DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

STEVEN V. ADLER · 2026 · Case ID: A26023073

MIXED

Summary

The Veteran, an Army Veteran who served from February 1957 to February 1959, appeals the denial of service connection for bilateral hand arthritis and the remand of his hypertension claim. He seeks service connection for a lumbar spine disorder, left knee disorder, left hand arthritis, right hand arthritis, and hypertension. The Veteran asserts that his lumbar spine and left knee disorders are due to numerous rough parachute landings during service. The Board found the evidence regarding these conditions to be in equipoise, applying the benefit of the doubt to grant service connection for the lumbar spine and left knee disorders. For the bilateral hand arthritis, the Veteran reported generalized osteoarthritis and pain in his hands, potentially from parachute jumps. However, the VA examiner opined it was less likely than not service-related, citing a lack of in-service treatment records and the late diagnosis of the condition. The Board found the Veteran's lay testimony regarding the hand arthritis to be non-persuasive, leading to a denial of service connection. The hypertension claim was remanded for a new VA examination and opinion, as the Board found the initial adjudication failed the duty to assist, citing a private medical opinion suggesting a link between chronic pain and hypertension, which was not adequately addressed by the initial VA examination.

Rationale

In-service event: Parachute jumps; Lack of STRs triggered heightened duty to assist; Equipoise of evidence; Benefit of the doubt applied

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251218-610509

Full Decision Text

Citation Nr: A26023073
Decision Date: 03/13/26 Archive Date: 03/13/26

DOCKET NO. 251218-610509
DATE: March 13, 2026

ISSUES

1. Entitlement to service connection for a lumbar spine disorder.

2. Entitlement to service connection for a left knee disorder.

3. Entitlement to service connection for left hand arthritis.

4. Entitlement to service connection for right hand arthritis.

5. Entitlement to service connection for hypertension.

ORDERS

Entitlement to service connection for a lumbar spine disorder is GRANTED.

Entitlement to service connection for a left knee disorder is GRANTED.

Entitlement to service connection for left hand arthritis is DENIED.

Entitlement to service connection for right hand arthritis is DENIED.

REMAND ORDER

Entitlement to service connection for hypertension is REMANDED.

FINDINGS OF FACT

1. The Veteran's lumbar spine and left knee disorders are a result of his parachute jumps during active duty service.

2. The evidence of record persuasively weighs against a finding that the Veteran's bilateral hand arthritis began during his active duty service or is related to any incident of service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a lumbar spine disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for a left knee disorder have been 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 left hand arthritis have not been 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 right hand arthritis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

FACTUAL AND PROCEDURAL HISTORY

The Veteran served on active duty in the Army from February 1957 until February 1959.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2025 rating decision. 38 C.F.R. § 20.301. If evidence was submitted during the period after the RO issued the decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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 entitlement to service connection for hypertension, any evidence the Board could not consider will be considered by the RO in the readjudication of that claim. 38 C.F.R. § 3.103 (c)(2) (ii).

The Board has reviewed all evidence of record permitted by the governing procedural rules, regardless of whether it is discussed in detail in the Decision. Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal).

REASONS AND BASES FOR THE FINDINGS AND CONCLUSIONS

Legal Criteria - Service Connection

Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.
is discussed in detail in the Decision. Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal).

REASONS AND BASES FOR THE FINDINGS AND CONCLUSIONS

Legal Criteria - Service Connection

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 disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may be established under the presumptive, direct, or secondary theories of relief. Establishing direct service connection generally requires (1) evidence of a current disability; (2) evidence of in-service occurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service event, disease, or injury and the present disability. Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303 (a).

Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. 38 C.F.R. § 3.303. The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a), which includes organic diseases of the nervous system. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015).

The Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d at 1376-77.

When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1376-77.

An appellant is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal," and does not require that the evidence be in exact equipoise. Evidence is in approximate balance when the evidence in favor of and opposing the veteran's claim is found to be almost exactly or nearly equal. Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).

II.

Analysis - Lumbar Spine & Left Knee

The Veteran contends that he has lumbar spine and left knee disorders, which are a result of his active-duty service.

Because the Veteran has a diagnosis of degenerative disc disease (DDD) of the lumbar spine and degenerative arthritis of the left knee, the first element of service connection is satisfied for both claims.

The second element necessary to prove service connection is an in-service event. The Veteran asserts that he was a paratrooper and engaged
evidence in favor of and opposing the veteran's claim is found to be almost exactly or nearly equal. Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).

II.

Analysis - Lumbar Spine & Left Knee

The Veteran contends that he has lumbar spine and left knee disorders, which are a result of his active-duty service.

The second element necessary to prove service connection is an in-service event. The Veteran asserts that he was a paratrooper and engaged in numerous parachute jumps which caused him to develop degenerative arthritis in his lumbar spine and left knee. Specifically, he has reported that he went to jump school in 1957 and completed between 13 and 15 high altitude parachute jumps. He noted that he could only remember having a clean landing on his very first jump, and that in all subsequent jumps he experienced rough landings, smashing into the ground feet first, with his knees hanging and buckling. He noted that his hips would smash into the ground and he would be dragged approximately 20 to 50 yards before regaining control of his parachute. He stated that as a result, he had issues with his knees and back.

The RO found that the Veteran's service treatment records (STRs) were unavailable because they were destroyed by a fire, and that any further attempts to obtain them would be futile. This triggers a heightened obligation to assist the Veteran in the development of the case, a heightened obligation to explain findings and conclusions, and a heightened duty to carefully consider the benefit of the doubt rule. Washington v. Nicholson, 19 Vet. App. 362 (2005). The law does not, however, lower the legal standard for proving a claim for service connection but rather increases the Board's obligation to evaluate and discuss in its decision all the evidence that may be favorable to the claimant. Russo v. Brown, 9 Vet. App. 46 (1996).

The Veteran's record is incomplete. The Board finds, however, that all reasonable efforts have been made to locate any outstanding records and the heightened duty to assist has been satisfied. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). The Veteran submitted a photograph of himself dressed in his jump uniform with a parachute. Given the Veteran's statements and the nature of his service, the Board finds that the second element of service connection, an in-service incurrence, is satisfied.

Therefore, the remaining question before the Board is whether there is a nexus between the Veteran's current lumbar spine and left knee disorders and his active-duty service. On this issue, there are two, contradicting opinions of record. In June 2024, the Veteran submitted a private opinion from his privately treating physician. The provider noted that he reviewed the Veteran's entire claims file in conjunction with rendering an opinion. The provider stated that the Veteran was a paratrooper in the Army, performing multiple jumps in the course of his training and duties during service. The examiner stated that according to the Veteran's statements, many of these jumps ended badly with injuries to his knees and back. The examiner stated that while they did not have access to his STRs, he reviewed a photograph of him in his jump gear, as well as his treatment history, which showed abnormal gait and a reduced range of motion of the lumbar spine. The examiner noted that the mechanism of injuries in falls from a great height supported these kinds of symptoms exhibited by the Veteran.

The examiner referred to medical articles which showed that various injuries can occur during parachute jumping and training, with the Army Public Health Center finding that the lower extremity region as well as head, neck, or back injuries appeared to be the most common injuries. And opined that given the Veteran's history, records, and available research data, it was at least as likely as not that the Veteran's lumbar spine and left knee disorders began during service and were a direct result of his paratrooper duties.

In April 2025, the Veteran was afforded VA examinations for his lumbar spine and left knee disorders. He reported ongoing pain since service in his knees and back as a result of rough landings during parachute jumps. His diagnoses were confirmed, but the examiner opined it was less likely than not that the Veteran's lumbar spine and left knee disorders were due to service. The examiner provided the same rationale for both disorders, reasoning that a review of the claims file did not show objective evidence of a chronic diagnosis or treatment for spine or knee disorders while in service,
at least as likely as not that the Veteran's lumbar spine and left knee disorders began during service and were a direct result of his paratrooper duties.

The examiner noted that while the Veteran did submit a personal statement regarding his time as a paratrooper and his back and knee conditions, his testimony establishes only a chronicity of symptoms but that he was not qualified to ascribe symptoms to a diagnosis. The examiner stated that the medical model states that all decisions of medical professionals must be based on credible medical evidence, and that lay testimony did not constitute credible medical evidence. The examiner, however, acknowledged that there was a breadth of medical evidence showing that parachute jumps contributed to lower extremity and spinal injuries, but found that there was no evidence of late onset conditions associated with parachute jumps. Based on that rationale, the examiner opined it was less likely than not that the Veteran's lumbar spine and left knee disorders were due to service.

The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge, and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993).

Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444, 448-49 (2000).

The opinions at issue-both VA and non-VA-were provided by medical professionals who, in the Board's estimation, possess the necessary education, training, and expertise to provide the requested opinions. Each opinion is based on a review of the Veteran's medical and service history and is accompanied by a sufficient explanation for its ultimate conclusion to be persuasive. The Board affords each probative weight. The matter is in equipoise.

The Board finds the evidence to be at least approximately balanced as to whether the Veteran's current lumbar spine and left knee disorders are related to his active-duty service. The Board is mindful of its heightened duty to carefully consider the benefit of the doubt rule in this case and, after doing so, concludes that the requirements to invoke this doctrine have been met. The Board finds that the third element of service connection is established by operation of the reasonable doubt doctrine. The appeal as to these issues is granted.

III.

Analysis - Bilateral Hand Arthritis

The Veteran asserts that he has bilateral hand arthritis that is due to his active duty service.

The Board assumes without deciding that the Veteran offered persuasive evidence sufficient to meet his burden for the first two elements of service connection, or the RO made favorable findings as to one or both.

A VA examination took place in April 2024. At that time, the Veteran was diagnosed, for the first time, with bilateral hand arthritis. When asked about onset, the Veteran stated that he completed 13-15 parachute jumps during service, and that he experienced generalized osteoarthritis and pain in his hands. And that he knew the pain was there, but it did not stop him from doing what he wished to do.

The examiner opined that it was less likely than not that the Veteran's bilateral hand arthritis was due to service. The examiner reasoned that a review of the claims file did not show any evidence of a chronic diagnosis or treatment for bilateral hand arthritis while in service or after service, and that a diagnosis was not rendered until approximately 2019, more than sixty years after service.

The examiner discussed the Veteran's account that his arthritis may be related to some injuries that "could have" been sustained from parachute jumps, but noted that injuries following parachute jumps had been extensively studied, and that lower extremity injuries made up 65% of total injures, followed by 22 percent of head injuries and neck or back injuries, with only 19 percent of upper extremity injuries. The examiner noted that while the research supported acute injury associated with parachute jumps, there was no evidence of late onset conditions in the hands as being associated with parachute jumps. The Board finds the opinion adequate for adjudication because it considers relevant evidence, including the Veteran's statements, and contains a clearly articulated rationale. The Board does not reach the question of whether it is persuasive evidence because it does not need to do so to decide the appeal.

At bottom, this is a matter of non-persuasion, not of persuasion, of competence and not credibility. The Board does not doubt the Veteran's sincerity nor believes he prosecuted his appeal in bad faith. It is instead a question of the allocation of the burden of proof. Once VA has fulfilled the duty to assist, if it is triggered as it is here, by providing an adequate examination, the burden lies with the Veteran to put in evidence sufficient to establish his claim. The Board believes the issue of causation for the condition at issue is medically complex because it requires consideration of diagnostic testing, physical examination, the attribution of symptoms that may support differing diagnoses, and the elimination of other less likely causes. After careful review, the Board is not persuaded the Veteran met his burden to establish a nexus to service, a necessary element to establish direct service connection. As such, the claim fails on this theory of relief.

REASONS FOR REMAND

IV.

Hypertension

The Veteran asserts that he has hypertension, which is a result of his service.

In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the Court set forth the criteria to be considered when determining whether a VA examination is necessary to assist in establishing service connection on a direct basis.

The Court held that a VA examination is warranted when there is:

(1) competent evidence of a current disorder or persistent or recurrent symptoms of a disorder; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disorder, or persistent or recurrent symptoms of a disorder, may be associated with the Veteran's active military service, but that (4) insufficient competent medical evidence is on file for the VA Secretary to make a decision on the claim.

Id. at 81.

The record evidence at the time of the decision on appeal included a diagnosis of hypertension. And a June 2024 private medical opinion, which discussed the results of a study published in a medical journal that showed intensity of chronic pain was a significant predictor of hypertensive status. The physician noted that this study suggested that chronic pain may be associated with an increased risk of hypertension. Applying the four-part test of McLendon to the facts of this case, the Board finds all four elements met, and, accordingly, concludes the RO failed to fulfill the duty to assist by not attempting to obtain a medical examination and opinion prior to adjudicating the claim in the first instance. The appropriate remedy to cure this act of statutory noncompliance is to remand the issue to the RO with instructions to cure the error. 38 C.F.R. § 20.802(a). It is so ordered.

The matter is REMANDED for the following actions:

1. Schedule the Veteran for a medical examination. The entire claims file should be made available to, and reviewed by, the examiner. Any indicated studies should be performed. The clinician is then asked to provide an opinion as to:

Whether any incident of service caused the Veteran's hypertension or, if not, whether it began in service.

If medical literature is relied upon, the clinician should identify and specifically cite each reference material used. The clinician should specifically discuss any contradictory evidence in the claims file and reconcile that evidence with their findings.

All opinions should be accompanied by a thorough supporting rationale explaining how the clinician arrived at the conclusions expressed.

If the clinician
matter is REMANDED for the following actions:

Whether any incident of service caused the Veteran's hypertension or, if not, whether it began in service.

All opinions should be accompanied by a thorough supporting rationale explaining how the clinician arrived at the conclusions expressed.

If the clinician determines that they cannot provide an opinion without resorting to speculation, the clinician should explain the inability to provide an opinion, identifying precisely what facts could not be determined.

They should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion.

STEVEN V. ADLER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Yacoub, 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.

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