstrated age-related degenerative changes. Since there was no evidence of other pelvis condition, and the condition resolved, it was less likely than not incurred in service. Also, the diagnosed degenerative arthritis, hip was likely age-related and was also in a different location from the resolved pubic rami stress fracture during service. The arthritis was located in the right femoral head. Arthritis was unrelated to service as there was no evidence of other pelvis/hip condition, therefore, it was less likely than not incurred in service. The July 2021 VA examiner opined that the claimed conditions were less likely than not proximately due to or the result of the Veteran's cracked pelvis/pelvis disorder; however, this condition had since resolved as proven on most recent pelvis x-rays. The degenerative arthritis was likely age-related. Therefore, it was less likely than not proximately due to or the result of the Veteran's pelvis disorder. Also, the pubic rami stress reaction already resolved, it was less likely than not that the lumbar degenerative disc disease and left lower extremity radiculopathy was proximately due to or the result of the Veteran's pelvis disorder. Since there was no evidence of pubic rami/cracked pelvis condition, it was less likely than not that the Veteran's lumbar degenerative disc, left knee strain, and left lower extremity radiculopathy were proximately due to the Veteran's cracked pelvis/pelvis disorder The Veteran's degenerative arthritis was not severe enough to result in imbalance of gait and undue stress in the knees and back and did not result in the left knee strain, left lower extremity radiculopathy, or degenerative disc disease of the lumbar spine. Also, the arthritis does not cause nerve irritation and radicular symptoms as those are solely due to nerve irritation from the lumbar condition Therefore, it was less likely than not (less than 50 percent probability) that the left knee strain, left lower extremity radiculopathy or degenerative disc disease of the lumbar spine were approximately due to or the result of the Veteran's right hip degenerative arthritis. The VA examiner also opined that the Veteran's lumbar degenerative disc disease, left knee strain, and left lower extremity radiculopathy were not aggravated by beyond their nature progression by the resolved pelvic stress changes or degenerative arthritis of the right hip. Based on a thorough review of the medical and lay evidence of record, the Board finds that the Veteran's claimed cracked pelvis, back disability, left leg disability, bilateral lower extremity radiculopathy and lymphedema are not related to her military service. All the VA examinations of record, taken together as a whole, are adequate and thoroughly addressed the etiology of the Veteran's claims. Particularly, the July 2021 VA examiner addressed the fact that the Veteran's claimed lymphedema was actually sciatica/radiculopathy. The July 2021 VA examiner discussed all of the Veteran's diagnoses and provided a sufficient rationale as to why they were not related to her pelvic injury in service. The Board acknowledges the Veteran's assertions that her claimed conditions are related to her military service. As to the questions of nexus, determining the etiology of such disabilities is complex, requiring medical expertise or knowledge which the Veteran is not shown to possess. Her statements are thus not considered competent evidence in support of the nexus element. For all the reasons described above, the Board finds that the weight of the evidence is against the Veteran's claim of entitlement to service connection for a back condition, cracked pelvis, left leg condition, radiculopathy of the left and right lower extremity, and lymphedema, and the evidence is not in approximate balance. There is no reasonable doubt to be resolved, and the claim is denied. 38 U.S.C. § 5107(b). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Crawford, 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.