DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

VITO A. CLEMENTI · 2025 · Case ID: 25000347

DENIED

Summary

The veteran, who served from September 1974 to September 1977, appeals the denial of service connection for secondary conditions to his already service-connected bilateral knee disability. Specifically, the veteran claimed entitlement to service connection for a lumbar spine disorder, a bilateral hip disorder, a bilateral ankle disorder, and a bilateral foot disorder, asserting each was caused or aggravated by his service-connected knee condition. The Board reviewed the evidence, including multiple VA examinations and the veteran's testimony. The primary medical evidence consisted of a March 2024 VA examination, which diagnosed degenerative arthritis in the lumbar spine, hips, ankles, and feet. The examiner opined that these conditions were less likely than not proximately due to or the result of the service-connected bilateral knee disability, and were not aggravated beyond their natural progression. The examiner noted a lack of medical literature supporting a causal link between knee issues and these other joint conditions, unless severe gait alterations occurred, which was not supported by the record. The Board found the March 2024 VA opinion to be highly probative and responsive, considering the veteran's history and relevant literature. The veteran's own testimony regarding the cause of his conditions was deemed not competent to provide a medical opinion. Consequently, the Board denied service connection for all four claimed secondary conditions, finding no reasonable doubt in favor of the veteran.

Rationale

March 2024 VA opinion found condition less likely than not due to service-connected knee disability; Lack of medical literature supporting causal relationship between knee and lumbar spine conditions; Veteran's testimony regarding cause deemed not competent for medical opinion

Special Benefit

NO SPECIAL BENEFIT

Docket No.

20-09 093

Full Decision Text

Citation Nr: 25000347
Decision Date: 01/10/25 Archive Date: 01/10/25

DOCKET NO. 20-09 093
DATE: January 10, 2025

ORDER

Service connection for a lumbar spine disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

Service connection for a bilateral hip disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

Service connection for a bilateral ankle disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

Service connection for a bilateral foot disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

FINDINGS OF FACT

1. The Veteran's lumbar spine disorder was not caused or aggravated by service-connected bilateral knee disability.

2. The Veteran's bilateral hip disorder was not caused or aggravated by service-connected bilateral knee disability.

3. The Veteran's bilateral ankle disorder was not caused or aggravated by service-connected bilateral knee disability.

4. The Veteran's bilateral foot disorder was not caused or aggravated by service-connected bilateral knee disability.

CONCLUSIONS OF LAW

1. The criteria to establish service connection for a lumbar spine disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303(d), 3.310.

2. The criteria to establish service connection for a bilateral hip disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303(d), 3.310.

3. The criteria to establish service connection for a bilateral ankle disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303(d), 3.310.

4. The criteria to establish service connection for a bilateral foot disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303(d), 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from September 1974 to September 1977.

This matter was before the Board of Veterans' Appeals (Board) in February 2024 when the issues of service connection for a lumbar spine disorder, a bilateral hip disorder, a bilateral ankle disorder, and a bilateral foot disorder, were remanded to the Regional Office (RO) to provide the Veteran with new VA examinations and VA medical opinions about whether the disorders were caused or aggravated by service-connected bilateral knee disability, to include as due to compensatory movement.

After review of the evidence, service connection for a lumbar spine disorder, a bilateral hip disorder, a bilateral ankle disorder, and a bilateral foot disorder, will be denied because the evidence does not show that the disorders were caused or aggravated by service-connected bilateral knee disability.

Service Connection

Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection shall be granted on a secondary basis under 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder caused or aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995).

1. Service connection for a lumbar spine disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

The Veteran's sole contention is that his lumbar spine disorder was caused or aggravated by service-connected bilateral knee disability. The claim is denied.

VA treatment records show diagnoses of lumbosacral strain, spondylosis, and degenerative arthritis of the spine.

A June 2011 VA examination shows a diagnosis of chronic lumbar sprain with spondylosis and degenerative disc disease (DDD). However, the examiner simply stated that the Veteran's lumbar spine disorder is not related to his bilateral knee disability. The opinion therefore lacks probative value. See Miller v. West, 11 Vet. App.
a lumbar spine disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

The Veteran's sole contention is that his lumbar spine disorder was caused or aggravated by service-connected bilateral knee disability. The claim is denied.

VA treatment records show diagnoses of lumbosacral strain, spondylosis, and degenerative arthritis of the spine.

In a February 2015 VA medical opinion, the examiner merely opined that the Veteran's lumbar spine disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Given this, the opinion lacks probative value. See Bloom v. West, 12 Vet. App. 185 (1999).

During the March 2022 Board hearing, the Veteran testified that he did not injure his back in service. Instead, he testified that his lumbar spine pain onset in 1982 when working for Acme Brick Company. However, he testified that he first sought medical treatment after service 15 to 20 years ago. Nonetheless, he testified to his belief that his service-connected bilateral knee disability caused his current lumbar spine disorder.

During the March 2024 VA examination and medical opinion, the examiner noted a diagnosis of lumbar spine degenerative arthritis. The Veteran reported that he noticed back pain over time, with onset in 1980.

The examiner opined that the Veteran's lumbar spine disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability.

The examiner stated that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5cm so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait.

However, the examiner stated that this level of severity is not supported based on record review, history, or examination. The examiner stated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. The examiner observed that based on a lack of medical literature noting a causal relationship between these conditions, medical history, and examination findings, the Veteran's lumbar spine disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability. The examiner also opined that the disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Instead, the examiner stated that the medical evidence shows worsening within the natural progression of the condition.

The March 2024 VA opinion is responsive and highly probative, as the examiner considered the Veteran's medical history and provided review of the medical literature. See Miller v. Wilkie, 32 Vet. App. 249, 254 (2020) (a medical opinion is adequate when the medical expert discussed the relevant facts of a claimant's case, including any relevant lay statements about the disability picture, such that the opinion and rationale sufficiently inform the Board of the expert's judgment on the medical question); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008) (a medical opinion is probative when the medical expert is informed of sufficient facts and data, and the reasoning for the medical opinion was based on reliable principles and methods).

The Veteran contends that his lumbar spine disorder was caused or aggravated by service-connected bilateral knee disability. Although he is competent to report his symptoms, the Veteran does not have the education, training, or experience to provide a medical opinion as to the cause of his lumbar spine disorder. 38 C.F.R. § 3.159(a)(1).

The evidence is not in approximate balance between that favoring the claim and against the claim. The Veteran is not competent to provide a medical opinion as to the cause and/or aggravation of his lumbar spine disorder. For the reasons discussed above, the June 2011 VA examination and February 2015 VA medical opinion lack probative value, and the competent, most probative, medical evidence does not show that the Veteran's lumbar spine disorder was caused or aggravated by service-connected bilateral knee disability. The March 2024 VA examiner opined that the
the education, training, or experience to provide a medical opinion as to the cause of his lumbar spine disorder. 38 C.F.R. § 3.159(a)(1).

The evidence is not in approximate balance between that favoring the claim and against the claim. The Veteran is not competent to provide a medical opinion as to the cause and/or aggravation of his lumbar spine disorder. For the reasons discussed above, the June 2011 VA examination and February 2015 VA medical opinion lack probative value, and the competent, most probative, medical evidence does not show that the Veteran's lumbar spine disorder was caused or aggravated by service-connected bilateral knee disability. The March 2024 VA examiner opined that the Veteran's lumbar spine disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability. There is no reasonable doubt, and the claim is denied.

2. Service connection for a bilateral hip disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

The Veteran's sole contention is that his bilateral hip disorder was caused or aggravated by service-connected bilateral knee disability. The claim is denied.

VA treatment records show a diagnosis of bilateral hip osteoarthritis (OA).

An October 2003 VA treatment record shows that the Veteran was evaluated for bilateral knee and hip pain. The examiner noted "questionable hip pain bilaterally," following injections of Depo-Medrol and Marcaine to the bilateral knee.

A June 2011 VA examination shows a diagnosis of bilateral hip early degenerative arthritis. However, the examiner simply stated that the Veteran's bilateral hip disorder is not related to his bilateral knee disability. As such, the opinion is not probative. See Miller, 11 Vet. App. at 345.

In a February 2015 VA medical opinion, the examiner merely opined that the Veteran's bilateral hip disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Given this, the opinion lacks probative value. See Bloom, 12 Vet. App. at 185.

During the March 2022 Board hearing, the Veteran testified to his belief that his service-connected bilateral knee disability caused his current bilateral hip disorder.

During the March 2024 VA examination and medical opinion, the examiner noted a diagnoses of bilateral hip degenerative arthritis and bilateral hip bursitis. The Veteran reported that he noticed hip pain, in 2014, stating that he had no specific injury and that the pain onset over time.

The examiner opined that the Veteran's bilateral hip disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability.

However, the examiner stated that this level of severity is not supported based on record review, history, or examination. The examiner stated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. The examiner opined that, based on a lack of medical literature noting a causal relationship between these conditions, medical history, and examination findings, the Veteran's bilateral hip disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability. The examiner also opined that the disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Instead, the examiner stated that the medical evidence shows worsening within the natural progression of the condition.

The Veteran contends that his bilateral hip disorder was caused or aggravated by service-connected bilateral knee disability. Although he is competent to report his symptoms, the Veteran does not have the education, training, or experience to provide a medical opinion as to the cause of his bilateral hip disorder. 38 C.F.R. § 3.159(a)(1).

The evidence is not in approximate balance between that favoring the claim and against the claim. The Veteran is not competent to provide a medical opinion as to the cause and/or aggravation of his bilateral hip
provided review of the medical literature. See Miller, 32 Vet. App. at 254; see also Nieves-Rodriguez, 22 Vet. App. at 302.

The evidence is not in approximate balance between that favoring the claim and against the claim. The Veteran is not competent to provide a medical opinion as to the cause and/or aggravation of his bilateral hip disorder. For the reasons discussed above, the June 2011 VA examination and February 2015 VA medical opinion lack probative value, and the competent, most probative, medical evidence does not show that the Veteran's bilateral hip disorder was caused or aggravated by service-connected bilateral knee disability. Indeed, the March 2024 VA examiner opined that the Veteran's bilateral hip disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability. There is no reasonable doubt, and the claim is denied.

3. Service connection for a bilateral ankle disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

The Veteran's sole contention is that his bilateral ankle disorder was caused or aggravated by service-connected bilateral knee disability. The claim is denied.

VA treatment records show a diagnosis of bilateral ankle strain.

In a February 2015 VA medical opinion, the examiner merely opined that the Veteran's bilateral ankle disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Given this, the opinion lacks probative value. See Bloom, 12 Vet. App. at 185.

During the March 2022 Board hearing, the Veteran testified to his belief that his service-connected bilateral knee disability caused his current bilateral ankle disorder.

During the March 2024 VA examination and medical opinion, the examiner noted a diagnosis of bilateral lateral collateral ligament sprain. The Veteran reported that the condition onset in the 1980s. He reported that he had ankle sprains to keep him from falling due to his bilateral knee condition.

The examiner opined that the Veteran's bilateral ankle disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability.

The examiner noted medical literature showing that a strain is an injury to a muscle and/or tendon that can occur from acute trauma due to a fall, twist, blow to the body, and/or poor body mechanics to lift something heavy. The examiner also noted medical literature showing that chronic muscle strains can result from repetitive injuries when you stress a muscle by doing the same motion over and over; muscle strains occur when a muscle is stretched beyond its limit or it has been forced to contract too strongly; and with mild strains, a simple stretch of only a few muscle fibers, the muscle remains intact and strong, but with severe strains, a strained muscle may be partially or completely torn and unable to function properly. The examiner noted that strains typically heal within six to eight weeks.

As such, the examiner opined that, based on a lack of medical literature noting a causal relationship between these conditions, medical history, and examination findings, the Veteran's bilateral ankle disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability. The examiner also opined that the disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Instead, the examiner stated that the medical evidence shows worsening within the natural progression of the condition.

based on a lack of medical literature noting a causal relationship between these conditions, medical history, and examination findings, the Veteran's bilateral ankle disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability. The examiner also opined that the disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Instead, the examiner stated that the medical evidence shows worsening within the natural progression of the condition.

The Veteran contends that his bilateral ankle disorder was caused or aggravated by service-connected bilateral knee disability. Although he is competent to report his symptoms, the Veteran does not have the education, training, or experience to provide a medical opinion as to the cause of his bilateral ankle disorder. 38 C.F.R. § 3.159(a)(1).

The evidence is not in approximate balance between that favoring the claim and against the claim. The Veteran is not competent to provide a medical opinion as to the cause and/or aggravation of his bilateral ankle disorder. For the reasons discussed above, the June 2011 VA examination and February 2015 VA medical opinion lack probative value, and the competent, most probative, medical evidence does not show that the Veteran's bilateral ankle disorder was caused or aggravated by service-connected bilateral knee disability. Indeed, the March 2024 VA examiner opined that the Veteran's bilateral ankle disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability. There is no reasonable doubt, and the claim is denied.

4. Service connection for a bilateral foot disorder, as caused or aggravated by service-connected bilateral knee disability, is denied.

The Veteran's sole contention is that his bilateral foot disorder was caused or aggravated by service-connected bilateral knee disability. The claim is denied.

VA treatment records show diagnoses of bilateral foot strain and degenerative arthritis.

A June 2011 VA examination shows a diagnosis of bilateral foot 1st metatarsophalangeal (MTP) degenerative joint disease (DJD). However, the examiner simply stated that the Veteran's bilateral foot disorder is not related to his bilateral knee disability. As such, the opinion lacks probative value. See Miller, 11 Vet. App. at 345.

In a February 2015 VA medical opinion, the examiner merely opined that the Veteran's bilateral foot disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Given this, the opinion lacks probative value. See Bloom, 12 Vet. App. at 185.

During the March 2022 Board hearing, the Veteran testified to his belief that his service-connected bilateral knee disability caused his current bilateral foot disorder.

During the March 2024 VA examination and medical opinion, the examiner noted diagnoses of bilateral foot plantar fasciitis, right foot hammer toes, and left foot degenerative arthritis. The Veteran reported that the condition onset in 1980.

The examiner opined that the Veteran's bilateral foot disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability.

However, the examiner stated that this level of severity is not supported based on record review, history, or examination. The examiner stated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. As such, the examiner opined that, based on a lack of medical literature noting a causal relationship between these conditions, medical history, and examination findings, the Veteran's bilateral foot disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability. The examiner also opined that the disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Instead, the examiner stated that the medical evidence shows worsening within the natural progression of the condition.

The March 2024 VA opinion is responsive and highly probative, as the examiner considered the Veteran's medical history and provided review of the medical literature. See Miller,
, but one joint's disease does not 'spread' to another or cause damage to it. As such, the examiner opined that, based on a lack of medical literature noting a causal relationship between these conditions, medical history, and examination findings, the Veteran's bilateral foot disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability. The examiner also opined that the disorder was not aggravated beyond natural progression by service-connected bilateral knee disability. Instead, the examiner stated that the medical evidence shows worsening within the natural progression of the condition.

The Veteran contends that his bilateral foot disorder was caused or aggravated by service-connected bilateral knee disability. Although he is competent to report his symptoms, the Veteran does not have the education, training, or experience to provide a medical opinion as to the cause of his bilateral foot disorder. 38 C.F.R. § 3.159(a)(1).

The March 2024 VA examiner opined that the Veteran's bilateral foot disorder is less likely than not proximately due to or the result of service-connected bilateral knee disability; and was not aggravated beyond its natural progression by service-connected bilateral knee disability. There is no reasonable doubt, and the claim is denied.

Vito A. Clementi

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Timothy T. Emmart

The Board's action is binding only in this case. 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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