DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served from April 1975 to August 1978, appeals the denial of service connection for a low back disability and for left and right shoulder disabilities secondary to the low back condition. The veteran claims an in-service motor vehicle accident caused his current low back disability. The Board reviewed the veteran's service treatment records, which noted a lumbosacral strain in service that resolved without residuals by separation. While the veteran and his wife later stated the back pain was chronic, post-service treatment records from 2013 and 2014 indicated the pain began decades after service, around 2003-2005. The Board found these earlier statements more probative than later statements made for disability compensation purposes. A February 2024 VA medical opinion concluded the veteran's current low back condition was more likely associated with age-related changes, finding it less likely than not related to the in-service strain, which had resolved. The Board agreed with this opinion, finding the evidence persuasively against direct service connection and denying the low back claim. Consequently, the secondary claims for left and right shoulder disabilities were also denied, as the prerequisite service-connected low back condition was not established. The Board found substantial compliance with prior remand directives.

Rationale

In-service strain resolved without residuals by separation.; Post-service treatment records indicate onset of pain decades after service.; VA medical opinion found condition more likely due to age-related changes.

Full Decision Text

Citation Nr: 25005636
Decision Date: 04/24/25	Archive Date: 04/24/25

DOCKET NO. 17-05 835
DATE: April 24, 2025

ORDER

Entitlement to service connection for a low back disability is denied.

Entitlement to service connection for a left shoulder disability secondary to a low back disability is denied.

Entitlement to service connection for a right shoulder disability secondary to a low back disability is denied.

FINDINGS OF FACT

1. The Veteran's low back disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

2. The Veteran's left shoulder disability is not secondary to a service-connected disability and is not otherwise related to an in-service injury or disease.

3. The Veteran's right shoulder disability is not secondary to a service-connected disability and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a low back disability are not met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for a left shoulder disability due to service or a service-connected low back disability are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a right shoulder disability due to service or a service-connected low back disability are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1975 to August 1978.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision.  The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in June 2019.  A transcript of that hearing is of record.  These matters have been previously remanded by the Board in December 2019 and December 2023. The Board finds there has been substantial compliance with its remand directives for the claims decided herein.  Stegall v. West, 11 Vet. App. 268 (1998).  

Service Connection

1. Entitlement to service connection for a low back disability

The Veteran contends that he injured his back in a motor vehicle accident during service, which was the cause of his current low back disability.

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran has a current diagnosis of degenerative arthritis of the spine, as evidenced by the February 2016 VA examination. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. 

The Veteran's service treatment records (STRs) reflect that he experienced a motor vehicle accident in May 1976, and was diagnosed with lumbosacral strain, resulting in convalescent leave in June and July 1976. However, the July 1978 separation examination found that the Veteran had a normal spine, and that his lumbosacral strain was now asymptomatic. The Veteran denied recurrent back pain in the July 1978 separation Report of Medical History. Although the Veteran testified in the June 2019 hearing that he did still have slight problems with his back at separation, this testimony is contradicted by his contemporaneous denial of recurrent back pain at separation. A July 2021 statement from the Veteran's wife indicates that the Veteran "always" complained of his back, but would treat
 vehicle accident in May 1976, and was diagnosed with lumbosacral strain, resulting in convalescent leave in June and July 1976. However, the July 1978 separation examination found that the Veteran had a normal spine, and that his lumbosacral strain was now asymptomatic. The Veteran denied recurrent back pain in the July 1978 separation Report of Medical History. Although the Veteran testified in the June 2019 hearing that he did still have slight problems with his back at separation, this testimony is contradicted by his contemporaneous denial of recurrent back pain at separation. A July 2021 statement from the Veteran's wife indicates that the Veteran "always" complained of his back, but would treat himself with Tylenol, and the Veteran reported in an April 2021 private treatment note that he has had chronic lumbar spine pain since the time of his in-service accident. However, the earliest available post-service treatment record, which is from December 2013, notes the in-service injury to his low back, but indicates that the Veteran had no trouble with his back for quite a long time following successful treatment, and only began noticing steadily increasing symptoms approximately 8-10 years previously, which would be approximately 2003-2005. This treatment note is consistent with a February 2014 private treatment note, in which the Veteran noted the 1976 motor vehicle accident but stated that his back problems started in 2004. 

The most probative evidence of record thus indicates that the Veteran's low back disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. The Veteran is competent to report his back pain. However, the Board notes that the treatment records from before the Veteran submitted his claim for a low back disability consistently acknowledge the in-service back injury but date the Veteran's back pain as beginning decades after service. These treatment records are consistent with the separation report of medical history where the Veteran denied recurrent back pain, and the separation examination finding that the Veteran's back was asymptomatic. The Board finds that these statements in earlier treatment records have greater probative value than statements for the purposes of obtaining disability benefits, or statements made in treatment records later in time. Pond v. West, 12 Vet. App. 341 (1999) (statements made for VA disability compensation purposes are of lesser probative value than his previous more contemporaneous in-service histories and his previous statements made for treatment purposes). The Board's finding is based upon the greater probative value of the older statements and is not based upon a lack of contemporaneous treatment records.

As discussed above, the most probative private treatment records show that the Veteran's post-service back pain did not start until approximately 2003, decades after separating from service and decades outside of the applicable presumptive period. Service connection for arthritis of the lumbar spine is thus not available based upon the chronic disease presumption. However, the Board must also consider whether service connection is available on a direct-incurrence basis.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

As noted above, the Veteran had a lumbosacral strain during service due to a motor vehicle accident and has a current low back disability. The question that remains is whether the Veteran's current low back disability is related to that in-service lumbosacral strain.

A February 2024 VA medical opinion found that it is less likely than not that the Veteran's low back disability was incurred in or caused by the claimed in-service injury. The rationale was that the back injury described in the Veteran's STRs indicates an acute episode of a lumbar muscular strain due to a motor vehicle accident that resolved without residuals. The clinician noted that the Veteran's imaging studies were interpreted as normal, and that the Veteran denied recurrent back pain in his separation report of medical history, and the clinician concluded that this evidence indicates the lumbar strain from the motor vehicle accident was acutely symptomatic, and an incident from which the Veteran healed. The clinician noted that it was not until decades later that there is objective evidence of low back symptoms. The examiner discussed the nature of arthritis and explained that age is a primary risk factor for the
 was incurred in or caused by the claimed in-service injury. The rationale was that the back injury described in the Veteran's STRs indicates an acute episode of a lumbar muscular strain due to a motor vehicle accident that resolved without residuals. The clinician noted that the Veteran's imaging studies were interpreted as normal, and that the Veteran denied recurrent back pain in his separation report of medical history, and the clinician concluded that this evidence indicates the lumbar strain from the motor vehicle accident was acutely symptomatic, and an incident from which the Veteran healed. The clinician noted that it was not until decades later that there is objective evidence of low back symptoms. The examiner discussed the nature of arthritis and explained that age is a primary risk factor for the development of osteoarthritis.  The clinician concluded that the objective evidence indicates that the Veteran's current back condition is more likely associated with the changes associated with the normal aging process. The Board finds that this opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Veteran's representative argued in a July 2024 brief that the February 2024 VA medical opinion was inadequate because it dismissed the Veteran's lay statements due to lack of corroboration of the medical record. However, as discussed above, the Board finds that the most probative evidence of record demonstrates that the Veteran's current back pain began in approximately 2003, decades after service. This finding is based upon weighing the probative value of the Veteran's contradictory statements, not a lack of contemporaneous treatment records. Although the February 2024 medical opinion noted the first objective evidence of low back pain symptoms was in 2013, presumably a reference to the December 2013 private treatment note, the rationale of the opinion is based upon interpretation of the Veteran's STRs, the clinician's knowledge of the nature of osteoarthritis, as well as the most probative evidence of record regarding the Veteran's post-service medical history. The clinician's assertion that the Veteran's back pain in service subsided and his current back pain began decades after service is consistent with the Board's findings above, and thus is not based upon an inaccurate understanding of the medical record. The February 2024 opinion is based upon an accurate understanding of the relevant medical history as well as the clinician's own medical knowledge, not merely a lack of contemporaneous treatment records.  

While the Veteran sincerely believes that his current low back disability was caused by the in-service back injury, the record does not reflect that the Veteran ahs the necessary medical expertise to determine the etiology of his current back pain. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a low back disability is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for a left shoulder disability secondary to a low back disability

3. Entitlement to service connection for a right shoulder disability secondary to a low back disability

The Veteran contends that his bilateral shoulder disabilities were caused by falls due to his low back disability.

Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection.

A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated by a service-connected disease or injury.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b).

The question for the Board is whether the Veteran has a current disability that is due to or the result of or was aggravated by service-connected disability.

As is discussed above, the Board denies service connection for a low back disability. Because the low back disability is not service-connected, the bilateral shoulder disabilities cannot be granted as secondary to the low back disability.  Therefore, there is no basis to grant the Veteran's claims as to the shoulder disabilities. Service connection for a left and right shoulder disability is thus denied. See 38 U.S.C. § 5107(b); 38 C.F.R.
 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b).

The question for the Board is whether the Veteran has a current disability that is due to or the result of or was aggravated by service-connected disability.

As is discussed above, the Board denies service connection for a low back disability. Because the low back disability is not service-connected, the bilateral shoulder disabilities cannot be granted as secondary to the low back disability.  Therefore, there is no basis to grant the Veteran's claims as to the shoulder disabilities. Service connection for a left and right shoulder disability is thus denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Budd, 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.