DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served from June 1969 to March 1973, appeals the denial of service connection for a lumbar spine disability, a left shoulder disability secondary to a service-connected left knee condition, and generalized arthritis. The Board found that the veteran had a current disability for all three conditions, as confirmed by VA examinations and treatment records. Regarding the lumbar spine, the Board noted the veteran's consistent 50-year history of reporting back pain related to service, despite mixed and often contradictory VA medical opinions that frequently relied on inaccurate factual premises or failed to address the veteran's consistent complaints and the theory of secondary connection. The Board afforded the veteran the benefit of the doubt due to the lack of probative opinions and the veteran's credible, consistent statements, granting service connection for the lumbar spine disability. For the left shoulder, the Board found the veteran's lay statements regarding a fall that injured his shoulder after injuring his knee in service to be competent and credible, corroborated by service records. Despite negative VA opinions that failed to address secondary connection, the Board applied the benefit of the doubt and afforded greater probative value to the veteran's lay statements, granting service connection for the left shoulder disability secondary to the left knee. For generalized arthritis, the Board found the VA opinions to be conclusory, lacking rationale, or not addressing the claim, and applied the benefit of the doubt to grant service connection. Service connection for all three conditions was granted.

Rationale

Veteran has consistent 50-year history of back pain related to service; Mixed VA opinions with inaccurate premises and lack of secondary connection analysis; Board applied benefit of the doubt due to lack of probative opinions

Full Decision Text

Citation Nr: 26003004
Decision Date: 03/05/26	Archive Date: 03/05/26

DOCKET NO. 18-28 233A
DATE: March 5, 2026

ORDER

Entitlement to service connection for a lumbar spine disability is granted.

Entitlement to service connection for a left shoulder disability secondary to the service-connected chondromalacia with degenerative changes of the left knee is granted.

Entitlement to service connection for generalized arthritis is granted.

FINDINGS OF FACT

1. The competent and credible evidence of record persuasively establishes a finding that the lumbar spine disability is related to active-duty service.

2. The competent and credible evidence of record persuasively establishes a finding that the left shoulder disability is related to the service-connected left knee.

3. The competent and credible evidence of record persuasively establishes a finding that the generalized arthritis is related to active-duty service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a lumbar spine disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for a left shoulder disability secondary to the service-connected chondromalacia with degenerative changes of the left knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to service connection for generalized arthritis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1969 to March 1973. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

These issues were previously before the Board in May 2020, July 2023, March 2025, and July 2025, remanded each time for further development. That development was completed, and the case has since been returned to the Board for appellate review.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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).

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

1. Entitlement to service connection for a lumbar spine disability

2. Entitlement to service connection for a left shoulder disability secondary to the service-connected chondromalacia with degenerative changes of the left knee

3. Entitlement to service connection for generalized arthritis

The Veteran alleges that he has a lumbar spine disability which began during service and has existed since that time. He alleges that the left shoulder disability is related to the service-connected left knee disability. And he alleges that he has generalized arthritis related to service.

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA examiners have confirmed diagnoses of degenerative arthritis of the spine, spinal stenosis, lumbar spondylos
 a left shoulder disability secondary to the service-connected chondromalacia with degenerative changes of the left knee

3. Entitlement to service connection for generalized arthritis

The Veteran alleges that he has a lumbar spine disability which began during service and has existed since that time. He alleges that the left shoulder disability is related to the service-connected left knee disability. And he alleges that he has generalized arthritis related to service.

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA examiners have confirmed diagnoses of degenerative arthritis of the spine, spinal stenosis, lumbar spondylosis, degenerative disc disease, and left shoulder replacement. VA treatment records have noted overall joint polyarthritis with persistent pain, stiffness, and radiculopathies. Accordingly, the first element of service connection is met.  

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). 

At a February 1978 Board hearing, the Veteran testified that he first strained his back during service in 1971, and that he was ultimately forced to resign from his position with the UPS the same month that he separated from service due to the back pain. In an April 2009 statement, he asserted that the back pain was due to constant heavy lifting during service. At a May 2010 VA examination, the Veteran shared that he first injured his back during service after a fall, but that his back did not start bothering him until after he separated from service. In a December 2013 statement, he reported that his back pain was due to his job delivering mail while stationed in Italy, up to 600 pieces of mail per day. September 1971 service treatment records (STRs) noted back pain for three days, and a diagnosis of back strain. Upon separation from service, the Veteran endorsed recurrent back pain and swollen or painful joints on a report of medical history, although the corresponding report of medical examination found his spine to be normal. A review of the military personnel records noted that the Veteran worked as a mail clerk during service, and that he had been primarily responsible for the receipt and dispatch of approximately 300,000 pounds of mails.

Regarding the left shoulder disability, in a September 2013 statement, the Veteran asserted that in 1990, the service-connected left knee caused him to fall, and injure his left shoulder.

And finally, the Board notes that the Veteran has not actually raised any specific argument or theory of entitlement for why generalized arthritis should be service-connected. On his October 2015 application, he included a claim for "arthritic," which the RO interpreted as arthritic (unspecified) on the August 2016 rating decision on appeal. The Veteran did not appeal that issue to the Board, and it was not included on the April 2018 Statement of the Case. Nonetheless, in the May 2020, the Board accepted jurisdiction over this issue without explanation.

The Board finds the Veteran's statements competent as they are capable of lay observation. 38?U.S.C. §?1154(a); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). Further, these statements have been corroborated by the STRs and military personnel records. Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the probative value of a witness statement may be affected by inconsistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, the second element of service connection is met.

Third, the Board finds that the evidence of record does support a finding that the lumbar spine disability, left shoulder disability, and generalized arthritis are related to active service.  

Lumbar Spine

A VA examiner in February 1977 found that although the Veteran was on bed rest when he returned from service for low back pain, there was no lower back orthopedic condition.

In May 2010, a VA examiner provided two opinions. In the first, they indicated that it is possible that the current symptoms are related to his current back pain. In the second, they found that although the back strain during service may have contributed in some extent to his current symptoms, it is less likely than not that the current symptoms are related to that incident.

In an April 2011 addendum opinion, the examiner acknowledged September 1974 findings of back pain but indicated that the current symptoms are unrelated to
.  

Lumbar Spine

A VA examiner in February 1977 found that although the Veteran was on bed rest when he returned from service for low back pain, there was no lower back orthopedic condition.

In May 2010, a VA examiner provided two opinions. In the first, they indicated that it is possible that the current symptoms are related to his current back pain. In the second, they found that although the back strain during service may have contributed in some extent to his current symptoms, it is less likely than not that the current symptoms are related to that incident.

In an April 2011 addendum opinion, the examiner acknowledged September 1974 findings of back pain but indicated that the current symptoms are unrelated to the isolated back strain during service. They found that while that incident may contribute to future symptoms, it is unlikely that they contributed to the development of multilevel degenerative disk disease.

A VA examiner in September 2015 opined that other than the 1971 complaint of back strain, they saw no evidence of repeated injuries or complaints during service.

In July 2020, a VA examiner acknowledged that the Veteran was intermittently evaluated for low back pain during service but found that there was no compelling evidence that he had a chronic, recurring back condition. They indicated that medical literature did not demonstrate a relationship between muscle strain and the development of arthritis.

In a September 2020 addendum opinion, the examiner noted that there was no basis in medical literature to show that a knee condition can cause or aggravate a low back condition.

A VA examiner in November 2022 noted that as the complaint of back strain in service was isolated, it appears that it was acute in nature. They found that the medical record was silent for any back condition until 2009, so without any evidence of chronicity, a post-service event or injury was more likely.

In March 2024, a VA examiner essentially repeated the November 2022 direct service connection opinion. On a secondary service connection basis, they considered the service-connected knee disabilities, and his fall history, but were unable to find any medical literature supporting a connection between these conditions. They explained that a review of orthopedic literature showed that there is no clear evidence 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 5 cm so that the individuals gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. They concluded that joint disease does not spread to another or cause damage to it.

A VA examiner in May 2024 noted the in-service complaint of back strain, and his history of delivering mail in the cold. They acknowledged that the Veteran reported recurrent back pain at separation, but as the examiner at that time found the spine to be normal, and that there was no documentation of a back condition until 2009, the in-service back strain was acute in nature and is unrelated to the current condition.

And finally, in a March 2025 addendum opinion, a VA examiner noted that common risk factors for spinal stenosis and degenerative arthritis included aging, genetic factors, obesity, male sex, history of cigarette smoking, and physical activities. They noted the in-service complaints of back pain, which is not consistent with the current condition given that he periodically denied any back pain in the subsequent years. Regarding the theory of entitlement that the condition is related to delivering mail in the cold, the examiner found that medical literature did not demonstrate a link between cold exposure and the development of spinal stenosis. They suggested that the Veteran's age, male gender, weight, smoking history, and career at the United States Postal Service were more likely factors.

A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

The Board affords low probative value to the May 2010, and April 2011 opinions as they are essentially nonsensical. The May 2010 opinion was contradictory, simultaneously finding that it is possible that the back strain was related to his current symptoms, that the back strain might have contributed to the current symptoms, and that the current symptoms are unrelated to the back strain. The April 2011 opinion found that while the back strain was unrelated to the development of arthritis, it is also possible for the back strain to contribute to the symptoms in the future. Id.

Low probative value is afforded to the September 2015, July 2020, November 2022, March 2024, May 2024, and March 2025 opinions as the exam
 May 2010, and April 2011 opinions as they are essentially nonsensical. The May 2010 opinion was contradictory, simultaneously finding that it is possible that the back strain was related to his current symptoms, that the back strain might have contributed to the current symptoms, and that the current symptoms are unrelated to the back strain. The April 2011 opinion found that while the back strain was unrelated to the development of arthritis, it is also possible for the back strain to contribute to the symptoms in the future. Id.

Low probative value is afforded to the September 2015, July 2020, November 2022, March 2024, May 2024, and March 2025 opinions as the examiners erred in concluding that Veteran had no subsequent back complaints until 2009. The medical record shows that the Veteran continued to complain of and seek treatment for back pain throughout 1974 and 1976. The Board observes that for nearly 50 years, the Veteran has consistently reported that he has back pain related to service. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993).

Essentially, there are no probative opinions of record. Given the Veteran's 50 year history of consistent, competent, and credible statements that he continued to have back pain, rather than remanding yet again for a more perfect opinion, the Board will not further delay his claim. The Board will afford the Veteran the benefit of the doubt and assign his statements significant probative value.

Left Shoulder

VA examiners in July 2020, March 2024, and May 2024 opined that as the STRs were silent for any left shoulder complaints, then it was less likely than not that the current left shoulder disability was caused or aggravated by the service-connected knees.

A VA examiner in March 2025 noted that common risk factors for left shoulder degenerative arthritis included aging, genetic factors, obesity, and physical activity. They also noted that the STRs were silent for any shoulder complaints, and that the Veteran had a 33 year work history with the Postal Service. This examiner did not address secondary service connection.

The Board affords low probative value to each of these opinions. The earlier examiners appear to not understand the concept of secondary service connection, which does not require a direct in-service incident, or injury. The Veteran has asserted that his service-connected left knee caused him to fall, which caused him to injure his shoulder. This satisfies the second element of service connection. The March 2025 examiner did not address this theory of entitlement at all. Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). As with the lumbar disability, rather than remanding yet again, the Board will afford the Veteran the benefit of the doubt and assign greater probative value to his lay statements.

Generalized Arthritis

A VA examiner in September 2020 provided a negative nexus opinion. They explained that there was a lack of medical literature which showed a relationship between working in cold temperatures, and the subsequent development of generalized arthritis of multiple joints.

In April 2024, a VA examiner provided a positive nexus opinion. They explained that it was at least as likely as not that the generalized arthritis was related to his duties as a postal courier specialist, and working in cold temperatures.

A March 2025 examiner provided a negative nexus opinion in which they simply duplicated their left shoulder opinion.

And a VA examiner in October 2025 provided an opinion for the bilateral hips and the right shoulder, for which VA had previously denied service connection and the Veteran did not appeal. They did not address generalized arthritis at all.

The Board affords low probative value to each of these opinions. Both the September 2020 and April 2024 opinions are conclusory and lacked any supporting rationale, and the March and October 2025 opinions did not actually address the claim in question. Nieves-Rodriguez, 22 Vet. App. 301.

Rather than further delaying adjudication of this appeal, the Board will afford the Veteran the benefit of the doubt.

Accordingly, the criteria for the claims of entitlement to service connection for a lumbar spine disability, a left shoulder disability, and generalized arthritis have been met, and the appeal is granted.

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogos, J.

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. 


 App. 301.

Rather than further delaying adjudication of this appeal, the Board will afford the Veteran the benefit of the doubt.

Accordingly, the criteria for the claims of entitlement to service connection for a lumbar spine disability, a left shoulder disability, and generalized arthritis have been met, and the appeal is granted.

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogos, J.

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.