BVA9504961 DOCKET NO. 93-11 726 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to service connection for a low back disability as secondary to service-connected left leg disabilities. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD E. J. McCafferty, Counsel INTRODUCTION The veteran had active service from June 1941 to August 1945. In conjunction with other claims, which are not properly before the Board of Veterans' Appeals (Board) at this time, the veteran underwent VA examinations in early 1993 with respect to disabilities which are not pertinent to the present appeal. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in effect, that the regional office (RO) committed error by not awarding service connection for his back disability based on his claim that it is secondary to his service-connected left leg disabilities. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against a claim for service connection for a back disorder as secondary to service-connected left leg disabilities. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. The veteran's low back disability is not shown to be etiologically related to his service-connected left leg disabilities. CONCLUSION OF LAW A low back disability is not proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds initially that the veteran's claim is "well grounded," that is, it is not inherently implausible. We also find that the facts relevant to the issue on appeal have been properly developed and that the statutory obligation of the VA to assist the appellant in the development of his claim has been satisfied. 38 U.S.C.A. § 5107(a) (West 1991). The veteran seeks service connection for a low back disability. It has neither been alleged, nor shown that a low back disability is of service origin, either on a direct or presumptive basis. Rather, the veteran has argued that his service-connected left leg disabilities are of such severity that they resulted in a change in his gait and that this in turn resulted in a low back disability many years post service. The record shows that the veteran has significant disabilities of the left lower extremity which are service connected. These disabilities include claw foot and bunionectomy with removal of all toes, left foot, postoperative status, rated as 30 percent disabling; gunshot wound scar of the left leg with old, healed, compound fracture of the tibia and fibula, with slight medial bowing and retained foreign bodies at fracture site, rated as 20 percent disabling; ankylosis, partial fibrous left ankle joint, rated 10 percent disabling; and mild, post-traumatic thrombophlebitis of the deep saphenous vein, left leg, rated as 10 percent disabling. At his hearing on appeal in August 1992 at the RO, the veteran reiterated his contentions concerning the alleged relationship between his service-connected left leg disabilities and his low back disability. The veteran described his back problems and why he felt that his service-connected disabilities of his left leg had caused his back problem. He indicated that one leg was shorter than the other and that his altered gait adversely affected his back. Private treatment records show the initial diagnosis of a back condition was of scoliosis of the lumbar spine in 1972. Private treatment records from 1979 to 1991 show treatment for various disabilities, but do not serve to relate the veteran's low back disability in a causal way to his service-connected left leg disabilities. A Department of Veterans Affairs (VA) examination in December 1991 described the veteran's left leg and back disabilities and furnished a diagnosis of degenerative joint disease of the spine. A special orthopedic examination was conducted in February 1992. Again, the examiner furnished a history of the veteran's condition. The examiner noted complaints of low back pain which were fairly constant and sometimes awakened the veteran at night. The veteran also complained of poor balance and increasing weakness in his lower extremities. Examination revealed absence of deep tendon reflexes at the ankles and very diminished deep tendon reflexes at the knees. Motor strength was intact and symmetric. Lumbar spine motion was decreased to 60 degrees forward flexion, 10 degrees extension and 10 degrees lateral bending. X-ray studies revealed advanced degenerative arthritis, especially in the L4-5 and L5 - S1 areas with degenerative spondylolisthesis of L5 on S1. The examiner was asked to furnish an opinion with respect to whether there is any relationship between the veteran's service- connected left leg disabilities and his low back disability. He responded that the veteran's back pain may be aggravated by his limb length discrepancy, however, he felt the underlying etiology of the back pain was spinal stenosis. Subsequent VA examinations, conducted in 1993, deal with issues not properly before the Board at this time and do not serve to relate the veteran's low back disability to his service-connected left leg disabilities. In order to establish service connection on a secondary basis, the claimed disability must be shown to be proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (1994). Thus, to grant service connection on a secondary basis, an etiological relationship between the veteran's service- connected disabilities of the left leg and the claimed low back disability must be demonstrated. In the present case, medical evidence supporting such an etiological relationship has not been furnished by the veteran. On the other hand, the VA orthopedic examiner has indicated while the veteran's left leg disabilities may cause back pain, they were not responsible for the veteran's low back disability. The veteran has submitted no medical treatise or opinion to support his position that his back disability is related to his service-connected left leg disabilities. In this regard, the veteran lacks the medical expertise to enter a judgment regarding a medical relationship between his claimed back disorder and his service-connected left leg disabilities. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The veteran's claim that his back disability has resulted from his service-connected left leg disabilities is unsupported by any clinical evidence or medical opinion of record. In fact, the VA orthopedic opinion indicates that the veteran's left leg disabilities are not the etiological source of the veteran's low back disability. Since the necessary etiological or causal relationship between the veteran's left leg disabilities and his low back disability is not established, no sound evidentiary basis exists to warrant service connection on a secondary basis. ORDER Service connection on a secondary basis for a low back disability is denied. JOHN E. ORMOND Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.