INTERVERTEBRAL DISC SYNDROME

E. I. VELEZ · 2025 · Case ID: A25077064

GRANTED

Summary

The veteran, who served honorably in the U.S. Air Force from October 1978 to March 2001, appeals the denial of service connection for lumbosacral strain, left hip strain, and left ankle talar dome defect with painful movement, claiming these conditions are secondary to his service-connected left knee disability. The veteran asserts that his left knee injury caused him to alter his gait and posture, leading to pain and strain in his back, left hip, and left ankle. He submitted a private medical opinion from September 2023, which concluded it was more likely than not that his service-connected left knee disability contributed to compromised walking biomechanics and overcompensation, resulting in the claimed secondary conditions. The Board found this private opinion adequate and probative. The Board also reviewed three negative VA nexus opinions, noting that while they acknowledged the potential for compensatory movements and altered loading patterns due to the knee condition, they failed to provide a clear explanation for denying the secondary connection. The Board afforded these negative opinions no probative weight, citing Stefl v. Nicholson for insufficient explanation. Consequently, the Board found the evidence established that the veteran's lumbosacral strain, left hip strain, and left ankle talar dome defect with painful movement are proximately due to his service-connected left knee disability. Service connection for these three conditions as secondary to the left knee disability was granted.

Rationale

Private medical opinion found it more likely than not that knee disability caused compromised biomechanics and overcompensation, leading to low back strain.; VA nexus opinions acknowledged potential for compensatory movements but failed to explain denial.; Board afforded negative VA opinions no probative weight due to insufficient explanation.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

240812-463078

Full Decision Text

Citation Nr: A25077064
Decision Date: 09/11/25 Archive Date: 09/11/25

DOCKET NO. 240812-463078
DATE: September 11, 2025

ORDER

Entitlement to service connection for lumbosacral strain, as secondary to a service-connected left knee disability, is granted.

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

Entitlement to service connection for left ankle talar dome defect with painful movement, as secondary to a service-connected left knee disability, is granted.

FINDINGS OF FACT

1. The Veteran's lumbosacral strain is proximately due to by his service-connected left knee disability.

2. The Veteran's left hip strain is proximately due to his service-connected left knee disability.

3. The Veteran's left ankle talar dome defect with painful movement is proximately due to his service-connected left knee disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for lumbosacral strain have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2024); 38 C.F.R. §§ 3.102, 3.310 (2025).

2. The criteria for service connection for left hip strain have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2024); 38 C.F.R. §§ 3.102, 3.310 (2025).

3. The criteria for service connection for left ankle talar dome defect with painful movement have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2024); 38 C.F.R. §§ 3.102, 3.310 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served honorably in the U.S. Air Force from October 1978 to March 2001.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2024 rating decision by the agency of original jurisdiction (AOJ).

In May 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an April 2024 AOJ decision. In August 2024, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2024 decision. Therefore, the Board may only consider the evidence of record at the time of the April 2024 decision.

In the August 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to service connection for lumbosacral strain

2. Entitlement to service connection for left hip strain

3. Entitlement to service connection for left ankle talar dome defect with painful movement

The Veteran contends that he should be granted service connection for a lumbosacral strain, a left hip strain, and a left ankle disability as secondary to his service-connected left knee disability. See VA 21-4138, Statement in Support of Claim. For the following reasons, the Board finds that secondary service connection is warranted.

Secondary service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disease or injury.? 38 C.F.R. § 3.310(a). The evidence must show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). Secondary service connection is not limited to a "single cause and effect" but also applies to conditions that "would have been less severe were it not for the service-connected disability." Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023).

When, after careful consideration of all the evidence, there is a reasonable doubt regarding service connection, such doubt will be resolved in favor of the veteran.? 38?U.S.C. §?5107(b); 38?C.F.R. §?3.102.? The phrase "reasonable doubt" means there is an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.? Id.? The evidence is not in approximate balance when the evidence "persuasively favors one side or the other."? Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

In the August 2024 rating decision, the AOJ made the following favorable findings: (1) the Veteran is service-connected for a left knee disability, (2) the Veteran has a current left ankle disability, (3) the Veteran has a current left hip disability, and (4) the Veteran has a current low back disability. Under the Appeals Modernization Act, the Board is bound by the favorable findings of the AOJ in the absence of clear and unmistakable error. 38 C.F.R. § 3.104. The Board finds no clear and unmistakable error in this instance. Therefore, the only issue before the Board is whether the Veteran's low back, left hip, and left ankle disabilities were either caused or aggravated by the Veteran's service-connected left knee disability.

The Veteran reports that ever since he injured his left knee while in service, he has had to alter how he stands and walks in order to cope with the pain in his left knee. See September 2023 Statement in Support of Claim. He asserts that due to these alterations to his posture, he has developed pain in his back, left hip, and left ankle.

The Veteran submitted a private medical opinion in connection with his supplemental claim. See September 2023 Private Opinion. In the private opinion, the clinician explains that overcompensation injuries are a common response to pain from an injury. By way of example, the clinician states that an individual will move differently to reduce stress on an injured leg, resulting in a different walking pattern which places more stress on other parts of the body. Citing to medical literature, the clinician concludes that it is more likely than not that the Veteran's service-connected left knee disability contributed to the development of compromised walking biomechanics and overcompensation, resulting in his low back, left hip, and left ankle disabilities.

The Board finds the September 2023 private opinion adequate for appellate review. There is no evidence the clinician was not competent or credible, and as the opinion is based on the Veteran's statements, medical records, a review of relevant medical literature, and the clinician's observations, the Board affords the opinion probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

The Board acknowledges the three negative VA nexus opinions provided in April 2024. Significantly, however, all three of these opinions acknowledge that the Veteran's left knee disability "may affect gait and biomechanics, leading to compensatory movements and altered loading patterns." In addition, the VA ankle opinion notes that a talar dome defect may be caused by repetitive microtrauma or biomechanical abnormalities; the low back opinion notes that a low back strain may be caused by repetitive activities that place strain on the lower back; and the left hip opinion notes that hip injuries are commonly associated with biomechanical imbalances and repetitive movements that place undue stress on the hip. Thus, all three opinions contain rationales that support granting secondary service connection. However, despite these admissions, the three opinions conclude, without explanation, the Veteran's left knee disability was unlikely to cause the Veteran's low back, left hip, and left ankle disabilities. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (stating a mere conclusion by a medical practitioner is insufficient to allow the Board to make an informed decision). The Board therefore affords the three negative nexus opinions no probative weight.

The Board finds that the Veteran's low back, left hip, and left ankle disabilities are proximately due to the Veteran's service-connected left knee disability. Accordingly, service connection for lumbosacral strain, left hip strain, and left ankle talar dome defect with painful movement, as secondary to the Veteran's service-connected left knee disability, is granted.

E. I. VELEZ

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Zimmerman, 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.

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