DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The Veteran, an Army Veteran who served from April 1968 to May 1975, appeals the denial of service connection for a low back disability. The Veteran claimed the low back disability was either directly related to service or secondary to his service-connected left foot, bilateral ankle, and bilateral knee disabilities. The Board found that the Veteran has a current disability of degenerative joint and disc disease of the lumbosacral spine, satisfying the first element for service connection. The second element, service connection for the underlying foot, ankle, and knee conditions, was also established. The primary issue was the nexus between these service-connected conditions and the low back disability, with obesity identified as a potential intermediate step. While initial VA opinions in January 2021 found no nexus between the service-connected conditions and the low back disability, they did not address obesity as an intermediate factor. The Board found that the Veteran's service-connected foot, ankle, and knee conditions aggravated his obesity due to an inability to exercise, as evidenced by treatment records showing worsening pain and weight gain. Multiple VA opinions attributed the low back disability solely to obesity. The Board concluded that the Veteran's obesity was a substantial factor in causing the low back disability and that the disability would not have occurred but for the obesity. Therefore, service connection for the low back disability was granted as secondary to the service-connected left foot, bilateral ankle, and bilateral knee disabilities.

Rationale

Current disability of degenerative joint and disc disease of the lumbosacral spine established.; Service-connected left foot, bilateral ankle, and bilateral knee disabilities established.; Obesity found to be a substantial factor in causing low back disability, and would not have occurred but for obesity.

Full Decision Text

Citation Nr: A25009172
Decision Date: 01/31/25	Archive Date: 01/31/25

DOCKET NO. 220421-237511
DATE: January 31, 2025

ORDER

Entitlement to service connection for a low back disability, to include as secondary to the Veteran's left foot disability and bilateral ankle and knee disabilities, is granted.

FINDING OF FACT

The most probative evidence of record demonstrates the Veteran's service-connected disabilities caused his low back disability, with obesity as an intermediate step.

CONCLUSION OF LAW

The criteria for service connection for a low back disability as secondary to a left foot disability, bilateral ankle disability, and bilateral knee disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from April 1968 to May 1975.

The Appeals Modernization Act (AMA) creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The AMA became effective on February 19, 2019. The AMA modernized review system applies to all claims for which VA issues a notice of an initial decision on or after the February 19, 2019 effective date of the modernized review system.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2021 Higher-Level Review decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claim was initially denied in a May 2012 rating decision issued under the Legacy system, which the Veteran has continuously pursued. 

In May 2014, the Veteran testified at a Board videoconference hearing before the undersigned VLJ.  The claims file includes a transcript of the proceeding.  

The Veteran's claim was remanded by the Board in July 2014, December 2015, November 2017, and November 2020. The Board finds that there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998).

Following the November 2020 Board remand, a supplemental statement of the case (SSOC) was issued in January 2021. The Veteran opted into the AMA by filing a VA Form 20-0996 Request for Higher Level Review, and an April 2021 rating decision denied the Veteran's claim.

In the April 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the direct review option. For the Direct Lane docket, the Board's review is limited to the evidentiary record at the time of the RO decision on appeal. See Andrews v. McDonough, 34 Vet. App. 151, (2021). 

Service Connection

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; 38?C.F.R. §?3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in the denial of service connection.

Additionally, service connection may be granted on a secondary basis when the evidence establishes (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.? See Wallin v. West, 11?Vet. App.?509, 512 (1998); 38?C.F.R. §?3.310.

The Court has held that the proper interpretation of establishing obesity as an intermediate step requires consideration of both proximate causation and aggravation. Walsh v. Wilkie, 32 Vet. App. 300, 306-7 (2020).  Thus, for secondary service connection to be granted under this theory, the record
, service connection may be granted on a secondary basis when the evidence establishes (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.? See Wallin v. West, 11?Vet. App.?509, 512 (1998); 38?C.F.R. §?3.310.

The Court has held that the proper interpretation of establishing obesity as an intermediate step requires consideration of both proximate causation and aggravation. Walsh v. Wilkie, 32 Vet. App. 300, 306-7 (2020).  Thus, for secondary service connection to be granted under this theory, the record must demonstrate (1) whether a service-connected disability (or service-connected disabilities combined) caused or aggravated (i.e., worsened) the Veteran's obesity; (2) if so, whether the obesity or aggravation of obesity as a result of service-connected disability was a substantial factor in causing the claimed current disability; and (3) whether the claimed disability would not have occurred but for obesity caused or aggravated by the service-connected disability. See Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020).

1. Entitlement to service connection for a low back disability, to include as secondary to the Veteran's left foot disability and bilateral ankle and knee disabilities, is granted.

The Veteran contends that his low back disability is related to his active-duty service, or alternatively, secondary to his service-connected disabilities. The Board finds that the Veteran's low back disability is related to his service-connected left foot, bilateral ankle and knee disabilities. Accordingly, the Board will not address the theory of direct service connection. Additionally, the Board notes that the issue of obesity as an intermediate step for the Veteran's low back disability has been raised by the record. 

In the April 2021 rating decision, the AOJ made a favorable finding that the Veteran has a current disability of degenerative joint and disc disease of the lumbosacral spine. 38 U.S.C. § 5104(b)(4); 5104A; 38 C.F.R. § 20.801(a). Accordingly, the Board finds the Veteran has a current disability element has been met.

The record also establishes that the Veteran is service connected for left foot, bilateral ankle and knee disabilities. Thus, this element of secondary service connection is also met.

The remaining question is whether there is a nexus between the Veteran's current disability and his service-connected disabilities. 

With respect to secondary service connection, in January 2021, multiple VA medical opinions were provided which found that the Veteran's low back disability was neither caused nor aggravated by his service-connected disabilities. However, the Board notes that the VA medical opinions did not address obesity as an intermediate step between the Veteran's service-connected disabilities and low back disability.

Although the January 2021 medical opinions did not address obesity as an intermediate step, the Board finds the medical evidence of record supports a finding of obesity as an intermediate step between the Veteran's left foot, bilateral ankle, and bilateral knee disabilities and his low back disability. The Veteran's VA treatment records indicate the Veteran has suffered from severe foot and ankle pain since at least 2006. An entry from April 2006 found the Veteran would require sedentary employment with limitations of walking to 500 feet. A later entry from November 2012 indicated the Veteran's knee arthritis was so severe it would render him incapable of getting in and out of trucks. In a September 2016 VA examination regarding the Veteran's knees, the Veteran reported his knees hurt so bad that he would have difficulty getting out of bed and he had trouble walking more than a few blocks. The Veteran's VA treatment records also indicate the Veteran continued to gain weight as his symptoms of his feet, ankles, and knee pain worsened. The Board finds this evidence clearly indicates the Veteran's bilateral foot and ankle and bilateral knee disabilities aggravated his obesity due to an inability to exercise.

The Board must next determine whether the Veteran's obesity was a substantial factor in causing his low back disability and whether the disability would not have occurred but for the obesity. In a May 2012 VA medical opinion, the examiner opined the Veteran's low back disability was not related to the Veteran's active service but was instead a result of spinal wear and tear due to the Veteran's obesity. In June 2016 a VA examiner opined the Veteran's low back disability was due to the Veteran being chronically overweight. Accordingly, multiple VA medical opinions attribute the Veteran's low back disability solely to obesity despite noting both in-service and post-service injuries to the Veteran's back. 

In light of the above evidence, the Board finds that the most probative evidence shows that the Veteran's obesity was a substantial factor in causing the Veteran's low back
 and whether the disability would not have occurred but for the obesity. In a May 2012 VA medical opinion, the examiner opined the Veteran's low back disability was not related to the Veteran's active service but was instead a result of spinal wear and tear due to the Veteran's obesity. In June 2016 a VA examiner opined the Veteran's low back disability was due to the Veteran being chronically overweight. Accordingly, multiple VA medical opinions attribute the Veteran's low back disability solely to obesity despite noting both in-service and post-service injuries to the Veteran's back. 

In light of the above evidence, the Board finds that the most probative evidence shows that the Veteran's obesity was a substantial factor in causing the Veteran's low back disability, and the Veteran's low back disability would not have occurred but for the obesity. As such, the necessary factors for the Veteran's obesity to be considered an intermediate step between his low back disability and his service-connected left foot disability, bilateral ankle, and bilateral knee disabilities have been satisfied. Consequently, entitlement to service connection for a low back disability is granted as secondary to the service-connected left foot disability, bilateral ankle, and bilateral knee disabilities. 

 

 

GAYLE STROMMEN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Risley, Haley

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.