DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served from December 1986 to December 2007, appeals the denial of service connection for a lower back disability as secondary to his service-connected right knee degenerative arthritis and right ankle sprain. The Board found that the evidence persuasively weighed against this claim. The veteran's lower back disability was not shown to be chronic in service, nor did it manifest to a compensable degree within the presumptive period. Continuity of symptomatology was not established, and the disability was not otherwise etiologically related to an in-service injury or disease. The Board placed significant probative weight on a November 2020 VA examination and medical opinion, which concluded that the veteran's lower back disability was not caused by or aggravated by his service-connected knee or ankle conditions. The examiner noted that these conditions are separate and distinct and can develop from long-term wear and tear independently. The Board found this opinion highly probative and the only one supporting the claim, while giving little weight to the veteran's own assertions about the etiology of his back pain due to lack of medical expertise. The Board also noted that the lower back arthritis did not manifest within a year of service discharge. Consequently, service connection for the lower back disability as secondary to the knee and ankle conditions was denied.

Rationale

No medical nexus found between service-connected knee/ankle conditions and lower back disability.; Examiner opined conditions are separate and distinct, developing from wear and tear.; Veteran's lay statements on etiology given little probative value due to lack of medical expertise.

Full Decision Text

Citation Nr: A26013902
Decision Date: 02/17/26	Archive Date: 02/17/26

DOCKET NO. 201117-121948
DATE:  February 17, 2026

ORDER

Entitlement to service connection for thoracolumbar degenerative arthritis and lumbar degenerative disk disease (DDD) (lower back disability) as secondary to right knee degenerative arthritis and right ankle sprain is denied.

FINDING OF FACT

The Veteran's lower back disability was not shown as chronic in service, nor did it manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; the disability is not otherwise etiologically related to an in-service injury or disease; and the disability is not caused or aggravated by the service-connected right knee degenerative arthritis and right ankle sprain.

CONCLUSION OF LAW

The criteria for service connection for a lower back disability due to service or right knee degenerative arthritis and right ankle sprain are not met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107;  38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from December 1986 to December 2007.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2020 Appeals Modernization Act (AMA) rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for a lower back disability as secondary to right knee degenerative arthritis and right ankle sprain. 

In November 2020, the Veteran filed a VA Form 10182, Notice of Disagreement, and elected the Hearing docket. A May 6, 2024, notification letter advised the Veteran that a hearing was scheduled for July 31, 2024. On June 12, 2024, VA received a letter from the Veteran seeking postponement of his hearing scheduled for May 6, 2024. A July 12, 2024, notification letter advised the Veteran that a hearing was scheduled for October 3, 2024. The Veteran did not appear for the scheduled Board hearing, and the record does not show that the Veteran subsequently provided evidence of good cause for the failure to appear at the hearing, nor does the record show a timely written document from the Veteran requesting a postponement of the October 3, 2024, hearing. Accordingly, his hearing request is deemed withdrawn.

For this AMA appeal on the Hearing docket whose hearing was withdrawn by the Veteran, the Board may consider only the evidence of record at the time of the November 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted within 90 days following the date of withdrawal of the hearing.  38 C.F.R. § 20.302(b). This period ended on January 2, 2025. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date of cancelation of the Board hearing, or (2) more than 90 days following the date of cancelation of the Board hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 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 VA Form 20-0995, Supplemental Claim, 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The November 2020 rating decision found that new and relevant evidence had been received to readjudicate the claim of service connection for a lower back disability as secondary to right knee degenerative arthritis and right ankle sprain. This is a favorable finding by the AOJ, and the Board will proceed to address the claim on the merits. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107;  38 C.F.R. § 3.303. The
 2020 rating decision found that new and relevant evidence had been received to readjudicate the claim of service connection for a lower back disability as secondary to right knee degenerative arthritis and right ankle sprain. This is a favorable finding by the AOJ, and the Board will proceed to address the claim on the merits. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107;  38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137;  38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 13 38 (Fed. Cir. 2013).

Establishing service connection on a secondary basis requires evidence sufficient to show the following: (1) a current disability exists, and (2) that the current disability was either (a) caused by, or (b) aggravated by, a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Service connection on a secondary basis is warranted for any incremental increase in disability, regardless of its permanence. See Ward v. Wilkie, 31 Vet. App. 233 (2019). Secondary service connection may be granted where a non-service-connected disability would have been less severe but for a service-connected disability. Spicer v. McDonough, 61 F. 4th 1360 (Fed. Cir. 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).

Entitlement to service connection for a lower back disability as secondary to right knee degenerative arthritis and right ankle sprain.

The Veteran claims entitlement to service connection for a lower back disability as secondary to service-connected right knee degenerative arthritis and service-connected right ankle sprain. The Board finds that the evidence persuasively weighs against such a finding. Because neither the Veteran nor the record have reasonably raised entitlement to direct service connection for the Veteran's lower back disability, the Board's adjudication considered only entitlement to secondary service connection.

Service connection on a secondary basis requires both a current disability and a primary, service-connected disability. The Board is bound by the favorable findings of the AOJ in the absence of evidence of clear and unmistakable error.  38 C.F.R. § 3.104(c). In its November 2020 rating decision, the AOJ included as favorable findings that the Veteran has a current disability (thoracolumbar degenerative arthritis and lumbar DDD), and that he is service connected both for right knee degenerative arthritis and for right ankle sprain. The record supports both findings, and both elements are met. What remains is consideration of whether the Veteran's current lower back disability was caused by or aggravated by his right knee degenerative arthritis and right ankle sprain.

In November 2020, VA afforded the Veteran a back disabilities examination. After an in-person examination of the Veteran, a review of the Veteran's records, and a telephonic interview of the Veteran, the examiner diagnosed the Veteran with thoracolumbar degenerative arthritis and lumbar DDD with radiculopathy affecting the right lower extremity. The Veteran reported that his lower back pain began in about 2019, and he denied any specific injuries or trauma to his back. In a corresponding November 2020 medical opinion, the examiner opined that the Veteran's lower back disability was not caused by either right knee degenerative arthritis or a right ankle sprain. The examiner noted that neither degenerative arthritis nor sprains are systemic illnesses
 November 2020, VA afforded the Veteran a back disabilities examination. After an in-person examination of the Veteran, a review of the Veteran's records, and a telephonic interview of the Veteran, the examiner diagnosed the Veteran with thoracolumbar degenerative arthritis and lumbar DDD with radiculopathy affecting the right lower extremity. The Veteran reported that his lower back pain began in about 2019, and he denied any specific injuries or trauma to his back. In a corresponding November 2020 medical opinion, the examiner opined that the Veteran's lower back disability was not caused by either right knee degenerative arthritis or a right ankle sprain. The examiner noted that neither degenerative arthritis nor sprains are systemic illnesses, nor do they spread by contingency or by blood stream. 

With respect to a nexus between the Veteran's lower back disability and right knee degenerative arthritis, the examiner wrote that the medical literature does not reveal a nexus between the two. In particular, the examiner noted that the Veteran's service-connected right knee degenerative arthritis "is separate and distinct from" his lower back disability. He also noted that both disabilities "can be developed with long-term wear and tear of the joint usage, but one is not the direct cause of the other." Similarly, regarding a nexus between the Veteran's lower back disability and a right ankle sprain, the examiner wrote that the medical literature does not reveal a nexus between the two. In particular, the examiner noted that the Veteran's service-connected right knee degenerative arthritis "is separate and distinct from" a lower back disability. 

The November 2020 VA examination and medical opinions were completed by a medical professional with the necessary education, training, and expertise to provide insight into the Veteran's condition. The Board places significant probative weight on these records because the medical professional directly interfaced with the Veteran and reviewed the Veteran's treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner also provided an adequate rationale for the opinion, and the opinion is consistent with other objective evidence of record. Consequently, it is highly probative.

The Board finds that the November 2020 VA medical opinion is the only probative medical opinion in the file, and it weighs against the Veteran's claim. The Veteran has not presented or identified any contrary medical opinion that supports his claim. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, nor are they permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991).

While the November 2020 examiner did not specifically address "aggravation," the Board finds that the opinion is distinguishable from the holding in El-Amin v. Shinseki, 26 Vet. App. 136 (2013). In that case, the U.S. Court of Appeals for Veterans Claims found that the examiner's opinion that it was "more likely than not that the Veteran's alcohol abuse was related to factors other than the Veteran's post-traumatic stress disorder" did not rule out the possibility that the Veteran's service-connected PTSD aggravated his alcohol abuse to some degree. Id. Here, by contrast, the examiner specifically opined that both the Veteran's service-connected right knee degenerative arthritis and his service-connected right ankle sprain are "separate and distinct from" the Veteran's lower back disability. Because the examiner clearly opined that there was no medical relationship whatsoever between the Veteran's service-connected disabilities and his lower back disability, the examiner's opinion, unlike that of the examiner in El-Amin, fully rules out the possibility that the Veteran's service-connected disabilities may have aggravated his non-service-connected lower back disability to some degree. Therefore, the Board finds that the August 2022 VA examiner's opinion addressed both causation and aggravation and is, therefore, probative regarding whether the Veteran's service-connected pes planus caused or aggravated his left knee disability. 

The only evidence associating the Veteran's lower back disability with his service-connected right knee degenerative arthritis and right ankle sprain is the Veteran's own assertion. In certain instances, lay testimony may be competent to establish medical etiology or nexus. While the Veteran is competent to report experiencing symptoms associated with his lower back disability, such as lower back pain and the lower right extremity radiculopathy, he is not competent to determine the etiology of his lower back disability. The Veteran has not demonstrated the necessary medical expertise (e.g. medical training or credentials) to do so. The etiology of thoracolumbar arthritis and lumbar DDD are not
 Veteran's service-connected pes planus caused or aggravated his left knee disability. 

The only evidence associating the Veteran's lower back disability with his service-connected right knee degenerative arthritis and right ankle sprain is the Veteran's own assertion. In certain instances, lay testimony may be competent to establish medical etiology or nexus. While the Veteran is competent to report experiencing symptoms associated with his lower back disability, such as lower back pain and the lower right extremity radiculopathy, he is not competent to determine the etiology of his lower back disability. The Veteran has not demonstrated the necessary medical expertise (e.g. medical training or credentials) to do so. The etiology of thoracolumbar arthritis and lumbar DDD are not simple questions that can be determined based on the personal observations of a lay person as they involve a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Therefore, the Board finds the questions of whether the Veteran's lower back disability was caused or aggravated by the service-connected right knee degenerative arthritis or right ankle sprain do not lie within the range of common experience or knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board places little probative value on the Veteran's statements attributing his lower back disability to the service-connected disabilities. 

In reaching its conclusion, the Board recognizes that arthritis is an organic disease of the nervous system, which is a chronic disease listed under  38 C.F.R. § 3.309(a). A grant of service connection for arthritis under  38 C.F.R. § 3.307 would require the arthritis to have manifested to a degree of 10 percent or more within one year after the date of separation from service.  38 C.F.R. §§ 3.307, 3.309(a). Here, arthritis of the lower back was not noted, manifested, or identified during service or within one year of separation. Indeed, the evidence persuasively shows both that the Veteran did not claim to suffer from lower back pain until June 2019, and that the Veteran did not have characteristic manifestations sufficient to identify the disease entity during a year after service discharge or until he complained of lower back pain in June 2019, which is over 10 years after service discharge.  38 C.F.R. § 3.303(b). For example, at his November 2020 examination, the Veteran reported that his back pain began in 2019. The Board has considered that the Veteran once noted that his back pain might have started a year before June 2019. That said, this still would be more than 10 years from service discharge. Consequently, service connection based on  38 C.F.R. § 3.303(b) is not warranted.

The Board finds that the evidence of record persuasively weighs against finding a nexus between the Veteran's lower back disability and his service-connected right knee degenerative arthritis and right ankle sprain. The benefit-of-the-doubt doctrine does not apply, and the claim is denied.  38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

 

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Louis M. Figueroa

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.