INTERVERTEBRAL DISC SYNDROME

Summary

The Veteran served from June 1978 to February 1987, with subsequent periods of service in 2002 and 2003. The Veteran appealed the denial of service connection for left and right knee osteoarthritis, which was granted by the Board in March 2024. Subsequently, the Veteran appealed that decision, leading to a remand in January 2025. The current decision addresses secondary claims for low back disability and left hip disability, alleged to be caused by the service-connected knee osteoarthritis. The Board considered private medical opinions from April 2014 and July 2016, which diagnosed lumbar strain with radiculitis and lumbar facet spondylitis, and a left hip fracture, respectively. These opinions also opined a biomechanical relationship between the knee condition and the low back and hip issues. The Board found the evidence evenly balanced regarding causation for both the low back and left hip disabilities. Applying the benefit of the doubt doctrine, service connection for low back disability and left hip disability, secondary to the service-connected left and right knee osteoarthritis, was granted. The Board found the private opinions probative, noting they were not contradicted by other evidence and were entitled to weight despite not having extensive rationales.

Rationale

Private physician opined biomechanical relationship to knee condition; Evidence evenly balanced; Benefit of doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: 25005767
Decision Date: 04/28/25	Archive Date: 04/28/25

DOCKET NO. 17-39 461
DATE: April 28, 2025

ORDER

Entitlement to service connection for lumbar strain with bilateral lower extremity radiculitis and lumbar facet spondylitis (low back disability), secondary to left and right knee joint osteoarthritis, on a causation basis, is granted.

Entitlement to service connection for left hip fracture residuals (left hip disability), secondary to left and right knee joint osteoarthritis, on a causation basis, is granted

FINDINGS OF FACT

1. The evidence is at least evenly balanced as to whether the Veteran's low back disability is caused by his service-connected left and right knee joint osteoarthritis.

2. The evidence is at least evenly balanced as to whether the Veteran's left hip disability is caused by his service-connected left and right knee joint osteoarthritis.

CONCLUSIONS OF LAW

1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for low back disability have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for left hip disability have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1978 to February 1987, May 2002 to September 2002, and February 2003 to October 2003.

This case initially came to the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for degenerative joint disease, left and right knee.  

In September 2015 the Veteran filed a notice of disagreement (NOD) and in July 2017 the agency of original jurisdiction (AOJ) issued a statement of the case (SOC).  In July 2017 the Veteran filed a substantive appeal (via VA Form 9).  In February 2023 the Board denied entitlement to service connection for left and right knee disability.

The Veteran appealed the Board's decision to the U.S. Court of Appeals for Veterans' Claims (Court).  In November 2023, while the matter was pending before the Court, the Veteran's then attorney and VA's General Counsel filed a joint motion for partial remand (JMPR).  In November 2023 the Court granted the parties' motion and remanded the matters for action consistent with the JMPR.

In March 2024 the Board granted entitlement to service connection for left and right knee osteoarthritis.  The Veteran appealed the Board's decision to the Court and in December 2024, while the matter was pending before the Court, the Veteran's then attorney and VA's General Counsel filed a JMPR.  In January 2025 the Court granted the parties' motion and remanded the matters for action consistent with the JMPR.

Low back disability and left hip disability 

In the January 2025 JMPR, the parties' determined that the Board did not address an April 2014 private opinion, a July 2016 private opinion, and the Veteran's statements indicating his low back and left hip disabilities are related to his left and right knee joint osteoarthritis. 

Evidence received in connection with a claim for service connection can raise separate issues of entitlement to service connection as a secondary disability.  See Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021) (38 C.F.R. § 3.155(d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  38 C.F.R. § 3.310(a).

An April 2014 private physician diagnosed the Veteran with lumbar strain with bilateral lower extremity radiculitis and lumbar facet spondylitis.  Also, a July 2016 private physician diagnosed the Veteran with a left hip fracture.  Thus, a current disability has been
 connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  38 C.F.R. § 3.310(a).

An April 2014 private physician diagnosed the Veteran with lumbar strain with bilateral lower extremity radiculitis and lumbar facet spondylitis.  Also, a July 2016 private physician diagnosed the Veteran with a left hip fracture.  Thus, a current disability has been demonstrated.  Further, the April 2014 private physician opined his "lumbar spine complaints are biomechanically related to the bilateral knee and feet condition."  Also, the July 2016 private physician opined his "bike injury subsequently led to the quadriceps injury after a fall, which caused weakness of his left leg, which led to his knee giving way causing his current hip injury."  This evidence raises the separate issues of entitlement to service connection for low back disability and left hip disability secondary to his service-connected left and right knee osteoarthritis.  Therefore, these issues have been added to the appeal, consistent with the instructions of the parties to the JMPR.

While the April 2014 and July 2016 private physicians relied on the service history provided by the Veteran, the discounting of a medical opinion that relies on service history provided by the Veteran is only warranted in certain circumstances, none of which are present here.  See Coburn v. Nicholson, 19 Vet. App. 427, 432-433 (2006) (reliance on the service history provided by the veteran only warrants the discounting of a medical opinion in certain circumstances, such as when the opinions are contradicted by other evidence in the record or when the Board rejects the statements of the veteran).  Although the April 2014 and July 2016 private physician's rationales were not extensive, reading the opinions as a whole and in the context of the evidence of record, they are entitled to some probative weight.  See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record).  Moreover, there is no contrary opinion of record.  

The April 2014 and July 2016 private physician's positive opinions support a relationship between the Veteran's low back disability and left hip disability and his service-connected left and right knee osteoarthritis.  The evidence is at least evenly balanced as to whether the Veteran's left and right knee osteoarthritis caused his low back disability and left hip disability.  As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for low back disability and left hip disability, secondary to service-connected left and right knee osteoarthritis, on a causation basis, is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Miller, 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.