DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served in the United States Army from February 1957 to December 1958, appeals the denial of service connection for a lumbar spine disorder, bilateral knee disorder, bilateral hip disorder, bilateral shoulder disorder, and bilateral ankle disorder. The veteran contended that he injured his back during service in 1958 while straightening pipes with a crowbar, and that his knee, hip, shoulder, and ankle disabilities are secondary to his back condition. The Board reviewed multiple opinions. A private physician in July 2015 opined that the Veteran's musculoskeletal diseases were more probable than not secondary to military service, but this opinion was deemed inadequate due to lack of rationale. Subsequent VA examinations in November 2020, April 2022, and December 2022 found the Veteran's lumbar spine conditions to be less likely related to service, citing a lack of in-service treatment records or manifestation of symptoms within a year of separation. The February 2024 VA examiner found the Veteran's claimed conditions, including the lumbar spine and bilateral extremities, to be less likely than not incurred in or caused by service, noting the absence of in-service diagnoses, chronicity of care, or continuity of symptoms, and that the conditions began years after service. The Board found the February 2024 opinion well-reasoned and afforded it great probative weight, noting the lack of adequate contrary medical opinion. As service connection for the primary back condition was denied, the secondary claims for the bilateral extremities were also denied as a matter of law. The Board found the Veteran's lay statements regarding the etiology of his conditions to be incompetent due to lack of medical training. The Board concluded that the weight of the evidence was against the Veteran's claims, rendering the benefit of the doubt doctrine inapplicable.

Rationale

No in-service injury documented in STRs; No manifestation or diagnosis within one year of separation; VA opinions found condition less likely than not related to service; Veteran's lay statements regarding etiology deemed incompetent

Full Decision Text

Citation Nr: 25014331
Decision Date: 11/25/25	Archive Date: 11/25/25

DOCKET NO. 19-08 287
DATE: November 25, 2025

ORDER

Service connection for a lumbar spine disorder is denied.

Service connection for a bilateral knee disorder is denied.

Service connection for a bilateral hip disorder is denied. 

Service connection for a bilateral shoulder disorder is denied.

Service connection for a bilateral ankle disorder is denied.

FINDINGS OF FACT

1. A lumbar spine disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service.

2. A bilateral knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by a service-connected disability.

3. A bilateral hip disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by a service-connected disability.

4. A bilateral shoulder disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by a service-connected disability.

5. A bilateral ankle disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a lumbar spine disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

2. The criteria for service connection for a bilateral knee disorder have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for a bilateral hip disorder have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for service connection for a bilateral shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for service connection for a bilateral ankle disorder have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from February 1957 to December 1958. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2017 by a Department of Veterans Affairs (VA) Regional Office, herein referred to as the Agency of Original Jurisdiction (AOJ). 

The above claims were remanded in October 2020, February 2022, August 2022, and January 2024 for additional development and they now return to the Board for further appellate review. 

Service Connection

1. Entitlement to service connection for a lumbar spine disorder.

2. Entitlement to service connection for a bilateral knee disorder. 

3. Entitlement to service connection for a bilateral hip disorder. 

4. Entitlement to service connection for a bilateral shoulder disorder.

5. Entitlement to service connection for a bilateral ankle disorder.

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). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Secondary service connection may be granted for a disability that is due to, or aggravated by
 for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Secondary service connection may be granted for a disability that is due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The Veteran contends that he injured his back during his active-duty service in 1958 while engaging in duties that required straightening a line of pipes with a crowbar. He further contended that he got stuck and could not straighten up. Additionally, in a December 2017 VA social work visit, the Veteran reiterated injuring his back when he tried to straighten a pipeline with a lever. He also reported that he was sent to the base hospital but was told that his problem was due to his prostate. However, he indicated that he was in disagreement and that he continued to have back problems. The Veteran also asserts that he has bilateral knee, hip, shoulder, and ankle disabilities secondary to his back disability.

As noted in the prior remands, the Veteran's service treatment records (STRs) do not reflect findings of a back injury, and some STRs may have been destroyed in a fire. In such instances where service treatment records are lost or missing, VA has a heightened duty to assist in developing the claim, as well as to consider the applicability of the benefit of the doubt rule and to explain its decision. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) citing Russo v. Brown, 9 Vet. App. 46, 51 (1996).

The Board notes that multiple opinions have been associated with the record during the appeal period. 

Specifically, post-service records show the Veteran was diagnosed with chronic low back pain and chronic myositis para-lumbar spine muscles in June 2015 by a private physician. The physician opined that the Veteran's musculoskeletal diseases are "more probable than not secondary to his military service performance." See July 2015 Third Party Correspondence.

Here, the Board notes that the July 2015 private treatment provider's opinion is conclusory and is not supported by a rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (stating that "The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion."). Therefore, the July 2015 nexus opinion is inadequate.

In contrast, in the Veteran's November 2020 VA back examination, the examiner noted diagnoses of lumbar intervertebral osteochondrosis, spondylosis, degenerative changes of facet joints, and lumbar muscle spasm. However, the examiner opined that the Veteran's back disorder was less likely related to service since STRs are silent for any of the Veteran's diagnosed back conditions, and there is no evidence of any manifestation or diagnosis of a low back disability within a year after separation from active service.

In April 2022, a VA examiner essentially provided the same rationale and reiterated that the Veteran's STRs are silent regarding any diagnosis or symptoms of a lumbar spine disability and therefore, there is no evidence of any manifestation or diagnosis of lumbar spine disorder within a year after separation from active service.

In December 2022, a VA examiner noted that the Veteran presents with advanced age and degenerative arthritis. The examiner's rationale was that there is no evidence on record to justify that pain is caused by injuries in military service. Thus, the examiner concluded the claimed conditions are less likely than not incurred in or caused by the claimed in-service injury, event, or illness.

Here, the Board finds the November 2020, April 2022, and December 2022 opinions to be inadequate as the examiners failed to address the Veteran's lay statements regarding the onset of
 or symptoms of a lumbar spine disability and therefore, there is no evidence of any manifestation or diagnosis of lumbar spine disorder within a year after separation from active service.

In December 2022, a VA examiner noted that the Veteran presents with advanced age and degenerative arthritis. The examiner's rationale was that there is no evidence on record to justify that pain is caused by injuries in military service. Thus, the examiner concluded the claimed conditions are less likely than not incurred in or caused by the claimed in-service injury, event, or illness.

Here, the Board finds the November 2020, April 2022, and December 2022 opinions to be inadequate as the examiners failed to address the Veteran's lay statements regarding the onset of his disabilities, and the examiners continued to uphold the lack of in-service documentary evidence as the reason why the Veteran's disorders are not related to service. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (finding that an examiner impermissibly ignored the appellant's lay assertions that he had sustained a back injury in service; see also Fountain v. McDonald, 27 Vet. App. 258, 272 (2015) (stating that the Board must first establish a proper foundation for drawing inferences against a claimant from an absence of documentation). 

Thereafter, in February 2024, a VA examiner opined that the Veteran's claimed conditions are less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner noted that although the Veteran injured his back during service in 1958, the event was acute and transient without sequela. During that time frame, and years after, there is no evidence of diagnoses related to the lumbar spine, chronicity of care, or treatment. Additionally, the examiner noted that there is insufficient evidence to establish any continuity of symptoms with military service. The examiner also acknowledged the Veteran's lay statements; however, as a layperson without medical training, he is not qualified to render a medical opinion regarding the diagnosis or etiology of disorders and disabilities. Finally, the examiner noted that the first documented treatment of a lumbar spine disability was noted in September 2006 and prior to this date, the document and clinical notes failed to support a lumbar condition, treatment and chronicity of care. Finally, with respect to the June 2015 private opinion, the VA examiner noted that the opinion lacks a physical examination and radiological imaging to support the opinion provided. Therefore, the examiner concluded that based on a review of the record, to include the Veteran's statements, the clinical and objective evidence supports that the Veteran's claimed lumbar spine condition began years after service and has followed the natural progression. 

The examiner additionally opined that the Veteran's claimed bilateral knee, hip, shoulder, and ankle disorders are less likely than not incurred in or caused by the in-service, injury, event or illness. Here, it is noted that the evidence of record shows that diagnoses pertaining to the bilateral hip, ankle, shoulder, and knees, were first noted in November 2020, November 2020, July 2004, and October 2012, respectively. Notably, STRs are silent to such disabilities and there is insufficient evidence to establish any continuity of symptoms. The opinions for such disabilities are essentially the same as the opinion provided for the lumbar spine disability. The examiner reiterated that the Veteran is not qualified to offer an opinion as to the etiology of the claimed conditions, and the clinical and objective evidence support that such conditions began years after active-duty service. 

The Board affords great probative weight to the February 2024 VA examiner's opinion as such considered all pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, supra; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no adequate medical opinion to the contrary.

Finally, as to the Veteran's theory regarding secondary service connection, as service connection for the Veteran's lumbar spine disability has not been established, the Veteran's claim of service connection for bilateral knee, hip, shoulder and ankle disabilities is not warranted as a matter of law. In this regard, there is no legal basis upon which to award service connection for a disability that is claimed as secondary to a disability that is not service-connected. Therefore, the Veteran's claims for service connection for bilateral knee, hip, shoulder, and ankle disorders as secondary to a back disorder must be denied
]medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no adequate medical opinion to the contrary.

Finally, as to the Veteran's theory regarding secondary service connection, as service connection for the Veteran's lumbar spine disability has not been established, the Veteran's claim of service connection for bilateral knee, hip, shoulder and ankle disabilities is not warranted as a matter of law. In this regard, there is no legal basis upon which to award service connection for a disability that is claimed as secondary to a disability that is not service-connected. Therefore, the Veteran's claims for service connection for bilateral knee, hip, shoulder, and ankle disorders as secondary to a back disorder must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

The Board has also considered the Veteran's assertions as to the etiology of his lumbar spine, and bilateral knee, hip, shoulder, and ankle disabilities. However, as a lay person, he does not have the requisite training and experience necessary to address such complex medical matters. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis).  In this regard, the etiology of musculoskeletal disabilities involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship.  Specifically, such requires knowledge of the musculoskeletal system, and the impact prior injuries have on the spine. Therefore, such matters may not be competently addressed by lay evidence. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinions are not competent evidence and, consequently, are afforded no probative weight.

Therefore, based on the foregoing, the Board finds that a lumbar spine disorder, bilateral knee, hip, shoulder, and ankle disorders are not shown to be causally or etiologically related to any disease, injury, or incident during service, and arthritis did not manifest to a compensable degree within one year of discharge from active duty. Consequently, service connection for such disorders is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claims for service connection, that doctrine is not applicable in the instant appeal, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Waite, Jennifer

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.