INTERVERTEBRAL DISC SYNDROME

Summary

The Veteran served on active duty from February 2010 to March 2011. He sought service connection for lower back disabilities, claiming they were secondary to his already service-connected knee instability, knee strain, ankle strain, and foot strain. The Board reviewed evidence of record up to the October 2023 rating decision. The Veteran's representative argued for the application of the combat presumption, but the Board granted the secondary service connection claim without analyzing combat status. The Veteran is diagnosed with lumbosacral strain, intervertebral disc syndrome (IVDS), and radiculopathy affecting his lower extremities. The Agency of Original Jurisdiction (AOJ) had previously found the in-service incurrence element met. A July 2023 VA examination provided a negative nexus opinion regarding individual knee, ankle, and foot conditions causing lower back worsening, but acknowledged that the combination of these conditions could impact lower back issues. The Board found this VA opinion, when considered with the Veteran's lay statements, established a positive medical nexus. The Board concluded that the Veteran's service-connected knee and foot conditions worsened his lower back disabilities beyond their natural progression, warranting secondary service connection. The appeal was granted.

Rationale

Positive medical nexus established by VA examiner's opinion and Veteran's lay statements; Combination of service-connected knee/foot conditions impacted lower back disabilities; Worsening beyond natural progression

Full Decision Text

Citation Nr: A25018509
Decision Date: 02/28/25	Archive Date: 02/28/25

DOCKET NO. 240212-415240
DATE: February 28, 2025

ORDER

Service connection for lumbosacral strain, intervertebral disc syndrome (IVDS), radiculopathy, lumbosacral right lower extremity and left lower extremity (lower back disabilities) as secondary to service connected knee instability, knee strain, ankle strain, and foot strain is granted.

FINDING OF FACT

The Veteran's current lower back disabilities have worsened due to his service connected knee instability, knee strain, ankle strain and foot strain. 

CONCLUSION OF LAW

The criteria for service connection for lower back disabilities as secondary to service connected knee instability, knee strain, ankle strain, and foot strain are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 2010 to March 2011. 

The rating decision on appeal was issued in October 2023 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  In the February 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

The Veteran filed a February 2022 VA Form 21-526EZ, Fully Developed Claim (Compensation) seeking service connection for his lower back disabilities as secondary to his service connected bilateral knee disabilities. A May 2022 rating decision by the agency of original jurisdiction (AOJ) denied the claim. In October 2022 the Veteran filed a VA Form 20-0996 Request for Higher-Level Review and the AOJ identified a duty to assist error, placing the Veteran's appeal into the supplemental claim lane. The AOJ denied the claim in a December 2022 rating decision, and the AOJ thereafter mandated a special review of the file, resulting in the October 2023 rating decision on appeal.

Therefore, the Board may only consider the evidence of record at the time of the October 2023 AOJ supplemental claim rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the supplemental claim decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service.  38?U.S.C. §?1110; 38?C.F.R. §?3.303. 

Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b).

Service connection for a lower back disability as secondary to service connected knee instability, knee strain, ankle strain, and foot strain

The Veteran contends that his lower back disabilities have worsened beyond their natural progress as a result of his service connected bilateral knee disabilities. See October 2022 Statement in Support of Claim. The Veteran's representative argues that the combat presumption should be applied in granting the Veteran's appeal. See July 2024 Appellate Brief. Because the Board is granting the Veteran's secondary service connection appeal, it has not analyzed the Veteran's combat status in reaching its conclusions.

The Veteran is currently diagnosed with lumbosacral strain, intervertebral disc syndrome (IVDS), radiculopathy, lumbosacral right lower extremity and left lower extremity. The Board is bound by the AOJ's favorable finding that the in-service incurrence element is met. 38 CFR § 3.104(c); See October 2023 Rating Decision. The remaining inquiry is whether there has been any increase in severity of his non-service connected lower back disabilities as a result of any of the Veteran's service connected disabilities. 

Although a July 2023 VA examiner provided a negative nexus opinion, reasoning that none of his knee instability, knee strain, ankle strain, and foot strain could individually cause worsening of lower back disabilities. The examiner also opined that, "however, the combination of these conditions can ... have an impact on conditions such
umbosacral right lower extremity and left lower extremity. The Board is bound by the AOJ's favorable finding that the in-service incurrence element is met. 38 CFR § 3.104(c); See October 2023 Rating Decision. The remaining inquiry is whether there has been any increase in severity of his non-service connected lower back disabilities as a result of any of the Veteran's service connected disabilities. 

Although a July 2023 VA examiner provided a negative nexus opinion, reasoning that none of his knee instability, knee strain, ankle strain, and foot strain could individually cause worsening of lower back disabilities. The examiner also opined that, "however, the combination of these conditions can ... have an impact on conditions such as lumbosacral strain, intervertebral disc syndrome, and radiculopathy." Id.

The Board finds this opinion established a positive medical nexus, and together with the Veteran's lay statements demonstrates that the Veteran's service connected knee instability, knee strain, ankle strain, and foot strain have worsened his lower back disabilities beyond it their natural progression. See Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  Accordingly, service connection of his lower back disabilities as secondary to his service connected knee instability, knee strain, ankle strain, and foot strain is warranted. His appeal is granted. 

 

 

S. C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackson, Atossa K.

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.