INTERVERTEBRAL DISC SYNDROME

Summary

The Veteran, a veteran who served from January 1986 to January 1990, appeals the denial of service connection for lumbar spine and left hip disabilities, claimed as secondary to his service-connected left knee condition. The Board reviewed the case following a September 2025 remand for new VA medical opinions. The VA examiners in October and November 2025 provided negative opinions for both direct and secondary service connection. For the lumbar spine, the examiner noted no current diagnosis, attributed post-service pain to work-related injuries, and found no in-service complaints or diagnosis in the service treatment records (STRs). The examiner opined that the lumbar spine condition was less likely than not related to service or secondary to the left knee condition, citing a lack of medical literature supporting a causal link and no evidence of chronic gait alteration. The examiner also found no basis for aggravation beyond natural progression. For the left hip, the examiner diagnosed left hip strain, attributing onset to wear and tear and carrying gear during service, but noted no in-service complaints or diagnosis in the STRs. The examiner opined the hip condition was less likely than not related to service or secondary to the left knee, citing lack of chronic gait alteration and absence of plausible nexus. The Board found the VA opinions highly probative, noting their thoroughness, consideration of medical literature, and consistency with prior negative opinions. The Board found the Veteran's lay statements regarding nexus and continuity of symptoms to be outweighed by the medical evidence, as determining etiology requires medical training. The Board concluded that the evidence persuasively weighs against service connection for both conditions, denying entitlement.

Rationale

No current diagnosis for lumbar spine disability.; STRs silent for lumbar spine condition during service.; VA examiner opined less likely than not related to service or secondary to left knee disability.; No medical literature supports causal link; no chronic gait alteration documented.

Full Decision Text

Citation Nr: 26001600
Decision Date: 02/04/26	Archive Date: 02/04/26

DOCKET NO. 16-49 378
DATE: February 4, 2026

ORDER

Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected left knee disability is denied.

Entitlement to service connection for a left hip disability, to include as secondary to service-connected left knee disability is denied.

FINDINGS OF FACT

1. The Veteran's lumbar spine disability is not secondary to service-connected left knee disability and is not otherwise related to an in-service injury or disease.

2. The Veteran's left hip disability is not secondary to service-connected left knee disability and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for lumbar spine disability due to service or service-connected left knee disability are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for left hip disability due to service or service-connected left knee disability are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1986 to January 1990.

These claims are back before the Board after they were most recently remanded in September 2025 for new VA medical opinions on direct and secondary service connection for the Veteran's lumbar spine and left hip disability

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability that is due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection for a disability can be granted on a secondary basis if a Veteran has a (1) current disability; (2) a separate disability already subject to service connection; and (3) the first disability is proximately due to or the result of or is aggravated beyond its natural progress by the service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310. Secondary service connection must be addressed in any decision when it has been reasonably raised by the record, i.e., in medical records or lay statements. Id. 

The Veteran is seeking entitlement to service connection for his lumbar spine and left hip disability, to include as due to his service-connected left knee disability. For the reasons discussed below, the Board finds that entitlement to service connection for these claims is not warranted. 

Pursuant to the September 2025 Board remand, the Veteran underwent VA examinations for his lumbar spine and left hip disabilities and VA medical opinions on direct and secondary service connection were obtained in October and November 2025. The examiners rendered negative opinions for both disabilities on a direct and secondary service connection basis. 

In the November 2025 VA examination report for back conditions, the examiner noted that the Veteran does not have a current diagnosis associated with the claimed lumbar spine disability. The Veteran reported the date of onset as 1990 and endorsed experiencing back pain caused by other injuries. The Veteran reported that he does not remember an overt injury but feels that he overcompensated for the other injuries causing his back condition.

For direct service connection, the VA examiner in October 2025 opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner further noted that service treatment records (STRs) are silent for any evidence of diagnosis, evaluations, treatments, or complaints related to a lumbosacral spine condition, and records are silent for lumbosacral spine condition until 1998 when lumbosacral strain is
 but feels that he overcompensated for the other injuries causing his back condition.

For direct service connection, the VA examiner in October 2025 opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner further noted that service treatment records (STRs) are silent for any evidence of diagnosis, evaluations, treatments, or complaints related to a lumbosacral spine condition, and records are silent for lumbosacral spine condition until 1998 when lumbosacral strain is diagnosed after an injury in March 1998 when the Veteran lifted a heavy object at work. The examiner noted that the Veteran's lay statements have been taken into complete consideration; however, the Veteran is not qualified with requested knowledge to provide a direct etiology of the background of the claimed contention.

As for secondary service connection, the examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner noted that the conditions of a lumbosacral spine disability and left knee degenerative arthritis/osteoarthritis and chondromalacia patella are not medically related, and the lumbosacral spine disability is a separate entity entirely from the left knee degenerative arthritis/osteoarthritis and chondromalacia patella and unrelated to it. The examiner further noted that a thorough review of medical literature failed to demonstrate a causal relationship, and a nexus has not been established. 

As for aggravation, the examiner answered "no" when asked whether it is at least as likely as not that the Veteran's lumbar spine disability was caused or aggravated by his service-connected left knee disability and noted that a baseline level of severity of the claimed condition based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by (service connected condition) could not be determined. The examiner noted that the baseline cannot be established as medical evidence is not sufficient to support a determination of a baseline level of severity. The examiner also answered "no" when asked if regardless of an established baseline, was the Veteran's lumbar spine disability at least as likely as not aggravated beyond its natural progression by the left knee disability. In the rationale, the examiner noted that records are silent for lumbosacral conditions until 1998 when lumbosacral strain is diagnosed and the Veteran reported original injury at work and was treated through work. The examiner noted that this is separate and unrelated to a left knee condition as etiology has been established in medical records as due to lifting a heavy object at work.

As for the left hip disability, in the November 2025 VA examination report, the examiner rendered the diagnosis of left hip strain. The Veteran reported 1990 as the date of onset and endorsed experiencing left hip pain that he attributed to wear and tear during his time in service. The Veteran further reported that he was required to carry gear that subsequently caused his hip condition.

For direct service connection, the VA examiner in October 2025 opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that there is a lack of evidence supporting a nexus between the current diagnosis of left hip tendonitis and service., and without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner further noted that STRs are silent for complaints, diagnosis, treatments, or evaluations related to a left hip condition, and the Veteran's lay statements have been taken into complete consideration; however, the Veteran is not qualified with requested knowledge to provide a direct etiology of the background of the claimed contention. The examiner found that left hip pain and a service-connected left knee condition are unrelated based on the available medical documentation, lack of chronic gait alteration, and the absence of a plausible nexus supported by evidence and establishing a causal relationship between these conditions would be speculative. The examiner noted that the absence of medical documentation of left hip complaints from separation in 1990 until the VA examination in 2020 indicates no chronicity or continuity of symptoms that would support a service connection or secondary aggravation. 

As for secondary service connection, the examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner noted there is no documentation of chronic gait alteration. The literature shows that biomechanical relationships between knee osteoarthritis and hip pathology can exist, but these typically require evidence of altered gait or compensatory mechanisms, which are not present in this case, and without documented gait disturbance,
 between these conditions would be speculative. The examiner noted that the absence of medical documentation of left hip complaints from separation in 1990 until the VA examination in 2020 indicates no chronicity or continuity of symptoms that would support a service connection or secondary aggravation. 

As for secondary service connection, the examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner noted there is no documentation of chronic gait alteration. The literature shows that biomechanical relationships between knee osteoarthritis and hip pathology can exist, but these typically require evidence of altered gait or compensatory mechanisms, which are not present in this case, and without documented gait disturbance, a secondary relationship is not supported. The examiner noted that records are silent for chronically impaired gait besides one mention of minimally antalgic gait in August 2017. 

As for aggravation, the examiner provided a negative nexus similar to the lumbar spine disability and noted that there is no evidence to suggest aggravation of a left hip condition beyond natural progression per thorough review of medical records. The examiner found that the claims file is silent for diagnosis, evaluations, and treatments related to the left hip until the 2020 VA examination. The examiner noted that medical literature emphasizes that osteoarthritis and joint pain have multifactorial etiologies, including age, body mass index (BMI), genetics, prior injury, and occupational exposures, but not all joint trauma or knee pathology leads to hip osteoarthritis or pain, and the biomechanical relationship is complex and not universally causal. The examiner found that the absence of medical documentation of left hip complaints for 30 years post-service, and lack of records indicating chronic gait alteration, means there is no objective basis to infer a causal or aggravating relationship. The examiner opined that VA guidelines and epidemiological principles require evidence-based, not speculative, causal inference for compensation decisions, and without contemporaneous medical evidence or documented chronic gait alteration, a nexus between the Veteran's left hip pain and service or the left knee condition cannot be established, and reliance solely on lay statements is insufficient for medical causation of that examination, and evidence of aggravation by a knee condition would be evident in objective medical record findings.

In an addendum medical opinion from November 2025 for both claimed conditions, the examiner noted that he had reviewed the August 2017 physical therapy report that noted minimally antalgic gait, as well as the treatment record from June 1997, which noted that the Veteran had lower back pain for years. The examiner found that the August 2017 physical therapy report was for bilateral knee pain and noted that back pain at that time was attributed to working in areas where the Veteran had to stand on hard surfaces for long hours as he was flat footed.

The Board has also reviewed the Veteran's lay statement that he submitted in December 2025 where he contends that it is at least as likely as not that his current lower back and hip pain were caused or aggravated by his service-connected knee condition and the physical demands of service, and his longstanding altered gait due to his left knee has directly affected his hips and lumbar spine.

Upon careful review of the evidence of record, the Board finds that entitlement to service connection for the lumbar spine and left hip disabilities, to include as secondary to service-connected left knee disability, is not warranted. 

In making a determination, the Board finds the October and November 2025 VA medical opinions highly probative and persuasive, as they were made by medical professionals with consideration of the specific facts in this case. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The examiners conducted a thorough in-person examination and relied on accurate facts gathered from the examination. Further, the examiners considered the Veteran's relevant medical records and medical history while supporting the rationale with medical literature. Further, the medical examiners' findings are consistent with all prior VA medical opinions of record, which provided a negative nexus on direct and secondary service connection for both these disabilities. 

The Board is cognizant of the Veteran's statements that his claimed disabilities are due to his service-connected left knee disability and the physical demands of his service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this regard, determining the diagnosis and etiology of the condition requires medical training and credentials. Thus, the Veteran's opinion as to the cause of his claimed disabilities does not constitute competent evidence. 

Further
izant of the Veteran's statements that his claimed disabilities are due to his service-connected left knee disability and the physical demands of his service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this regard, determining the diagnosis and etiology of the condition requires medical training and credentials. Thus, the Veteran's opinion as to the cause of his claimed disabilities does not constitute competent evidence. 

Further, the Veteran contends that his longstanding altered gait due to his service- connected left knee has directly affected his hips and lumbar spine. However, the evidence reflects that besides the August 2017 physical therapy notation reflecting minimally antalgic gait, the Veteran was not noted to have an abnormal gait. Treatment records from August 2005, June 2007, June 2009, October 2010, July 2015, and March 2021 all note normal gait. As noted earlier, treatment records reflect that the Veteran had previously attributed his back pain due to standing at places of work with flat feet and his back injury was noted to be due to lifting a heavy object at work in 1998. Here, the Veteran has not provided any other medical evidence that supports his contentions that his lumbar spine and left hip disabilities are secondary to his left knee condition and are related to his service. Accordingly, the probative value of the Veteran's lay statements is low and outweighed by the medical evidence of record, and the Veteran's lay statements regarding nexus and continuity of symptomatology are outweighed by the medical evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012).

In conclusion, the evidence does not demonstrate that the Veteran had any lumbar spine or left hip issues during or immediately after service. The post-service medical treatment records are silent for treatment or findings on either disability for many years after the Veteran was discharged, and VA medical providers have consistently opined that the Veteran's lumbar spine and left hip disabilities are not related to service or secondary to his service-connected left knee disability. 

As such, the evidence of record persuasively weighs against finding that the Veteran's lumbar spine and left hip disabilities are related to an in-service injury or disease or secondary to his service-connected left knee disability. Accordingly, the criteria for service connection on a direct or secondary basis are not met, and entitlement to service connection for the lumbar spine and left hip disability must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the evidence persuasively favors one side, the doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Khan, Associate 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.