DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served from April 8, 1983, to May 13, 1983, appeals the denial of service connection for thoracolumbar spine degenerative disc disease and lumbosacral strain, right hip osteoarthritis, and right knee osteoarthritis. The veteran claims these conditions are secondary to his service-connected acquired flat feet. The Board found that the evidence regarding the etiology of these conditions was in equipoise. A private physician, Dr. S.F.W., opined that the degenerative processes in the veteran's spine, right hip, and right knee were at least as likely as not related to his service-connected pes planus, citing excess stress. Conversely, the VA examiner concluded these conditions were less likely than not due to pes planus, primarily citing the passage of over 20 years since the initial diagnosis, but failed to adequately explain the relevance of time given the degenerative nature of the conditions. The Board found neither opinion more probative, noting the VA examiner's rationale disregarded the known association between flat feet and pain in the back and lower extremities. The Board also noted that neither opinion addressed the impact of a 2012 motor vehicle accident that caused a fractured right ankle, which the veteran believed contributed to his back and hip pain, though the Board found the veteran incompetent to make this attribution. Given the equipoise in the nexus evidence, the Board resolved all reasonable doubt in the veteran's favor, granting service connection for the thoracolumbar spine disorder, right hip arthritis, and right knee arthritis.

Rationale

Private physician opined condition related to service-connected pes planus due to excess stress.; VA examiner opined condition less likely than not due to pes planus, citing passage of time.; Board found opinions in equipoise, with VA examiner's rationale weakened by disregarding association between flat feet and pain.

Full Decision Text

Citation Nr: A25076897
Decision Date: 09/11/25	Archive Date: 09/11/25

DOCKET NO. 240112-408838
DATE: September 11, 2025

ORDER

Entitlement to service connection for thoracolumbar spine disorder, diagnosed as degenerative disc disease and lumbosacral strain, status post laminectomy and diskectomy, is granted.

Entitlement to service connection for right hip arthritis, status post total right hip arthroplasty, is granted.

Entitlement to service connection for right knee arthritis is granted.

FINDING OF FACT

The Veteran's degenerative disc disease of the thoracolumbar spine and lumbosacral strain, right hip osteoarthritis, and right knee osteoarthritis are due to his service-connected acquired flat feet.

CONCLUSIONS OF LAW

1. The criteria for service connection for degenerative disc disease of the thoracolumbar spine and a lumbosacral strain are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for right hip arthritis, status post total right hip arthroplasty are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for right knee arthritis are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran had active service from April 8, 1983, to May 13, 1983.

The instant matter comes to the Board of Veterans' Appeals (Board) from an August 2023 rating decision by a Department of Veterans Affairs (VA) Regional Office.  The Veteran appealed that decision by filing a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in January 2024.  He elected the Evidence Submission docket.  Therefore, the Board may only consider the evidence of record at the time of the August 2023 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his attorney with, or within 90 days from receipt of the VA Form 10182, i.e., April 11, 2024.  See 38 C.F.R. § 20.303.  Evidence was not received within this period.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for thoracolumbar spine degenerative arthritis and degenerative disc disease, right hip arthritis, and right knee arthritis

The Veteran contends that his thoracolumbar	spine degenerative disc disease, right hip osteoarthritis, and right knee osteoarthritis are due to his service-connected acquired flat feet.

Establishing service connection on a secondary basis requires evidence sufficient to show (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.  Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).  Compensation may be established for any incremental increase in disability or any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected disabilities, above the degree of disability existing before the increase regardless of its permanence.  Ward v. Wilkie, 31 Vet. App. 233, 239 (2019).

The AOJ favorably found that the Veteran has a current diagnosis for a thoracolumbar spine strain based on a June 2023 VA examination.  The record also shows that the Veteran has a diagnosis for degenerative disc diseases and underwent a laminectomy and diskectomy
 of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).  Compensation may be established for any incremental increase in disability or any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected disabilities, above the degree of disability existing before the increase regardless of its permanence.  Ward v. Wilkie, 31 Vet. App. 233, 239 (2019).

The AOJ favorably found that the Veteran has a current diagnosis for a thoracolumbar spine strain based on a June 2023 VA examination.  The record also shows that the Veteran has a diagnosis for degenerative disc diseases and underwent a laminectomy and diskectomy at L5-S1 in March 2018.  A current diagnosis for osteoarthritis in the right hip is shown as well. See June 2023 VA examination.  The record also shows that the Veteran underwent total right hip arthroplasty in July 2021.  The AOJ found that the Veteran had a diagnosis for right knee osteoarthritis based on a June 2023 VA examination.  The Veteran is service connected for bilateral acquired flat feet, evaluated as 50 percent disabling from August 8, 2022.  The first and second requirements are met.

The question is whether the Veteran's degenerative disc disease and lumbosacral strain, right hip osteoarthritis, and right knee osteoarthritis are due to his service-connected bilateral flat feet.  

The Board concludes that the evidence regarding the etiology of the Veteran's back, hip, and knee disorders is in equipoise.  The Veteran's family doctor, Dr. S.F.W. opined in August 2022 that Veteran's severe degenerative processes in his thoracolumbar spine, right hip, and right knee, were at least as likely as not related to his service-connected pes planus.  Dr. S.F.W. stated that the excess stress placed on his joints caused by the acquired pes planus caused and contributed to the premature degenerative disease of his spine, right hip, and right knee.

The VA examiner responsible for the three examinations in June 2023 opined that thoracolumbar spine, right hip, and right disorders were less likely than not due to the Veteran's pes planus.  In her rationale, the examiner stated that pes planus can contribute to the development of degenerative disorders in the back and lower extremities.  The rationale states that flat feet, also known as fallen arches or pes planus foot structure, is a condition where the arch on the inside edge of the foot (medial longitudinal arch) appears to be flat.  Flat feet are one of the most common causes of lower limb pain and can actually cause back, hip and even knee pain.  Where pes planus is symptomatic, it can be accompanied by complaints of pain in the midfoot, heel, lower leg, knee, hip, and or back.  Nevertheless, the examiner concluded that the Veteran's lower back, right hip, and right knee disorders were not due to his pes planus because of the passage of more than 20 years since his diagnosis for pes planus in April 13, 1983.  According to the examiner, the passage of time made it unlikely that flat feet diagnosed while the Veteran was on active duty contributed to the right knee, right hip and back conditions.

The Board concludes that neither opinion is more probative than the other.  Dr. S.F.W.'s opinion is supported by a very brief rationale associated with the stress associated with pes planus.  The rationale for the negative VA opinion cites medical literature supporting the rationale for Dr. S.F.W.'s positive opinion, identifying flat feet as a cause of back conditions and lower extremity conditions.  The opinion, however, disregards the association between flat feet and pain in the lower extremities and back and instead concludes based solely on the passage of time that pes planus is less likely than not the cause of the Veteran's flat feet.  The examiner does not explain why the passage of time is relevant, which weakens the probative weight of the opinion in light of the degenerative nature of the Veteran's diagnoses.

The Board also notes that neither opinion addresses the impact, if any, of a 2012 motor vehicle accident in which the Veteran suffered a broken right ankle that required open reduction and internal fixation.  In November 2017 private treatment records, the Veteran attributed hip pain and back pain to compensating for pain in his right ankle.  Importantly, however, the Veteran is not competent to attribute his back, hip, and knee pain to a fractured ankle.  The's Veteran's opinion in November 2017 private treatment records is not competent because he does not have the needed knowledge, experience, or
 of time is relevant, which weakens the probative weight of the opinion in light of the degenerative nature of the Veteran's diagnoses.

The Board also notes that neither opinion addresses the impact, if any, of a 2012 motor vehicle accident in which the Veteran suffered a broken right ankle that required open reduction and internal fixation.  In November 2017 private treatment records, the Veteran attributed hip pain and back pain to compensating for pain in his right ankle.  Importantly, however, the Veteran is not competent to attribute his back, hip, and knee pain to a fractured ankle.  The's Veteran's opinion in November 2017 private treatment records is not competent because he does not have the needed knowledge, experience, or training to opine on the cause of his various degenerative disorders.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  In addition, the Board cannot make any independent determinations regarding the impact of the injuries sustained in the motor vehicle accident.  See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991).  Here, neither Dr. S.F.W. nor the VA examiner thought it necessary to address the Veteran's November 2017 reports regarding the consequences of his right ankle fracture on his back right hip, or right knee.

The evidence regarding a nexus is in equipoise.  Thus, after resolving all reasonable doubt in the Veteran's favor, the third requirement for secondary service connection for a degenerative disc disease of the thoracolumbar spine and a lumbosacral strain, right hip osteoarthritis, and right knee osteoarthritis is met. 

Service connection for degenerative disc disease of the thoracolumbar spine with a lumbosacral strain, right hip osteoarthritis, and right knee osteoarthritis is granted.

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Douglas M. Humphrey, 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.