INTERVERTEBRAL DISC SYNDROME

J. KIRBY · 2025 · Case ID: A25109766

DENIED

Summary

The Veteran served in the Army from May 1992 to December 1996, with subsequent service in 2006 and 2009. The Veteran sought service connection for a mechanical low back disorder, muscle spasms of the thoracolumbar spine, and a neck condition (cervicalgia), all claimed as secondary to existing service-connected left knee chondromalacia with patellofemoral pain syndrome, right knee degenerative meniscus, and right ankle status-post medial malleolus fracture repair. The Veteran argued that these service-connected knee and ankle conditions led to an altered gait, which in turn caused or aggravated the claimed back and neck conditions. The Board reviewed the evidence, including private and VA medical opinions. The Board found the August 2024 VA examiner's opinions to be more probative than the September 2020 private opinion. The VA examiner concluded that the Veteran's neck and back conditions, including degenerative disc disease and muscle spasms, were separate entities unrelated to the service-connected knee and ankle conditions. The examiner cited medical literature indicating that normal aging contributes to degenerative disc disease and that injuries to one joint do not typically cause significant impact on another uninjured joint or limb, especially when the service-connected injuries did not result in a significantly altered gait. The Board noted that the Veteran's claimed neck pain predated reports of a limp and was exacerbated by work-related lifting. The Board also found that the Veteran's lay testimony regarding the anatomical relationships between his knee/ankle conditions and his neck/back pain was outside his competence. The Board concluded that the evidence persuasively weighed against a finding that the claimed conditions were secondary to or aggravated by the service-connected disabilities. The benefit of the doubt doctrine was not applied as the evidence favored one side. Service connection for all claimed conditions was denied.

Rationale

August 2024 VA examiner opined low back disorder unrelated to service-connected knee/ankle conditions.; Medical literature does not support causal relationship between joint injuries and low back disorders via altered gait.; Veteran's claimed neck pain predated reports of limp; work-related lifting exacerbated pain.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241031-489168

Full Decision Text

Citation Nr: A25109766
Decision Date: 12/19/25 Archive Date: 12/19/25

DOCKET NO. 241031-489168
DATE: December 19, 2025

ORDER

Service connection for mechanical low back disorder is denied.

Service connection for a neck condition, to include cervalgia, is denied.

Service connection for muscle spasms of the thoracolumbar spine is denied.

FINDINGS OF FACT

1. The Veteran's mechanical low back disorder is not secondary to a service-connected disability.

2. The Veteran's neck condition is not secondary to a service-connected disability.

3. The Veteran's muscle spasms of the thoracolumbar spine are not secondary to a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for mechanical low back disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for a neck condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for muscle spasms of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the Army from May 1992 to July 1992, May 1993 to August 1993, March 1994 to December 1996, in April 2006, and in May 2009.

In September 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a September 2024 decision. In October 2024, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior September 2024 decision.

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

Therefore, the Board may only consider the evidence of record at the time of the September 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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.

Service Connection

Service connection on a direct basis requires (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995); see also Spicer v. McDonough
pertinent to service, establishes that the disease was incurred in service. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995); see also Spicer v. McDonough, 61 F.4th 1360 (2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

The Veteran seeks service connection for a low back disorder, muscle spasms, and neck pain, all secondary to a service-connected disability. See March 2021 VA 21-4138 Statement in Support of Claim. At the March 2021 HLR Conference, he contended that his low back disorder, thoracolumbar muscle spasm, and neck disorder are secondary to altered gait from his service-connected left knee chondromalacia with patellofemoral pain syndrome; right knee degenerative meniscus; and right ankle status-post medial malleolus fracture repair. 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 Veteran's representative argues that per Morton v. West and Hensley v. West, medical treatises "may serve to establish a "plausible," "possible," or "capability of substantiating" a "well-grounded claim," and that according to Arthritis and Allied Conditions 11th edition"... muscle weakness, joint disease and its associated pain, swelling, instability, contracture, or deformity, leg-length discrepancy, and postural deformities may lead to awkward, inefficient gait patterns that impose excessive strains on the joints." The Board recognizes that the concept of a "well-grounded claim" is outdated but generally acknowledges this argument. See, e.g., Harvey v. Shulkin, 30 Vet. App. 10, 20 (2018); see also McCray v. Wilkie, 31 Vet. App. 243, 257 (2019).

The AOJ made a favorable finding that the Veteran has current diagnoses of lumbosacral strain, spasms of the thoracolumbar spine, and cervicalgia with radiology findings of C5-6 endplate degenerative changes and mild uncovertebral hypertrophy) and primary service-connected left knee, right knee, and right ankle disabilities. VA also made a favorable finding of an in-service condition relating to thoracolumbar spasms (upper back swelling and pain on September 29, 1995). These are favorable findings and binding on the Board, absent clear and unmistakable error. See 38 C.F.R. § 3.104(c). Additionally, the Board concedes that the Veteran has been observed to have an altered gait. See September 2020 Back Disability Benefits Questionnaire; see also May 2021 Medical Opinion Disability Benefits Questionnaire.

Thus, the question for the Board is whether the Veteran's current disabilities are related to or aggravated by service-connected right knee, left knee, or right ankle disabilities. After review of the record, for the reasons discussed below, the Board concludes that the evidence of record persuasively weighs against findings that the Veteran's claimed neck, back, and muscle spasm disabilities are due to the result of or aggravated by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen, supra; 38 C.F.R. § 3.310(a).

Service connection for cervicalgia.

The Veteran submitted a September 2020 back, muscle injuries, and oneck disability benefits questionnaires completed by a private provider. The provider did not opine on the etiology of the neck condition.

In May 2021, the Veteran was afforded a VA neck examination. The examiner provided negative opinions addressing the causation prong of secondary service connection for the service-connected bilateral knee and right ankle disabilities, including the theory of altered gait. However, the examiner similarly used the invalidated evidentiary standard of proximate cause as set forth in Spicer and did not address aggravation.

The August 2024 VA examiner explained that the conditions of neck disorder and left knee chondromalacia with patellofemoral pain syndrome are not medically related. The Veteran is diagnosed
back, muscle injuries, and oneck disability benefits questionnaires completed by a private provider. The provider did not opine on the etiology of the neck condition.

The August 2024 VA examiner explained that the conditions of neck disorder and left knee chondromalacia with patellofemoral pain syndrome are not medically related. The Veteran is diagnosed with degenerative disc disease other than intervertebral disc syndrome (IVDS) and Bilateral Radiculopathy.

The examiner opined that neck disorder is a separate entity entirely from the left knee chondromalacia with patellofemoral pain syndrome and unrelated to it. He explained that over time, normal wear and tear can lead to degenerative disc "disease" with the development of small cracks and tears and/or loss of fluid in the discs. This can lead to changes in the neighboring spinal vertebrae, including the formation of bone spurs. The examiner opined that calling this condition a "disease" is somewhat misleading because these changes occur with normal aging, and there are many older people with degenerative disc disease who have no symptoms. The examiner explained that almost everyone has some disk degeneration after age 40, but it leads to back pain in about 5 percent of adults. Factors increasing the risk of degenerative disc disease include acute back injuries, obesity, smoking, and working a physically demanding job. Finally, the examiner opined that the Veteran's cervical degenerative disc disease with bilateral radiculopathy was not caused by altered gait from the service-connected left knee chondromalacia with patellofemoral pain syndrome and that a change in the Veteran's walking pattern has no degenerative effect on his neck, and that a thorough review of medical literature failed to demonstrate a causal relationship between degenerative disc disease, chondromalacia, and patellofemoral pain syndrome.

An August 2024 opinion for the neck condition also addressed whether it is related to a right knee condition. The examiner explained that the Veteran's claimed neck disorder is a separate entity entirely from the right knee degenerative meniscus and unrelated to it.

The examiner referenced the April 2021 VA examination which confirmed the diagnosis of degenerative disc disease other than intervertebral disc syndrome (IVDS) and bilateral radiculopathy, and explained that the diagnosis of cervicalgia was made in error as it is not a medical diagnosis of a pathological condition, but rather a medical term for "neck pain." The examiner explained that over time, normal wear and tear can lead to degenerative disc "disease" (breakdown of the spinal discs), with the development of small cracks and tears and/or loss of fluid in the discs. This can lead to changes in the neighboring spinal vertebrae, including the formation of bone spurs. As stated above, the examiner explained that calling this condition a "disease" is somewhat misleading because these changes occur with normal aging, that there are many older people with degenerative disc disease who have no symptoms, and that almost everyone has some disk degeneration after age 40, but it leads to back pain in about 5 percent of adults.

The examiner explained that the Veteran's cervical degenerative disc disease with bilateral radiculopathy was not caused by altered gait from the service-connected right knee degenerative meniscus because medical literature failed to demonstrate a causal relationship between degenerative disc disease and right knee meniscus degeneration.

As to the Veteran's contention that his neck condition is secondary to the service-connected right ankle status-post medial malleolus fracture repair, the August 2024 examiner explained that the Veteran's neck disorder and right ankle status-post medial malleolus fracture repair are not medically related. The examiner again explained that normal wear and tear can lead to degenerative disc "disease" and that changes occur with normal aging, and there are many older people with degenerative disc disease who have no symptoms (1). Finally, the examiner opined that Veteran's cervical degenerative disc disease with bilateral radiculopathy was not caused by altered gait from the service-connected right ankle status-post medial malleolus fracture repair, and that a thorough review of medical literature failed to demonstrate a causal relationship between degenerative disc disease and residuals s/p repair of ankle fracture.

Significantly, the Veteran states that he has had neck pain since 2012. See July 2019 VA Treatment record. The pain was exacerbated by the lifting related to his job at a bowling alley
tear can lead to degenerative disc "disease" and that changes occur with normal aging, and there are many older people with degenerative disc disease who have no symptoms (1). Finally, the examiner opined that Veteran's cervical degenerative disc disease with bilateral radiculopathy was not caused by altered gait from the service-connected right ankle status-post medial malleolus fracture repair, and that a thorough review of medical literature failed to demonstrate a causal relationship between degenerative disc disease and residuals s/p repair of ankle fracture.

The August 2024 VA examiner also opined that it is less than likely that the Veteran's cervical degenerative disc disease with bilateral radiculopathy underwent any incremental increase in disability, regardless of its permanence, due to right ankle surgical scar, status post left inguinal hernia repair with scar. The rationale was that scars on separate body areas (right ankle and left inguinal region) do not affect the cervical spine, and the scars do not limit range of motion and do not cause altered gait. The severity of the claimed condition is not related to the service-connected condition.

The Veteran's cervical degenerative disc disease with bilateral radiculopathy was not caused by right ankle surgical scar, status post left inguinal hernia repair with scar and left knee surgical scars. A thorough review of medical literature failed to demonstrate a causal relationship between degenerative disc disease and any scar.

The August 2024 VA examiner also explained that the Veteran's neck condition was not aggravated beyond its natural progression by the service-connected condition of right knee degenerative meniscus. It is less than likely that the Veteran's cervical degenerative disc disease with bilateral radiculopathy underwent any incremental increase in disability, regardless of its permanence, due to an altered gait from the service-connected right knee degenerative meniscus. The examiner explained that a change in the Veteran's walking pattern would not affect his neck, and thus the severity of the claimed condition is not related to the service-connected condition, its treatment, or altered gait.

The August 2024 examiner also opined that the Veteran's right ankle condition did not aggravate his nonservice-connected neck condition. The examiner explained that a change in the Veteran's walking pattern would not affect his neck, or cause any incremental increase in disability, regardless of its permanence, due to an altered gait from the service-connected right ankle status-post medial malleolus fracture repair. The examiner opined that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait (defined as 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) based on record review, history or exam. Thus, the severity of the claimed condition is not related to the service-connected condition, its treatment, or altered gait.

Regarding the Veteran claims that cervical degenerative disc disease with bilateral radiculopathy was aggravated beyond its natural progression by the service-connected condition of left knee chondromalacia with patellofemoral pain syndrome, the August 2024 VA examiner opined that it is less than likely that the Veteran's cervical degenerative disc disease with bilateral radiculopathy underwent any incremental increase in disability, regardless of its permanence, due to an altered gait from the service-connected left knee chondromalacia with patellofemoral pain syndrome. A change in the Veteran's walking pattern would not affect his neck. Again, the examiner explained that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait (defined as 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) based on record review, history or exam. Thus, the severity of the claimed condition is not related to the service-connected condition, its treatment, or altered gait.

Overall, the Board finds the August 2024 VA opinions more probative than the September 2020 private opinion of record. As explained above, the examiner did not offer an opinion on secondary service connection for the neck condition. The August 2024 VA examiner provided opinions with adequate rationale. Nieves
another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait (defined as 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) based on record review, history or exam. Thus, the severity of the claimed condition is not related to the service-connected condition, its treatment, or altered gait.

Overall, the Board finds the August 2024 VA opinions more probative than the September 2020 private opinion of record. As explained above, the examiner did not offer an opinion on secondary service connection for the neck condition. The August 2024 VA examiner provided opinions with adequate rationale. 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). As the opinions were based on accurate facts and they reflect consideration of the Veteran's medical history in conjunction with medical principles, the Board finds the August 2024 opinions are entitled to significant probative weight as to the etiology of the Veteran's claimed disabilities. Nieves-Rodriguez, supra.

The evidence does not support left knee chondromalacia with patellofemoral pain syndrome, right knee degenerative meniscus, or right ankle status-post medial malleolus fracture repair or medications taken for treatment of the conditions, or altered gait impacted the neck condition since the evidence shows that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait. Additionally, there are no opinions of record supporting the theory that the Veteran's neck condition was secondary to or aggravated by a service-connected condition, to include altered gait.

The Board acknowledges that the Veteran believes the claimed neck disability is due to or the result of or aggravated by a service-connected disability. While the Veteran may report his experienced symptoms, the issue is medically complex, as it requires knowledge of anatomical relationships. 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).

Accordingly, the appeal is denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence persuasively favors one side or the other, the doctrine is not for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc); 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Service connection for muscle spasms of the thoracolumbar spine.

The Veteran claims thoracolumbar muscle spasm secondary to the service connected condition of left knee, right knee, and right ankle conditions. The Veteran is diagnosed with thoracolumbar muscle spasm.

The Veteran submitted September 2020 back, muscle injuries, and neck disability benefits questionnaires completed by a private provider. The provider did not opine on the etiology of the thoracolumbar muscle spasm condition.

The Veteran was afforded VA back and muscle injuries examinations in December 2020. The examiner opined that the muscle spasm disorder was less likely due to the service-connected left knee but did not address a theory of altered gait (or relation to service-connected right knee or right ankle disabilities). Problematically, the examiner failed to address the aggravation prong of secondary service connection. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (holding that a medical opinion that only addresses whether a service-connected disability caused a nonservice-connected disability does not address whether the former aggravated the latter). The examiner also used the invalidated evidentiary standard of proximate cause. See Spicer, supra.

The May 2021 examiner provided negative opinions addressing direct and secondary service connection. Although the examiner did address all relevant contentions, the opinions for causation under secondary service connection used the invalidated evidentiary standard of proximate cause. Based on the preceding, VA failed to obtain adequate opinions addressing aggravation of the back disability by the service-connected bilateral knee and right ankle disabilities; causation of the muscle spasms by the service-connected disabilities;
26 Vet. App. 136 (2013) (holding that a medical opinion that only addresses whether a service-connected disability caused a nonservice-connected disability does not address whether the former aggravated the latter). The examiner also used the invalidated evidentiary standard of proximate cause. See Spicer, supra.

The May 2021 examiner provided negative opinions addressing direct and secondary service connection. Although the examiner did address all relevant contentions, the opinions for causation under secondary service connection used the invalidated evidentiary standard of proximate cause. Based on the preceding, VA failed to obtain adequate opinions addressing aggravation of the back disability by the service-connected bilateral knee and right ankle disabilities; causation of the muscle spasms by the service-connected disabilities; and causation and aggravation of the neck disability by the service-connected disabilities. Therefore, the Board remanded the claims in August 2024 for further development.

The August 2024 VA examiner explained that the Veteran's muscle spasm is not caused by his left knee, right knee, or right ankle conditions. The conditions of thoracolumbar muscle spasm and left knee, right knee, and right ankle conditions are not medically related. Muscle spasms (cramps) are painful contractions and tightening of muscles that are common, involuntary and unpredictable. Causes of back spasms include not using muscles enough (too much sitting, poor posture, weakened abominable core strength, lack of exercise) or using your muscles too much (athletes, heavy lifting), dietary issues (dehydration, electrolyte imbalance) or trauma. The examiner explained that thoracolumbar muscle spasm was not caused by altered gait from service connected knee or ankle conditions. Thus, the thoracolumbar muscle spasm is a separate entity entirely from the left and right knee, or right ankle conditions and unrelated to it.

After reviewing the claims file, the August 2024 examiner also explained that there was no evidence to support the claim that left knee chondromalacia with patellofemoral pain syndrome, right ankle status-post medial malleolus fracture repair, right knee condition, medication taken for treatment of the condition, or altered gain will impact the claimed muscle spasm condition, and that it was less likely that the Veteran's muscle spasm was caused by, aggravated beyond its natural progression or underwent any incremental increase in disability, regardless of its permanence, and the severity of the condition is not related to the Veteran's right or left knee condition or right ankle conditions. The examiner referenced medical articles to support her opinion.

As stated above, the August 2024 examiner noted, the private examiner diagnosed the Veteran's with muscle spasms in the September 2020 Muscle Injuries Disability Benefits Questionnaire, with onset after "loading up equipment hurt his upper back, didn't go to doctor took ibuprofen, but has hurt since." The examiner, however, did not offer an opinion relating the Veteran's muscle spasm disorder to a service-connected condition.

The VA examiner ultimately opined that it is less than likely that the Veteran's thoracolumbar muscle spasm underwent any incremental increase in disability, regardless of its permanence, due to left knee chondromalacia with patellofemoral pain syndrome, right knee degenerative meniscus, or right ankle status-post medial malleolus fracture repair. The severity of the claimed condition is not related to any of the service-connected conditions.

Overall, the Board finds the August 2024 VA opinions probative, as they contained adequate rationale. Nieves-Rodriguez; Barr; Stefl; Prejean. As the opinions were based on accurate facts and they reflect consideration of the Veteran's medical history in conjunction with medical principles, the Board affords the August 2024 opinions significant probative value as to the etiology of the Veteran's claimed disabilities. Nieves-Rodriguez, supra.

The evidence does not support left knee chondromalacia with patellofemoral pain syndrome, right knee degenerative meniscus, or right ankle status-post medial malleolus fracture repair or medications taken for treatment of the conditions, or altered gait impacted the muscle spasm condition since the evidence shows that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait. Additionally, there are no opinions of record supporting the theory that the Veteran's muscle spasm condition was secondary to or aggravated by a service-connected condition, to include altered gait.

The Board acknowledges that the Veteran believes the claimed muscle spasm disability is due to or the result of or aggravated by a service-connected disability. While the Veteran may report his experienced symptoms, the issue is medically complex, as it requires knowledge of anatomical relationships. It is outside the competence of the Veteran in this case because the
gait impacted the muscle spasm condition since the evidence shows that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait. Additionally, there are no opinions of record supporting the theory that the Veteran's muscle spasm condition was secondary to or aggravated by a service-connected condition, to include altered gait.

Service connection for mechanical low back disorder.

In the description of the Veteran's medical history, the September 2020 private examiner documented that the Veteran's knee surgery and pain caused gait abnormality, which caused lower back pain. The examiner documented the Veteran's date of diagnosis as September 2020. The examiner did not offer rationale for his opinion. Additionally, the Veteran's treatment records show complaints of and treatment for low back pain in October 2018. See October 2018 VA treatment record. A January 2019 treatment record documents chronic low back pain.

Regarding the Veteran claims that the Veteran's low back condition is secondary to a service-connected condition, the August 2020 VA examiner opined that there is no evidence to support left knee chondromalacia with patellofemoral pain syndrome, right knee degenerative meniscus, and right ankle status-post medial malleolus fracture repair or medications taken for treatment of the conditions will impact the claimed condition.

There is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait (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) based on record review, history or exam.

The Veteran was afforded VA back and muscle injuries examinations in December 2020. The examiner opined that the low back disorder was less likely due to the service-connected left knee but did not address a theory of altered gait (or relation to service-connected right knee or right ankle disabilities). Problematically, the examiner failed to address the aggravation prong of secondary service connection. See El-Amin. The examiner also used the invalidated evidentiary standard of proximate cause. See Spicer, supra.

The AOJ obtained an additional opinion regarding the back in May 2021. The negative opinions address causation under secondary service connection due to the service-connected disabilities (including altered gait), as well as aggravation from the left knee and right ankle (but not the right knee). The latter indicates that temporary aggravation is plausible without any explanation. The examiner used the invalidated evidentiary standard of permanent aggravation. See Ward, supra.

Regarding the Veteran's claim that his low back disorder was aggravated beyond its natural progression by the service-connected condition of left knee chondromalacia with patellofemoral pain syndrome, the August 2024 examiner also opined that it was less likely that the Veteran's low back disorder was aggravated beyond its natural progression by the claimed conditions. The examiner stated that review of orthopedic literature does not support that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait (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) based on record review, history or exam.

Additionally, the examiner opined that the Veteran's low back disorder was not aggravated beyond its natural progression by the service-connected condition of right ankle surgical scar, status post left inguinal hernia repair with scar and left knee surgical scars. There is no evidence to support right ankle surgical scar, status post left inguinal hernia repair with scar and left knee surgical scars will impact the claimed condition. Scars on separate body areas do not affect the thoracolumbar spine. The scars do not limit range of motion and do
a significantly altered gait (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) based on record review, history or exam.

Additionally, the examiner opined that the Veteran's low back disorder was not aggravated beyond its natural progression by the service-connected condition of right ankle surgical scar, status post left inguinal hernia repair with scar and left knee surgical scars. There is no evidence to support right ankle surgical scar, status post left inguinal hernia repair with scar and left knee surgical scars will impact the claimed condition. Scars on separate body areas do not affect the thoracolumbar spine. The scars do not limit range of motion and do not cause altered gait. The severity of the claimed condition is not related to the service-connected condition.

Aggravation of the Veteran's low back pain was related to lifting related to his job at the bowling alley in an August 2019 VA treatment record.

Overall, the Board finds the August 2024 VA opinions more probative than the September 2020 private opinion of record. As explained above, the examiner did not offer rationale on the opinion offered for etiology of the claimed back condition. The August 2024 VA examiner provided opinions with adequate rationale. Nieves-Rodriguez; Barr; Stefl; Prejean. As the opinions were based on accurate facts and they reflect consideration of the Veteran's medical history in conjunction with medical principles, the Board finds they are entitled to significant probative weight as to the etiology of the Veteran's claimed disabilities. Nieves-Rodriguez, supra. Thus overall, the Board affords more weight to the August 2024 VA examinations of record than the September 2020 private opinion.

The evidence does not support left knee chondromalacia with patellofemoral pain syndrome, right knee degenerative meniscus, or right ankle status-post medial malleolus fracture repair or medications taken for treatment of the conditions, or altered gait impacted the low back condition since the evidence shows that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb as the Veteran's service-connected injuries did not result in a significantly altered gait.

The Board acknowledges that the Veteran believes the claimed back disability is due to or the result of 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; Kahana.

J. Kirby

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T.B.

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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