DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

MICHAEL LANE · 2026 · Case ID: 26003456

MIXED

Summary

The veteran, who served in the Army from November 1988 to March 1989 and January 1991 to May 1991, with subsequent National Guard and Reserve service, appeals the denial of service connection for a back disability. The veteran claimed the back condition was secondary to his service-connected right knee disability, citing physical training and daily marches with heavy weight as the cause. The Board reviewed pre-service, in-service, and post-service medical records, noting the absence of back complaints or diagnoses during service or within one year of discharge. A January 2006 MRI showed mild degenerative changes, and the veteran reported intermittent pain starting around 2006. A February 2024 VA examination diagnosed degenerative arthritis of the spine, attributing it to age and other risk factors, not service, due to the lack of in-service complaints or documentation. An October 2024 VA medical opinion similarly concluded it was less likely than not that the back disability was service-related, citing the mild nature of degenerative changes and the absence of in-service complaints. The Board found the veteran's lay assertions regarding service connection and the medical opinions to be most probative, concluding the evidence weighed against service connection. The Board denied service connection for the back disability, finding the veteran's lay testimony insufficient to establish a nexus in the absence of medical evidence. Several other issues related to knee disabilities and TDIU were remanded for further development.

Rationale

Lack of in-service complaints or diagnosis of back condition; Medical opinions attributed condition to age and non-service factors; Veteran's lay assertions insufficient to establish nexus without medical evidence

Service Branch

ARMY

Special Benefit

TDIU

Docket No.

10-98 936A

Full Decision Text

Citation Nr: 26003456
Decision Date: 03/17/26 Archive Date: 03/17/26

DOCKET NO. 10-98 936A
DATE: March 17, 2026

ORDER

Entitlement to service connection for a back disability is denied.

REMANDED

Entitlement to non-service connected pension benefits prior to July 28, 2010, is remanded.

Entitlement to initial increased ratings for right knee instability - currently rated as 10 percent disabling from October 19, 2010, to March 31, 2012; zero percent disabling from April 1, 2012, to April 13, 2021; and to include whether a separate compensable rating for right knee instability is warranted prior to October 19, 2010 - is remanded.

Entitlement to initial increased disability ratings for chronic right knee strain with bursitis - currently rated as 10 percent disabling from August 28, 2008, to February 16, 2012; and 20 percent disabling from April 1, 2012, to April 14, 2021 - is remanded.

Entitlement to an initial increased rating for status post right total knee replacement - currently rated as 60 percent disabling from April 14, 2022, to September 30, 2024, and as 30 percent disabling from September 30, 2024 - is remanded.

Entitlement to a total disability rating based on individual unemployability (TDIU) prior to April 14, 2022, is remanded.

FINDING OF FACT

The evidence of record persuasively weighs against finding that a back disability began during active service, otherwise was caused by service, or was caused or aggravated by a service-connected disability.

CONCLUSION OF LAW

The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from November 1988 to March 1989 and from January 1991 to May 1991, with additional service in the Army National Guard and the Army Reserve.

These matters come before the Board of Veterans' Appeals (Board) on appeal from January 2010 (grant of service connection for chronic right knee strain with bursitis and denial of TDIU) and March 2010 (denials of service connection for a back disability and non-service-connected pension benefits) rating decisions of a Department of Veterans Affairs (VA) regional office (RO).

In September 2020, the Veteran testified at a virtual hearing held before the undersigned Veterans Law Judge (VLJ) and a transcript of that hearing has been associated with the electronic claims file.

The issue of entitlement to service connection for an acquired psychiatric disorder will be addressed in a separate decision, as the Veteran testified as to this issue before multiple VLJs.

In 2010, the Veteran perfected an appeal of a denial of entitlement to non-service-connected pension benefits. In June 2017, a RO granted non-service-connected pension benefits effective July 28, 2010, and paid pension benefits effective August 1, 2010, as the higher benefit of compensation and pension benefits. The benefit paid was changed to compensation benefits effective from March 1, 2012, to March 31, 2012, and the benefit pain was changed back to pension benefits effective April 1, 2012. The benefit was changed back to compensation benefits effective January 1, 2016. In October 2017 and in January and February 2018, the RO issued Supplemental Statements of the Case (SSOCs) on the issue of entitlement to non-service-connected pension benefits from August 28, 2008, to July 27, 2010. In August 2018, the benefit was changed back to pension benefits effective July 1, 2018. Later in August 2018, the Veteran filed a notice of disagreement with the August 2018 determination and requested pension benefits be awarded back to January 1, 2016. In an October 2018 deferred rating decision, a RO determined that the Veteran was entitled to payment of non-service-connected pension benefits effective January 1, 2016, and that this grant was a full grant of the benefit sought on appeal. The Board, however, notes that the issue of entitlement to non-service-connected pension benefits prior to July 28, 2010, is still pending.

In a July 2018 claim, the Veteran asserted that his back disability was secondary
to pension benefits effective July 1, 2018. Later in August 2018, the Veteran filed a notice of disagreement with the August 2018 determination and requested pension benefits be awarded back to January 1, 2016. In an October 2018 deferred rating decision, a RO determined that the Veteran was entitled to payment of non-service-connected pension benefits effective January 1, 2016, and that this grant was a full grant of the benefit sought on appeal. The Board, however, notes that the issue of entitlement to non-service-connected pension benefits prior to July 28, 2010, is still pending.

In a July 2018 claim, the Veteran asserted that his back disability was secondary to the service-connected right knee disability. In an August 2019 statement, the Veteran raised the theory of entitlement to service connection for the back disability as secondary to the service-connected bilateral knee and bilateral hip disabilities. As such, the Board will consider secondary service connection for the back disability.

In an August 2013 rating decision, a RO granted a 100 percent disability rating for chronic right knee strain with bursitis effective from February 16, 2012, to March 31, 2012, pursuant to 38 C.F.R. § 4.30. The RO also assigned a 20 percent disability for chronic right knee strain with bursitis effective April 1, 2012. As the 20 percent disability rating is not the maximum rating, this claim remains in appellate status. AB v. Brown, 6 Vet. App. 35, 38-39 (1993).

In the August 2013 rating decision, a RO granted service connection for right knee instability effective October 19, 2010. That RO assigned a 10 percent disability rating effective from October 19, 2010, to March 31, 2012, and a zero percent disability rating effective April 1, 2012. In January 2014, the Veteran filed a notice of disagreement in which he argued for higher ratings as well as an earlier effective date for the grant of service connection for right knee instability. In March 2016, a RO issued a Statement of the Case (SOC) on the issues of entitlement to an earlier effective date for the grant of service connection for right knee instability, and entitlement to increased ratings for right knee instability. The Veteran did not file a VA Form as to the March 2016 SOC. The RO, however, did address these issues in October 2017 and January and February 2018 SSOCs.

The Board finds that the issues of entitlement to initial increased ratings for right knee instability currently rated as 10 percent disabling form October 19, 2010, to March 31, 2012; zero percent disabling from April 1, 2012, to April 14, 2021; and to include whether a separate compensable rating for right knee instability is warranted prior to October 19, 2010 are part and parcel of the issue of initial increased ratings for right chronic right knee strain with bursitis currently rated as 10 percent disabling from August 28, 2008, to February 15, 2012; and 20 percent disabling from April 1, 2012, to April 13, 2021.

On April 14, 2021, the Veteran underwent a right total knee arthroplasty. In an August 2021 rating decision, a RO assigned a 100 percent disability rating status post right knee replacement from April 14, 2021, to August 31, 2021, pursuant to 38 C.F.R. § 4.30 and 38 C.F.R. § 4.71a, Diagnostic Code 5055. In a June 2022 rating decision, a RO assigned a 60 percent disability rating for status post right knee replacement effective March 14, 2022. An October 2024 rating decision decreased the Veteran's rating for his status post right total knee replacement from 60 percent to 30 percent, effective September 30, 2024. In an October 2024 statement, the Veteran expressly expressed his dissatisfaction with the assigned 30 percent rating.

In light of the above, the issues regarding the right knee disability are as stated on the title page.

A September 2024 rating decision granted entitlement to TDIU, effective April 14, 2022. As the grant did not constitute a complete grant of the benefits requested, the issue remains on appeal for the period prior to April 14, 2022.

In March 2023, the Board remanded the issues for additional development. As there has been substantial compliance with the
post right total knee replacement from 60 percent to 30 percent, effective September 30, 2024. In an October 2024 statement, the Veteran expressly expressed his dissatisfaction with the assigned 30 percent rating.

In light of the above, the issues regarding the right knee disability are as stated on the title page.

In March 2023, the Board remanded the issues for additional development. As there has been substantial compliance with the prior remand directives as to the back disability claim, the Board concludes that a decision is warranted. See Stegall v. West, 11 Vet. App. 268, 271 (1998).

1. Entitlement to service connection for a back disability

The Veteran seeks service connection for a back disability, to include the stresses of physical training.

Generally, service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1131; 38 C.F.R. § § 3.303.

To establish service connection for a disability, the 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection also may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Under 38 U.S.C. § 101(2), a "Veteran" is defined as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." The term "active military, naval, or air service" includes (1) active duty; (2) any period of active duty for training (ADT) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and; (3) any period of inactive duty training (IDT) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6(a); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991).

ADT is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505; 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). This includes the two weeks of annual training that each Reservist or National Guardsman must perform each year. It can also include the initial period of training. IDT includes duty, other than full-time duty, performed for training purposes by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(c). This includes the twelve four-hour weekend drills that each Reservist or National Guardsman must perform each year.

A claimant may also be service connected for an injury or, (in the case of ADT and/or a disease), incurred while proceeding directly to or returning directly from ADT or IDT training. 38 C.F.R. § 3.6(e).

National Guard duty is different from other Reserve service in that a member of the National Guard may be called to duty by the governor of their state. Members of the National Guard only serve the Federal military when they are formally called into the military service of the United States; at all other times, National Guard members serve solely as members of the State militia under the command of a state governor. Allen v. Nicholson, 21 Vet. App. 54, 57 (2007). Therefore, to have basic eligibility for Veterans benefits based on a period of duty as a member of a state National Guard, a National Guardsman must have: (1) been ordered into Federal service by the President of the
3.6(e).

In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled as a result of a disease or injury incurred or aggravated in the line of duty on Reserve ADT / IDT or during Federalized National Guard service. In the absence of such evidence, the period of ADT would not qualify as "active military, naval, or air service" and the claimant would not achieve veteran status for purposes of that claim. See 38 U.S.C. § 101(2), (24).

Prior to entering service, an October 1988 Report of Medical History included the Veteran's denial of a current or past history of recurrent back pain. In a contemporaneous Report of Medical Examination, the Veteran had a normal examination of the spine. In a May 1989 Report of Medical History, the Veteran denied a current or past history of recurrent back pain. In a contemporaneous Report of Medical Examination, the Veteran had a normal examination of the spine. In a January 1991 Report of Medical History prior to the Veteran's second period of active service, the Veteran described his health as excellent and denied a current or past history of recurrent back pain. In a contemporaneous Report of Medical Examination, the Veteran had a normal examination of the spine. The Veteran declined a separation examination prior to separation from his second period of active service.

After his periods of active service and during the Veteran's service in the National Guard, a January 1993 Report of Medical Examination included a normal spine examination. In a contemporaneous Report of Medical History, the Veteran denied a current or past history of recurrent back pain. He stated that his overall health was good.

A January 2006 MRI of the lumbar spine showed disc protrusion at T12-L1 and L4-L5. Contemporaneous x-rays showed degenerative changes with no evidence of fracture.

In June 2015, the Veteran reported back arthralgias. In January 2016, the Veteran described constant pain in the back.

In an August 2019 statement, the Veteran stated, "The back pain is secondary [to] muscular trauma from having to sit, walk, and ride in abnormal, awkward positions and gaits due to the original right knee injury."

During his September 2020 Board hearing, the Veteran contended that he had a current back disability to his service. He claimed to have injured himself during infantry training as a result of his daily road marches with heavy weight. The Veteran experienced ongoing back symptoms from service, with only the severity of symptoms increasing over time.

Multiple attempts were made to contact the private facilities identified by the Veteran, but no response from the private facility was received. VA notified the Veteran that the records had not been provided by the private treatment providers to VA and notified the Veteran that he could provide the records directly to VA.

The Veteran was afforded a VA examination in February 2024. The examiner diagnosed degenerative arthritis of the spine. The Veteran reported 11 years of service in the Army National Guard / Army Reserve, starting in 1988. The Veteran denied any specific injury during service, but he did have high intensity training that imposed stresses and strains resulting in back pain. Some examples discussed by the Veteran were carrying heavy backpacks, equipment, weight, and weapons while marching. The Veteran completed military service in 1999, but was first evaluated for complaints of back pain by an unknown VA physician in 1993. Currently, the Veteran experienced intermittent back pain that was most evident early in the morning (that improved with stretching) and at night. The Veteran had not been seen or evaluated for his low back for approximately 10 years.
The Veteran reported 11 years of service in the Army National Guard / Army Reserve, starting in 1988. The Veteran denied any specific injury during service, but he did have high intensity training that imposed stresses and strains resulting in back pain. Some examples discussed by the Veteran were carrying heavy backpacks, equipment, weight, and weapons while marching. The Veteran completed military service in 1999, but was first evaluated for complaints of back pain by an unknown VA physician in 1993. Currently, the Veteran experienced intermittent back pain that was most evident early in the morning (that improved with stretching) and at night. The Veteran had not been seen or evaluated for his low back for approximately 10 years. X-rays showed mild to moderate multilevel degenerative changes of the lumbar spine, with no high-grade compression fracture. Following examination, the examiner concluded that it was less likely than not that the claimed back disability was incurred in or otherwise caused by service, including the stresses of physical training. The rationale noted a diagnosis of degenerative arthritis of the lumbosacral spine that was mild to moderate in nature. The examiner stated, "It is a medically known fact that osteoarthritis is the most common type of arthritis to affect the spine. Multiple risk factors have been linked to the pathogenesis of OA [i.e. osteoarthritis]. Risk factors for OA include age, joint injury, obesity, genetics, anatomical factors including joint shape and alignment, and sex. There is no evidence of complaints or treatment of back condition during active duty for training from January 1991 to May 1991 or evidence of manifestation of back condition within 1 year from discharge from active duty for training in May 1991... [The] Veteran was first evaluated for chronic lumbosacral pain [in January 2006]. Evidence of mild to moderate degenerative changes present on lumbosacral spine radiological imaging performed in conjunction with today's visit [] it is reasonable to state that based on lack of documentation of injury / ongoing back complaints during active duty periods (including November 1988 - March 1989, January 1991 - May 1991) or 1 year thereafter, it is reasonable to state that Veteran's diagnosis of spine osteoarthritis / back condition can be attributed to other risk factors."

An October 2024 VA medical opinion concluded that it was less likely than not that the Veteran's low back disability was incurred in or caused by service. The rationale noted the past diagnoses of intervertebral disc syndrome, which the medical professional indicated was secondary to the Veteran's previously diagnosed degenerative osteoarthritis of the spine. The medical professional stated that the opinion and rational applied to both diagnoses. During a February 2024 interview of the Veteran, he denied any specific injury to the back during service. The medical professional also noted the absence of any complaints or diagnosis of a back disability in the service treatment records. That said, the medical professional acknowledged that the Veteran's MOS of Infantry would involve significant stresses during physical training. In addition, the medical professional discussed how there were no documented symptoms or diagnoses during or within 1 year of each of the Veteran's periods of active service. The medical professional also observed that the "Veteran himself reported that he was first seen by non VA physician in 1993 which was over 1 year after discharge from active duty for training in May 1991 (though that record is unavailable)." The available medical records documented that the Veteran was diagnosed with degenerative arthritis of the spine in 2006 at the age of 49 and the condition at that time was mild in nature. The medical professional stated, "It is a medically known fact that age is the most significant risk factor for Osteoarthritis. Osteoarthritis most commonly presents in patients over the age of 40. Therefore it is reasonable to attribute [the] Veteran's mild osteoarthritis in [2006] to [the] Veteran's age at diagnosis of 49 years. This is further supported by the fact that the Veteran has not received any specific treatment or evaluations for back condition which would be the case if the Veteran had increased severity of back condition resulting in ongoing symptoms for 30 years." X-rays from February 2024 showed mild to moderate multilevel degenerative changes to the spine. "It is reasonable to expect that if the Veteran had sustained injury of the lumbar spine during active duty in military service which ended in May 1991, that Osteoarthritis would be progressive and severity of osteoarthritis on radiological imaging would be expected to be significant after 3 decades. In fact, in this Veteran severity of degenerative arthritis of the lumbar spine - mild to moderate -
further supported by the fact that the Veteran has not received any specific treatment or evaluations for back condition which would be the case if the Veteran had increased severity of back condition resulting in ongoing symptoms for 30 years." X-rays from February 2024 showed mild to moderate multilevel degenerative changes to the spine. "It is reasonable to expect that if the Veteran had sustained injury of the lumbar spine during active duty in military service which ended in May 1991, that Osteoarthritis would be progressive and severity of osteoarthritis on radiological imaging would be expected to be significant after 3 decades. In fact, in this Veteran severity of degenerative arthritis of the lumbar spine - mild to moderate - corresponds with what would be expected at the age of 67 years. Therefore it is reasonable to state that the Veteran's degenerative arthritis did not begin during active duty for training from November 1988 to March 1989, nor is there any evidence that it manifested within 1 year of discharge from active duty for training in March 1989, nor did it begin during active duty for training January 1991 to May 1991 not is there any evidence that it manifested within 1 year from discharge from active duty for training in May 1991." As to whether the back disability was caused or aggravated by the Veteran's service-connected right and left hip or knee disabilities, the medical professional stated that "Based on the degree of severity of degenerative arthritis in this Veteran which is to be expected at the age of 67, (not out of proportion to what would be expected at 67 [years] of age) there is no evidence that this was aggravated by any other medical condition."

Thus, the Veteran has a current back disability. The critical question, therefore, is whether the current disability was incurred in service or otherwise caused by service. The Board concludes it was not.

The medical evidence of record does not support the Veteran's claim. In that regard, the Board finds the February 2024 VA examination report and the October 2024 VA medical opinion of significant probative value. The medical professionals considered all the evidence of record, including the Veteran's lay assertions, and concluded that the most likely cause of the Veteran's current back disabilities was the natural aging process and not his active service or service-connected disability. The medical professionals provided multiple rationales as to why it was less likely than not that the back issues were due to active service or service-connected disability and the rationales were consistent with the evidence of record. For these reasons, the Board finds the February 2024 VA examination report and the October 2024 VA medical opinion the most probative evidence of record.

The sole evidence in support of the Veteran's claims are his assertions that the back disability is related to his active service and/or a service-connected disability. In this case, the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires medical knowledge and understanding of the interaction of the back with other body systems and their effects on each other. The Veteran also is not competent to link his current back disability to his activities in service, particularly in the absence of a continuity of symptoms from service, as evidenced by the denial of a current or past history of symptoms in the January 1993 Report of Medical History after his periods of active service. After that point, the Veteran has not reported any specific injury during any period of ADT or IDT. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

The Board concludes that the evidence of record persuasively weighs against the claim, and that service connection is not warranted. As such, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001).

REASONS FOR REMAND

1. Entitlement to non-service connected pension benefits prior to July 28, 2010, is remanded.

2. Entitlement to initial increased ratings for right knee instability - currently rated as 10 percent disabling from October 19, 2010, to March 31, 2012; zero percent disabling from April 1, 2012, to April 13, 2021; and
rule does not apply, and the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001).

REASONS FOR REMAND

1. Entitlement to non-service connected pension benefits prior to July 28, 2010, is remanded.

2. Entitlement to initial increased ratings for right knee instability - currently rated as 10 percent disabling from October 19, 2010, to March 31, 2012; zero percent disabling from April 1, 2012, to April 13, 2021; and to include whether a separate compensable rating for right knee instability is warranted prior to October 19, 2010 - is remanded.

3. Entitlement to initial increased disability ratings for chronic right knee strain with bursitis - currently rated as 10 percent disabling from August 28, 2008, to February 16, 2012; and 20 percent disabling from April 1, 2012, to April 14, 2021 - is remanded.

4. Entitlement to an initial increased rating for status post right total knee replacement - currently rated as 60 percent disabling from April 14, 2022, to September 30, 2024, and as 30 percent disabling from September 30, 2024 - is remanded.

5. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to April 14, 2022, is remanded.

The Board remanded the above issues in a March 2023 determination for additional development. The record does not clearly indicate that all the requested development was completed, specifically readjudication of the issues via a Supplemental Statement of the Case (SSOC). (By contrast, the low back disability issue, adjudicated above, was adjudicated in a November 2024 SSOC.) As such, there has not been substantial compliance with the prior remand instructions and a remand is necessary to complete the requested development and readjudication of the issues. See Stegall v. West, 11 Vet. App. 268, 271 (1998).

The matters are REMANDED for the following action:

After undertaking all necessary development, readjudicate the claims on appeal, to include consideration of the old and new criteria for rating knee disabilities. If any benefit sought in connection with the claims remains denied, the Veteran and his representative should be provided with an appropriate Supplemental Statement of the Case (SSOC) and given the opportunity to respond.

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. J. Houbeck, 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.

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