DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served in the Marine Corps from March 1977 to January 1981, appeals the denial of service connection for degenerative arthritis of the spine (claimed as low back pain), left knee strain, right knee strain, and presbyopia (claimed diminished eyesight). The Board found that the veteran's service treatment records (STRs) contained complaints of low back and bilateral knee pain during service, and that the AOJ had made favorable findings on these conditions. While initial VA examinations provided negative nexus opinions, the Board found them inadequate, citing Ledford v. Derwinski and Buchanan v. Nicholson, which state that absence of treatment records or contemporaneous documentation is not fatal to a claim. A subsequent private medical opinion provided a positive nexus, linking the low back and bilateral knee conditions to the veteran's service, which the Board found adequate and persuasive. The Board also found the veteran's statements regarding these conditions to be competent and credible. Service connection for degenerative arthritis of the spine, left knee strain, and right knee strain was granted. The Board also granted service connection for presbyopia, finding it secondary to service-connected sarcoidosis. This finding was based on a persuasive private medical opinion that linked the veteran's cataracts to sarcoidosis, overcoming an initial inadequate VA opinion. The claim for an increased evaluation for sarcoidosis was remanded due to conflicting information regarding corticosteroid treatment between two VA examinations.

Rationale

Persuasive evidence of record shows condition incurred in service.; AOJ favorable findings for low back pain and degenerative arthritis.; Adequate private opinion linked condition to service.

Full Decision Text

Citation Nr: A26020858
Decision Date: 03/09/26	Archive Date: 03/09/26

DOCKET NO. 201005-113676
DATE: March 9, 2026

ORDER

Entitlement to service connection for degenerative arthritis of the spine (claimed as low back pain) is granted.

Entitlement to service connection for left knee strain is granted.

Entitlement to service connection for right knee strain is granted.

Entitlement to service connection for presbyopia (claimed diminished eyesight) is granted.

REMANDED

Entitlement to an increased evaluation for service-connected sarcoidosis is remanded.

FINDINGS OF FACT

1. The persuasive evidence of record shows that the Veteran's low back condition was incurred in service.

2. The persuasive evidence of record shows that the Veteran's left knee strain was incurred in service.

3. The persuasive evidence of record shows that the Veteran's right knee strain was incurred in service.

4. Resolving reasonable doubt in the Veteran's favor, his vision disability, to include presbyopia, began during his active service and is secondary to his service-connected sarcoidosis.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a low back disability, to include degenerative arthritis of the spine, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(b), 3.309(a).

2. The criteria for entitlement to service connection for a left knee disability, to include left knee strain, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for a right knee disability, to include right knee strain, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for a vision disability, to include presbyopia, are met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1977 to January 1981.

In the October 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 17, 2024.

Therefore, the Board may only consider the evidence of record at the time of the October 2019 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claim of sarcoidosis, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Entitlement to service connection for degenerative arthritis of the spine (claimed as lower back pain) is granted.

Entitlement to service connection for left knee strain is granted.

Entitlement to service connection for right knee strain is granted. 

The Veteran contends that he has bilateral knee strains and a low back condition that began during his active military service. Additionally, he contends that his diminished eyesight is due to his service-connected sarcoidosis.

Service Connection

Service connection may be granted for a current disability related to active duty.
 claim of sarcoidosis, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Entitlement to service connection for degenerative arthritis of the spine (claimed as lower back pain) is granted.

Entitlement to service connection for left knee strain is granted.

Entitlement to service connection for right knee strain is granted. 

The Veteran contends that he has bilateral knee strains and a low back condition that began during his active military service. Additionally, he contends that his diminished eyesight is due to his service-connected sarcoidosis.

Service Connection

Service connection may be granted for a current disability related to active duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection generally requires competent evidence of (1) a current disability; (2) an in-service event; and (3) a causal relationship between the current disability and in-service event, the so-called nexus. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the injury or disease was incurred in service. 38 C.F.R. § 3.303(d).

Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159 (a). Competent lay evidence means any evidence not requiring the layperson to have specialized education, training, or experience. For testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration and must have personal knowledge in order to be considered competent to testify to a matter. Layno v. Brown, 6 Vet. App. 465, 469 (1994).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant; however, if the evidence of record is either persuasively for or persuasively against the claim, then the benefit-of-the-doubt rule no longer applies, and the claim is instead adjudicated in accordance with the evidence. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

As to the first and second elements of service connection, the Board observes the October 2019 rating decision which notes favorable findings that the Veteran has been diagnosed with degenerative arthritis of the lumbar spine and bilateral knee strain; that his military service records shows complaints of low back pain in June and December 2000 and complaints of bilateral knee pain in December 2000. The Board is bound by these favorable findings absent clear and unmistakable error. 38 C.F.R. § 3.104. The Board finds no clear and unmistakable error. Therefore, the first and second elements have been satisfied.

In regard to the last element, the nexus, VA obtained medical opinions in August 2019. At that time, the examiner provided negative opinions stating that the Veteran's low back and knee conditions were acute only during service and there was no chronicity of care. The examiner noted that the Veteran complained of and was treated for a low back condition while on active duty which condition was associated with his in-service diagnosis of sarcoidosis and that the Veteran indicated stiffness of joints and pain in his lower back and knees. The Veteran was diagnosed with and treated for a lumbar strain during service and was admitted to the naval hospital for 5 weeks with a history of low back pain progressing to lower extremity pain and swelling. The examiner noted that he did not seek medical treatment afterwards for fear of being dismissed from service and has not sought treatment since retiring from service.

The Board find these opinions to be inadequate for VA adjudication purposes. In that regard, the absence of documented treatment in service or thereafter is not fatal to a service connection claim, and the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (
. The Veteran was diagnosed with and treated for a lumbar strain during service and was admitted to the naval hospital for 5 weeks with a history of low back pain progressing to lower extremity pain and swelling. The examiner noted that he did not seek medical treatment afterwards for fear of being dismissed from service and has not sought treatment since retiring from service.

The Board find these opinions to be inadequate for VA adjudication purposes. In that regard, the absence of documented treatment in service or thereafter is not fatal to a service connection claim, and the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Further, an absence of contemporaneous treatment records cannot be the sole basis for determining that the Veteran did not experience the symptoms he reports. See Buchanan, 451 F.3d at 1337 (Fed. Cir. 2006).

In September 2024, the Veteran provided a private opinion. At that time, the examiner provided a positive opinion stating that the Veteran served on active duty in the Marine Corps for 14 years with combat experience and that the nature of the Marines leads to an underreporting of musculoskeletal injuries. The examiner provided extensive medical evidence to show that the Veteran's low back and bilateral knee conditions were consistent with his service, which contentions are supported by the Veteran's service treatment records (STRs). The Board finds this opinion to be adequate for VA adjudication purposes. See Jones v. Shinseki, 23 Vet. App. 382 (2010) (discussing adequacy of medical opinion evidence).

The Board notes that the Veteran is competent to report symptoms of low back and bilateral knee pain during and after his active service and there is nothing to explicitly contradict these reports. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Additionally, the evidence in this instance is consistent with the circumstances, conditions, and hardships of the Veteran's service. Therefore, the Board finds the Veteran's statements to be competent and credible and assigns high probative value.

The Board finds that the evidence of record is persuasively for finding service connection for the Veteran's low back condition and bilateral knee strain. When the evidence persuasively favors the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be granted on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). In this case, the evidence is persuasively for the Veteran's claims. Therefore, service connection for degenerative arthritis of the spine (claimed as lower back pain) and bilateral knee strain is granted.

Entitlement to service connection for presbyopia (claimed diminished eyesight) is granted. 

The Veteran contends that his diminished eyesight began during his active service and was caused by his service-connected sarcoidosis. 

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a 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). As to the third Wallin element, the current disability may be proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Ward v. Wilkie, 31 Vet. App. 233 (2019).

As to the first and second element of service connection, the Board observes the October 2019 rating decision and Codesheet. The rating decision notes a favorable finding that the Veteran has been diagnosed with presbyopia and the Codesheet shows that he is service connected for sarcoidosis. The Board is bound by these favorable findings absent clear and unmistakable error. 38 C.F.R. § 3.104. The Board finds no clear and unmistakable error. Therefore, the first and second elements have been satisfied.

In regard to the last element, the nexus, VA obtained a medical opinion in August 2019. At that time, the examiner provided a negative opinion stating that the Veteran had no current diagnosis and his diminished eyesight was from a developmental
 first and second element of service connection, the Board observes the October 2019 rating decision and Codesheet. The rating decision notes a favorable finding that the Veteran has been diagnosed with presbyopia and the Codesheet shows that he is service connected for sarcoidosis. The Board is bound by these favorable findings absent clear and unmistakable error. 38 C.F.R. § 3.104. The Board finds no clear and unmistakable error. Therefore, the first and second elements have been satisfied.

In regard to the last element, the nexus, VA obtained a medical opinion in August 2019. At that time, the examiner provided a negative opinion stating that the Veteran had no current diagnosis and his diminished eyesight was from a developmental condition of presbyopia and was less likely than not caused by claimed in-service injury as it is a natural condition of age. 

The Board finds this opinion to be inadequate for VA adjudication purposes. In that regard, the opinion is conclusory. Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). 

In September 2024 the Veteran provided a private opinion. At that time, the examiner provided a positive opinion stating that sarcoidosis is one of the leading causes of inflammatory eye disease. Glaucoma and cataracts can be complications from the inflammation itself or adverse effects from therapy and cataract formation leads to visual loss. Additionally, any form of corticosteroid therapy, including topical, regional or systemic corticosteroids, can cause cataract and ocular hypertension. Ultimately, the examiner opined that considering the Veteran's relative early age at diagnosis, it is highly probable that his cataracts are secondary to his sarcoidosis. The Board finds this opinion to be adequate for VA adjudication purposes. See Jones v. Shinseki, 23 Vet. App. 382 (2010).

Notably, the Veteran's STRs show complaints of vision problems, to include diminished eyesight while driving and reading in January 2001. See June 2019 STR. 

The Board finds that the evidence of record is persuasively for finding service connection for the Veteran's presbyopia. When the evidence persuasively favors the claim of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be granted on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). In this case, the evidence is persuasively for the Veteran's claim. Therefore, service connection for presbyopia is granted.

REASONS FOR REMAND

Entitlement to an increased evaluation for service-connected sarcoidosis is remanded.

The issue of entitlement to an increased evaluation for service-connected sarcoidosis is remanded to correct a pre-decisional duty to assist error. 

The Veteran contends that he is entitled to an increased evaluation for his service-connected sarcoidosis.

Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v Nicholson, 21 Vet. App. 303, 311 (2007). 

Here, there is conflicting information regarding whether the Veteran required high dose corticosteroids for control of his service-connected sarcoidosis. In that regard, the April 2021 C&P Exam noted that there were no corticosteroids or other immunosuppressive medications used for treatment; however, the December 2021 exam notes that the Veteran was currently off Prednisone - a high dose corticosteroid - but had been taking that medication for the past 9 months. Therefore, the Board finds that clarification of the conflicting information is warranted. 

?

The matters are REMANDED for the following action:

Obtain an addendum/clarifying opinion from the appropriate clinician regarding whether the Veteran required systemic high dose (therapeutic) corticosteroids for control of his service-connected sarcoidosis and the specific duration of such treatment. 

 

MARJORIE A. AUER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Marchese, Angel N.

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.