DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served in the U.S. Army from September 1985 to June 1988, appeals the denial of service connection for lumbosacral strain with degenerative arthritis of the spine and intervertebral disc syndrome (IVDS), right leg neuropathy, right hip tendonitis, and left hip tendonitis. The veteran attributes his low back condition to an in-service fall, though service treatment records are largely unavailable. However, the Board found sufficient corroboration from fellow service members who witnessed the fall and provided testimony. A February 2019 chiropractic opinion and a September 2024 addendum opinion from the same chiropractor related the low back condition to service, stating it was more probable than not service-related. A May 2019 VA opinion was negative due to lack of treatment records, but the Board found it inadequate for failing to address the veteran's reported in-service injury and continuous symptoms. A second VA opinion in September 2019 was also negative, but the Board found it limited by not considering the veteran's reports of in-service injury and continuous symptomatology. The Board found the evidence nearly balanced and resolved doubt in the veteran's favor, granting service connection for the low back condition. Service connection for right leg neuropathy was granted secondarily to the low back condition, based on VA examinations noting radiculopathy and a private opinion linking it to service. The hip conditions were remanded due to inadequate VA opinions that failed to address the nexus to service or aggravation by the service-connected low back condition, and did not provide sufficient rationale.

Rationale

Corroborated in-service fall; Inadequate VA opinions; Benefit of the doubt applied

Full Decision Text

Citation Nr: A26034214
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 200925-113092
DATE: April 14, 2026

ORDER

Entitlement to service connection for lumbosacral strain with degenerative arthritis of the spine and intervertebral disc syndrome (IVDS) is granted.

Entitlement to service connection for right leg neuropathy is granted.

REMANDED

Entitlement to service connection for right hip tendonitis is remanded.

Entitlement to service connection for left hip tendonitis is remanded.

FINDINGS OF FACT

1. The evidence is in approximate balance to find that the Veteran's lumbosacral strain with degenerative arthritis of the spine and IVDS is a result of the Veteran's fall during active service. 

2. The Veteran's right leg neuropathy is due to his now service connected lumbosacral strain with degenerative arthritis of the spine and IVDS.

CONCLUSIONS OF LAW

1. The criteria for service connection for lumbosacral strain with degenerative arthritis of the spine and IVDS have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for right leg neuropathy have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1985 to June 1988 in the United States Army.  

These matters come before the Board of Veterans' Appeals (Board) from a September 2019 rating decision issued by a VA Regional Office (RO/AOJ).  The Veteran appealed that decision by filing a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) on September 25, 2020.  He elected to have a Hearing with a Veterans Law Judge.  

The Appellant testified at a hearing before the undersigned Veterans' Law Judge on July 26, 2024.  The transcript is associated with the claims file.  Consideration can only be given to the evidence of record at the time of the September 2019 rating decision, evidence submitted at the July 2024 hearing, and evidence submitted within 90 days of the hearing, i.e., October 24, 2024.  38 C.F.R. § 20.302.  Evidence of record specifically identified by the Veteran or his representative at his July 26, 2024, hearing is likewise considered "submitted" during the evidence submission window.  See Cash v. Collins, 2026 U.S. App. LEXIS 3596, 2026 LX 94368, __ F.4th __, 2026 WL 302984, (Fed. Cir., Feb. 5, 2026).  

If evidence was received during the timeframe when the Board cannot consider evidence and if the appellant wishes to have this evidence considered, he may file a supplemental claim with the AOJ.  Instructions on how to file a supplemental claim are included with this decision.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., 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).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of
ing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant.  38 U.S.C. § 5107(b).  An approximate balance of the evidence includes but is not limited to equipoise.  Lynch v. McDonough, 21 F.4th 6, 781 (Fed. Cir. 2021).  Evidence is not in "approximate balance" or "nearly equal" when the evidence persuasively favors one side or the other.  Id.

1. Entitlement to service connection for lumbosacral strain with degenerative arthritis of the spine and IVDS.

The Veteran contends that he has lumbosacral strain with degenerative arthritis of the spine and IVDS due to service.  More specifically, he attributes his low back disorder to an in service incident wherein he slipped while descending from the top of a tracked vehicle and landed on his back.  He states that the impact was so severe that he does not remember the fall only that he regained consciousness looking up at the sky and having fellow service members gathered around him keeping him immobile until he was transported to the hospital.  He is aware that his claims file is absent any treatment records from this incident.  See July 2024 Board Hearing.      

The Veteran's diagnoses of lumbosacral strain with degenerative arthritis of the spine and IVDS were made at a September 2019 VA examination.  The first element of service connection has been met.

As to the question of service incurrence, the Veteran generally argues that he first noticed a problem with his lower back following his fall during service.  His service treatment records (STRs) are mostly unavailable.  The Veteran's claims file is missing his separation examination.  In such situations, where STRs are missing, the Board has a heightened obligation to explain its findings and conclusions and carefully consider the benefit of the doubt rule.  See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991).

Although the Veteran's claims file is absent any treatment for his reported fall, there is a single February 1987 treatment record that documents that he was seen for complaints of low back pain.  He stated that he had strained his back the day before.  There was no specific reference to a fall. However, he provided a detailed description of the fall and resulting injury (outlined above) at his July 2024 Board hearing.  In support of his claim Mr. F., who served with the Veteran and witnessed the Veteran's fall, also provided testimony at the July 2024 Board hearing.  Mr. F. provided corroborating testimony that ostensibly mirrored that of the Veteran's.  Specifically, that the Veteran slipped while descending from a 113 tracked armored personnel carrier and landed on his back.  Mr. F. also submitted a written statement reporting the same.  

A witness support statement was also provided by Mr. G., who was in the same platoon as the Veteran. Although he did not witness the Veteran's fall, Mr. G. reports seeing the Veteran on the ground immediately after his fall.  He states he was in contact with the Veteran during service and since separation, and that the Veteran has continuously complained about low back pain since service.  Given the Veteran's reports during his Board hearing, the testimony of Mr. F, the written statements provided by Mr. F. and Mr. G, and after resolving all reasonable doubt in his favor, there is sufficient evidence to support the finding that the Veteran injured his low back in service - the slip and fall accident. 

The remaining question is whether the Veteran's current low back disorder is due to his in-service low back injury.

In July 2019, the Veteran presented to a VA thoracolumbar spine examination wherein he was diagnosed with degenerative arthritis of the spine with IVDS.  In the accompanying opinion the examiner determined that the Veteran's low back conditions are less likely than not incurred in or caused by the claimed inservice injury, event, or illness.  The examiner noted the absence of treatment during service as the basis for the negative nexus opinion.
 and Mr. G, and after resolving all reasonable doubt in his favor, there is sufficient evidence to support the finding that the Veteran injured his low back in service - the slip and fall accident. 

The remaining question is whether the Veteran's current low back disorder is due to his in-service low back injury.

In July 2019, the Veteran presented to a VA thoracolumbar spine examination wherein he was diagnosed with degenerative arthritis of the spine with IVDS.  In the accompanying opinion the examiner determined that the Veteran's low back conditions are less likely than not incurred in or caused by the claimed inservice injury, event, or illness.  The examiner noted the absence of treatment during service as the basis for the negative nexus opinion.  See July 2019 VA Opinion.  The examiner did not consider the Veteran's reports of an in-service injury with continued symptomatology that began in service and has continued since separation. Such limits the probative value of the opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination was inadequate where the examiner did not comment on the Veteran's report of in-service injury and instead relied on the absence of service medical records to provide a negative opinion).

The Veteran presented to a second VA thoracolumbar spine examination in September 2019 wherein he was diagnosed with lumbosacral strain with degenerative arthritis of the spine and IVDS.  In the accompanying opinion the examiner determined that the Veteran's low back conditions are less likely than not incurred in or caused by the claimed inservice injury, event, or illness.  The examiner seemingly relied on the absence of treatment during service and since separation until 2014.  However, the Board again notes that the mere absence of evidence of treatment, does not necessarily contradict a Veteran's statements about his symptom history.    

Neither of the opinions considered the Veteran's lay contentions of experiencing lumbosacral pain in service and that such pain has continued since separation.  Such limits the probative value of those opinions.  See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Dalton v. Nicholson, 21 Vet. App. 23 (2007).  

As for the positive evidence in support of the Veteran's claim, he submitted opinions from his chiropractor Dr. P.D.A. (Doctor of Chiropractic's) and Dr. G.J.R. MD in May 2019 and an opinion from Dr. P.D.A. received in September 2024.  

The May 2019 opinion from Dr. P.D.A. relates the Veteran's current low back conditions to his military service.  Specifically, Dr. P.D.A. referenced the Veteran's self-reported injuries while inservice which included pain from running in combat gear and driving personnel carriers and tanks with no suspension.  Dr. P.D.A. determined that based upon the Veteran's reports on inservice injuries and the absence of post service injuries that it is "more probable than not that his low back pain was caused by his service in the military."

The May 2019 opinion from Dr. G.J.R. relates the Veteran's current low back conditions to his military service.  Dr. G.J.R. noted the Veteran's reports of chronic low back pain which began when he was inservice carrying heavy backpacks as well as ammunition.  Although Dr. G.J.R. did not review the Veteran's claims file, he ultimately determined that the Veteran's chronic back pain "is just as likely as not to be service related."  The Board takes notice that Dr. G.J.R. did not review the Veteran's claims file and ostensibly based the opinion on the Veteran's reports alone, such limits the probative value of the opinion.   

Subsequent to the Veteran's Board hearing he submitted a private medical opinion in September 2024.  Dr. P.D.A. noted that he has reviewed the Veteran's claims file, private treatment records, interviewed the Veteran, and is his treating chiropractor since 2015.  Dr. P.D.A. noted that after the aforementioned review he determined that "on a more probable than not basis, [the Veteran's] neck, back, and radicular conditions are related to his military service."

There are positive and negative nexus opinions.  The opinions were provided by competent medical professionals, and the Board has no reason to doubt their credibility.  Thus, based on the foregoing, and after resolving all doubt in his favor, the Board finds the evidence nearly balanced as to whether the Veteran's lumbosacral strain with degenerative arthritis of the spine and IVDS are related to his conceded inservice slip and fall while descending from a 113 tracked armored personnel carrier.  The third element of direct service connection has been met.  

Service connection for lumbosacral strain with
 determined that "on a more probable than not basis, [the Veteran's] neck, back, and radicular conditions are related to his military service."

There are positive and negative nexus opinions.  The opinions were provided by competent medical professionals, and the Board has no reason to doubt their credibility.  Thus, based on the foregoing, and after resolving all doubt in his favor, the Board finds the evidence nearly balanced as to whether the Veteran's lumbosacral strain with degenerative arthritis of the spine and IVDS are related to his conceded inservice slip and fall while descending from a 113 tracked armored personnel carrier.  The third element of direct service connection has been met.  

Service connection for lumbosacral strain with degenerative arthritis of the spine and IVDS is granted.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for right leg neuropathy.

The Veteran contends that he has right leg neuropathy due to his low back disabilities.  See July 2024 Board Hearing.  

The Veteran has a current diagnosis of right lower extremity radiculopathy as determined in the July 2019 VA lumbosacral spine examination.  As a result of the decision herein, service connection for lumbosacral strain with degenerative arthritis of the spine and IVDS (the primary service connected disability) has been established.  The first and second elements of secondary service connection have been met. 

The question is whether the Veteran's right leg neuropathy was caused by the Veteran's now service connected low back disabilities.  In that regard, the July 2019 VA thoracolumbar spine examination diagnosed the Veteran as having  degenerative arthritis of the spine and IVDS along with right lower extremity radiculopathy with sciatic nerve involvement.  Such was echoed in the September 2019 VA thoracolumbar spine wherein the Veteran was diagnosed with lumbosacral strain with degenerative arthritis of the spine and IVDS with right lower extremity radiculopathy with sciatic nerve involvement.  Both examiners determined that the Veteran has radicular pain or other signs or symptoms due to radiculopathy.  

In the September 2024 opinion, Dr. P.D.A. determined that "on a more probable than not basis, [the Veteran's] neck, back, and radicular conditions are related to his military service."  

Thus, after resolving all doubt in the Veteran's favor, the Board finds that the evidence establishes that his right lower extremity neuropathy was caused by, due to, or the result of his now service connected low back disabilities.  The third element of secondary service connection has been met.

Service connection for right leg neuropathy is granted.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), the Board must remand to the AOJ to correct pre-decisional duty to assist errors (including when the AOJ failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion).  38 C.F.R. § 20.802 (a).

1. Entitlement to service connection for right hip tendonitis.

2. Entitlement to service connection for left hip tendonitis.

The Veteran contends that he has a bilateral hip condition due to service.  Specifically, he argues that his current bilateral hip condition is due to his now service connected lower back disabilities.  See July 2024 Board Hearing.  

The May 2019 opinion from Dr. G.J.R. relates the Veteran's current hip conditions to his military service.  Dr. G.J.R. noted the Veteran's reports of chronic hip pain.  Although Dr. G.J.R. did not review the Veteran's claims file, he ultimately determined that the Veteran's chronic hip pain "is just as likely as not to be service related."  The Board takes notice that Dr. G.J.R. did not review the Veteran's claims file and ostensibly based the opinion on the Veteran's reports alone, such limits the probative value of the opinion.

In an effort to determine the nature and etiology of the Veteran's bilateral hip condition he presented to a VA hip conditions examination in July 2019 wherein he was diagnosed with right and left hip tendonitis.  In the accompanying opinions, it was determined that the Veteran's bilateral hip tendonitis was less likely than not proximately due to or the result of the Veteran's low back injuries.  See July 2019 VA opinion; July 2019 VA
 chronic hip pain "is just as likely as not to be service related."  The Board takes notice that Dr. G.J.R. did not review the Veteran's claims file and ostensibly based the opinion on the Veteran's reports alone, such limits the probative value of the opinion.

In an effort to determine the nature and etiology of the Veteran's bilateral hip condition he presented to a VA hip conditions examination in July 2019 wherein he was diagnosed with right and left hip tendonitis.  In the accompanying opinions, it was determined that the Veteran's bilateral hip tendonitis was less likely than not proximately due to or the result of the Veteran's low back injuries.  See July 2019 VA opinion; July 2019 VA opinion.  No discernable rationale was provided. 

The Veteran presented to a second VA hip conditions examination in September 2019 wherein his diagnoses of right and left hip tendonitis was confirmed and continued.  The examiner determined that the Veteran's bilateral hip tendonitis was less likely than not proximately due to or the result of the Veteran's low back injuries.  Instead, the examiner related the Veteran's bilateral hip condition to his post-service employment as a truck driver and prolonged sitting along with getting in and out of a semi-truck multiple times per day.  See September 2019 VA Opinion.  There was again little terms of rationale for the negative opinion concerning the bilateral hip disability and the Veteran's low back disorder.

Additionally, neither examiner provided an opinion as to whether the Veteran's bilateral hip condition was aggravated beyond its natural progression by his service connected disability.  See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013).  

The foregoing represent pre-decisional duty to assist errors.  A remand is necessary to cure this defect.

The matters are REMANDED for the following action:

Obtain an addendum opinion to address the nature and etiology of the Veteran's bilateral hip condition.  The examiner must review the claims file, and provide a response to the following:

(a.) Whether it is as least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed bilateral hip tendonitis:

i.	had its onset in service or is otherwise etiologically related to his active service.

ii.	was caused by or the result of a service connected disability including his lumbosacral strain with degenerative arthritis of the spine and IVDS.

iii.	underwent any incremental increase in disability, regardless of its permanence, due to a service connected disability including his lumbosacral strain with degenerative arthritis of the spine and IVDS.

The examiner is advised that proximate cause is not required for secondary service connection.  Rather, the question is whether the Veteran's lumbosacral strain with degenerative arthritis of the spine and IVDS is a "but for cause" of his current bilateral hip tendonitis and would have been less severe but for any such service connected conditions.

The term "incremental increase in disability" means additional impairment of earning capacity.  Objective measurement, or numerical quantification, is not required to ascertain an increase in disability.  Moreover, any "incremental increase in disability" need not be permanent.

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scheirich, David B.

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.