Entitlement to service connection for a left calf condition is remanded.

Citation Nr: 26001442 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 17-00 061A DATE: January 30, 2026 REMANDED Entitlement to service connection for a left calf condition is remanded. Entitlement to service connection for a left knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1978 to September 1982. These matters come before the Board of Veterans' Appeals (Board) on appeal from July 2014 and May 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing in July 2021 before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. The claims on appeal were denied in a February 2024 Board decision. The Veteran appealed to the Court of Appeals for Veterans Claims (Court) which, in a May 2025 memorandum decision, vacated the Board decision and remanded the issues for action consistent with the terms of the decision. Based on the Court's guidance and the evidence of record, the Board finds that further remand is needed. 1. Entitlement to service connection for a left calf condition is remanded. The Veteran's appeal is premised on complaints described as a "left calf condition" directly attributed to active service. The Board previously denied this claim finding the persuasive weight of the evidence, to include February and August 2023 VA medical examiners, determined that the pain and cramping the Veteran experiences in his left calf were caused by stenosis of the spinal canal. The Veteran, however, is already service-connected for lumbosacral spondylolisthesis and, more importantly, left lower extremity sciatic radiculopathy. As such, the Board denied the appeal in the February 2024 decision finding the claimed condition was already compensated as he is in receipt of a 20 percent rating under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8520. This rating has been granted due to constant pain in the left lower extremity. See May 2022 VA examination. As such, he is already receiving compensation for pain symptomology located in the left calf associated with lumbosacral spondylolisthesis. Consistent with the terms of the memorandum decision, however, the Board has been directed to discuss whether cramping and pain in the left calf are the same or separate symptoms. In particular, in the memorandum decision, the Court raised question as to whether calf cramps were contemplated in DC 8520 or whether such manifestations raised the possibility of a separate disability in which service connection could be considered. The underlying question, however, is medical in nature and, therefore, the Board finds a medical opinion is necessary to resolve whether the Veteran's left calf complaints / manifestations are indicative of a separate disability, a separate functional impairment of earning capacity, or if they are indicative of symptomatology ordinarily associated with the already service-connected lumbosacral spondylolisthesis disability regardless of how described by the Veteran's lay statements. See generally Bailey v. Wilkie, 33 Vet. App. 188 (2021); see also Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board cannot make independent medical findings). In that regard, the Board notes that the provisions of 38 C.F.R. § 4.55 preclude the combining of a muscle injury rating with a peripheral nerve paralysis evaluation involving the same body part when the same functions are affected. The exception to this rule is only when entirely different functions are affected. As such, a medical analysis is needed upon remand as to whether the left calf cramps described by the Veteran involve the same functions as his left lower extremity pain already compensated under DC 8520. See 38 C.F.R. § 4.55. Accordingly, a new VA examination and medical opinion should be obtained upon remand. 2. Entitlement to service connection for a left knee condition is remanded. The Veteran also contended that a left knee condition is the direct result of active service. Evidence in the claims file raised a secondary theory of entitlement to service connection. See Robinson v. Peake, 21 Vet. App. at 552, aff'd sub nom. Robinson v. Shinseki, 557 F.3d at 1355. An October 2016 private treatment record noted the Veteran's complaint that physical therapy for his left calf pain aggravated his left knee pain. He wished to discontinue therapy due to the increased left knee pain. Further, at the July 2021 hearing, the Veteran testified that when marching in service, his left calf would cramp and he would fall. He claimed that was how he "busted" his knee. He attributed his claimed left calf and left knee conditions and his lumbar spine condition to falling in service and had pain constantly since then. Given these lay reports of a left knee condition originating from or being aggravated by the claimed left calf condition, the Board finds that entitlement to service connection for a left knee condition is inextricably intertwined with the left calf condition appeal and a decision regarding the left knee condition would be premature. See Harris v. Derwinski, 1 Vet. App. 180 (1991). There is a VA medical opinion of record discussing whether the claimed left calf condition is secondary to the left knee condition, but no opinion as to whether the left knee condition is secondary to any left calf cramping secondary to the service-connected lumbosacral spondylolisthesis. As such, if left calf cramping is deemed a separate symptom from pain and involving a separate function than service-connected left lower extremity sciatic radiculopathy, a secondary opinion should also be obtained upon remand. Regarding all claims remanded herein, the Board is mindful of the holding in Smith v. Wilkie, 32 Vet. App. 332 (2020), and the impact of implicit credibility determinations within remand orders. The Board does not at this time make any determinations regarding the credibility of any evidence currently of record, to include those described in this remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations from an appropriate clinician to determine the nature and etiology of the claimed left calf condition and left knee condition. The claims folder should be made available to and be reviewed by the examiner. All indicated tests and studies should be performed. Following a review of the record, the examiner is asked to: (a.) With regard to the Veteran's (1) complaints of cramping in the left calf and his (2) complaints of pain, opine as follows: i. Are they the same or are they different symptoms? IF the answer is "DIFFERENT SYMPTOMS" then answer "ii" ii. Do the DIFFERENT SYMPTOMS (cramping and pain) in the left calf affect the same or different function as his left lower extremity radiculopathy? (b.) If and only if BOTH left calf cramping is a different symptom from pain affecting a different function than service-connected left lower extremity sciatic radiculopathy: 1. Determine the affected muscle group and severity of the symptomatology. 2. Determine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the claimed left knee condition 1) was caused by his left calf cramping or treatment therefor; or 2) was aggravated by his left calf cramping or treatment therefor. NOTE: It is "but for" causation or aggravation that is required, not proximate cause. Specifically, determine whether the Veteran would have developed the claimed disability or whether such disability would have been less severe but for the left calf cramping, either because there is an etiological link or because the left calf cramping resulted in the inability to treat the claimed disability. If the examiner determines that the claimed condition was aggravated by the left calf cramping, s/he must provide the baseline level of severity of the claimed disability established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the claimed disability. See 38 C.F.R. § 3.310(b). In considering any lay statements of record, the examiner should note that the Veteran is competent to attest to matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. If medical literature is relied upon, the examiner should identify and specifically cite each reference material used and discuss how it relates to the Veteran's particular medical history. The examiner should specifically discuss any contradictory evidence in the claims file and reconcile that evidence with their findings. All opinions should be accompanied by supporting rationale explaining how the examiner arrived at the conclusions expressed. If the examiner determines that s/he cannot provide an opinion without resorting to speculation, s/he should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the appeals. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Rachel E. Jensen, 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.