DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The Veteran, who served in the Army from March 2002 to March 2005 and later in the Army National Guard from December 2005 to April 2010, appeals the denial of service connection for degenerative disc disease of the lumbar spine. The Veteran also sought to establish this condition as secondary to her service-connected bilateral knee joint osteoarthritis. The Board reviewed evidence including pre-deployment health assessments, service treatment records, VA treatment records, and private treatment records. Key evidence included an October 2003 service treatment record noting back pain after a fall from a vehicle, but subsequent records and post-deployment assessments were silent on back pain or indicated it was not duty-related. A May 2008 service treatment record noted back pain, and later records indicated it began in 2007. The Veteran testified about the fall and subsequent back pain, and a private clinician suggested a link between knee and back conditions. However, the Board found the Veteran's lay testimony regarding continuity of back pain inconsistent with other evidence. The Board gave greater weight to VA examiner opinions from October 2015 and August 2020, which concluded the Veteran's back conditions were less likely than not incurred in or caused by service, citing the acute and self-limiting nature of the in-service sprain and the lack of contemporaneous service treatment record complaints. The Board also found the private opinion lacked probative value due to speculation and insufficient rationale. Service connection was denied as the evidence weighed against a nexus to service, and the secondary claim was not established.

Rationale

Evidence weighs against nexus to service; Lack of contemporaneous service treatment record complaints; Inconsistent lay testimony regarding continuity of symptoms

Full Decision Text

Citation Nr: A26015831
Decision Date: 02/20/26	Archive Date: 02/20/26

DOCKET NO. 200730-104207
DATE: February 20, 2026

ORDER

Entitlement to service connection for degenerative disc disease of the lumbar spine, to include as secondary to service-connected bilateral knee joint osteoarthritis, is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran's degenerative disc disease of the lumbar spine began during active service, is secondary to service-connected bilateral knee joint osteoarthritis, or is otherwise related to an in-service injury.

CONCLUSION OF LAW

The criteria for service connection for degenerative disc disease of the lumbar spine, to include as secondary to service-connected bilateral knee joint osteoarthritis, are not met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from March 2002 to March 2005, with additional service in the Army National Guard from December 2005 to April 2010.

This matter previously came before the Board of Veterans' Appeals (Board) on an appeal in the legacy system from a November 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In July 2019, the Board remanded the case for further development.  There has been substantial compliance with the Board's remand directives.  Stegall v. West, 11 Vet. App. 268, 271 (1998).

In June 2020, the agency of original jurisdiction (AOJ) issued a supplemental statement of the case (SSOC). 

The Veteran opted the claim into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a July 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement).

In August 2020, the AOJ issued another SSOC. 

In the July 2020 Notice of Disagreement, the Veteran elected the Hearing docket.  A Board hearing was held on June 7, 2024; a transcript is associated with the claims folder.  Therefore, the Board may only consider the evidence of record at the time of the August 2020 SSOC, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 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 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.

Entitlement to service connection for degenerative disc disease of the lumbar spine, to include as secondary to service-connected bilateral knee joint osteoarthritis, is denied.

The Veteran seeks service connection for a thoracolumbar spine condition, which she assert is related to an injury she sustained when she fell out of a military vehicle.  During the June 2024 Board hearing, the Veteran raised a new theory of entitlement not previously before the AOJ, namely that her back condition was caused or aggravated by her service-connected bilateral knee joint osteoarthritis.

For the reasons discussed below, the Board concludes that service connection is not warranted.

Legal Standards

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, 116
 knee joint osteoarthritis.

For the reasons discussed below, the Board concludes that service connection is not warranted.

Legal Standards

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, such as arthritis, 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; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303, 3.307, 3.309.

Service connection may be granted for a Persian Gulf veteran with a qualifying chronic disability that became manifest to any degree at any time.  38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1).  A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI).  38 C.F.R. § 3.317(a)(2)(i).  

For purposes of section 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness (MUCMI); and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection.  38 C.F.R. § 3.317(a)(2).

An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Further, lay persons are competent to report objective signs of illness. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004).

A MUCMI is one defined by a cluster of signs or symptoms, and specifically includes chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome.  A MUCMI means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.  Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2).

Objective indications of chronic disability include both signs, in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of an undiagnosed illness or a medically unexplained chronic multisymptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022.  Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presum
3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022.  Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presumptive service connection for Persian Gulf War veterans.  Presumptive conditions under 38 C.F.R. § 3.317(a) and (b) may now manifest to any degree at any time.  There is no longer a requirement for a chronic disability to manifest to a degree of 10 percent or more prior to December 31, 2026.

Additionally, the PACT expanded the definition of a Persian Gulf veteran to include those who served in the countries of Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan, along with those who served in the Southwest Asia theater of operations as defined in 38 C.F.R. § 3.317(e).

Here, a January 2023 VA Memorandum indicates that the Veteran meets the definition of a Persian Gulf Veteran as specified by 38 U.S.C. § 1117 based on her service in Afghanistan.  A December 2022 VA Memorandum indicates that the Veteran had military service that constitutes presumptive toxic exposure per 38 U.S.C. § 1119 based on her service in Afghanistan.  Further, an August 2023 VA Memorandum indicates that the Veteran participated in a toxic exposure risk activity (TERA) based on non-deployment related exposure to fuels, solvents and other chemicals related to her military occupational specialty of quartermaster and chemical equipment repairer.

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

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

The Board notes that in addressing the in this in this case, it has considered all evidence presented in the record (e.g., lay contentions, VA examination reports, and treatment records) although it may not have specifically discussed every piece of evidence.  See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007); see also Gonzales v. West, 218 F.3d 1378, 138081 (Fed. Cir. 2000).

Evidence

Turning to the evidence of record, in a February 2002 Report of Medical History, the Veteran denied recurrent back pain or any back problems.  A February 2002 Report of Medical Examination indicates a normal clinical evaluation of the spine, other musculoskeletal.

In February 2003 and July 2003 pre-deployment health assessments, the Veteran denied having any medical problems.  

An October 2003 service treatment record indicates that the Veteran reported that she had fallen out of a LMTV three days ago and was having back pain.  A clinician assessed back sprain, with a treatment plan consisting of "RICE" (rest, ice, compression, and elevation), heat, ibuprofen, and stretching, and indicated "RTD" (return to duty).

In a May 2004 post-deployment health assessment, the Veteran denied having back pain, denied developing medical problems during her August 2003 to May 2004 deployment, and denied having questions or concerns about her health.

A November 2006 VA treatment record indicates that during an initial visit to establish care, the Veteran complained of knee and leg pain, swelling extending into her toes, and heartburn; she did not report back pain.

A June 2007 private treatment record indicates that the Veteran's back had normal curvature, no flank tenderness, and no spinal tenderness.  

A January 2008 service treatment record indicates that the Veteran complained of chronic low back pain that began several months ago.

An April 2008 service treatment record indicates that the Veteran complained of daily lower back pain.

A May 2008 service treatment record indicates that the Veteran reported hurting
2003 to May 2004 deployment, and denied having questions or concerns about her health.

A November 2006 VA treatment record indicates that during an initial visit to establish care, the Veteran complained of knee and leg pain, swelling extending into her toes, and heartburn; she did not report back pain.

A June 2007 private treatment record indicates that the Veteran's back had normal curvature, no flank tenderness, and no spinal tenderness.  

A January 2008 service treatment record indicates that the Veteran complained of chronic low back pain that began several months ago.

An April 2008 service treatment record indicates that the Veteran complained of daily lower back pain.

A May 2008 service treatment record indicates that the Veteran reported hurting her back in January of 2007 while working as a certified nursing assistant.  She reported that she lifted a patient and she began to have low back and right leg pain. She reported that any sort of lifting, stooping, bending, and sitting seemed to exacerbate the pain.  She reported that she had not worked since January of 2007.  The clinician noted that imaging completed in January 2008 showed mild discogenic degenerative changes at L5-S1 and a central disk protrusion at L5-S1 with mild impingement on the thecal sac.

An October 2008 service treatment record indicates a complaint of lower back pain with some radiation down the back of her legs to her knees.  

A December 2008 Licking Memorial Hospital treatment record indicates that the Veteran received a lumbar epidural steroid injection.

A February 2009 service treatment record indicates that the Veteran was issued a temporary physical profile to May 2009 for lower back strain, back pain (and left knee pain).

Licking Memorial Hospital treatment records dated from March 2009 to July 2009 generally indicate that the Veteran received steroid injections and nerve branch blocks to treat back pain.

An August 2009 service treatment record indicates that the Veteran's physical profile was continued to November 2009. 

A September 2009 private treatment record indicates an assessment of lumbar degenerative disc disease, lumbar disc bulging at L5-S1, and right sacroiliitis.

A November 2009 service treatment record indicates that the Veteran was issued a permanent profile for chronic back and knee pain and hearing loss.  The clinician noted: "Medical documentation reviewed.  Recommend referral to the Physical Disability Evaluation System or medical separation ... for her back and knees.  The Soldier reports these are NOT duty related."

A February 2010 Adjutant General's Department Memorandum notified the Veteran that based on a review of her current retention physical and permanent profile, she no longer met the Army medical standards for retention, and that she must elect either discharge or appeal to a non-duty related Physical Evaluation Board (PEB) for retention ruling only. 

A February 2010 personnel record indicates that the Veteran understood she was physically unfit for retention and elected to be discharged for medical retention disqualification.  

Licking Memorial Hospital treatment records dated from July 2010 to August 2011 generally indicate that the Veteran received regular treatment for lower back pain.

A January 2012 VA treatment record indicates the Veteran reported lower back pain. A June 2012 VA treatment record indicates the Veteran reported that she has had low back pain since 2008.  VA treatment records dated from June 2012 to September 2015 generally indicate complaints of lower back pain. 

The Veteran was afforded a VA examination in October 2015 and diagnosed with lumbar degenerative disc disease.  The examiner also noted signs or symptoms of radiculopathy in the right lower extremity.  The Veteran reported that she hurt her back when she fell out of a military vehicle and that her lower back condition was getting worse.  The examiner opined that the Veteran's back conditions, including lower back injury, bulging disk lower back, and degenerative disk lower back, were less likely than not incurred in or caused by her back injury during service.  As a rationale, the examiner stated that the October 2003 service treatment record indicated the Veteran was assessed with right lateral back sprain after she fell out of a military vehicle, and that the sprain was acute, self-limiting, and portended to no chronic sequelae.

In an April 2017 lay statement, the Veteran stated that she was medically discharged from service due to her knees and back.

In an August 2020 addendum opinion, the VA examiner again opined that the Veteran's back conditions were less likely than not incurred in or caused by her back injury in service.  As a rationale, the examiner restated that the Veteran's in-service back injury was assessed as right lateral back sprain, which is acute, self-limiting, and portending to no chronic sequelae.  Further, the examiner stated that
 with right lateral back sprain after she fell out of a military vehicle, and that the sprain was acute, self-limiting, and portended to no chronic sequelae.

In an April 2017 lay statement, the Veteran stated that she was medically discharged from service due to her knees and back.

In an August 2020 addendum opinion, the VA examiner again opined that the Veteran's back conditions were less likely than not incurred in or caused by her back injury in service.  As a rationale, the examiner restated that the Veteran's in-service back injury was assessed as right lateral back sprain, which is acute, self-limiting, and portending to no chronic sequelae.  Further, the examiner stated that the Veteran's service treatment records are silent for any chronic low back conditions; that the February 2010 notification of medical disqualification indicated that her chronic back pain was a non-duty related condition; and that her November 2009 physical profile for chronic back and knee pain stated, "the soldier reports these are not duty related."

During the June 2024 Board hearing, the Veteran testified that while deployed to Afghanistan, she fell while getting out of an LMTV and dropped approximately five feet to the ground.  She testified that she was treated and then returned to her duties with mass casualty.  She testified that she continued to experience back pain after the fall and through her deployment.  She also testified that her service-connected bilateral knee condition has impacted her back.  

Within 90 days of the June 2024 Board hearing, the Veteran submitted a June 2024 private treatment record which states in pertinent part: "Discussed that the knees could definitely affect the back and cause back problems due to compensating for the chronic knee pain so the spinal degeneration can be a result of her service related injuries as well as other comorbidities."

Analysis

Having reviewed the evidentiary record, the Board concludes that service connection is not warranted. 

First, the Veteran's claimed back condition is neither an undiagnosed illness or MUCMI, and are not eligible for service connection on this basis.  See 38 C.F.R. § 3.317.  The Veteran has been diagnosed with degenerative disc disease of the lumbar spine and bulging disc, so her condition is not undiagnosed.  Also, while the Veteran suffers from back pain, there are no other associated symptoms present that might indicate a MUCMI.  See 38 C.F.R. § 3.317(b).

Second, the Veteran's current back disorder has been diagnosed as degenerative disc disease, as opposed to degenerative joint disease (or arthritis). Thus, regulations pertaining to chronic diseases are not applicable.    

Third, direct service connection is not warranted because the evidence of record persuasively weighs against finding that a nexus exists between the Veteran's current back disability and an in-service injury or event.  38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303.  

VA and private treatment records show that the Veteran was not diagnosed with her current lumbar spine disability until May 2008, years after separating from active service.  While the Veteran is competent to report ongoing back pain since service, her report is largely not credible due to inconsistency with other evidence in the record.  Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).  After her fall from the LMTV, service treatment records are silent for complaints, symptoms, or treatment for back pain.  Further, in a May 2004 post-deployment health assessment, the Veteran denied having back pain, denied developing medical problems during her August 2003 to May 2004 deployment, and denied having questions or concerns about her health.  Post-discharge, a November 2006 VA treatment record indicates that during an initial visit to establish care, the Veteran complained of various conditions but did not report back pain.  

The lack of notation of back pain relatively soon after deployment and discharge, and for purposes of establishing care, suggests that back pain was not present at that time. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (explaining that where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the conditions or symptoms did not exist).  Further, a May 2008 service treatment record indicates that the Veteran reported hurting her back in January of 2007 while working as a certified nursing assistant.  A June 2012 VA
 complained of various conditions but did not report back pain.  

The lack of notation of back pain relatively soon after deployment and discharge, and for purposes of establishing care, suggests that back pain was not present at that time. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (explaining that where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the conditions or symptoms did not exist).  Further, a May 2008 service treatment record indicates that the Veteran reported hurting her back in January of 2007 while working as a certified nursing assistant.  A June 2012 VA treatment record indicates the Veteran reported that she has had low back pain since 2008.  A November 2009 service treatment record indicates that the Veteran was issued a permanent profile for chronic back (and other conditions) and the clinician noted that the Veteran reported the condition was NOT duty related.  

The October 2015 VA examiner's medical nexus opinion and the August 2020 addendum opinion weigh against the claim.  The Board finds these medical opinions competent probative, as they were from medical professionals and were based on consideration of the lay contentions, a review of the Veteran's medical history and other relevant VA documents, and are supported by a sufficient rationale.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The examiner's opinion that the Veteran's in-service back sprain was acute, self-limiting, and portending to no chronic sequela, is fully consistent with the medical records, which show that the Veteran denied having back pain shortly after the fall from the LMTV and began making regular complaints of ongoing back pain after hurting her back while working as a certified nursing assistant.  

The Board acknowledges that the Veteran believes her current back condition is related to an in-service injury or event.  The Veteran, however, is not competent to provide a nexus opinion regarding this issue.  The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing.  Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the medical training or credentials to make such a determination.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the October 2015 VA examiner's opinion and August 2020 addendum.

While VA has an obligation to provide examinations for any service connection claim which cannot be granted where there is evidence of a TERA, VA has identified several exceptions to this general obligation where there is no indication of an association between the disability and the TERA.  Specifically, a TERA examination is not required for disabilities resulting from physical trauma; mental disorders; disabilities that have not been shown to have any positive association with herbicide exposure; and disabilities that manifested during service or with a clear etiology that is not associated with toxic exposure.  See VBA Letter 20-22-10 at 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022).  In this case, the Veteran asserts that her back condition is due to physical trauma.  Thus, an exception to the TERA examination requirement applies, and an examination is not warranted on this basis.  See 38 U.S.C. § 1168 (b). 

Fourth, and finally, service connection on a secondary basis is not warranted.  

In reaching this conclusion, the Board acknowledges the Veteran's June 2024 Board hearing testimony that her back condition was caused or aggravated by her service-connected bilateral knee joint osteoarthritis.  However, as discussed above, the Veteran is not competent to provide a nexus opinion.  Jandreau v. Nicholson, 492 F.3d at 1377.  The Board also acknowledges the June 2024 private treatment record, which states that the clinician and Veteran discussed that the knees "could definitely affect" the back and cause back problem due to compensating for the chronic knee pain so the spinal degeneration can be a result of her service-related injuries as well as other comorbidities.  The Board, however, finds this private opinion to have little to no probative value because it is too speculative and conclusory (having no accompanying rationale).  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("A mere conclusion
 nexus opinion.  Jandreau v. Nicholson, 492 F.3d at 1377.  The Board also acknowledges the June 2024 private treatment record, which states that the clinician and Veteran discussed that the knees "could definitely affect" the back and cause back problem due to compensating for the chronic knee pain so the spinal degeneration can be a result of her service-related injuries as well as other comorbidities.  The Board, however, finds this private opinion to have little to no probative value because it is too speculative and conclusory (having no accompanying rationale).  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("A mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion.").  There is also no indication that the June 2024 private clinician reviewed any of the Veteran's medical records.

The Board notes that entitlement to service connection on a secondary basis was first raised during the June 2024 Board hearing.  Because this issue was raised after the decision on appeal, the VA does not have a duty to assist in the development of this theory of entitlement.  38 C.F.R. § 3.159(c).  The Veteran, however, is reminded of her option to submit a Supplemental Claim (VA Form 20-0995), if she so wishes, supported by new evidence, such as a new medical opinion that adequately addresses service connection for her back condition, secondary to her service-connected bilateral knee disability.  

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?

In sum, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit of the doubt doctrine does not apply.  Service connection for degenerative disc disease of the lumbar spine, to include bulging disc, is denied.  38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M.T.

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.