INTERVERTEBRAL DISC SYNDROME

Summary

The Veteran, a Veteran who served from November 1984 to November 1991, appeals the denial of service connection for a lumbar disability claimed as secondary to his service-connected bilateral knee conditions. The Veteran testified that his back pain is a result of an antalgic gait caused by his knee pain. Service treatment records did not indicate any lumbar issues. A December 2018 VA examination found the lumbar condition less likely than not related to service, citing no significant limp. However, private treatment records from February 2019 noted an antalgic gait, and a May 2019 VA treatment record from the Veteran's primary care provider (PCP) indicated his lumbar pain worsened with his knee condition, opining a direct relation. A subsequent August 2019 VA examination diagnosed lumbosacral strain and degenerative arthritis, but the examiner opined it was less likely than not related to service, citing lack of evidence for gait alteration causing spinal issues. Further VA examinations in October 2019 and February 2020 also found no service connection. However, a May 2020 private etiology letter from a chiropractor concluded the altered gait from knee pain caused chronic low back pain. A June 2020 VA knee examination provider noted lower back pain related to antalgic gait. The Board found the May 2019 and May 2020 private opinions from the Veteran's treating physicians to be probative, supported by adequate rationales and continuous treatment. These opinions linked the lumbar disability to the knee conditions and gait. The Board noted conflicting VA examiner opinions, but also acknowledged that later VA records and examinations did note an abnormal gait or linked lower back pain to antalgic gait. Finding reasonable doubt in the Veteran's favor due to the balance of evidence, the Board granted service connection for the lumbar disability as secondary to the service-connected knee conditions.

Rationale

Proximity to service-connected knee disabilities; Positive opinions from treating physicians; Evidence of antalgic gait

Full Decision Text

Citation Nr: A26005289
Decision Date: 01/21/26	Archive Date: 01/21/26

DOCKET NO. 200728-100584
DATE: January 21, 2026

ORDER

Entitlement to service connection for a back (lumbar) disability as secondary to the service-connected left and right knee disability, is granted.

FINDING OF FACT

The Veteran's lumbar disability is related to the service-connected knee disabilities. 

CONCLUSION OF LAW

The criteria for service connection for a lumbar disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1984 to November 1991.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2020 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran provided testimony at a May 2024 hearing before a Veterans Law Judge.  A transcript of the hearing is associated with the claims folder.

The claim is now before the Board on a July 2020 Hearing Review Request by the Veteran under the Appeals Modernization Act (2019) ("AMA"). Under the AMA, when a claimant seeks appellate review through the Board's hearing docket, the Board may consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal, additional evidence submitted on the date of the Board hearing (including testimony), and additional evidence submitted within 90 days of the hearing. 38 U.S.C. § 7113(b). The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the VA Form 10182 was received, (2) evidence submitted during the period after the VA Form 10182 was received and the day before the Board hearing, and (3) evidence received 91 or more days after the Board hearing. 38 C.F.R. § 20.303.

Entitlement to service connection for a lumbar condition

The Veteran claims lumbar disability is related to service. Specifically, during the May 2024 Board hearing he alleged he has had back pain as a result of his antalgic gait caused by his service-connected knee pain. For the reasons discussed below, the Board finds service connection is warranted.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

For specific enumerated diseases designated as "chronic" there is a presumption that such chronic disease was incurred in or aggravated by service even though there is no evidence of such chronic disease during the period of service. For the presumption to attach, the disease must have become manifest to a degree of 10 percent or more within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).

Presumptive service connection for chronic diseases may alternatively be established by way of continuity of symptomatology under 38 C.F.R. § 3.303(b). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a). 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. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en
.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a). 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. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the weight of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded by the claimant.

Turning to the evidence, service treatment records (STRs) do not reflect any symptoms, diagnosis, or treatment for a lumbar back disability. 

Post service, a December 2018 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with lumbosacral strain. 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. It was reasoned that:

Although the Veteran did have pain and decreased range of motion on examination to the knees and back; no limp was noted on examination and no reports of significant limping over an extended period of time was reported. The lack of limping over time is significant because given theoretical biomechanical considerations the force borne by the normal joint or surrounding muscles could possibly be increased and thus damaged under the following conditions: 1. Major displacements of the center of gravity of the body's mass in both the vertical and horizontal planes during gait - e.g. severe Trendelenburg lurch 2. Significant leg length discrepancy greater than four to five centimeters. 3. The alteration of the gait pattern occurring over a prolonged period of time Thus the likely hood of the Veterans Right Knee Sprain causing secondary back condition is minimal.

In the remarks section the examiner found that limping does not increase weight borne by the normal leg. It was noted that there is no clear evidence to suggest that an injury to one lower extremity would have any significant impact on the opposite uninjured limb unless the injury resulted in major muscle or nerve damage. This damage would cause partial or complete paralysis of the damaged leg, and/or shortening of the injured lower extremity which would result in a limb length discrepancy of more than four or five centimeters so that the individual's gait pattern has been altered to the extent that clinically there is an obvious lurching type gait (a significant limp), according to the examiner. 

In February 2019 private treatment records, the Veteran was seen for bilateral knee complaints. Upon physical examination it was noted that he has an antalgic gait. 

In May 2019 VA treatment records noted an opinion from primary care provider (PCP), T.V. It was noted that the Veteran has been under the PCP's care since March 2016. The PCP indicated a review of the Veteran's military records at that time revealed he had an initial injury while active duty in 1988 at Ft. Carson for his knees. He has undergone multiple trials of physical therapy and bracing with limited improvement in his condition and he limps due to knee pain. It was noted that since the worsening of his knee condition his lumbar pain and radiculopathy have increased, and treatment has provided limited improvement. Due to these findings, it was opined that the Veterans lumbar pain is directly related to his service-connected knee injury. 

An August 2019 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with lumbosacral strain and degenerative arthritis of the spine. He reported an onset of low back pain to a mild degree spontaneously without injury. He indicated that his physical therapist mentioned that his antalgic gait from his knee conditions lead to the back pathology. 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. It was reasoned that there is insufficient medical evidence that pathology of one joint leading to altered gait pattern leads to deg
 pain is directly related to his service-connected knee injury. 

An August 2019 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with lumbosacral strain and degenerative arthritis of the spine. He reported an onset of low back pain to a mild degree spontaneously without injury. He indicated that his physical therapist mentioned that his antalgic gait from his knee conditions lead to the back pathology. 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. It was reasoned that there is insufficient medical evidence that pathology of one joint leading to altered gait pattern leads to degenerative arthritis of the spine. It was noted that other etiologies such as occupational, genetic, trauma, or other factors are more likely the Veteran's lumbar etiology. 

An October 2019 VA examination report for the knee indicated the Veteran's patellar tendonitis is likely due to overuse of left knee with PFPS, including ataxic gait and decreased extension of knee.

A February 2020 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. The examiner opined the claimed condition is less likely than not proximately due to or result of the Veteran's service-connected condition. It was reasoned, arthritis in one joint does not cause arthritis in another joint, concluding there is no objective medical evidence to support the claim that a lumbosacral strain and degenerative arthritis are related to right knee strain with osteoarthritis. It was noted that medical literature does not support this. 

In April 2020 VA treatment records a letter from the PCP, T.V. indicated there was no additional supportive information that could be provided to assist in the lumbar claim.

The Veteran provided a May 2020 etiology letter from a chiropractic doctor, B.H. The doctor indicated that the Veteran has ongoing back pain with consistent swelling. The Veteran has good correction on his alignment; however, his body pulls his alignment back out over time and the doctor indicated this is due to his bilateral knee pain. It was concluded that the Veteran's altered gait throws the alignment out in his low back and pelvis and causes chronic low back pain condition. 

In a June 2020 examination for the knee the provider noted that the lower back pain is related to antalgic gait caused by the knees. 

The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is related to service.

After careful consideration of the evidence, any reasonable doubt remaining, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3.  If the evidence is not in approximate balance or nearly equal, the claim is to be denied.  The United States Court of Appeals for the Federal Circuit clarified in Lynch v. McDonough that the proper standard of review is whether the factors are in an "approximate balance." Lynch v. McDonough, 999 F.3d 1391 (2021).  Lynch held that the Veteran is entitled to the benefit of the doubt when the evidence is in an approximate balance or "nearly equal" and does not require the evidence to be in exact equipoise. Id. 

In this regard the Board finds the May 2019 and May 2020 private opinions probative. The opinions are supported by adequate rationales and both opinions were provided by the Veteran's primary physicians who have treated him continuously. Both physicians found that the low back disability is related to the knees and the gait. The VA examiners found that the disability is not related to the knees. Notably the December 2018 VA examiner found there was no limp or abnormal gait noted on the examination, however, the February 2019 and October 2019 VA treatment records noted the Veteran has abnormal gait. Additionally, although a rationale was not provided, during a June 2020 examination for the knee the provider noted that the lower back pain is related to antalgic gait caused by the knees. 

Given the positive opinions from treating physicians and the evidence of at least an antalgic gait, the Board finds reasonable doubt should be found in the Veteran's favor. Accordingly, service connection for a lumbar disability as related to the service-connected knees, is warranted. 

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JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackman, Bridget

The Board's decision in this case is binding only with respect to the instant matter decided. This decision
 a June 2020 examination for the knee the provider noted that the lower back pain is related to antalgic gait caused by the knees. 

Given the positive opinions from treating physicians and the evidence of at least an antalgic gait, the Board finds reasonable doubt should be found in the Veteran's favor. Accordingly, service connection for a lumbar disability as related to the service-connected knees, is warranted. 

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JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jackman, Bridget

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.