DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The Veteran, an Army wireman who served from October 1976 to February 1977, appeals the denial of service connection for lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and degenerative disc disease (DDD). The Veteran claimed these conditions were related to his in-service duties and aggravated by his service-connected pes planus. The Board found that the Veteran has a current diagnosis of these back conditions and a service-connected pes planus disability. However, the evidence did not support direct service connection, as service treatment records were negative for back complaints, and the Veteran's own testimony indicated symptom onset in 2014, decades after service. A VA examiner opined the back disability was less likely than not related to service due to the lack of in-service records and later symptom onset. The Board found this opinion probative for direct service connection. For secondary service connection, the Board considered the Veteran's treating neurosurgeon's opinion, which linked his foot injuries and pes planus to worsening back problems and negatively impacted his post-surgical recovery. While a VA examiner provided a negative opinion for secondary connection, the Board found it used an incorrect causation standard. Giving the benefit of the doubt, the Board found the evidence in approximate balance and granted service connection for the lumbar conditions as secondary to pes planus.

Rationale

Current diagnosis of lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and DDD established.; Service-connected pes planus established.; Treating neurosurgeon's opinion linked foot condition to worsening back problems.; VA examiner's negative opinion for secondary connection used incorrect causation standard.; Benefit of the doubt applied due to approximate balance of evidence.

Full Decision Text

Citation Nr: A26015252
Decision Date: 02/19/26	Archive Date: 02/19/26

DOCKET NO. 220713-259993
DATE: February 19, 2026

ORDER

Entitlement to service connection for lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and degenerative disc disease (DDD), including as secondary to pes planus, is granted.

FINDING OF FACT

The Veteran's service-connected pes planus disability is a "but-for" cause of his lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and DDD.

CONCLUSION OF LAW

The criteria for entitlement to service connection for lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and DDD, including as secondary to pes planus, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the U.S. Army from October 1976 to February 1977.

A January 6, 2021 rating decision denied service connection for lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and DDD. The Veteran requested a Higher-Level Review (HLR) and received a decision on October 27, 2021. The Agency of Original Jurisdiction (AOJ) again denied the claim on appeal. The Veteran timely appealed this decision to the Board by requesting the Appeals Modernization Act (AMA) Hearing Lane for a reevaluation of the evidence considered by the Agency of Original Jurisdiction (AOJ). See July 2022 VA Form 10182. As this is a Hearing appeal of an HLR decision under the AMA, the record closed on the date of the earlier January 2021 rating decision, reopened on the date of the February 12, 2026 hearing, and would close 90 days after the hearing on May 13, 2026.  However, at the hearing the Veteran waived the additional 90 days.  Additionally, because the Board is granting the Veteran's service connection claim, he is not prejudiced by this adjudication and the Board will proceed accordingly. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the claims on appeal. 38 C.F.R. § 20.300.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). It follows that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Secondary Service Connection

Service connection is also warranted for disability that is "but-for" due to or the result of service-connected disease or injury, and where a non-service-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. See 38 C.F.R. § 3.310(a); Spicer v. McDonough, 61 F.4th 1360, 1364-66 (2023) (invalidating the requirement of "proximate cause" and instead holding "but-for" causation or aggravation is enough to show entitlement to secondary service connection).

Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a primary, service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (
 resulted in the inability to treat the non-service-connected disability. See 38 C.F.R. § 3.310(a); Spicer v. McDonough, 61 F.4th 1360, 1364-66 (2023) (invalidating the requirement of "proximate cause" and instead holding "but-for" causation or aggravation is enough to show entitlement to secondary service connection).

Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a primary, service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988).

Compensation may be established for any incremental increase in disability or any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected disabilities above the degree of disability existing before the increase regardless of its permanence. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). There is no requirement for objective measurement or numeric quantification for VA to ascertain an increase in disability for compensation purposes. See id. Compensation may also be established for "the natural progression of a condition not caused by a service-connected injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability." See Spicer v. McDonough, 61 F.4th 1364 (Fed. Cir. 2023).

1. Entitlement to service connection for lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and DDD, including as secondary to pes planus, is granted.

The Veteran contends that his current back disability is related to his duties as a wireman during service, and that it is worsened by his service-connected foot disability. See, e.g., October 2020 VA Form 21-526EZ ("I was communication field wireman (31C) & I climbed poles daily with metal scabs on my feet with a 50lb Rucksack. Can't walk & stand for long periods of time. Back condition exacerbated & interfered w/ ability to function & quality of life."); April 2020 VA Form 21-526EZ ("My back and feet causes me severe pain . . . can not stand or sit for long periods of time.").

The AOJ made the favorable findings that the Veteran has a current disability diagnosis of degenerative arthritis of the spine to include spinal fusion and spinal stenosis. See October 2021 HLR Decision. Therefore, the Board finds this element of service connection has been established.

Additionally, the AOJ made the favorable findings that his claimed back disability is a presumptively service-connected form of arthritis under 38 C.F.R. § 3.309(a), that the Veteran meets the minimum service requirements for presumptive service connection, and the Veteran's back disability became manifest to a degree of 10 percent or more following service. See October 2021 HLR Decision. Therefore, the Board finds these elements of presumptive service connection have been established.

Considering the evidence of record, however, the persuasive weight of the probative evidence is against the Veteran's back disability manifesting to a compensable degree from within one year of this 1977 discharge. The Veteran has consistently attested that his back symptomology began in 2014, several decades after his 1977 discharge. See, e.g., October 24, 2019 Private Treatment Record ("Patient reports low back pain that began in 2014."); January 2021 VA Back Examination (indicating 2014 date of onset). There is also no available contemporary record of the Veteran experiencing any back symptoms during service, with the available STR's focusing on his pes planus symptomology. See, e.g., January 19, 1977 STR. During his February 2019 VA examination, the Veteran once described that he "he injured his lower back by climbing poles on a daily basis while he was in service, and he did not seek treatment for the back injury," but the Board assigns this testimony minimal probative weight as he did not maintain this contention in future filings. 

Because the persuasive weight of the probative evidence of record is against a grant of service connection for the Veteran's back disability on presumptive grounds, the Board next considers whether service connection may be awarded on direct grounds.

As noted above, the persuasive weight of the probative evidence of record appears to be against an in-service incurrence relevant to the Veteran's back claim. Although the Veteran once attested he injured his back during his training as a "wireman," he has since consistently attested his symptomology began in 2014. Compare February 2019 VA Back Examination with October 24, 2019 Private Treatment Record; January 2021
 this testimony minimal probative weight as he did not maintain this contention in future filings. 

Because the persuasive weight of the probative evidence of record is against a grant of service connection for the Veteran's back disability on presumptive grounds, the Board next considers whether service connection may be awarded on direct grounds.

As noted above, the persuasive weight of the probative evidence of record appears to be against an in-service incurrence relevant to the Veteran's back claim. Although the Veteran once attested he injured his back during his training as a "wireman," he has since consistently attested his symptomology began in 2014. Compare February 2019 VA Back Examination with October 24, 2019 Private Treatment Record; January 2021 VA Back Examination. See also September 2021 VA Form 20-0996 (stating underwent "training as a wireman").

In a January 2021 VA medical opinion, the examiner opined that the Veteran's current back disability is "less likely than not" related to his service because examiner was "unable to locate any STR's during active service with complaints or treatment" for back symptoms, unable to locate medical records of back symptomology from within one year of discharge, and the Veteran's own testimony indicated his back symptoms began in approximately 2014. The Board assigns this opinion probative weight as to direct service connection for the Veteran's back disability.

As only one element of direct service connection has been established by the evidence of record at this time, the Veteran is not entitled to service connection for his back disability on direct grounds.

The Board next considers whether the evidence of record is consistent with a grant of service connection on secondary grounds.

In addition to the AOJ's favorable finding of a current back disability, it also made the favorable finding the Veteran has a primary, service-connected disability of bilateral pes planus. See October 2021 HLR Decision. Therefore, the Board finds these elements of secondary service connection have been established.

The Board next considers whether the evidence of record is consistent with a medical nexus between the Veteran's current back disability and his service-connected foot disability.

In an additional January 2021 VA medical opinion, the examiner opined that the Veteran's back disability is "less likely than not proximately due to or the result of" his service-connected foot disability because "degenerative changes of the spine are mostly the result the natural aging process or direct wear and tear on the lumbar spine," and flat feet "would more than likely increase the risk for further stress and injury on foot and ankle but less likely affect the lower back." The Board assigns this opinion little probative weight as written because it uses an incorrect, stricter causation standard to provide its negative secondary service connection opinion. See Spicer.

Although it is not formatted as a formal nexus opinion, the Veteran's treating neurosurgeon opined in November 2020 that the Veteran has "a history of foot injuries and achilles injury which led to worse[n]ing back problems." The neurosurgeon also indicated that the Veteran's pes planus negatively impacted his 2015 back post-surgical outcomes due to "co-morbidities" including his "feet injury" interfering with "mobilization" and his ability to return to "physical labor without restrictions." The Board finds these treatment notes highly probative to a medical nexus between the Veteran's current back disability and his service-connected foot disability, enhanced because these conclusions were reached by the Veteran's treating neurosurgeon at the time.

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?

Giving the benefit of the doubt to the Veteran, the evidence is in at least approximate balance that his service-connected pes planus is a "but-for" cause of his current back disability. Resolving all doubt in the Veteran's favor, the claim for entitlement to service connection for lumbar degenerative arthritis of the spine, spinal fusion, spinal stenosis, and DDD, including as secondary to pes planus, is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

Martin T. Mitchell

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Galik, E.

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.