THORACOLUMBAR OR LUMBAR SPINE LIMITATION OF MOTION

Summary

The Veteran, who served from September 1970 to March 1972, appeals the denial of service connection for his lower back, cervical neck, and bilateral knee conditions. The Veteran testified about experiencing issues with his back, neck, and knees prior to service and during service, and that these issues have persisted. The enlistment examination noted "normal" findings for the back, neck, and knees, but also indicated that the Veteran underwent cervical and lumbar x-rays and that the back x-ray was negative. However, the service treatment records and enlistment examination also noted pre-service neck and back issues. The Board found the Veteran credible regarding his disclosure of pre-service issues to the enlistment examiner. Applying the benefit of the doubt, the Board found the Veteran to be sound at enlistment concerning these conditions. The Board granted service connection for the lower back and cervical neck conditions, citing the Veteran's testimony of persistent pain since service and buddy statements corroborating back issues. For the bilateral knee conditions, the Veteran claimed secondary service connection to his back. The Board relied on a June 2025 VA medical opinion which provided a positive secondary nexus, stating it was at least as likely as not that the lower back pain caused the knee pain due to biomechanical interrelationship. The VA examiner's opinion was deemed adequate, citing expertise, knowledge, training, consideration of lay evidence, medical history, and literature. Service connection for all four conditions was granted.

Rationale

Benefit of the doubt applied; Veteran found credible; Persistent pain since service; Buddy statements corroborate back issues

Full Decision Text

Citation Nr: A26034250
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 251112-616910
DATE: April 14, 2026

ORDER

Entitlement to service connection for a lower back condition is granted.

Entitlement to service connection for a cervical neck condition is granted.

Entitlement to service connection for a left knee condition is granted.

Entitlement to service connection for a right knee condition is granted.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his lower back condition is at least as likely as not related to service.

2. Resolving reasonable doubt in the Veteran's favor, his cervical neck condition is at least as likely as not related to service.

3. The Veteran's left knee condition is due to his service-connected lower back condition.

4. The Veteran's right knee condition is due to his service-connected lower back condition.

CONCLUSIONS OF LAW

1. The criteria for service connection for a lower back condition are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a cervical neck condition are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a left knee condition, as secondary to the Veteran's service-connected lower back condition, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for a right knee condition, as secondary to the Veteran's service-connected lower back condition, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1970 to March 1972.

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

In September 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for his lower back, cervical neck, left knee, and right knee, most recently addressed in June 2025 and August 2025 rating decisions. In October 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal. 

In the November 12, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on March 9, 2026.

Therefore, the Board may only consider the evidence of record at the time of the October 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran 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. 

The Board notes that the Veteran waived the 90-day evidence window during the March 2026 Board hearing, 

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. 

The Board notes that the November 2025 VA Form 10182 lists a rating decision of September 1970, which does not exist, and was actually a date during the time the Veteran was in service. The Board liberally interprets the November 2025 VA Form 10182 to mean the October 2025 rating decision that most recently addressed the Veteran's claims. 

At the outset, the Board notes that the AOJ denied the claims primarily based upon the alleged pre-existing nature of the Veteran's disabilities. See October 2025
, 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. 

The Board notes that the November 2025 VA Form 10182 lists a rating decision of September 1970, which does not exist, and was actually a date during the time the Veteran was in service. The Board liberally interprets the November 2025 VA Form 10182 to mean the October 2025 rating decision that most recently addressed the Veteran's claims. 

At the outset, the Board notes that the AOJ denied the claims primarily based upon the alleged pre-existing nature of the Veteran's disabilities. See October 2025 rating decision. Indeed, the Veteran testified at the March 2026 Board hearing about the fact that his back, neck, and knees had issues prior to service. He said that he informed the examiner at his enlistment examination, but that he was ultimately inducted. 

Veterans are presumed to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. 38 C.F.R. § 3.304(b). Only such conditions as are recorded in examination reports are to be considered as noted. Id. 

Of note, the April 1970 enlistment examination indicates that, the examiner marked "normal" for lower extremities, neck, and spine/other musculoskeletal. The report notes that the Veteran underwent cervical and lumbar x-rays, and that the cervical x-ray was within normal limits and that the back x-ray was negative. Also, there are documents in the service treatment records (STRs), along with the enlistment examination, that note neck and back issues before service. At the March 2026 Board hearing, the Veteran testified that he had provided these documents to the examiner and told the examiner about his prior back, neck, and knee issues before his enlistment examination. These documents and the fact that the examiner obtained x-rays corroborates the Veteran's testimony that he indeed mentioned potential pre-existing issues to the examiner at that time. Therefore, the Board finds the Veteran credible in that regard.

Based on the above, particularly that the examiner marked "normal" related to the Veteran's back, neck, and knees, and in giving the Veteran the benefit of the doubt, the Board finds that the Veteran was sound as it relates to his back, neck, and knees at the time of enlistment. 

1. Entitlement to service connection for a lower back condition 

2. Entitlement to service connection for a cervical neck condition 

The Veteran contends that he is entitled to service connection for a lower back condition and a cervical neck condition. See November 2025 VA Form 10182.

The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

In the October 2025 rating decision, the AOJ made findings of a diagnosed cervical strain with degenerative arthritis, degenerative disc disease, intervertebral disc syndrome, and spondylolisthesis and of a diagnosed lumbosacral strain. Also, while the AOJ said there was no new and relevant evidence, it proceeded to readjudicate the claims; therefore, the Board finds that to be an implied finding of new and relevant evidence. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

In the April 2025 back examination report, the Veteran reported that his back hurt because, during basic training, he had to run and do long marches, carrying heavy packs and equipment. In the June 2025 VA neck examination report, the Veteran reported that his neck hurt because of physical training and activities with the military and stress on it. The Veteran reported that he "still" deals with his neck issues, which the Board finds implies that he has dealt with this issue since service. Id.

The Veteran testified at the March 2026 Board hearing that his back and neck were hurt in basic training and have been bothering him since service. He said that his pain level is "still" currently high, and that that he has used over-the-counter medication since service, which the Board finds implies that he has dealt with these issues since service. 

Also, there are various buddy statements uploaded in September 2025 that address the Veteran's back issues and how he complained about his back as it relates to his military
 hurt because of physical training and activities with the military and stress on it. The Veteran reported that he "still" deals with his neck issues, which the Board finds implies that he has dealt with this issue since service. Id.

The Veteran testified at the March 2026 Board hearing that his back and neck were hurt in basic training and have been bothering him since service. He said that his pain level is "still" currently high, and that that he has used over-the-counter medication since service, which the Board finds implies that he has dealt with these issues since service. 

Also, there are various buddy statements uploaded in September 2025 that address the Veteran's back issues and how he complained about his back as it relates to his military experience. 

The Board acknowledges that there are no positive medical opinions and that there is evidence against the claims. Nevertheless, the Board finds that it can grant service connection for the back and neck because the Veteran has current disabilities, there is evidence of an in-service occurrence, and the Veteran has testified that he has had issues with pain in his back and neck since service. The Board finds the Veteran competent and credible in this regard. 

Therefore, after resolving any reasonable doubt in favor of the Veteran, the Board finds that service connection for lower back and cervical neck conditions is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Entitlement to service connection for a left knee condition

4. Entitlement to service connection for a right knee condition 

The Veteran contends that he is entitled to service connection for his bilateral knees. See November 2025 VA Form 10182. In a November 2024 VA Form 21-526EZ, the Veteran contended that his knees should be service connected as secondary to his back.

Service connection on a secondary basis requires (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability either (a) caused, or (b) aggravated, the nonservice-connected disability. 38 C.F.R. § 3.310; 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).

In the October 2025 rating decision, the AOJ made a finding of diagnosed bilateral knee strain, instability and degenerative arthritis. Also, while the AOJ said there was no new and relevant evidence, it proceeded to readjudicate the claims; therefore, the Board finds that to be an implied finding of new and relevant evidence. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

The instant Board decision has granted service connection for a lower back condition. Therefore, the remaining question is a nexus.

A June 2025 VA medical opinion provided a positive secondary nexus between the Veteran's now-service-connected lower back disability and his bilateral knees. The examiner said that there is certainly a causal relationship between lower back pain and knee pain and that, due to the biomechanical interrelationship of joints, lower back pain can directly cause knee pain. The examiner concluded that it is at least as likely that the lower back pain started the knee pain. In making this opinion, the examiner provided a sufficient rationale and cited literature.

The Board finds the examiner's opinion to be adequate in that the examiner relied upon the examiner's own expertise, knowledge, and training. Further, the examiner considered lay evidence, the medical history of the Veteran, and medical literature.

Therefore, after resolving any reasonable doubt in favor of the Veteran, the Board finds that service connection for a bilateral knee condition is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

I. Cannaday

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Veljic, Erica A.

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.