INTERVERTEBRAL DISC SYNDROME

Summary

The veteran, a Marine Corps veteran who served from June 1985 to June 1986, appeals the denial of service connection for several conditions, including lumbar spine disability with radiculopathy, cervical spine disability with radiculopathy, migraine headaches, left shoulder disability, right knee disability, and right hip disability. The veteran claimed the spine and headache conditions were due to service, with the latter two being secondary to the spine conditions. Service treatment records indicated a low back injury in May 1986, diagnosed as mild mechanical lumbar strain, with no cervical spine injury noted. However, private medical opinions from Dr. D.D. and Dr. T.J.S. linked the low back injury to current lumbar spine disability and subsequent cervical spine issues and cervicogenic headaches, opining a service connection was more likely than not. The VA examiner, while acknowledging the in-service low back injury, found insufficient objective evidence to link current lumbar disc disease to it, citing a lack of continuity of symptoms and intervening events. The VA examiner also found the cervical spine and headache claims less likely than not secondary to service, though noted the cervical condition aggravated the migraines. The Board found the private opinions more persuasive than the VA examiner's negative nexus, resolving doubt in the veteran's favor. Consequently, service connection for lumbar spine disability with radiculopathy, cervical spine disability with radiculopathy (secondary to lumbar spine), and migraine headaches (secondary to cervical spine) were granted. Claims for left shoulder, right knee, and right hip disabilities were denied due to lack of current diagnosis or functional impairment, despite private opinions suggesting a connection.

Rationale

In-service low back injury documented in May 1986.; Persuasive private medical opinions linking current disability to in-service injury.; Resolving reasonable doubt in favor of the Veteran.

Full Decision Text

Citation Nr: A25109807
Decision Date: 12/19/25	Archive Date: 12/19/25

DOCKET NO. 250131-515583
DATE: December 19, 2025

ORDER

The claim of service connection for a lumbar spine disability with radiculopathy of the bilateral lower extremities is granted. 

The claim of service connection for a cervical spine disability with radiculopathy of the left upper extremity, to include as secondary to the lumbar spine disability, is granted.

The claim of service connection for migraine headaches, to include as secondary to the cervical spine disability, is granted. 

The claim of service connection for a left shoulder disability, to include as secondary to the cervical spine disability, is denied.

The claim of service connection for a right knee disability, to include as secondary to the lumbar spine disability, is denied.

The claim of service connection for a right hip disability, to include as secondary to the lumbar spine disability, is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in favor of the Veteran, the evidence supports the finding that his lumbar spine disability with radiculopathy of the bilateral lower extremities is due to his active-duty service.

2. Resolving reasonable doubt in favor of the Veteran, the evidence supports the finding that his cervical spine disability with radiculopathy of the left upper extremity is due to his service-connected lumbar spine disability.

3. Resolving reasonable doubt in favor of the Veteran, the evidence supports the finding that his migraine headaches are due to his service-connected cervical spine disability.

4. The competent medical evidence does not demonstrate a current diagnosis of a left shoulder disability.

5. The competent medical evidence does not demonstrate a current diagnosis of a right knee disability.

6. The competent medical evidence does not demonstrate a current diagnosis of a right hip disability.

CONCLUSIONS OF LAW

1. The criteria for service connection of a lumbar spine disability with radiculopathy of the bilateral lower extremities have been met.  38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

2.  The criteria for service connection of a cervical spine disability with radiculopathy of the left lower extremity, to include as secondary to the lumbar spine disability, have been met.  38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

3. The criteria for service connection of migraine headaches, to include as secondary to the cervical spine disability, have been met.  38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

4. The criteria for service connection for a left shoulder disability, to include as secondary to the service-connected cervical spine disability, have not been met.  38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

5. The criteria for service connection for a right knee disability, to include as secondary to the service-connected lumbar spine disability, have not been met.  38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

6. The criteria for service connection for a right hip disability, to include as secondary to the service-connected lumbar spine disability, have not been met.  38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from June 1985 to June 1986.

These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2020 Rating Decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2020, the Veteran simultaneously filed a VA Form 9 Appeal

to Board of Veterans' Appeals and a VA Form 20-0996 request for Higher-Level

Review.  In April 2020 correspondence, VA notified the Veteran that the VA Form

20-0996 was incomplete, and that
, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from June 1985 to June 1986.

These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2020 Rating Decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2020, the Veteran simultaneously filed a VA Form 9 Appeal

to Board of Veterans' Appeals and a VA Form 20-0996 request for Higher-Level

Review.  In April 2020 correspondence, VA notified the Veteran that the VA Form

20-0996 was incomplete, and that it was unable to process the request for higher

review.  No action was taken on the VA Form 9.

In March 2021, the Veteran timely filed a VA Form 10182, Decision Review

Request: Board Appeal (Notice of Disagreement) and elected the Evidence

Submission docket.  

The Board remanded the appeal for additional development in February 2024.  Specifically, the Veteran requested a copy of the February 2019 VA examiner's curriculum vitae. 

Following compliance with the February 2024 Board remand, a November 2024 rating decision denied the claims. 

The Veteran filed a timely appeal to the Board (VA Form 10182) in January 2025 selecting Direct Review Docket.  Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.

Service Connection

Under the laws administered by VA, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a).  Service connection may also be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred during service.  38 C.F.R. § 3.303(d).

Generally, the evidence 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.  38 C.F.R. §§ 3.303 (a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may be established under the provisions of 38 C.F.R. §§ 3.303(b) when the evidence, regardless of its date, shows that a veteran had a chronic condition in service, such as arthritis, or during the applicable presumptive period. In addition, certain chronic diseases may be presumed to have been incurred or aggravated during service if they become disabling to a compensable degree within one year of separation from active duty.  38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.

For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time.  If chronicity is not established, then a showing of continuity of symptomatology after discharge is required to support the claim.  38 C.F.R. § 3.303 (b).  However, the regulatory provisions pertaining to chronicity and continuity of symptomatology are constrained by 38 C.F.R. § 3.309 (a), and, thus, such provisions are only available to establish service connection for the specific chronic diseases listed in 38 C.F.R. §§ 3.309 (a).  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

In addition, service connection may also be established on a secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disability.  38 C.F.R. § 3.310 (a).

Cervical and lumbar spine disabilities

Migraine headaches, to include as secondary to cervical spine disability

The Veteran contends that his cervical and lumbar spine disabilities were the result of his military service.  He also contends that his migraine headaches are secondary to his cervical spine disability.

Turning to the evidence of record, the Veteran's service treatment records reflect that he reported low back pain in May 1986 after unloading a truck.  He stated that afterwards his back felt tight and when he awoke his back began to hurt.  There was difficult with
 secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disability.  38 C.F.R. § 3.310 (a).

Cervical and lumbar spine disabilities

Migraine headaches, to include as secondary to cervical spine disability

The Veteran contends that his cervical and lumbar spine disabilities were the result of his military service.  He also contends that his migraine headaches are secondary to his cervical spine disability.

Turning to the evidence of record, the Veteran's service treatment records reflect that he reported low back pain in May 1986 after unloading a truck.  He stated that afterwards his back felt tight and when he awoke his back began to hurt.  There was difficult with his bowels and bladder as well as numbness and tingling to his lower extremities.  The pain was localized to his lower back.  Mild mechanical lumbar strain was indicated.  While his service treatment records within claims file are limited, there is no evidence of complaints, treatment or diagnosis of a cervical spine injury or diagnosis. 

VA treatment records dated May 2013 reflect that the Veteran reported left neck pain radiating to the shoulder and right lumbar spine radiating to the right upper buttock.  He stated he has experienced pain since he was in the military.  

In an August 2015 letter from Dr. D.D., the Veteran's private chiropractor, stated that the Veteran's low back injury during service in May 1986 led to his current low back disability.  The Veteran reported that he was discharged from service shortly after in June 1986 while he was still recovering from his back injury.  Furthermore, Dr. D.D. stated that the Veteran started experiencing left neck pain and severe headaches in 2006.  Following a review of the Veteran's service medical records, his medical history, and an examination Dr. D.D. opined that the Veteran's neck pain was secondary to his low back pain.  Dr. D.D. stated that "Since injuring his low back in service and lack of treatment the [V]eteran has altered his posture and biomechanics."  As a result of the neck pain, it is "more likely than not the [V]eteran's neck condition is directly related to the injury in service... and migraines are secondary to the neck pain."

In June 2017, the Veteran submitted a back condition report from Dr. T.J.S., a private physician, where a diagnosis of lumbosacral strain, degenerative disc disease (DDD), and intervertebral disc syndrome (IVDS) was confirmed.  The onset was noted as the 1986 in-service injury and the condition continued to degenerate.  According to a neck condition report, Dr. T.J.S. confirmed a diagnosis of cervical spondylosis, DDD, foraminal stenosis/central stenosis, and radiculopathy.  Dr. T.J.S. determined that the onset was secondary to the thoracolumbar spine condition in 1996 and has continued to degenerate since then.  Dr. T.J.S.'s headache report indicated a diagnosis of cervicogenic headaches (CGH) where the Veteran's thoracolumbar spine injury in service led to lumbar spondylosis which in turn led to the development of secondary cervical spondylosis, and subsequently resulting in cervicogenic headaches.

In a letter accompanying the reports, Dr. T.J.S. opined that the Veteran's thoracolumbar spine condition was "as likely as not" related to the May 1986 injury during service.  Regarding the Veteran's cervical spine disability, Dr. T.J.S. opined that it was the result of the thoracolumbar spine disability.  While citing medical literature, Dr. T.J.S. stated:

The "spatial interrelationship of thoracolumbar and cervical spine columns"... allows for pathological transmission of force along the vertebral column so that "regional spinal pathologies... can have significant impact beyond the region of focus... It is believed that "cervical deformity may present concomitantly with thoracolumbar deformity and represent ... a compensatory measure resulting from thoracolumbar deformity"... As such, after a review of the pertinent records and medical literature, and after conducting a history and physical exam, it is my professional medical opinion that it is as likely as not that [the Veteran's] cervical spine condition is service connected as secondary to his thoracolumbar spine condition.

Regarding the Veteran's CGH, Dr. T.J.S. explained:

The signs and symptoms that [the Veteran] exhibits are very consistent and characteristic of his condition.  His headache pain can be precipitated by sustained awkward head positioning as well as external pressure over the right occipital region.  During
 may present concomitantly with thoracolumbar deformity and represent ... a compensatory measure resulting from thoracolumbar deformity"... As such, after a review of the pertinent records and medical literature, and after conducting a history and physical exam, it is my professional medical opinion that it is as likely as not that [the Veteran's] cervical spine condition is service connected as secondary to his thoracolumbar spine condition.

Regarding the Veteran's CGH, Dr. T.J.S. explained:

The signs and symptoms that [the Veteran] exhibits are very consistent and characteristic of his condition.  His headache pain can be precipitated by sustained awkward head positioning as well as external pressure over the right occipital region.  During a headaches he has ipsilateral neck pain as well as restriction of neck range of motion....CGH is referred pain from the cervical spine... where this [V]eteran has a known condition.  As such, after a review of the pertinent records and medical literature, and after conducting a history and physical exam, it is my professional medical opinion that it is as likely as not that [the Veteran's] cervicogenic headache condition is service connected as secondary to his cervical spine condition. 

In January 2019, the Veteran was afforded VA examination of the lumbar and cervical spine disabilities.  The VA examiner determined that the Veteran was diagnosed with IVDS of the lumbar spine, lumbar disc disease, and radiculopathy of the bilateral sciatic nerve.  The VA examiner that the records reflect an injury to the Veteran's low back in May 1986.  However, a negative nexus was provided where the VA examiner explained:

[The Veteran] was diagnosed with mild mechanical low back strain [in service]. There is, however, no additional documentation in the [service treatment records] after that visit to suggest the development of chronic symptoms.  Though the [V]eteran separated 8 days after this event, there is no documentation of low back pain in the year following military service.  There is therefore no objective evidence to suggest a chronic condition during military service or in the year following.  The [V]eteran was without healthcare for many years

after service but even after initiating VA healthcare in 2010 there is no

documentation of back pain at first visit in [October 2010] or next several visits in [August 2011] or [January 2012].  It [was not] until 2 years after entering the VA healthcare system that he reported low back pain in conjunction with prolonged sitting at work, with persistence and progression of symptoms after that time. Additionally, there is documentation in 2016 of a specific injury while pushing his disabled daughter during which he felt a pop in his back with MRI then showing disc extrusion.  As such, there is insufficient objective evidence to link his current diagnosis of lumbar disc disease to the mild back pain during military service, and the at least as likely as not criteria has not been objectively met.

The VA examiner further explained:

Though the letter of support from [Dr. T.J.S.] gives the opinion that

the [V]eteran's back condition is related to service as a primary condition, it does [not] reasonably address the fact that there is no objective evidence following the single documentation of low back pain in in [May 1986] of any ongoing low back symptoms until more than 25 years later.  It also does not address the facts that VA records first document low back pain in 2012 in association with prolonged sitting at work or the acute back injury/symptoms occurring in 2016 after pushing his daughter that led to the MRI diagnosis of disc

extrusion.  The letter of support from the [V]eteran's chiropractor Dr. D.D. similarly does not address the above issues.

Regarding the Veteran's headaches, the VA examiner confirmed a diagnosis of migraine including migraine variants.  Following a review of the evidence of record, the Veteran's lay statements, and an examination, the VA examiner stated:

Based upon the data documented above, it appears that the veteran's migraines began prior to significant neck/back pain and are less likely as not secondary to his spine disease.  However, migraine frequency/severity does seem to have escalated in conjunction with worsening of his neck [symptoms] and there is now significant documentation of cervical disc disease/arthritis.  It is as likely as not that the [V]eteran's diagnosis of migraine headaches is aggravated by his diagnosis of cervical disease.

In March 2021, following examinations of the low back, neck, and migraine the Veteran submitted a letter from Dr. D.D. discussing the etiology of the Veteran's disabilities. 

Beginning with the low back disability, Dr. D.D. stated that the Veteran injured his back during service, placed on light duty, and discharged shortly thereafter.
 neck/back pain and are less likely as not secondary to his spine disease.  However, migraine frequency/severity does seem to have escalated in conjunction with worsening of his neck [symptoms] and there is now significant documentation of cervical disc disease/arthritis.  It is as likely as not that the [V]eteran's diagnosis of migraine headaches is aggravated by his diagnosis of cervical disease.

In March 2021, following examinations of the low back, neck, and migraine the Veteran submitted a letter from Dr. D.D. discussing the etiology of the Veteran's disabilities. 

Beginning with the low back disability, Dr. D.D. stated that the Veteran injured his back during service, placed on light duty, and discharged shortly thereafter.  Dr. D.D. stated that "The repetitive motion of twisting from right and left while catching and tossing a heavy bag is no surprise that the [V]eteran had back pain.  Twisting can overstretch the muscles and could cause inflammation to the lumbar anatomy (muscle, ligaments, tendons etc.)  The inflammation can cause pain the back from the trauma.  He was unable to receive health insurance after being discharged so his low back was never addressed right after, and he continued to be in the reserved causing more physical stress on the low back.

Dr. D.D. stated that the Veteran started to experience severe migraines and "that was the primary pain he wanted to address when he first found out he was eligible for treatment at the VA."  Dr. D.D. expressed disagreement with the VA examiner's assessment that the VA treatment records first reflected low back pain after an injury after pushing his disabled daughter.  The imaging revealed the Veteran had disc extrusion as well as DDD.  However, "DDD takes many years to develop and most likely than not did not develop from the injury with his daughter."  Dr. D.D. added that "I had also been seeing the [Veteran] in 2015, before the injury and it was documented that he had low back pain and spasm.  There is also documentation in his VA file in 2014 that he had complaints of low back pain.  This is evidence of a pre-existing condition before the incident with his daughter that was in 2016."  Therefore, Dr. D.D. opined that it was "more likely than not that [the Veteran's] low back condition originated in service... the incident with his daughter was not the first injury to his low back [it] is an aggravation of a previous back condition." 

Finally, Dr. D.D. expressed agreement with Dr. T.J.S.'s opinion that the Veteran's cervical spine disability was "more likely than not secondary to the thoracolumbar condition... the posterior chain not only is in relationship with the low back and the lower extremities but the entire posterior body.  If there is dysfunction occurring in the lumbar spine, often posture and gait are altered and the muscle imbalances continue to occur."  Dr. D.D. referred to Dr. T.J.S.'s opinion which cited to medical literature that "the spatial interrelationship of thoracolumbar and cervical spine columns allows for pathological transmission of force along the vertebral column so that the regional spinal pathologies... can have significant impact beyond the region of focus."  Additionally, the tightness and tension in the Veteran's neck "it can progress into a migraine." 

Given the above, the Board resolves any reasonable doubt in favor of the Veteran and finds that the Veteran's low back disability was the result of a May 1986 in-service injury.  As the Veteran's lumbar spine disability is service-connected, the Veteran's claim of service connection for the cervical spine disability is too, granted.  Furthermore, the Board finds that as the Veteran's cervical spine disability is now service-connected, the evidence of record supports the finding that the Veteran's current migraine headaches are secondary to his cervical spine disability. 

The Board has carefully considered the evidence of record, the Veteran's lay statements, as well as the opinions of the VA examiner, Dr. D.D., and Dr. T.J.S.  However, after comparing the positive and negative opinions, the Board does not find the rationale of the negative opinion to be so compelling as to outweigh the conclusion of Dr. D.D. and Dr. T.J.S.  As such, the weight of the evidence is in at least relative equipoise.  Therefore, service connection a lumbar spine disability with radiculopathy; a cervical spine disability, to include as secondary to the service-connected lumbar spine disability; and migraines, to include as secondary to the service-connected cervical spine disability, is granted.

Additionally, the Board grants service connection of radiculopathy of the bilateral lower extremities as a result of the service-connected lumbar spine disability and radiculopathy of the
  However, after comparing the positive and negative opinions, the Board does not find the rationale of the negative opinion to be so compelling as to outweigh the conclusion of Dr. D.D. and Dr. T.J.S.  As such, the weight of the evidence is in at least relative equipoise.  Therefore, service connection a lumbar spine disability with radiculopathy; a cervical spine disability, to include as secondary to the service-connected lumbar spine disability; and migraines, to include as secondary to the service-connected cervical spine disability, is granted.

Additionally, the Board grants service connection of radiculopathy of the bilateral lower extremities as a result of the service-connected lumbar spine disability and radiculopathy of the left upper extremity as a result of the service-connected cervical spine disability.

The Veteran's service-connected lumbar and cervical spine disability will be rated under the General Rating Formula for Disease and Injuries of the Spine.  38 C.F.R. § 4.71A.  Note (1) to the General Rating Formula directs VA to evaluate any objective neurologic abnormalities associated with spine disabilities - such as radiculopathy - separately, under an appropriate Diagnostic Code.  See 38 C.F.R. § 4.71A.

Here, the evidence of record reflects the Veteran has signs and symptoms of radiculopathy involving the left C5/C6, upper radicular group, nerve root and bilateral L4/L5/S1/S2/S3, sciatic, nerve root. 

Therefore, the Board has recharacterize the issues to include radiculopathy. 

Left shoulder disability, to include as secondary to the cervical spine disability

Right hip and right knee disabilities, to include as secondary to the lumbar spine disability

The Veteran contends that his left shoulder, right hip, and right knee disabilities are the result of his now service-connected disabilities of the lumbar spine or cervical spine disabilities. 

The service treatment records, dated January 1987 and February 1987, reflected that while the Veteran was serving in the reserves the Veteran reported a history of right knee pain.  Probable patellar bursitis was indicated. 

According to the August 2015 letter from Dr. D.D., the Veteran stated his right knee was injured while "running hilly terrain."  The Veteran had a right hip and right knee disability.  Dr. D.D. stated "I have reviewed the [Veteran's] service medical record and based on the [V]eteran's medical records, medical history, my examination and the [V]eteran's current diagnosis, I believe that the low back pain is more likely than not directly related to injury in service while the right hip and knee are secondary to the low back injury."  Dr. D.D. further stated that the Veteran left shoulder had decreased range of motion and opined that the left shoulder pain was secondary to his neck. 

The Veteran was afforded VA examinations of the knees shoulder, and hip in January 2019 where the VA examiner determined that the Veteran did not have a current diagnosis of these disabilities.  Imaging of the right knee and the right hip did not reveal degenerative or traumatic arthritis.  The VA examiner explained "There is no primary diagnosis of a chronic hip condition/disability.  Based upon history and physical exam, hip pain appears to be radicular related to his low back condition.  Right hip imaging today is negative."  Regarding the left shoulder, the VA examiner stated "There is no primary diagnosis of a left shoulder condition/disability.  Based upon history and physical exam, left shoulder pain appears to be radicular related to his neck condition.  There is some pain with shoulder movement but the pain is in the left neck/trapezius musculature.  Specific exam of the left shoulder is normal."  Furthermore, regarding the right knee disability, the VA examiner explained:

[T]here is a single episode of right knee pain, diagnosed as bursitis, documented in the [service treatment records] [January 1987].  There is no evidence in the available [service treatment records] that there were chronic complaints of knee pain.  There are no medical records from separation until VA healthcare begins in 2010.  Initial report of right knee pain occurred in 2013, around the same time as his initial [documentation] of low back pain post service.  There is nothing in the records linking the development of right knee pain to his low back pain.  It is less likely as not that his right knee pain is directly related to knee pain in service and it is less likely as not that his right knee pain is secondary to his lumbar spine condition.

According to Dr. D.D.'s March 2021 letter:

It was also mentioned in his affidavit and while talking with the [V]eteran that there is also concern for
 complaints of knee pain.  There are no medical records from separation until VA healthcare begins in 2010.  Initial report of right knee pain occurred in 2013, around the same time as his initial [documentation] of low back pain post service.  There is nothing in the records linking the development of right knee pain to his low back pain.  It is less likely as not that his right knee pain is directly related to knee pain in service and it is less likely as not that his right knee pain is secondary to his lumbar spine condition.

According to Dr. D.D.'s March 2021 letter:

It was also mentioned in his affidavit and while talking with the [V]eteran that there is also concern for his right knee and right hip that are also linked to his in-service injury.  The [V]eteran recalls while in the reserves he was in California where they had to run every day.  The [V]eteran described it as a very long intense training ... soldiers were out of shape as they were not in active duty and they had stopped running completely a couple days after he injured his knee as many soldiers were injured due to the runs.  He remembers having an altered gait due to low back pain and at the end of the event his right knee was extremely swollen and in lots of pain.  There is imaging done on [January 2019] that shows that there is a loose fragment in his right knee.  There is no way for sure to know whether this was directly from this but looking at the history and the way the knee was swollen makes me conclude that this was the start of his knee problems.

Dr. D.D. further explained: 

[The Veteran's] right hip, and sometimes the left, has also been an issue from the low back pain.  He tends to change his gait when [he] has low back pain or even knee pain.  As we know from anatomy about muscles and their attachment, issues with low back pain/S1 joint pain can then cause secondary injury to the lower extremities.  This is the same for knee pain affected the hip as well.  It is extremely common with acute and chronic low back pain to have the hip joint is affected as many muscles that attach to the sacrum (gluteal musculature and piriformis) attach to the hip.  This is duo to compensation as well as muscle imbalances.  This is also true for knee pain affecting the hip or even the hip affecting the knee (posterior kinetic chain).  With that in mind, I think I showed that the low back pain, right hip and right knee are all very much connected.

A review of the VA treatment records reflects complaints of left shoulder, right knee, and right hip pain.  However, a diagnosis of a current disability was not shown. 

The Board has reviewed the evidence of record in conjunction with the applicable laws and regulations and finds that service connection for a left shoulder disability, right knee, and right hip disability is not warranted.

Ultimately, there is no evidence of a confirmed diagnosis of a current a left shoulder, right knee, and right hip disability.  In the absence of proof of present disability there can be no successful claim.  Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  The Court has held that the requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary's adjudicate on of the claim.  See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). 

The Board acknowledges that the Dr. D.D. indicated the Veteran had a left shoulder, right knee, and right hip disability.  However, this is not reflected in the treatment records.  Despite the reports of pain, there is no evidence that the Veteran was diagnosed with these disabilities.  Dr. D.D. also stated that the January 2019 imaging showed there were loose fragments in the Veteran's right knee.  Upon careful review of the claims file, there is no evidence in medical records to support this finding.

In reaching this conclusion, the Board is cognizant of the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) which held that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis.  In sum, pain alone resulting in functional impairment may in fact be considered a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis.  No objective findings of disease process in these joints were identified during the VA examinations that supported the
 in the Veteran's right knee.  Upon careful review of the claims file, there is no evidence in medical records to support this finding.

In reaching this conclusion, the Board is cognizant of the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) which held that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis.  In sum, pain alone resulting in functional impairment may in fact be considered a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis.  No objective findings of disease process in these joints were identified during the VA examinations that supported the Veteran's subjective complaints.  However, here, the objective medical evidence reflects that the Veteran's pain in the left shoulder and right hip was identified as radicular pain stemming from the service-connected cervical spine and lumbar spine disabilities, respectively.  As decided above, the Veteran has now been service-connected for a lumbar spine disability with radiculopathy of the bilateral lower extremities; and a cervical spine disability with radiculopathy of the left upper extremity, to include as secondary to the lumbar spine disability.

Furthermore, there is no evidence that the Veteran's right knee pain resulted in functional impairment.  The VA knee and lower leg examination report reflects the following: 

[The Veteran] reports having right knee pain that comes and goes, is significantly less bothersome than his back...  He reports no evaluation for knee pain until around 2012-2013 at the VA.  Since then just physical therapy and conservative mgmt.  Lives in [two] floor house, remains able to do [activities of daily living] and household tasks.  He no longer does yardwork but mostly [because] of his back.  He walks for exercise in the warmer weather, up to 1 mile with a hill.  Works as a VA disability lawyer.  Generally works from home and can set his schedule around when he feels able to work.  Knee is not generally limiting to his ability to work.

It is reiterated that to the extent there is functional impairment due to pain in these joints, such pain is associated with the radiculopathy that has been service-connected herein.

The Board acknowledges the Veteran's lay contentions.  He is considered competent to report the observable health effects he experiences.  See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994).  His assertions that he experienced symptoms are also credible.  However, the presence of symptoms alone does not mean the Veteran has a diagnosis of a current diagnosis, or that his claimed disabilities are secondary to service-connected disability, as determining etiology is a medically complex question which the Veteran lacks the medical training and expertise to answer.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  

Based on the foregoing, the evidence of record is persuasively against the claims. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  Accordingly, service connection for the left shoulder, right knee, and right hip disability are denied.   

 

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. Yoo, 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.