THORACOLUMBAR OR LUMBAR SPINE LIMITATION OF MOTION

Summary

The veteran, who served in the Army from August 1975 to July 1979, appeals the denial of service connection for a low back condition, right lower extremity radiculopathy, and left lower extremity radiculopathy. The veteran contended that the low back condition was secondary to service-connected knee disabilities, and the radiculopathy claims were secondary to the low back disability. The Board denied service connection for all three conditions, finding the evidence persuasively weighed against a secondary connection for the low back disability. A February 2022 VA examination opined the low back condition was less likely than not related to the service-connected knee disabilities, citing a lack of severe gait impairment. The Board found this opinion adequate and the veteran's arguments against it unpersuasive. As the low back claim was denied, the secondary radiculopathy claims were also denied as a matter of law. The Board remanded claims for an increased rating for left knee osteoarthritis and for Total Disability based on Individual Unemployability (TDIU). The remand was based on an inadequate VA examination for the left knee, which failed to provide range of motion estimates during flare-ups, and because the TDIU claim was intertwined with the knee claim.

Rationale

VA examination opined low back condition less likely than not secondary to knee disabilities.; Examiner found severity not supported by record, history, or exam.; Board found evidence persuasively against secondary connection.

Full Decision Text

Citation Nr: A25098803
Decision Date: 11/13/25	Archive Date: 11/13/25

DOCKET NO. 241003-480320
DATE: November 13, 2025

ORDER

Entitlement to service connection for a low back condition is denied.

Entitlement to service connection for right lower extremity radiculopathy is denied.

Entitlement to service connection for left lower extremity radiculopathy is denied.

REMANDED

Entitlement to an evaluation in excess of 30 percent for left knee osteoarthritis is remanded.

The claim for entitlement to a total disability based upon individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. The Veteran's low back condition is not secondary to service-connected knee disabilities, and is not otherwise related to an in-service injury or disease.

2. The Veteran's right lower extremity radiculopathy condition is not secondary to service-connected knee disabilities, and is not otherwise related to an in-service injury or disease.

3. The Veteran's left lower extremity radiculopathy condition is not secondary to service-connected knee disabilities, and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for low back disability due to service or service-connected knee disabilities are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for right lower extremity radiculopathy due to service or service-connected disease or injury 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 left lower extremity radiculopathy due to service or service-connected disease or injury 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 in the United States Air Force from July 5, 1973 to July 23, 1973 and in the United States Army from August 1975 to July 1979. 

In June 2023, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2022 decision.  In September 2023, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior June 2022 decision.  Therefore, the Board may only consider the evidence of record at the time of the June 2022 decision and any evidence submitted during an applicable evidentiary window. 

In the October 3, 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the June 2022 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or 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 AOJ issued the decision, which was subsequently subject to higher-level review 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. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of increased rating for left knee disability and a TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103
 evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of increased rating for left knee disability and a TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

1. Entitlement to service connection for a low back condition

The Veteran seeks service connection for a low back condition. He contends that his current low back condition is secondary to his service-connected knee disabilities.

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.

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

The question for the Board is whether the Veteran has a current disability that is due to or the result of, or is aggravated by service-connected knee disability.

The Veteran was afforded a VA examination in February 2022. The Veteran reported gradual onset of low back pain. He denied direct injury to the back. The examiner opined that the Veteran's low back condition is less likely than not secondary to his service-connected knee disabilities. The examiner explained that there here is no clear evidence from review of orthopedic literature (Wheeless' Textbook of Orthopedics) 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 5cm. The examiner continued that this level of severity would alter an individual's gait pattern to the extent that clinically there would be an obvious Trendelenburg gait. In the Veteran's specific case, however, the examiner found that this level of severity was not supported based on record review, history or exam. The examiner indicated that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. Therefore, the examiner concluded that the Veteran's low back condition is less likely than not related to the Veteran's service-connected knee disabilities.

The Board concludes that, while the Veteran has a current low back disability, the evidence of record persuasively weighs against finding that the Veteran's low back disability 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 February 2022 VA examiner opined that the Veteran's low back disability is less likely than not related to the service-connected knee disabilities. The examiner explained that an injury to one joint would not generally have a significant impact on other joints unless the injury was sufficiently severe to result in an obvious Trendelenburg gait. However, the examiner determined that this level of severity was not supported by their record review, the Veteran's history, or the examination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Barr v. Nicholson, 21 Vet. App. 303 (2007), Stefl v. Nicholson, 21 Vet. App. 120 (2007), Prejean v. West, 13 Vet. App. 444 (2000).

The Veteran argues that the VA examination is inadequate. In the October 2024 brief, the Veteran argues that the VA examiner is too literal and limited in their interpretation of the back being secondary to the Veteran's knee disabilities. The veteran argued that secondary service connection was warranted because his low back disability was due to more than a decade of improper ambulation, which resulted in additional stress on the back beyond the natural aging process. The Board disagrees. The Board finds that VA opinion addressed this theory, explaining that for the underlying knee disability would need to be sufficiently severe to result in a clinically obvious Trendelenburg gait. The examiner found that this severity was not supported by the medical record, the Veteran's history, or the VA examination itself. Thus, the examiner concluded that the current low back condition was less likely related to the
 brief, the Veteran argues that the VA examiner is too literal and limited in their interpretation of the back being secondary to the Veteran's knee disabilities. The veteran argued that secondary service connection was warranted because his low back disability was due to more than a decade of improper ambulation, which resulted in additional stress on the back beyond the natural aging process. The Board disagrees. The Board finds that VA opinion addressed this theory, explaining that for the underlying knee disability would need to be sufficiently severe to result in a clinically obvious Trendelenburg gait. The examiner found that this severity was not supported by the medical record, the Veteran's history, or the VA examination itself. Thus, the examiner concluded that the current low back condition was less likely related to the Veteran's service-connected knee disabilities. While adverse, the VA opinion provided a clear explanation for why the Veteran's low back condition was less likely related to his service-connected knee disabilities, including the Veteran's argument that improper ambulation due to the Veteran's knee disabilities caused the Veteran's low back disability. 

The Veteran believes the claimed low back condition is due to or the result of 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 and pathology. 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 February 2022 VA examination.

Accordingly, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a low back condition is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Entitlement to service connection for right lower extremity radiculopathy 

3. Entitlement to service connection for left lower extremity radiculopathy

The Veteran asserts that he suffers from radicular symptoms in his right and left lower extremities as a result of his low back disability. 

Service connection may be established on a secondary basis for a disability resulting from a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023). 

The Board has carefully reviewed the evidence of record and finds that the evidence is persuasively against the claim for service connection for radiculopathy of the lower extremities. As discussed herein, the Veteran is not service connected for their back disability. Therefore, the Veteran's claim for service connection for radiculopathy of the lower extremities secondary to a back disability must be denied as a matter of law.

Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and entitlement to service connection for radiculopathy of the left and right lower extremities secondary to a back disability is not warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

REASONS FOR REMAND

1. Entitlement to an evaluation in excess of 30 percent for left knee osteoarthritis is remanded.

The Veteran seeks an increased rating for left knee osteoarthritis. Upon review of the claims file the Board finds that a pre-decisional duty to assist error has occurred that requires remand of the claims.

The Board notes overlapping claims with respect to the Veteran's claim for increased rating for the left knee and TDIU. Generally, a claimant may not file for a different kind of review while their initial review selection is pending, due to the rule against concurrent election. 38 C.F.R. § 3.2500 (b).

Here, the RO denied left knee and TDIU claims in June 2022 and September 2022 rating decisions.  The Veteran submitted a September 2023 VA Form 10182 appeal for entitlement to an increased rating for left knee disability and a TDIU
 the claims file the Board finds that a pre-decisional duty to assist error has occurred that requires remand of the claims.

The Board notes overlapping claims with respect to the Veteran's claim for increased rating for the left knee and TDIU. Generally, a claimant may not file for a different kind of review while their initial review selection is pending, due to the rule against concurrent election. 38 C.F.R. § 3.2500 (b).

Here, the RO denied left knee and TDIU claims in June 2022 and September 2022 rating decisions.  The Veteran submitted a September 2023 VA Form 10182 appeal for entitlement to an increased rating for left knee disability and a TDIU. These issues were already under review pending the June 2023 HLR request. The Board adjudicated the September 2023 VA Form 10182 appeal in an October 2025 Board decision that remanded these claims for additional development. The Board finds that the appeal for left knee and TDIU is properly before it, as the June 2023 HLR request was submitted prior to the VA Form 10182 appeal. In doing so, the Board will not disturb the October 2025 Board decision though it also notes that the evidence of record for both appeals is largely identical.

The Veteran was afforded a VA examination in September 2021. During the VA examination, the Veteran reported having flareups moderate in severity that occurred once every three months with symptoms lasting three to four days. He described them as a constant dull pain that is caused by excess mobility and alleviated by over-the-counter medicine, ice, heat, or Voltaren cream. However, the examiner did not provide an estimate range of motion during flareups.

In an August 2022 medical opinion, the examiner indicated he had no basis to offer additional losses of function or motion during flareups. Rather, he stated that, based on the lack of general knowledge among the medical community at large rather than due to his own personal aversion to offering an opinion not directly observed, he could only speculate the amount of loss of function or motion with flare ups. The Board finds this opinion to be inadequate as it failed to provide the information required to comply with the precedential decision Sharp v. Shulkin, 29 Vet. App. 26 (2017). While the examiner indicates that his speculation is a part of the broad medical community, it is known that, with direct observation, estimation can be rendered. Therefore, the RO should have obtained the examination that was previously cancelled so that the Veteran's condition could be observed. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate).

2. The claim for entitlement to a total disability based upon individual unemployability (TDIU) is remanded.

Finally, because a decision on the remanded issue of increased rating for left knee disability could significantly impact a decision on the issue of a TDIU, the issues are inextricably intertwined.  A remand of the claims for a TDIU is required.

The matters are REMANDED for the following action:

1. The AOJ should schedule the Veteran for a VA examination with an examiner with the appropriate expertise to determine the severity of all impairment that result from the Veteran right and left knee disabilities. The examiner must provide all information required for rating purposes, to include findings consistent with Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017).

If possible, the examiner should report range of motion findings in degrees, on both active and passive range of motion testing, in weightbearing and non-weightbearing circumstances, in the examination report. If there are flare-ups, but the examination is not conducted during a flare-up, the examiner should estimate the functional impairment of the flare-up, to include as due to pain, in terms of degrees lost from range of motion. Furthermore, if any opinion cannot be offered without resort to mere speculation, the examiner should clearly explain why this is the case and identify any additional evidence that may allow for a more definitive opinion.

In order to comply with Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use
. Furthermore, if any opinion cannot be offered without resort to mere speculation, the examiner should clearly explain why this is the case and identify any additional evidence that may allow for a more definitive opinion.

In order to comply with Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees.

 

 

M. MILLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Lauritzen

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.