DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The Veteran, who served in the U.S. Army from February 1976 to February 1980, appeals the denial of service connection for a low back disability. The Veteran's service was later determined to be dishonorable for VA purposes. The appellant, the Veteran's surviving spouse, was substituted after the Veteran's death in November 2025. The Veteran claimed his low back disability was secondary to his service-connected right knee, bilateral shoulder, and neck disabilities, alleging compensation for pain and gait abnormalities. The Veteran testified to experiencing low back pain onset around 2013, attributing it to compensating for service-connected knee, neck, and shoulder issues. VA treatment records from January 2015 and June 2018 noted low back pain in the context of these other service-connected conditions. The Board found the August 2021 and July 2023 VA medical opinions inadequate, as they failed to properly consider the Veteran's lay assertions and apply medical literature to the individual case. The VA examiners opined that the low back disability was less likely than not related to the service-connected knee, neck, or shoulder conditions, stating they were pathologically and mechanically unrelated. In the absence of adequate medical opinions, the Board considered the Veteran's competent and credible lay testimony regarding the biomechanical cause of his low back pain. Finding the evidence in equipoise, the Board resolved reasonable doubt in favor of the Veteran, granting service connection for a low back disability.

Rationale

Competent and credible lay testimony regarding biomechanical cause; Inadequate VA medical opinions; Evidence in equipoise

Full Decision Text

Citation Nr: 26001008
Decision Date: 01/28/26	Archive Date: 01/28/26

DOCKET NO. 19-22 722
DATE: January 28, 2026

ORDER

Entitlement to service connection for a low back disability is granted.

FINDING OF FACT

The Veteran's low back disability was caused by service-connected right knee, bilateral shoulder, and neck disabilities. 

CONCLUSION OF LAW

The criteria for service connection for a low back disability are met.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had honorable active duty service with the U.S. Army from February 1976 to February 1980.  The Veteran's military service from February 3, 1980, to April 10, 1984, has been determined to be dishonorable for VA purposes.  He died in November 2025.  The Appellant is his surviving spouse, and has been properly substituted under 38 C.F.R. § 3.1010.  

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision by the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA).

The Veteran and the appellant testified at a September 2022 hearing held before the undersigned via videoconference.  A transcript of the hearing is associated with the claims file.

In June 2023, the Board remanded this matter for further evidentiary development.  The matter is again before the Board.  D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998).

The Board also remanded the issue of entitlement to service connection for chronic obstructive pulmonary disease (COPD).  In July 2024 rating decision, the AOJ granted the benefit sought.  This action constituted a full grant of the benefit sought, and is no longer on appeal.  Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997).

Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service.  38 U.S.C. § 1131; 38 C.F.R. § 3.303.  Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period.  38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a).  For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection.  38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013).  Arthritis is a listed condition, with a presumptive period of one year following separation from service.

Service connection may also be warranted for disability proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  This permits service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a disability by a service-connected disability.  See Allen v. Brown, 7 Vet. App. 439, 
 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013).  Arthritis is a listed condition, with a presumptive period of one year following separation from service.

Service connection may also be warranted for disability proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  This permits service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a disability by a service-connected disability.  See Allen v. Brown, 7 Vet. App. 439, 448 (1995).  In the case of aggravation by a service-connected disability, a Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation.  Id.; see also 38 C.F.R. § 3.310(b).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the persuasive weight of the evidence is against the claim, in which case the claim is denied.  38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  If there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

The appellant asserts that service connection is warranted for a low back disability; she alleges that the Veteran's service-connected right knee, bilateral shoulder, and neck disabilities caused him to compensate with his lower back.  At the September 2022 Board hearing, the Veteran testified that the pain in his right knee went to his hip and then to his back.  The appellant testified that the claimed low back disability had affected the Veteran's gait.  She further testified that the Veteran also walked hunched and bent over to alleviate pain in his neck and shoulders.  She noted that she had to remind the Veteran to straighten himself.  

The Veteran did not contend, nor does the evidence of record show, that a low back disability had its onset or manifested in active service.  Indeed, at the September 2022 Board hearing, the Veteran endorsed an approximate onset date of 2013 for symptoms of back pain, but did not seek treatment at the time due to a lack of resources and familial responsibilities.  VA treatment records dated January 2015 reflect that the Veteran endorsed pain in his neck, shoulders, lower back, and right knee, as well as difficulties with sleep.  The Board notes that in subsequent VA treatment records in June 2018, April 2021, and October 2021, low back pain and stiffness were referenced to treating clinicians in the context of the neck, shoulders, and knee.  During this period, the Veteran was assessed with low back pain and degenerative joint disease of the lumbar spine.  

The Veteran was afforded a VA examination in August 2021.  The VA examiner diagnosed the Veteran with degenerative arthritis of the lumbar spine and intervertebral disc displacement of the lumbar region.  In rendering a negative nexus opinion on a secondary basis, the VA examiner opined that the claimed low back disability was less likely than not proximately due to or the result of the Veteran's service-connected right knee disability.  The VA examiner opined that joint disease does not spread to another or cause damage to it, and an injury to one joint would not cause any significant impact on another or opposite uninjured joint or limb absent major muscle or nerve damage or limb shortening.  

As the August 2021 VA examiner did not provide a secondary nexus opinion regarding the Veteran's service-connected neck or bilateral shoulder disabilities, VA medical opinions were obtained in July 2023 pursuant to the Board's June 2023 remand.  The VA examiner opined that the Veteran's low back disability was neither caused nor aggravated by the service-connected neck and bilateral shoulder disabilities.  The VA examiner indicated that the disabilities are pathologically, physiologically, and mechanically unrelated to each other.  

The Board finds that the August 2021 and July 2023 VA medical opinions are not entitled to any probative weight.  The VA examiners did not appropriately address or consider the Veteran's lay assertions regarding the onset of low back pain or its biomechanical cause.  Further, while the July 2023 VA examiner cited medical literature in support of her opinions, she did not discuss how they applied to the Veteran's individual case.  

In the absence of an adequate opinion, the remaining evidence consists of the Veteran's competent and credible assertion of an onset low back pain to compensate
-connected neck and bilateral shoulder disabilities.  The VA examiner indicated that the disabilities are pathologically, physiologically, and mechanically unrelated to each other.  

The Board finds that the August 2021 and July 2023 VA medical opinions are not entitled to any probative weight.  The VA examiners did not appropriately address or consider the Veteran's lay assertions regarding the onset of low back pain or its biomechanical cause.  Further, while the July 2023 VA examiner cited medical literature in support of her opinions, she did not discuss how they applied to the Veteran's individual case.  

In the absence of an adequate opinion, the remaining evidence consists of the Veteran's competent and credible assertion of an onset low back pain to compensate and alleviate the pain and functional limitations caused by his service-connected neck, bilateral shoulder, and right knee disabilities, and diagnoses of degenerative arthritis of the lumbar spine and intervertebral lumbar disc displacement.  At worst, the evidence is in equipoise as to whether there is a nexus between the low back disability and the aforementioned service-connected disabilities.  Reasonable doubt is resolved in favor of the Veteran and appellant, and service connection for a low back disability is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	G.A. Ong, 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.