LUMBOSACRAL STRAIN

Summary

The veteran, who served in the Army Reserve for a period of active duty for training (ACDUTRA) from January 2001 to March 2001, appeals the denial of service connection for a low back disability, a right hip disability, and an acquired psychiatric disorder. The Board found that the veteran's low back disability, diagnosed as lumbosacral strain and scoliosis, preexisted service and was not aggravated beyond its natural progression during his brief ACDUTRA period. While service records indicated complaints of back pain during training, a VA examiner opined that the underlying conditions were unlikely to be significantly impacted by the short training period. The Board accorded this opinion great weight, finding the evidence persuasively weighed against aggravation. For the right hip disability, diagnosed as a stress fracture, the Board found the evidence also weighed against service connection. Although in-service records showed hip pain complaints and a stress fracture, post-service records and a VA examination suggested the current disability was more likely related to a later motor vehicle accident and lacked sufficient nexus to service. The Board found the VA hip examination opinion to be well-reasoned and accorded it great probative weight. The claim for an acquired psychiatric disorder, diagnosed as adjustment disorder with mixed anxiety and depressed mood, was remanded. The Board found the VA mental health examiner's opinion inadequate because it failed to address an in-service assessment of adjustment disorder. The case was remanded for a new opinion addressing the etiology of the psychiatric disorder in relation to service, specifically considering the in-service assessment.

Rationale

VA examiner found disability preexisted service and was not aggravated beyond natural progression.; Examiner's opinion accorded great probative weight.; Evidence persuasively weighs against aggravation.

Full Decision Text

Citation Nr: A26029334
Decision Date: 04/01/26	Archive Date: 04/01/26

DOCKET NO. 250417-535290
DATE: April 1, 2026

ORDER

Entitlement to service connection for a low back disability is denied.

Entitlement to service connection for a right hip disability is denied.

REMANDED

Entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder with mixed anxiety and depressed mood, is remanded.

FINDINGS OF FACT

1. The Appellant's low back disability preexisted his 2001 period of active duty service for training (ACDUTRA), and the evidence of record persuasively weighs against finding the low back disability worsened beyond its natural progression therein.

2. The evidence of record persuasively weighs against finding the Appellant's right hip disability manifested during or is otherwise related to a period of qualifying service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 101, 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303.

2. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Appellant had a period of ACDUTRA in the United States Army Reserve from January 2001 to March 2001.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from January 2025 and April 2025 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office, which serves as the agency or original jurisdiction (AOJ).

A September 2024 rating decision readjudicated and denied service connection for low back and right hip disabilities. The Appellant requested a higher-level review of the September 2024 denials, and the January 2025 rating decision continued the denials of service connection for low back and right hip disabilities based on the evidence of record as of the date of the September 2024 rating decision. The April 2025 rating decision readjudicated and denied service connection for an acquired psychiatric disorder.  

In April 2025, the Appellant timely appealed the January and April 2025 rating decisions by filing Decision Review Request: Board Appeal (Notice of Disagreement (VA Form 10182) and requested direct review of the evidence considered by the AOJ. In this regard, he waived any remaining time to select a different Board review option in December 2025. Williams v. McDonough, 37 Vet. App. 305 (2024).

Therefore, the Board may only consider the evidence of record at the time of the September 2024 AOJ decision, which was subsequently subject to higher-level review, for the issues of service connection for low back and right hip disabilities and at the time of the April 2025 AOJ decision for the issue of service connection for an acquired psychiatric disorder. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decisions, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Appellant would like VA to consider any evidence that was submitted that the Board could not consider, he 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. However, as the Board is remanding the issue of entitlement to service connection for an acquired psychiatric disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of such claim. 38 C.F.R. § 3.103(c)(2)(ii). 

Service Connection

Initially, the Board notes that the preliminary determination in any claim for veterans' benefits is whether the claimant is considered a "veteran" as defined under VA law. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). Special rules apply to National Guard and Reserves service. Service in
 Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, as the Board is remanding the issue of entitlement to service connection for an acquired psychiatric disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of such claim. 38 C.F.R. § 3.103(c)(2)(ii). 

Service Connection

Initially, the Board notes that the preliminary determination in any claim for veterans' benefits is whether the claimant is considered a "veteran" as defined under VA law. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). Special rules apply to National Guard and Reserves service. Service in the Reserves, even during period of ACDUTRA, without more, will not suffice to give one "veteran" status. Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). The term "veteran" is defined as a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C. § 101(2).

ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1).

Thus, in order for the Appellant to establish "veteran status" with respect to service in the Reserves, and therefore, eligibility for service connection, the record must establish that he was disabled due to a disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA. In the absence of such evidence, the period of ACDUTRA would not qualify as "active military, naval, or air service," and the Appellant would not qualify as a "veteran" by virtue of the ACDUTRA service alone. See 38 U.S.C. § 101(2), (24); 38 C.F.R. § 3.6(a).

When a claim for service connection is based only on a period of ACDUTRA, no presumptions (including the presumptions of soundness, of aggravation, or for presumptive diseases) attach to those periods unless "veteran" status is attained during those periods. See Smith v. Shinseki, 24 Vet. App. 40 (2010). Therefore, the application of 38 C.F.R. §§ 3.307, 3.309 (presumption of service incurrence), 3.306 (presumption of aggravation), and 38 U.S.C. §§ 1110, 1111, 1131 (presumption of soundness) is not available for the appellant during any period of ACDUTRA or INACDUTRA. Smith, 24 Vet. App. at 47.

The Appellant's personnel record shows he had a period of ACDUTRA from January 2001 to March 2001 without an additional period of service. He is not currently service-connected for any disability based on his period of ACDUTRA.

Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When an appellant seeks benefits and the evidence is in relative equipoise, the appellant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other.  Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

1. Entitlement to service connection for a low back disability.

The Appellant is seeking service
 of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When an appellant seeks benefits and the evidence is in relative equipoise, the appellant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other.  Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

1. Entitlement to service connection for a low back disability.

The Appellant is seeking service connection for a low back disability, which he asserts manifested during, or is otherwise related to, his period of ACDUTRA as a result of the physical requirements of basic training.

As will be explained, the Board finds the Appellant's low back disability preexisted his 2001 period of ACDUTRA, and the evidence of record persuasively weighs against finding the low back disability worsened beyond its normal progression therein.

Turning to the facts of the Appellant's case, the January 2025 rating decision favorably found the Appellant had a current diagnosis of a low back disability, specifically a lumbosacral strain and scoliosis. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c).

The Appellant's service treatment records show his spine was clinically evaluated as normal on October 2000 entrance examination. He indicated he did not experience recurrent back pain on the accompanying report of medical history. 

However, a February 2001 service treatment record shows the Appellant complained of low back pain that had lasted four weeks. A March 2001 Entrance Physical Standards Board report notes that the Appellant reported he had experienced the back pain intermittently for the past year and that the symptoms had increased in severity during basic training. An X-ray showed scoliosis. The standards board physicians diagnosed chronic low back pain that existed prior to service. The Appellant concurred with such proceedings and requested to be discharged from the service without delay.

Thereafter, non-VA treatment records show the Appellant complained of low back pain with a history of scoliosis in April 2001; however, an April 2001 X-ray revealed normal findings relative to the Appellant's thoracic and lumbar spine. He continued to report low back pain in May 2001.

In September 2018, the Appellant began seeking VA medical treatment. He denied chronic low back pain or stiffness. In October 2018, he reported having occasional lower back spasms. A November 2018 VA treatment record notes he reported he had back and hip pain that resulted from a September 2016 motor vehicle accident. A January 2020 treatment note reflects that the Appellant continued to report low back pain, and contemporaneous imaging studies reflect a diagnosis of mild level scoliosis with an otherwise unremarkable exam.

The Appellant was provided a VA back examination in August 2024. He reported his back pain began during basic training and had increased in severity since that time. The examiner diagnosed a lumbosacral strain and scoliosis, but opined the back disability clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness.

The examiner acknowledged the Appellant's service treatment records show he complained of back pain that increased in severity during basic training. He explained, however, that scoliosis and a lumbosacral strain are conditions that develop and progress over time due to a variety of factors, including genetic predisposition, biomechanical stress, and natural aging processes. The natural course of scoliosis often involves a slow progression over years, with the curvature of the spine gradually worsening, while a lumbosacral strain typically arises from acute or chronic overuse, muscle imbalances, or improper body mechanics. The examiner noted that the Appellant's brief period of ACDUTRA was unlikely to result in significant, permanent changes in the structural integrity of the spine or the severity of scoliosis. The examiner acknowledged that while military training involves physically demanding activities, any exacerbation of symptoms during this time would likely be temporary and reversible with appropriate rest and treatment. Rather, the underlying structural abnormalities associated with scoliosis and the tendency for lumbosacral strain to recur are influenced by long-term factors rather than short-term physical stress. In other words, even considering the Appellant's reports of back symptoms in service, the examiner still found no evidence, as expressed above, that the low back disability was aggravated beyond its natural progression during service.

The Board finds that the examiner's opinion that the Appellant
 ACDUTRA was unlikely to result in significant, permanent changes in the structural integrity of the spine or the severity of scoliosis. The examiner acknowledged that while military training involves physically demanding activities, any exacerbation of symptoms during this time would likely be temporary and reversible with appropriate rest and treatment. Rather, the underlying structural abnormalities associated with scoliosis and the tendency for lumbosacral strain to recur are influenced by long-term factors rather than short-term physical stress. In other words, even considering the Appellant's reports of back symptoms in service, the examiner still found no evidence, as expressed above, that the low back disability was aggravated beyond its natural progression during service.

The Board finds that the examiner's opinion that the Appellant's current back  disability existed prior to service and was not aggravated beyond its natural progression therein to be supported by the record, as well as unequivocally stated and supported by a cogent rationale. While the examiner applied the nonapplicable clear-and-unmistakable standard, as opposed to the benefit-of-the-doubt standard, the application of the higher standard reflects the examiner found the low back disability at least as likely as not preexisted the period of ACDUTRA service and was less likely than not aggravated beyond it's natural progression during the period of ACDUTRA. As such, the Board finds the August 2024 VA medical opinion regarding the etiology of the Appellant's low back disability should be accorded great probative weight. Nieves-Rodriguez, supra; Stefl, supra. Further, there is no medical opinion to the contrary. 

The Board has also considered the Appellant's general assertions that his current low back disability was incurred in or otherwise related to his period of ACDUTRA. In an April 2024 statement, the Appellant's sister also asserted he had injured his back during basic training and had continued to experience back pain thereafter. The Appellant is competent to report observable low back symptoms and the fact that he believes his low back disability worsened during service, and his sister is competent to report she witnessed him experience back pain during and after service. However, the question of whether the condition was aggravated beyond its natural progression during service requires medical expertise, which he and she are not shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Appellant's and his sibling's opinions as to the etiology of the claimed back disability are not competent evidence and, consequently, are afforded no probative weight.

Based on the foregoing, the Board finds that service connection for a low back disability is not warranted as there is no probative and credible evidence demonstrating that the Appellant's preexisting low back disability worsened beyond its natural progression during his period of ACDUTRA.

In sum, the Board finds that the most probative evidence of record is against showing that the Appellant's low back disability was aggravated by his period of ACDUTRA. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. The criteria for entitlement to service connection for a low back disability have not been met, and the appeal is denied.

2. Entitlement to service connection for a right hip disability. 

The Appellant is seeking service connection for a right hip disability, which he asserts manifested during, or is otherwise related to, his period of ACDUTRA as a result of the physical requirements of basic training.

As will be explained, the Board finds the evidence of record persuasively weighs against finding the Appellant's right hip disability manifested during or is otherwise related to a period of qualifying service.

Turning to the facts of the Appellant's case, the January 2025 rating decision favorably found the Appellant had a current diagnosis of a current right hip disability, specifically right pubic ramus stress fracture with proximal femur fracture, status post open reduction and internal fixation (ORIF). The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c).

The Appellant's service treatment records show he complained of right hip pain in January and February 2001. He indicated that such had a gradual onset and denied any specific trauma to his hip. Rather, he noted that he noticed the pain while completing a march in basic training. He also related the pain to bouncing around inside a truck. An X-ray was ordered and revealed stress fracture of the right inferior pubic ramus.   

Post-service treatment records reflect that the Appellant reported to his private doctor that he fractured his right pelvis during basic training, but there is no indication he reported the right hip pain was ongoing. An April 2001 X-ray of the pelvis was negative, without evidence of fracture or dislocation.
(c).

The Appellant's service treatment records show he complained of right hip pain in January and February 2001. He indicated that such had a gradual onset and denied any specific trauma to his hip. Rather, he noted that he noticed the pain while completing a march in basic training. He also related the pain to bouncing around inside a truck. An X-ray was ordered and revealed stress fracture of the right inferior pubic ramus.   

Post-service treatment records reflect that the Appellant reported to his private doctor that he fractured his right pelvis during basic training, but there is no indication he reported the right hip pain was ongoing. An April 2001 X-ray of the pelvis was negative, without evidence of fracture or dislocation. Treatment records are subsequently silent for complaints, symptoms, or treatment related to a right hip disorder until September 2018. In this regard, VA treatment records show the Appellant reported he fractured his right pelvis during basic training. However, the September 2018 VA treatment records also show he reported he was experiencing right hip pain due to a 2016 motor vehicle accident. A November 2018 VA treatment record noted he reported he had experienced right hip pain since the accident.

In an April 2024 statement, the Appellant's sister reported he felt pain in his hip and lower back during basic training and had not been the same since due to the pain.  

The Appellant was provided a VA hip examination in August 2024. He reported his right hip pain during basic training and persisted following the 2016 motor vehicle accident and surgery. 

The examiner diagnosed right pubic ramus stress fracture and proximal femur fracture, status post ORIF (hip surgery). In a corresponding medical opinion, the VA examiner opined that the Appellant's current right hip disability was less likely than not the result of his documented in-service stress fracture. The examiner acknowledged the Appellant complained of hip pain for three weeks following a right pubic ramus stress fracture in-service, but found due to an absence of hip assessments between service and 2016, it was difficult to find the claimed hip disability to be a chronic condition related to his period of ACDUTRA without resorting to speculation. He concluded a nexus was not established.

The Board finds the examiner's opinion that the Appellant's current right hip disability is unrelated to service to be supported by the record, as well as unequivocally stated and supported by a cogent rationale. While the examiner did not address the April and May 2001 post-service treatment records that show the Veteran reported he injured his right pelvis during service, those records also do not show an evaluation of the right hip, aside from the negative X-ray, was performed. As such, the Board finds that this August 2024 VA medical opinion regarding the etiology of the Appellant's right hip disability should be accorded great probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Further, there is no medical opinion to the contrary. 

The Board has also considered the lay statements of the Appellant and his sibling asserting that the Appellant's right hip disability is due to his initial active duty for training. However, as lay persons, they do not have the requisite training and experience necessary to address such a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Appellant's and his sister's opinions as to the etiology of the claimed right hip disability are not competent evidence and, consequently, are afforded no probative weight.

Based on the foregoing, the Board finds the evidence of record persuasively weighs against finding the Appellant's right hip disability manifested during or is otherwise related to a period of qualifying service. As the
 statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Appellant's and his sister's opinions as to the etiology of the claimed right hip disability are not competent evidence and, consequently, are afforded no probative weight.

Based on the foregoing, the Board finds the evidence of record persuasively weighs against finding the Appellant's right hip disability manifested during or is otherwise related to a period of qualifying service. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Consequently, the criteria for entitlement to service connection for a right hp disability have not been met, and the appeal is denied.

REASONS FOR REMAND

3. Entitlement to service connection for an acquired psychiatric disorder.

The Board sincerely regrets the additional delay in adjudication but finds a remand of the appeal seeking service connection for an acquired psychiatric disorder is required to obtain a new medical opinion.

The Appellant is seeking service connection for an acquired psychiatric disorder, which he asserts resulted from emotional abuse he experienced and witnessed other others receive during his period of ACDUTRA. 

The Appellant's service treatment records show a treatment provider assessed him with adjustment disorder in February 2001 when he sought treatment for right hip pain. The treatment provider noted the Appellant was teary-eyed and had a flat affect.

The Appellant was provided a VA mental disorders examination in January 2025. The examiner diagnosed adjustment disorder with mixed anxiety and depressed mood and opined the acquired psychiatric disorder was less likely than not incurred in or caused by service. The examiner explained, in part, that there is no documentation of an in-service mental health diagnosis. However, the examiner failed to address the February 2001 assessment of adjustment disorder. Accordingly, the Board finds the examiner's etiology opinion is inadequate.  See Reonal v. Brown, 5?Vet. App.?458, 461 (1993) (finding a medical opinion based on an inaccurate factual premise has no probative value).

Therefore, the Board finds the AOJ erred in not ensuring an adequate pre-decisional opinion was provided and must remand the matter of service connection for an acquired psychiatric disorder for such to be provided. Barr v. Nicholson, 21?Vet. App.?303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); see 38?C.F.R. §?20.802.

The matter is REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Appellant's acquired psychiatric disorder.

Following consideration of the evidence of record (both lay and medical), the examiner is asked to address the following:

(a) Identify (by medical diagnosis) each acquired psychiatric disorder found.

(b) As to any (and each) acquired psychiatric disorder diagnosed, including adjustment disorder with mixed anxiety and depressed mood, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such disability was incurred or aggravated during the period of ACDUTRA from January 2001 to March 2001, to include the February 2001 assessment of adjustment disorder?

The examiner must explain the rationale for all opinions. 

 

William Skowronski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Deal, Katie

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.