DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, an Army veteran who served from October 1966 to September 1969, including service in Vietnam, appealed the denial of service connection for a back disability and bilateral shoulder disabilities. The appellant, the veteran's surviving spouse, contended that the back and shoulder conditions were secondary to the veteran's service-connected knee disabilities. The veteran had previously stated that his knee issues caused shoulder pain due to increased physical demand and that his back began hurting after knee surgery. The Board reviewed the evidence, including the veteran's service treatment records (STRs), which did not document complaints or treatment for back or shoulder issues. While VA treatment records showed complaints of back and shoulder pain and a fall related to his knee, the veteran did not report trauma or overuse related to his knees or other service-connected conditions in those records. The Board found the veteran's statements about his knee issues causing back and shoulder pain inconsistent with the medical evidence and his own reporting, deeming them not credible. The Board gave significant weight to recent June 2025 VA examination opinions, which found the back and bilateral shoulder conditions less likely than not related to service, citing a lack of medical literature supporting a causal link. The Board concluded the evidence persuasively weighed against service connection, and the benefit of the doubt doctrine did not apply. Service connection for the back and bilateral shoulder disabilities was denied.

Rationale

Service treatment records did not reflect complaints or treatment for back disability.; Veteran's statements regarding knee issues causing back pain were found not credible.; June 2025 VA opinion found back disability less likely than not related to service.

Full Decision Text

Citation Nr: 25011821
Decision Date: 09/16/25	Archive Date: 09/16/25

DOCKET NO. 14-30 174
DATE: September 16, 2025

ORDER

Service connection for a back disability, diagnosed as degenerative arthritis of the lumbar spine, is denied.

Service connection for a right shoulder disability, diagnosed as degenerative arthritis of the right shoulder, is denied.

Service connection for a left shoulder disability, diagnosed as degenerative arthritis of the left shoulder, is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that a back disability began during active service or otherwise was caused by service, nor is it related to a service-connected disability.

2. The evidence of record persuasively weighs against finding that a right shoulder disability began during active service or otherwise was caused by service, nor is it related to a service-connected disability. 

3. The evidence of record persuasively weighs against finding that a left shoulder disability began during active service or otherwise was caused by service, nor is it related to a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for back disability have not been met.  38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for right shoulder disability have not been met.  38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for left shoulder disability have not been met.  38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Army from October 1966 to September 1969, to include service in the Republic of Vietnam. 

Unfortunately, the Veteran passed away in December 2016.  The Appellant is his surviving spouse.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).  

The Board remanded this case in June 2018, August 2021, February 2022, November 2022, May 2023, November 2024, and June 2025 for further development.

In the August 2021 decision that also remanded the issues on appeal for further development, the Board denied an increased rating for his service-connected posttraumatic stress disorder (PTSD).  The Veteran appealed the Board's August 2021 decision to the United States Court of Appeals for Veterans Claims (Court), which in a June 2022 order, granted the parties' joint motions for partial remand (JMPR), vacating the Board's August 2021 decision and remanding the claim for an increased rating for PTSD for compliance with the terms of the JMR.

Service Connection

1. Service connection for a back disability is denied. 

2. Service connection for a right shoulder disability is denied. 

3. Service connection for a left shoulder disability is denied. 

The Appellant contends the Veteran's low back and bilateral shoulder conditions were secondary to the Veteran's service-connected disabilities.  Specifically, prior to his death, the Veteran stated that, due to the severity of his knee disabilities, he had shoulder pain, as his knees required more physical demand of his shoulders from getting up and down from a seated position or due to the use of a cane.  Further, the Veteran reported that his back had started hurting once he had his right knee operation.  See August 2010 Statement. 

Further, in an August 2014 brief, the Veteran's representative argued that the Veteran's painful ambulation due to his knees caused detrimental anatomical alignment of the low back, resulting in the back disability. 

Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service.  38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a).  Disorders diagnosed after discharge will be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d). 

Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present
 anatomical alignment of the low back, resulting in the back disability. 

Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service.  38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a).  Disorders diagnosed after discharge will be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d). 

Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, 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 (Fed. Cir. 2004). 

Secondary service connection may be granted where a non-service-connected disability would have been less severe but for a service-connected disability.  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). 

The Board notes that this broad language applies to the natural progression of a condition not caused by a service-connected injury or disease, but that, nonetheless, would have been less severe were it not for the service-connected disability.  Stated another way, § 1110 provides for compensation for a worsening of functionality-whether through an inability to treat or a more direct, etiological cause.  The Federal Circuit noted that nothing in the statute limits § 1110 to onset or etiological causes of a worsening in functionality.  Thus, the Court in Spicer found the phrase "proximately due to" under 3.310(b) inconsistent with § 1110 and, therefore "unlawful," consequently, for "aggravation of non-service-connected disabilities" it is enough to show that "but for" the service-connected disability the incremental-increase in severity of a nonservice-connected disease or injury would not have occurred.  Id.

Finally, the Federal Circuit further held that 38 C.F.R. § 3.310(b), which addresses the aggravation prong of secondary service connection, was inconsistent with 38 U.S.C. § 1110 and was therefore unlawful to the extent that VA applied it to reject the Veteran's theory of compensation.  Spicer, 61 F.4th at 1366.  

Certain chronic diseases, including arthritis, 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; see also Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 

The Board also notes that under certain circumstances, lay evidence may be sufficient to establish a nexus.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994).  Lay evidence has been found to be competent regarding a disease that has "unique and readily identifiable features" that are "capable of lay observation."  See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). 

When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). 

The Board is charged with the duty to assess the credibility and weight given to evidence.  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 
, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). 

The Board is charged with the duty to assess the credibility and weight given to evidence.  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).  Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability.  Id. at 1076; see also 38 U.S.C. § 7104(a).   Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that, in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence.  Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). 

When the evidence is in approximate balance in the Veteran's favor or nearly equal regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 

Upon review of the evidence, and as will be further discussed below, the Board finds that the evidence persuasively weighs against a grant of service connection for a back disability or bilateral shoulder disabilities. 

The Veteran's service treatment records (STRs) do not reflect treatment for, or complaints of back or shoulder disability, or symptomatology associated with either a back disability or a bilateral shoulder disability. 

The Board notes that, prior to his death, the Veteran was not afforded VA examinations regarding either his back or bilateral shoulder disabilities.  However, since the Veteran's death, many VA opinions have been provided regarding the etiology of the Veteran's back and bilateral shoulder disabilities, none of which reflect that an examiner provided a positive nexus opinion regarding any theory of service connection. 

Most recently, in June 2025 VA opinions, a VA examiner opined that the Veteran's back disability was less likely than not due to, the result of, or aggravated by his service connected disabilities, reasoning that the Veteran's back disability is not medically related to any of his service-connected disabilities and as there is a lack of medical literature to support a causal relationship between degenerative arthritis of the lumbar spine and his service-connected disabilities, to specifically include his knee and hip disabilities. 

Similarly, the examiner opined that the Veteran's right and left shoulder disabilities were less likely than not due to, the result of, or aggravated by his service-connected disabilities, reasoning that there is a lack of medical literature to support a causal relationship between degenerative arthritis of the shoulders and his service-connected disabilities, to specifically include his knee disabilities. 

The Board notes that VA treatment records document complaints of back and bilateral shoulder pain, as well as a fall that occurred in February 2007 due to his right knee giving out.  See February 2003, March 2004, February 2007, January 2009 VA Medical Center (VAMC) records.  However, in VAMC records, the Veteran's denied injury or trauma to either and did not report over usage or compensation due to his knees or any other service-connected disabilities.  Id. 

The Board, in its role as a finder of fact, finds the Veteran's reports inconsistent with the medical evidence of record, as well as inconsistent with his own reporting throughout the appellate period prior to his death.  Considering the factors described above, the Board finds that the Veteran's statements indicating back or bilateral shoulder pain due to his knee disabilities are not credible.  The evidence of record does not otherwise show any complaints in the Veteran's treatment records which would indicate his back or shoulder pain was caused by any of his service-connected disabilities.  Accordingly, the Board finds that the evidence
 records, the Veteran's denied injury or trauma to either and did not report over usage or compensation due to his knees or any other service-connected disabilities.  Id. 

The Board, in its role as a finder of fact, finds the Veteran's reports inconsistent with the medical evidence of record, as well as inconsistent with his own reporting throughout the appellate period prior to his death.  Considering the factors described above, the Board finds that the Veteran's statements indicating back or bilateral shoulder pain due to his knee disabilities are not credible.  The evidence of record does not otherwise show any complaints in the Veteran's treatment records which would indicate his back or shoulder pain was caused by any of his service-connected disabilities.  Accordingly, the Board finds that the evidence does not support finding that the Veteran's knee disabilities or any of his other service-connected disabilities caused either his back or bilateral shoulder disabilities. 

The Board concludes that the findings and conclusions of the June 2025 VA examiner are the most probative evidence of record, as the examiner thoroughly reviewed the Veteran's entire medical history and offered a cogent rationale in support of their assessment. 

For the above reasons, the evidence is neither evenly balanced nor approximately so regarding whether service connection for a back or bilateral shoulder disability is warranted.  Rather, the evidence persuasively weighs against a grant of service connection.  The benefit of the doubt doctrine does not apply.  See 38 U.S.C. §5107(b); Lynch, 21 F.4th 776 (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). 

 

 

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Mountjoy, Associate 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.