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DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)
WENDY DAKNIS · 2025 · Case ID: A25071558
Summary
The veteran, who served in the United States Army from July 1963 to June 1965, appeals the denial of service connection for bilateral ankle and cervical spine disabilities, secondary to his service-connected left knee degenerative joint disease. The Board granted service connection for a lumbar spine disability, finding it was at least as likely as not caused by his service-connected left knee condition, resolving reasonable doubt in the veteran's favor. The Board denied service connection for the bilateral ankle and cervical spine conditions, finding that the evidence persuasively weighed against a secondary connection. The Board noted that the veteran's claims regarding these conditions were medically complex and outside his competence to opine on nexus. The Board also remanded claims for left and right hip disabilities, secondary to the left knee condition, and for Total Disability based on Individual Unemployability (TDIU). The remand for hip conditions was due to the VA examiner's failure to address the impact of the veteran's antalgic gait on his hips. The TDIU claim was remanded because it is inextricably intertwined with the rating for the newly granted lumbar spine disability.
Rationale
Resolving reasonable doubt in Veteran's favor; Evidence in equipoise; Lumbar spine disability caused by service-connected left knee condition
Full Decision Text
Citation Nr: A25071558 Decision Date: 08/25/25 Archive Date: 08/25/25 DOCKET NO. 250212-515653 DATE: August 25, 2025 ORDER Service connection for a lumbar spine disability, secondary to service-connected left knee degenerative joint disease, is granted. Service connection for a left ankle disability, to include as secondary to service-connected left knee degenerative joint disease, is denied. Service connection for a right ankle disability, to include as secondary to service-connected left knee degenerative joint disease, is denied. Service connection for a cervical spine disability, to include as secondary to service-connected left knee degenerative joint disease, is denied. REMANDED Service connection for a left hip disability, to include as secondary to service-connected left knee degenerative joint disease, is remanded. Service connection for a right hip disability, to include as secondary to service-connected left knee degenerative joint disease, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his lumbar spine disability is at least as likely as not due to service-connected left knee degenerative joint disease. 2. The Veteran's left ankle disability is not secondary to service-connected left knee degenerative joint disease and is not otherwise related to an in-service injury or disease. 3. The Veteran's right ankle disability is not secondary to service-connected left knee degenerative joint disease and is not otherwise related to an in-service injury or disease. 4. The Veteran's cervical spine disability is not secondary to service-connected left knee degenerative joint disease and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for lumbar spine osteoarthritis due to service-connected left knee disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for a left ankle disability due to service or service-connected left knee disabilities 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 ankle disability due to service or service-connected left knee disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for a cervical spine disability due to service or service-connected left knee disabilities 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 in the United States Army from July 1963 to June 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ). In a March 2025 notice of disagreement (NOD) (VA Form 10182, Decision Review Request: Board Appeal), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the Agency of Original Jurisdiction (AOJ) issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. Service Connection 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 inc appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. Service Connection 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). 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). Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected left knee degenerative joint disease. The Veteran contends that his lumbar back condition is due to service. Specifically, he states that this condition is secondary to, that is, caused or aggravated by, his service-connected left knee degenerative joint disease. See August 2022 Application for Disability Compensation. The question for the Board is whether the Veteran has a current disability that is due to or aggravated by service-connected disability. The Veteran was afforded a VA examination in October 2022. At that time the Veteran was noted to be diagnosed with mild anterolisthesis of the L4 over L5 with associated severe facet joint arthropathy, mild multilevel intervertebral osteochondrosis, spondylosis, and facet joint arthropathy, diagnosed in May 2022. The examiner noted that the Veteran "has an antalgic gait" while describing the additional factors contributing to the disability. A separate October 2022 medical opinion notes the antalgic gait is caused by the Veteran's service-connected left knee disabilities. Resolving reasonable doubt in the Veteran's favor, the Board finds that the evidence is at least in equipoise that his mild anterolisthesis of the L4 over L5 with associated severe facet joint arthropathy, mild multilevel intervertebral osteochondrosis, spondylosis, and facet joint arthropathy is caused by his service-connected left knee condition. Accordingly, the Board finds that service connection for mild anterolisthesis of the L4 over L5 with associated severe facet joint arthropathy, mild multilevel intervertebral osteochondrosis, spondylosis, and facet joint arthropathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected left knee degenerative joint disease. Entitlement to service connection for a right ankle disability, to include as secondary to service-connected left knee degenerative joint disease. The Veteran contends that his bilateral ankle condition is due to service. Specifically, he states that these conditions are secondary to, that is caused or aggravated by, his service-connected left knee degenerative joint disease. See August 2022 Application for Disability Compensation. 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. The question for the Board is whether the Veteran has a current disability that is due to or aggravated by service-connected disability. The Veteran was afforded a VA examination in October 2022. At that time the Veteran was diagnosed with bilateral ankle tendinitis. The October 2022 VA examiner found that the Veteran's ankle disability was not present in service or for many years thereafter and opined that it was not due to his service-connected disabilities. The examiner noted that the Veteran's service-connected left knee disability is a different anatomical region and that any incident or diagnoses that could affect one of the sites is independent from the other. In an August 2023 decision Board's adjudication will consider only entitlement to secondary service connection. The question for the Board is whether the Veteran has a current disability that is due to or aggravated by service-connected disability. The Veteran was afforded a VA examination in October 2022. At that time the Veteran was diagnosed with bilateral ankle tendinitis. The October 2022 VA examiner found that the Veteran's ankle disability was not present in service or for many years thereafter and opined that it was not due to his service-connected disabilities. The examiner noted that the Veteran's service-connected left knee disability is a different anatomical region and that any incident or diagnoses that could affect one of the sites is independent from the other. In an August 2023 decision, the Board found that the examiner did not address aggravation and remanded the claim for an addendum opinion regarding such. In October 2023, an addendum opinion was provided which concluded the Veteran's bilateral ankle disabilities were not aggravated by his service-connected left knee disability. The examiner noted that the Veteran has an antalgic gait but is not placing more weight on any particular extremity and no weight shifting per the gait analysis. According to the examiner there was no evidence that the Veteran's bilateral ankle tendinitis was aggravated beyond the natural progression of the disease. The examiner noted that having constant severe pain at both ankle joints and decreased range of motion of the ankle joints are part and parcel of having bilateral ankle tendinitis. In essence, the examiner stated that the Veteran's bilateral ankle disabilities followed their natural progression. Based on the above evidence, the Board concludes that, while the Veteran has a current disability of bilateral ankle tendinitis, the evidence of record persuasively weighs against finding that the Veteran's bilateral ankle tendinitis is due to or the result of, or aggravated by, service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The multiple VA examiners' opinions show that the Veteran's bilateral ankle disability was not present in service, was not caused by his service-connected knee disability, and was not aggravated by his service-connected knee disability. While the Veteran believes the claimed bilateral ankle disability is due to or aggravated by a service-connected disability, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the skills or medical training 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). Consequently, the Board gives more probative weight to the medical opinions of record. Entitlement to service connection for a cervical spine disability, to include as secondary to service-connected left knee degenerative joint disease. The Veteran contends that his cervical spine condition is due to service. Specifically, he states that this condition is secondary to his service-connected left knee degenerative joint disease. See August 2022 Application for Disability Compensation. 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. The question for the Board is whether the Veteran has a current disability that is due to or aggravated by service-connected disability. The Veteran was afforded a VA examination in October 2022. At that time the Veteran was noted to be diagnosed with cervical myositis, bilateral C6 radiculitis, and cervical spondylosis. The October 2022 VA examiner opined that the Veteran's cervical spine disability was not due to his service-connected disabilities. The examiner noted that the Veteran's cervical spine disability has an unrelated pathophysiology from the Veteran's service-connected disabilities. In the August 2023 decision, the Board found that the examiner did not address aggravation and remanded the claim for an addendum opinion regarding such. In October 2023, an addendum opinion was provided which found that the Veteran's cervical spine disability was not aggravated by a service-connected condition. The examiner noted that there was no evidence of aggravation on the Veteran's cervical spine examination. In essence, the examiner stated that the Veteran's cervical spine disabilities followed their natural progression. Based on the above evidence, the Board concludes that, while the Veteran has a current disability of cervical spine arthritis and radiculopathy, the evidence of disability has an unrelated pathophysiology from the Veteran's service-connected disabilities. In the August 2023 decision, the Board found that the examiner did not address aggravation and remanded the claim for an addendum opinion regarding such. In October 2023, an addendum opinion was provided which found that the Veteran's cervical spine disability was not aggravated by a service-connected condition. The examiner noted that there was no evidence of aggravation on the Veteran's cervical spine examination. In essence, the examiner stated that the Veteran's cervical spine disabilities followed their natural progression. Based on the above evidence, the Board concludes that, while the Veteran has a current disability of cervical spine arthritis and radiculopathy, the evidence of record persuasively weighs against finding that the Veteran's cervical spine disabilities are due to or the result of, or aggravated by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The multiple VA examiners' opinions show that the Veteran's cervical spine disabilities were not caused by his service-connected knee disability and were not aggravated beyond their natural progression by his service-connected knee disability. While the Veteran believes the claimed cervical spine disabilities are due to or aggravated by a service-connected disability, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the skills or medical training 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). Consequently, the Board gives more probative weight to the medical opinions of record. REASONS FOR REMAND Entitlement to service connection for a left hip disability, to include as secondary to service-connected left knee degenerative joint disease. Entitlement to service connection for a right hip disability, to include as secondary to service-connected left knee degenerative joint disease. Regarding the Veteran's hip disabilities, the October 2022 VA examiner cited medical literature finding no relationship between the Veteran's service-connected knee disability and his bilateral hip condition. However, the examiner did not address the antalgic gait that is noted due to the Veteran's left knee disability and what impact, if any, that would play on his hip disabilities. As such, remand is warranted for a new opinion. Entitlement to a TDIU. Finally, the Board has granted service connection for a back disability. As entitlement to a TDIU is dependent on the Veteran's schedular evaluation, the claim for entitlement to a TDIU is inextricably intertwined with the rating for his lumbar spine disability. Therefore, a remand of the claim for entitlement to a TDIU is required. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's left or right hip disability is at least as likely as not caused by or aggravated by his service-connected left knee disability, to include as due to any antalgic gait. Wendy Daknis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Uller, 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.