Source: https://va-claim.com/2019/02/06/left-hip-disability-claimed-as-secondary-to-a-service-connected-lumbar-spine-disability-and-diagnosed-as-degenerative-joint-disease-left-sciatic-nerve-neuralgia-denuied/
Timestamp: 2019-04-21 20:34:41+00:00

Document:
Entitlement to service connection for a left hip disability, claimed as secondary to a service connected lumbar spine disability, and diagnosed as degenerative joint disease, is denied.
Entitlement to a rating greater than 10 percent for left sciatic nerve neuralgia prior to October 19, 2016, and greater than 20 percent from October 19, 2016, is denied.
1. Degenerative joint disease of the left hip was not manifest during service or for many years after service, and it is not attributable to service or to a service-connected disability.
2. For the entire period prior to October 19, 2016, the Veteran's service-connected left sciatic nerve neuralgia was manifested by, at worst, mild incomplete paralysis of the sciatic nerve.
3. For the entire period from October 19, 2016, the Veteran's service-connected left sciatic nerve neuralgia has been manifested by, at worst, moderate incomplete paralysis of the sciatic nerve.
1. The criteria for service connection for a left hip disability, diagnosed as degenerative joint disease, are not met.  38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2018).
2. The criteria for a disability rating greater than 10 percent, for left sciatic nerve neuralgia prior to October 19, 2016, and greater than 20 percent from October 19, 2016, have not been met.  38 U.S.C. §§ 1155, 5110(b)(2) (2012); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8520 (2018).
The Veteran served on active duty from November 1990 to July 1995.
This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office.
The Veteran asserts that he has a left hip disability that is secondary to his service connected lumbar spine disability.
The question for the Board is whether the Veteran has a current left hip disability that is proximately due to or the result of, or was aggravated by service-connected disability.
The Board concludes that, while the Veteran has a current diagnosis of degenerative joint disease of the left hip, the preponderance of the evidence is against finding that this diagnosis is proximately due to or the result of, or aggravated by a service-connected disability.  38 U.S.C. § 1110; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a).
An October 2016 VA examiner opined that the only hip disability that the Veteran had was degenerative joint disease which was consistent with his age and weight.  He reported that the finding of degenerative joint disease was incidentally made by x-ray in 2010, which showed mild degenerative changes in both hips.  He noted that the areas of hip pain that the Veteran complained of involve sciatic pain rather than actual joint pain.  He also pointed out that when the Veteran filed the Notice of Disagreement in November 2014, he said, "I'm claiming that sciatic nerve damage is causing left leg numbness/pain; not the joint disease as stated in the rating decision."
The October 2016 VA examiner explained that the radiculopathy that the Veteran has had for years is often mistaken for a hip disability.  He noted that the incidental finding by x-ray in 2010 of mild degenerative changes in both hips during a lumbar spine examination often did not cause symptoms until it progressed further.  He concluded by opining that the Veteran's left hip degenerative joint disease was less likely than not due to or the result of the Veteran's service connected degenerative joint disease of the lumbar spine itself or to any treatment, including steroid injections, for the lumbar spine.
A June 2014 VA examiner similarly negated a nexus between the Veteran’s degenerative joint disease of the left hip and his service connected lumbar spine disability.  She opined that the longitudinal medical evidence provided and reviewed did not support that the Veteran's current mild bilateral hip degenerative joint disease was secondary to his service connected arthritis of the spine, nor did it support functional limitations.  She noted that the Veteran was over 45 years of age and that people over age 45 can demonstrate degenerative joint changes due to normal wear and tear and the natural progression of aging.  She also noted that being overweight increased the risk of developing degenerative joint disease and that the Veteran’s Body Mass Index had been over 39 since 2011.
The VA opinions outlined above are probative since they are based on an accurate history and are accompanied by well-reasoned rationale as well as supporting data.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).  Moreover, these is no contrary medical opinion on file.
To the extent that the Veteran believes that he has a left hip disability which is proximately due to or the result of/aggravated beyond its natural progression by his service-connected back disability, he is not competent to provide a nexus opinion in this case.  The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  In short, the Board gives more probative weight to the October 2016 and June 2014 VA medical opinions.
Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s left hip degenerative joint disease is related to an in-service injury, event, or disease.  38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d).  In this regard, treatment records do not document complaints, injuries or treatment with respect to the Veteran’s left hip in service or for many years after service, and the Veteran was not diagnosed as having mild hip degenerative changes until 2010.
As the weight of evidence is against the claim for service connection for a left hip disability, diagnosed as degenerative joint disease, the claim must be denied.  38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
The Veteran's left sciatic nerve neuralgia is currently evaluated under 38 C.F.R. § 4.124a, Diagnostic Code (Code) 8520.  Under Code 8520, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis; and a 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy.  A maximum 80 percent rating is assigned for complete paralysis of the sciatic nerve; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost.  Id.
The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree.  38 C.F.R. § 4.124a.
The Veteran was assessed by a VA examiner in June 2014 as having mild incomplete paralysis of the left lower extremity.  Findings revealed mild intermittent pain and numbness, normal reflexes, normal sensory findings, normal strength (5/5) and a normal gait.  The examiner reported that the disability did not impact the Veteran’s ability to work (VA outpatient records show that the Veteran worked as a prison corrections officer).
Having reviewed the June 2014 VA examination report, along with the other evidence of record, the Board finds that the totality of the evidence does not support granting a higher than 10 percent rating at any point prior to October 19, 2016.  As noted, neurological findings at the June 2014 VA examination were unremarkable except for mild intermittent pain and numbness.  Those findings, which are consistent with VA outpatient records for that period showing the Veteran’s occasional complaints of left leg pain and cramping, do not more closely approximate moderate impairment of the sciatic nerve.  38 C.F.R. 4.124a, Code 8520.
Findings at a VA examiner in October 2016 revealed mild paresthesias of the left lower extremity and moderate sciatic pain.  There was also some decreased strength at 4/5 and some decreased left lower extremity sensory findings.  The examiner reported that the Veteran was unable to lift over 40 pounds at work.
The Board does not find that the October 2016 VA examination report, or the remaining record evidence, including VA treatment records showing complaints of worsening radicular pain in October 2016, support the criteria for a higher rating of 40 percent at any point from October 19, 2016.  That is, the findings of moderate sciatic pain and some decreased strength and sensory findings do not more closely approximate moderately severe impairment of the sciatic nerve.  38 C.F.R. 4.124a, Code 8520.
The Veteran's belief that he is entitled to a higher than 10 percent rating prior to October 19, 2016, and a higher than 20 percent rating from October 19, 2016, is outweighed by the objective medical findings of record.  That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination reports and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran's general belief that he is entitled to higher ratings.
Consideration has been given to assigning staged ratings.  However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned.  Hart v. Mansfield, 21 Vet. App. 505 (2007).
In light of the above, the Board finds that a preponderance of the evidence is against a rating greater than 10 percent for left sciatic nerve neuralgia at any point prior to October 19, 2016, and a rating greater than 20 percent at any point from October 19, 2016.  Accordingly, these claims must be denied.  38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

References: § 1110
 v. 
 § 3
 v. 
 v. 
 v. 
 § 1110
 v. 
 § 3
 § 5107
 v. 
 § 4
 § 4
 v. 
 § 5107
 v.