Citation Nr: 0003880 Decision Date: 02/15/00 Archive Date: 02/23/00 DOCKET NO. 94-21 868 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an increased evaluation for service connected low back pain syndrome, currently evaluated as 20 percent disabling. 2. Entitlement to service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy, claimed as secondary to service-connected low back pain syndrome. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD T.J. Kniffen, Associate Counsel INTRODUCTION The veteran had active service from July 1959 to July 1979. This matter is before the Board of Veterans' Appeals (Board) on appeal of a September 1992 rating decision from the Waco, Texas Department of Veterans Affairs (VA) Regional Office (RO) that denied the veteran's claim of entitlement to an increased evaluation for his service-connected low back syndrome which had been assigned a 10 percent disability rating. In a May 1994 rating decision the RO increased the veteran's disability rating for low back syndrome to 20 percent. In AB v. Brown, 6 Vet. App. 35 (1993), the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") held that on a claim for an original or increased rating, the veteran will generally be presumed to be seeking the maximum benefit allowed by law and regulation, and it follows that such a claim remains in controversy where less than the maximum benefit available is awarded. In this case, the veteran has continued to express disagreement with the disability ratings assigned. The Board notes that the May 1994 RO decision also denied service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy. Both issues were duly appealed and will be addressed herein. FINDINGS OF FACT 1. The veteran's service-connected low back pain syndrome is currently manifested by muscle spasm and associated pain. 2. There is no competent medical evidence that the veteran's current lumbar spine facet degenerative changes with bilateral sciatic neuropathy was caused or aggravated by his service-connected low back pain syndrome. CONCLUSIONS OF LAW 1. The criteria for an increased disability rating for low back pain syndrome have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.20, 4.71a, Diagnostic Code 5295 (1999). 2. The claim of service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy, claimed as secondary to service-connected low back pain syndrome, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran seeks an increased disability rating for his service connected low back pain syndrome. In essence, he contends that this service-connected disability has become worse in recent years. He also seeks service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy, which he contends was caused by his service-connected low back pain syndrome. In the interest of clarity, the Board will review the factual background of this case and then proceed to analyze the claim and render a decision. Factual background Service clinical notations from February 1977 reflect the veteran reported intermittent lower back pain in the entire lumbar area. The examiner noted full range of motion, mild tenderness and ability of the veteran to raise his legs to straight position and walk normally. The impression of the examiner was lower back pain probable second degree to sleeping on abdomen. In his service retirement report of medical history in March 1979, the veteran reported experiencing recurrent back pain. In the accompanying clinical evaluation the examiner indicated the veteran's lower extremities were normal. The veteran was diagnosed with low back syndrome. In October 1979 the veteran presented for a VA examination including x-rays of his back and spine. The x-rays of the veteran's spine revealed the individual lumbar verterbral segments and their disc spaces appeared normal. No fracture, destructive lesion or posterior arch defects were noted. During the October 1979 VA examination the veteran reported the onset of pain and discomfort in his low back while in service. The veteran reported that approximately a year and one-half later he was examined and advised to exercise, his lower back pain subsiding until approximately 1978. According to the veteran, the lower back pain again subsided and returned for two or three days just prior to the 1979 VA examination. Upon physical examination of the veteran, the examiner noted dorsal and lumbar spine in the midline with no kyphosis or scoliosis. Range of motion of the lumbar spine was free and within normal limits and no muscle spasm of the lumbar spine was noted. No radiating pain into the lower extremities was noted, nor was sensory disturbance to pin prick in the lower extremities. The veteran was diagnosed with residuals of injury to lower back. In December 1979 the veteran was granted entitlement to service connection for low back pain and a 10 percent disability rating was assigned based upon the 1979 VA examination. The Board notes no pertinent medical records for the time period from October 1979 to August 1990. In August 1990 the veteran obtained treatment from G.F., M.D.. He reported experiencing pain, popping sensation and spasm in back while working as a postal worker when he tried to grab a dolly that was knocked over. The veteran also reported injuries to his back during an automobile accident two days after the work related accident. Dr. G.F. noted slow movements, mild tenderness in the lumbosacral area and limited range of motion. Dr. G.F. diagnosed the veteran with lumbosacral back pain with no evidence of protruding disc. During a September 1990 post-operative follow-up examination with Dr. G.F. the veteran reported improvement in his lumbosacral back and indicated a desire to return to his job. Dr. G.F. noted good range of motion and minimal tenderness. The veteran was diagnosed with muscle strain in lumbosacral area of his back. Dr. G.F. diagnosed the veteran with chronic back pain and continued this diagnosis in December 1990. In February 1991 Dr. G.F. noted back tenderness below the edge of the veteran's right scapula. The veteran was diagnosed with muscle spasm of the right middle back and chronic low back syndrome. In March and April 1991 Dr. G.F. examined the veteran and diagnosed the veteran with chronic low back pain with improvements. In April 1991 the veteran was examined by M.P., M.D.. The veteran reported injuring his back at work in July 1990 and an automobile accident two days later during which he injured his back and neck. Examination of lower back revealed some mild tenderness to palpation over upper lumbar facet joints. Reflexes, motor strength and sensation in lower extremities were within normal limits. Examination revealed no tenderness to palpation over sacroiliac joints bilaterally. The veteran was diagnosed with low back pain and lumbar radiculopathy, probably aggravated by accidents in July 1990. The evidence of record contains the results of an April 1991 (MRI) examination. The examiner's impression were early desiccation changes seen at L4-L5 without disc herniation or foraminal encroachment seen, with no significant annular bulge noted at any level. In May 1992 the veteran was treated by M.R., M.D. for injuries he sustained in the automobile accident in July 1990. The veteran reported pain radiating to his left and right legs and from his neck into his arms. The veteran also reported pain radiating to his groin, scrotum and medial thighs. The veteran was diagnosed with internal disc disruption at L1-2 disc which accounted for excessive pain on any motion of the trunk. After a June 1992 examination of the veteran Dr. M.R. noted leg weakness with numbness. In July 1992 Dr. M.R. diagnosed the veteran with bilateral common peroneal sciatic neuropathy with severe leg weakness. Dr. M.R. examined the veteran in August 1992 and made reference to the April 1991 MRI that revealed degenerative disc disease of the lumbar region and no findings of degenerative disc disease at L4-5 and L5-S1, with degenerative facet arthropathy, left greater than right at L5-S1. No disc herniation was noted and the pelvic MRI was normal as to the region of the sciatic nerve. The veteran was diagnosed with left L4-5 faceitis and pararesis secondary to bilateral sciatic neuropathy. The RO denied entitlement to an increased rating in the September 1992 rating decision on the basis that the veteran sustained internal disc disruption at L1-2 from an after service intercurrent injury and that any increased severity experienced by the veteran was caused by the July 1990 accidents that occurred after service. M.P., M.D. examined the veteran and stated in a December 1992 letter that the veteran reported that he injured his back while working in July 1990 and in a subsequent automobile accident. Dr. M.P. stated examination of the veteran did not show evidence of acute lumbar strain but did show significant sciatic neuropathy with uncertain etiology. There is no mention of the veteran's military service in Dr. M.D.'s letter, nor was there mention of the veteran's service- connected disability, except to the extent that Dr. P. did not find evidence of lumbar strain. In a January 1994 letter, Dr. M.P. stated his opinion that examination of the veteran showed no objective findings of current lumbar strain. Dr. M.P., in response to an inquiry from the United States Department of Labor regarding the veteran's workers compensation claim, stated that if the veteran was diagnosed with sciatic neuropathy, no connection existed with the work related and automobile accidents reported by the veteran. Military service or the service- connected disability was not mentioned, except to the extent that Dr. P. identified no objective findings of current lumbar strain. A hearing was held at the RO in March 1994. The veteran described back pain from his shoulder blades that proceeded down his legs. He testified that occasionally his legs were numb and that he used a cane to walk. He also reported experiencing physical discomfort riding as a passenger in an automobile. In April 1994 the veteran presented for a VA examination. The veteran reported the onset of his lower back pain in 1958 when he picked up the trail of a 105mm howitzer. He reported a recurrence of this pain in 1977 and again in 1990 when moving boxes as an employee of the postal service. In July 1990, according to the veteran, he was involved in an automobile accident that, according to the veteran, aggravated his back pain. Physical examination of the lumbosacral spine revealed lateral bending at 60 percent of normal range in both directions, with forward bending to approximately 40 to 50 degrees. The examiner diagnosed the veteran with history of muscle sprain in the lumbosacral spine from the lifting incident during service in 1958 and moderate impairment of back function. Shortly after the April 1994 VA examination, an MRI was completed. The examiner's impressions were mild to moderate facet degenerative changes at L2-L3, L3-L4 and L4-L5 and severe degenerative change at facet joints and ligamentous hypertrophy as well as posterior disc bulge at L4-L5. In May 1994, a RO decision increased the disability rating for the veteran's service-connected low back disability to 20 percent, based upon the April 1994 VA examination, MRI and May 1994 Hearing Officer Decision. Service connection was denied for lumbar spine facet degenerative changes with bilateral sciatic neuropathy. Dr. G.F. in May 1995 diagnosed the veteran with chronic lumbosacral back pain and bilateral sciatic neuropathy. Dr. G.F.'s letter contained no mention of the veteran's military service. Dr. G.F. did state that the veteran's then-current symptoms of chronic back pain and sciatic neuropathy were not related to what Dr. G.F. described as the veteran's current injuries. Dr. G.F. further stated the veteran's initial injury was back strain which had resolved. In June 1997 the veteran presented for a VA neurological disorders examination including x-rays of his lumbosacral spine. The veteran reported low back pain that radiated down to his feet. The examiner was requested to answer whether or not the veteran's low back disorder was secondary to muscle strain and injury. The veteran reported the accident involving his back while working in 1990 as well as the 1990 automobile accident in which his back was injured. The examiner stated that the veteran's low back pain and muscle spasms were related to the injuries incurred during service, but that the tingling and numbness felt by the veteran in his legs and feet were caused by degenerative disc disease that was not caused by the veteran's service connected injury. The veteran was diagnosed with history of low back disorder secondary to muscle strain and injury during service. He was also diagnosed with degenerative disc disease and bulging discs which the examiner stated were not secondary to his muscle strain and injury. The examiner stated that the degenerative disc disease that caused numbness and tingling in the veteran's legs and feet is separate from the back injury he experienced during service. 1. Entitlement to an increased evaluation for service- connected low back syndrome, currently evaluated as 20 percent disabling. Applicable law and regulations Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Schedule), 38 C.F.R. Part 4 (1998). The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Governing regulations include 38 C.F.R. §§ 4.1 and 4.2 (1999), which require the evaluation of the complete medical history of the veteran's condition. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings . See 38 C.F.R. §§ 4.1, 4.2 (1999); See also Francisco v. Brown, 7 Vet. App. 55 (1994). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. 38 C.F.R. § 4.20. The veteran's service connected low back pain syndrome is rated by analogy to lumbosacral strain under 38 C.F.R. § 4.71a, Diagnostic Code 5295. Under Diagnostic Code 5295, which pertains to lumbosacral strain, a 10 percent rating is warranted where there is characteristic pain on motion; a 20 percent rating is warranted where there is muscle spasm on extreme forward bending, unilateral loss of lateral spine motion in a standing position; and a 40 percent rating, the highest available rating under Diagnostic Code 5295, requires a severe lumbosacral strain as manifested by a listing of the whole spine to the opposite side, positive Goldthwait's sign, marked limitation of forward bending in a standing position, loss of lateral motion with osteoarthritis changes, or narrowing or irregularity of the joint space, or some of the aforementioned with abnormal mobility on forced motion. 38 C.F.R. § 4.71a, Diagnostic Code 5295. The Board is cognizant of the provisions of 38 C.F.R. § 4.21: "It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases." The evaluation of a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain under 38C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.40 state that the disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. According to this regulation, it is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, the regulations state that the functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. The provisions of 38 C.F.R. § 4.45 state that when evaluating the joints, inquiry will be directed as to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. Analysis Preliminary matters: well-groundedness of the claim; duty to assist; standard of proof Initially, the Board concludes that the veteran's claim of entitlement to an increased evaluation for low back pain syndrome is well grounded within the meaning of the statutes and judicial construction. See 38 U.S.C.A. § 5107(a) (West 1991). When a veteran claims that he has suffered an increase in disability, or that the symptoms of his disability are more severe than is contemplated by the currently assigned rating, that claim is generally considered well grounded. Bruce v. West, 11 Vet. App. 405, 409 (1998); Proscelle v. Derwinski, 2 Vet. App. 629, 631-632 (1992). Upon the submission of a well-grounded claim, the VA has a duty to assist the veteran in developing the facts pertinent to his claim. 38 U.S.C.A. § 5107. In this case, there is ample medical and other evidence of record, the veteran has been provided a hearing and a recent VA examination, and there is no indication that there are additional records that have not been obtained and which would be pertinent to the present claims. Thus, no further development is required in order to comply with VA's duty to assist as mandated by 38 U.S.C.A. § 5107(a). 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 veteran. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the evidence must preponderate against the claim. See also Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Discussion As noted above, the veteran's service connected low back disability, which has been diagnosed as low back pain syndrome, is rated by analogy to lumbosacral strain under 38 C.F.R. § 4.71a, Diagnostic Code. See 38 C.F.R. § 4.20. The assignment of a particular Diagnostic Code is "completely dependent on the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993). One Diagnostic Code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and demonstrated symptomatology. Any change in Diagnostic Code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In this case, the Board has considered whether another rating code is "more appropriate" than the one used by the RO. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). The veteran's service-connected low back pain syndrome is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5295. The Board believes that based on the diagnosis, history and symptomatology of the veteran's disability, Diagnostic Code 5295 is the most appropriate. The veteran has not pointed to any more appropriate Diagnostic Code. A request for an increased rating must be viewed in light of the entire relevant medical history. See 38 C.F.R. §§ 4.1, 4.41 (1998); Peyton v. Derwinski, 1 Vet. App. 282, 287 (1991). The Board observes that the evidence of record does not show complaints from the veteran as to his back from October 1979, a few months after he left service, until August 1990, shortly after a reported work-related injury and automobile accident. The Board also notes the January 1994 opinion of Dr. M.P. in which it was stated the veteran showed no objective findings of lumbar strain and Dr. G.F.'s May 1995 statement that the veteran's initial back strain had been resolved. On the other hand, there is much evidence, which has been reported in detail above, to the effect that the post-service 1990 injury or injuries have resulted in severe degenerative changes with sciatic neuropathy. Of significance, the most recent VA examiner, in June 1997, specifically excluded the lower extremity problems from the service-connected back disability. The back spasms and pain identified on the most recent VA examination as being part of the service-connected low back pain syndrome are consistent with the award of a 20 percent disability rating under Diagnostic Code 5295. There is no evidence, either during the June 1997 examination or elsewhere in the record, of a listing of the veteran's whole spine to the opposite side, positive Goldthwait's sign, marked limitation of forward bending in standing position or any of the other symptomatology which would be consistent with a 40 percent disability rating. Indeed, some of the medical evidence of record, in particular the opinions of Dr. P., did not identify the low back syndrome at all and essentially attributed the veteran's low back pathology exclusively to the disc problems beginning in 1990. That opinion appears to be consistent with the medical history, which demonstrated no back complaints for a decade between service and 1990, and constant complaints thereafter. The Board has also considered whether an evaluation in excess of 20 percent is warranted on the basis of functional loss under 38 C.F.R. §§ 4.40 and 4.45. The Board is cognizant that the veteran uses a motorized wheelchair and complains of weakness and fatigability, which he ascribes to his service- connected disability. However, the Board believes that no additional compensation is warranted under 38 C.F.R. §§ 4.40 and 4.45 for the reasons expressed above, namely that the additional pathology which has occurred since 1990 has been associated with the post-service injury and resulting degenerative disease of the lumbar spine, not the service- connected low back disability. See, in particular, Dr. P.'s comment in April 1991, reported above. Therefore, the Board finds that the veteran's lower back syndrome does not warrant an additional disability rating under 38 C.F.R. §§ 4.40, 4.45. See DeLuca, 8 Vet. App. at 207-208. In summary, based on its review of the relevant evidence in this matter, and for the above stated reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for an evaluation in excess of 20 percent for service-connected low back syndrome. The veteran's claim is, therefore, denied. 2. Entitlement to service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy, claimed as secondary to service-connected low back pain syndrome. Initially, the Board notes that neither the veteran nor his representative have asserted that service connection should be granted on a direct or presumptive basis, that is, the veteran's lumbar spine facet degenerative changes with bilateral sciatic neuropathy was incurred in service or occurred within one year thereafter or is otherwise directly due to service. See 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. The Board has identified no evidence which would lead to that conclusion. Therefore, the Board's discussion will focus upon a consideration of whether this disability was caused or aggravated by the veteran's service-connected low back syndrome. The factual background of the veteran's back disabilities has been set out in detail above and will not be repeated. Applicable law and regulations Service connection Service connection will be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (1999). The United States Court of Veterans Appeals (Court) has held that when a service-connected disability aggravates but is not the proximate cause of a non-service-connected disability, the veteran is entitled to service connection for the portion of the severity of the non-service-connected disability that is attributable to the service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Well grounded claims The threshold question that must be resolved with regard to this claim is whether the veteran has presented evidence that the claim is well grounded. 38 U.S.C.A. § 5107(a); Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997). A well grounded claim is a plausible claim, meaning a claim that appears to be meritorious on its own or capable of substantiation. Epps. An allegation that a disorder is service-connected is not sufficient; the veteran must submit evidence in support of the claim that would "justify a belief by a fair and impartial individual that the claim is plausible." Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of the evidence required to meet this statutory burden depends upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). In order for a claim for secondary service connection to be well grounded, there must be a medical diagnosis of a current disability, a service-connected disability, and medical evidence of a nexus between the in-service disease or injury and the current disability. See Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). A secondary service connection claim is well grounded only if there is medical evidence to connect the asserted secondary condition to the service-connected disability. Velez v. West, 11 Vet. App. 148, 158 (1998); see Locher v. Brown, 9 Vet. App. 535, 538-39 (1996) (citing Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995), for the proposition that lay evidence linking a fall to a service-connected weakened leg sufficed on that point as long as there was "medical evidence connecting a currently diagnosed back disability to the fall"); Jones (Wayne) v. Brown, 7 Vet. App. 134, 136-37 (1994) (lay testimony that one condition was caused by a service-connected condition was insufficient to well ground a claim). A lay person is not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. Therefore, if the determinant issue is one of medical etiology or a medical diagnosis, competent medical evidence must be submitted to make the claim well grounded. See Grottveit, 5 Vet. App. at 93. A lay person is, however, competent to provide evidence on the occurrence of observable symptoms during and following service. If the claimed disability is manifested by observable symptoms, lay evidence of symptomatology may be adequate to show the nexus between the current disability and the in-service disease or injury. Nevertheless, medical evidence is required to show a relationship between the reported symptomatology and the current disability, unless the relationship is one to which a lay person's observations are competent. See Savage v. Gober, 10 Vet. App. 488, 497 (1997). If the veteran fails to submit evidence showing that his claim is well grounded, VA is under no duty to assist him in any further development of the claim. Epps, 1469. VA may, however, dependent on the facts of the case, have a duty to notify him of the evidence needed to support his claim. U.S.C.A. § 5103; see also Robinette v. Brown, 8 Vet. App. 69, 79 (1995). Analysis As noted above, the threshold question with regard to a veteran's claim for service connection is whether the claim is well grounded pursuant to 38 U.S.C.A. § 5107(a). In order for a claim to be well grounded, there must be competent evidence of (1) a current disability ; (2) a service- connected disability; (3) a nexus between the service- connected disability and the current disability (medical evidence). All three prongs of the Caluza/Reiber test must be met. The veteran's April 1994 MRI revealed posterior disc bulge at L4-L5. Thus, the Board finds that the veteran has satisfied the first prong of Caluza, as he has submitted evidence of a current disability. The Board also finds that the second prong of the Caluza/Reiber test has been met because the veteran has service-connected low back syndrome. However, as stated previously, a secondary service connection claim is well grounded only if there is medical evidence which connects the asserted secondary condition to the service-connected disability. Velez v. West, 11 Vet. App. 148, 158 (1998); see Locher v. Brown, 9 Vet. App. 535, 538-39 (1996) [citing Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995)]. After reviewing the record, the Board finds that the veteran has not satisfied the Valez and Reiber requirements, as there is no competent medical evidence of record which establishes the veteran's lumbar spine facet degenerative changes with bilateral sciatic neuropathy was caused or aggravated by the veteran's service-connected low back syndrome. The veteran's representative contends that the June 1997 VA examiner "stated that the veteran's degenerative changes are probably related to the muscle strain and injury that the veteran had in service." If this statement is correct, then medical nexus evidence has been presented which is sufficient to make the veteran'' claim well grounded. It appears that the veteran's representative is referring to the following sentence contained in the June 1997 VA examination report: "As to the question of whether the patient's degenerative changes are secondary to the muscle strain and injury that he had in the Army, it is the opinion of this examiner that the degenerative changes are probably related to his problems which he had in the service." The Board notes, however, the examiner stated the very opposite later in the same paragraph, "So we have two sets of problems here, the first being the low back pain and muscles spasm which are related to his service connection, the second being the tingling and numbness in his legs and feet which are caused by the degenerative disc disease which is not a part of the service connected injury." The Board further notes that on two occasions the examiner re-stated the opinion that the veteran's degenerative disc disease is separate from the low back syndrome that he incurred in service. Most significantly, in the Diagnosis section of the examination report, the examiner stated as follows: History of low back disorder secondary to muscle strain and injury while he was in the service and degenerative disc disease and bulging discs which are not secondary to his muscle strain and injury. The degenerative disc disease causing the numbness and tingling in his legs and feet which [sic] is separate from the disorder which he suffered while in the service. This diagnosis makes it quite clear that there is no relationship between the service-connected disability and the disc disease. The diagnosis is consistent with the tenor of the entire examination report, which as noted above indicates that there is no relationship between the service-connected low back pain syndrome and the degenerative changes with sciatic neuropathy. As for the sentence relied on by the veteran's representative, it is clearly inconsistent with the remainder of the examination report. The most likely explanation is that the word "not" was merely inadvertently omitted from "are" and "probably" in the sentence. Therefore, the Board concludes the statement relied upon by the veteran's representative contained a typographical error. Absent the June 1997 report, the veteran's representative has pointed to no competent medical nexus evidence which links the service-connected low back pain syndrome and the degenerative changes of the veteran's lumbar spine with sciatic neuropathy. The Board has been unable to identify any such medical nexus evidence on its own. Even though the veteran and his representative assert otherwise, the veteran is not competent to provide medical nexus evidence in order to render a claim well grounded. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board notes in passing that in addition to the June 1997 examiner's opinion, which as noted above works against rather than in favor of the veteran's claim, neither Dr. G.F. nor Dr. M.D. made any reference to the veteran's military service in their respective letters and reports concerning the etiology of the veteran's disc problems. In summary, as discussed in detail above, there is no competent medical evidence of a nexus between the veteran's service-connected low back pain syndrome and his lumbar spine facet degenerative changes with bilateral sciatic neuropathy. See Caluza, 7 Vet. App. at 506 (1995). The Court has held that in the absence of a causal link to service or evidence of chronicity or continuity of symptomatology, a claim is not well grounded. See Chelte v. Brown, 10 Vet. App. 268 (1997). Therefore, the Board finds that he has not submitted a well- grounded claim of entitlement to secondary service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy pursuant to 38 U.S.C.A. § 5107(a). Thus, his claim is denied. Additional Matter Because the veteran's claim for service connection is not well grounded, VA is under no duty to further assist him in developing facts pertinent to his claim. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.159(a) (1999); Epps v. Gober, 126 F.3d 1454 (Fed. Cir. 1997); see also Morton v. West, 12 Vet. App. 477 (July 14, 1999), req. for en banc consideration denied, No. 96-1517 (U.S. Vet. App. July 28, 1999) (per curiam) (holding that VA cannot assist a claimant in developing a claim which is not well grounded). The Court has held that VA, in certain circumstances, may be obligated to advise the claimant of evidence that is needed to complete his application for benefits. This obligation depends upon the particular facts of the case and the extent to which VA has advised the claimant of the evidence necessary to be submitted in connection with his claim. See Robinette v. Brown, 8 Vet. App. 69 (1995). The Court has also held that the obligation exists only in the limited circumstances where an appellant has referenced other known and existing evidence. Epps v. Brown, 9 Vet. App. 341 (1996). In this case, the veteran has not referenced other known and existing evidence. This decision service to further inform the veteran of the kind of evidence which is need to make his claim well grounded, namely medical nexus evidence. ORDER Entitlement to an increased evaluation for service connected low back pain syndrome is denied. Entitlement to service connection for lumbar spine facet degenerative changes with bilateral sciatic neuropathy, claimed as secondary to service-connected low back pain syndrome, is denied. Barry F. Bohan Member, Board of Veterans' Appeals