DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

TIMOTHY COTHREL · 2026 · Case ID: A26036100

GRANTED

Summary

The veteran, who served in the United States Army Reserve from February 1998 to February 2004, including periods of active duty for training (ADT), appeals the denial of service connection for a lower back disability and left foot metatarsalgia. The veteran also appealed the denial of service connection for ophthalmic migraine, but this issue was dismissed as moot because the agency of original jurisdiction (AOJ) had granted it in a subsequent decision. The Board found that the evidence supported aggravation of a pre-existing lower back condition during a June 2021 ADT period, resolving doubt in the veteran's favor, and granted service connection. For the left foot metatarsalgia, the Board also resolved doubt in the veteran's favor, finding the injury was incurred during a September 2019 ADT period, and granted service connection. The Board noted that while service treatment records were silent for both conditions, private medical records and the veteran's testimony, combined with the timing of the disabilities following periods of ADT, supported the grants. The VA examiner's opinion for both conditions was unfavorable, stating less likely than not related to service, but the Board found the evidence, when viewed in conjunction with the veteran's assertions and the timing of the disabilities, warranted the grants.

Rationale

Evidence is at least evenly balanced; Resolving doubt in veteran's favor; Aggravated during ADT service

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210607-164557

Full Decision Text

Citation Nr: A26036100
Decision Date: 04/17/26 Archive Date: 04/17/26

DOCKET NO. 210607-164557
DATE: April 17, 2026

ORDER

Entitlement to service connection for a lower back disability (claimed as lower back pain) is granted.

Entitlement to service connection for left foot metatarsalgia is granted.

Entitlement to service connection for ophthalmic migraine (also claimed as tension, migraine headaches) is dismissed.

FINDINGS OF FACT

1. The evidence is at least evenly balanced as to whether the Veteran's current lower back disability is related to exertive injury incurred during active duty for training (ADT) service.

2. The evidence is at least evenly balanced as to whether the Veteran's left foot metatarsalgia is related to exertive injury incurred during active duty for training (ADT) service.

3. In a March 2023 rating decision, the AOJ granted service connection for ophthalmic migraine and assigned a rating of 30 percent disabling from October 29, 2019; therefore, no case or controversy remains regarding the benefit sought on appeal.

CONCLUSIONS OF LAW

1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for a lower back disability have been met. 38 U.S.C. §§ 101(24), 1110, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303.

2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for left foot metatarsalgia have been met. 38 U.S.C. §§ 101(24), 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303.

3. The criteria for dismissal of service connection for ophthalmic migraine have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on initial active duty for training in the United States Army from February 1998 until July 1998. Subsequently, the Veteran served on active duty in the United States Army Reserve from December 2002 until her honorable discharge in February 2004.

The Veteran had additional periods of inactive duty for training and active duty for training.

This matter is before the?Board of Veterans' Appeals?(Board) from a May 2021 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ).

On the June 2021 Notice of Disagreement (NOD or VA Form 10182), the Veteran elected the Hearing docket. In September 2024, the Veteran testified before a Veterans Law Judge; the hearing transcript is in the record.

Therefore, the Board may consider only the evidence of record at the time of the May 2021 rating decision, as well as any evidence submitted during (including via testimony) or within 90 days after the September 3, 2024 hearing. 38 C.F.R. §§ 20.301 and?20.302.

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 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.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

In general, the Board grants service connection if the evidence establishes in-service onset of a disability. 38 C.F.R. § 3.303(a). For a disability that does not manifest until after the veteran's separation from service, service connection is warranted when the evidence establishes three key facts, or elements: (1) an existing disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or "nexus," between the present disability and the in- service incurrence. 38 C.F.R. § 3.303(d), Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 201
, the Board grants service connection if the evidence establishes in-service onset of a disability. 38 C.F.R. § 3.303(a). For a disability that does not manifest until after the veteran's separation from service, service connection is warranted when the evidence establishes three key facts, or elements: (1) an existing disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or "nexus," between the present disability and the in- service incurrence. 38 C.F.R. § 3.303(d), Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010).

Additionally, certain diseases identified as "chronic" in 38 C.F.R. § 3.309(a), including arthritis and organic disease of the nervous system, will be presumed related to service if they manifest to a compensable degree within a presumptive period following separation from service; or, if not, if there is a showing of "continuity and chronicity," which means an injury or disease was noted in service, and symptomatology associated with that injury or disease continued after service. 38 C.F.R. § 3.309(a). Walker v. Shinseki,?708 F.3d 1331, 1338?(Fed. Cir. 2013). Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. Barr v. Shinseki, 21 Vet. App. 303, 308 (2007).

Qualifying Service

Active duty for training includes full-time duty with the Reserves, or the National Guard of any State under 32 U.S.C. §§ 316, 502, 503, 504, or 505, or the prior corresponding provisions of law. See 38 U.S.C. § 101(22)(b) and (C); 38 C.F.R. § 3.6(c). Basically, this refers to the two weeks of annual training, which each Reservist or National Guardsman must perform each year. It can also refer to the initial period of training.

For Reserve or National Guard service, service connection may be granted only for a disability due to a disease or injury incurred or aggravated while on active duty for training (ADT), or from an injury incurred or aggravated during inactive duty training (IDT), but not for a disease during inactive duty training, with exceptions for an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident. 38 U.S.C. §§ 101(24), 106; 38 C.F.R. § 3.6.

In the absence of such evidence, the period of inactive duty for training would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" by virtue of inactive duty for training service alone. Id. See also 38 U.S.C. § 101(2), (24); 38 C.F.R. §§ 3.1(d), 3.6(d).

In addition, certain presumptions do not apply for establishing service connection for periods of ADT and IDT because of duty status. The presumption of a nexus to service for certain chronic diseases does not apply to claims based on a period of ADT. Smith v. Shinseki, 24 Vet. App. 40, 46-47 (2010).

In addition, in-service aggravation of a pre-existing injury is not presumed for ADT and ITD periods. However, a disability may still be aggravated by ADT and IDT service. In such cases, the claimant is still entitled to the benefit of the doubt in meeting the burden of showing that (1) a preexisting disability worsened in service and (2) that such worsening was beyond the natural progress of the disease. 38 U.S.C. § 5107(a); see also, Donnellan v. Shinseki, 24 Vet. App. 167, 174-75 (2010).

1. Entitlement to service connection for a lower back disability (claimed as lower back pain) is granted.

The Veteran contends that she developed chronic low back pain during active service and the pain persists to the present. See November 2018 Application for Disability Compensation (VA Form 21-526EZ).

Procedural Background

1. Entitlement to service connection for a lower back disability (claimed as lower back pain) is granted.

The Veteran contends that she developed chronic low back pain during active service and the pain persists to the present. See November 2018 Application for Disability Compensation (VA Form 21-526EZ).

Procedural Background

This appeal derives from the Veteran's November 2018 initial claim for service connection for lower back pain. In April 2019, the AOJ denied the claim and in April 2020, the Veteran filed an untimely request for HLR. In August 2020, the AOJ identified a duty to assist error, treated the HLR as a supplemental claim, sought additional VA examinations and in a May 2021 rating decision denied service connection for lower back pain. As noted above, in June 2021, the Veteran sought Board appeal, elected the Hearing docket, and the hearing was held on September 3, 2024.

In addition to seeking HLR in April 2020 for the initial denial of her claim, from June to September 2019, the Veteran filed six new claims for service connection of her lower back disability, which resulted in April 2019 and December 2019 rating decisions also denying service connection for lower back disability. In July 2020, the Veteran appealed the December 2019 rating decision to the Board. Although the present appeal of lower back pain was already pending, the Board erroneously docketed the July 2020 Board appeal of the same issue. In a March 2024 decision, the Board noted that the Veteran had multiple periods of active and inactive Reserve duty and remanded the claim, directing the AOJ to obtain complete service records to determine whether any of the claimed dates of disability occurred during a verified period of military service. The AOJ compiled the Veteran's service records, readjudicated the claim and in June 2025, again denied service connection.

Therefore, the issue now on appeal has already been considered by the Board, and there has been additional evidentiary development of the claim. The Board finds the erroneous docketing of the later appeal to be harmless procedural error, as the AOJ issued a May 2021 rating decision after addressing the duty to assist error found in the August 2020 rating decision. 38 C.F.R. § 3.2500(b). Because the period on appeal in the present claim derives from the initial claim and included a hearing after which the Veteran submitted additional evidence, rather than dismiss the claim, the Board has again considered the claim with the benefit of that additional evidence.

Evidence and Analysis

The Veteran has a current disability of chronic back pain, as conceded in the May 2021 rating decision.

The questions for the Board are whether the Veteran's current disability began during active service and has a causal nexus with service.

The Board begins this analysis by noting that the Veteran initially claimed she injured her lower back in March 2015 including by doing physical training on concrete. See November 2018 VA Form 21-526EZ. Over time she has asserted other dates of onset, including: 2003 during initial active service, January 2015; "during a 2014 drill weekend"; "during training in February 2015"; and January 2019. See, e.g., 2019 VA Forms 21-526EZ; September 2019 VA Form 21-4138 Statement; December 2020 VA examination.

The Board has reviewed her multiple asserted dates in conjunction with her service records over many years of Reserve active and inactive duty training. The Veteran is competent to report on her symptoms, but the diagnosis and causal connection of symptoms to prior events is medically complex and outside her competence, where the record does not show the Veteran has the medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

The Board finds, resolving doubt in the Veteran's favor, that the evidence supports a finding that the Veteran's lower back disability was aggravated during active service and service connection is warranted.

The Veteran's Service Treatment Record (STR) from her initial 1998 active-duty training and December 2002 to February 2004 active service is silent for complaints or treatment for lower back pain. During that period, no private medical records reflect back pain or injury. The Board further notes that the Veteran sought a Line of Duty (LOD), which formally establishes the occurrence of an in-service injury, for a knee injury but did not seek a LOD for her back injury. Therefore, the Veteran does not have the benefit in this analysis of a presumption of aggravation of
, resolving doubt in the Veteran's favor, that the evidence supports a finding that the Veteran's lower back disability was aggravated during active service and service connection is warranted.

Thus, the Board's review involves determining whether the Veteran has demonstrated that (1) a preexisting disability worsened in service and (2) that such worsening was beyond the natural progress of the disease by an approximate balance standard. 38 U.S.C. § 5107(a); Donnellan v. Shinseki, 24 Vet. App. at 174-75

In December 2020, the Veteran underwent a VA examination. The examiner reviewed the STRs and concluded that there was no evidence supporting a low back claim and her medical evaluations during her active duty as a reservist were not consistent and did not constitute a chronic condition. The examiner opined that less likely than not, the disability was incurred in or caused by an event or injury during service. See December 2020 VA examination. The Board notes that the examination addresses only a direct service connection and does not address the possibility of aggravation during service of a pre-existing injury.

The Board has reviewed the Veteran's STRs and private medical records, which provide a history of the Veteran's lower back disability. See, e.g., 2016 - 2018 records, September 2019 STR - Reserve STR; 2016 - 2018 records, March 2019 Medical Treatment Record (MTR) - Non-Government Facility (NGF).

The Veteran asserted back injury during a "2014 drill weekend." No service or private records support this as a date of injury.

The Veteran asserted she injured her back in February 2015 during service and from doing fitness training on concrete; and asserted an injury during "March 2015 training." No records support these dates of injury. In addition, on her July 2015 Periodic Health Assessment (PHA), the Veteran noted no back pain and that she was on a pregnancy profile with a due date of December 7, 2015. See July 2015 record, September 2019 STR - Reserve STR.

June 2016 private records show the Veteran sought treatment for lumbar pain that began in February 2016 after her second pregnancy. The record shows she denied an acute injury. X-rays showed no fracture or subluxation, no significant joint disease and no paraspinal soft tissue abnormalities. See June 2016 record, March 2019 MTR - NGF.

In July 2016, service records show annual Reserve duty from May 2-17, 2016. A July 2016 PHA shows she had a temporary profile for "back pain, already managed". See July 2016 PHA, September 2019 STR - Reserve STR.

A July 2016 private record shows the Veteran reported having a gradual onset of back pain that started in February 2016 after her second pregnancy. She had no numbness or tingling and was given physical therapy instructions for postural correction for stretching and lumbar stabilization. See July 2016 record, March 2019 MTR - NGF.

In September 2016, the Veteran sought a profile due to chronic back pain for four months with ongoing physical therapy and noted on the profile application that the condition did not occur while on duty. She submitted a private September 2016 medical diagnosis of chronic back pain. September 2016, September 2019 STR - Reserve STR. The Veteran reported that she did not seek a line of duty for the 2016 back pain. See May 2018 record, September 2019 STR - Reserve STR.

In May 2017, a private record shows the Veteran had recovered from the episode of back pain and completed physical therapy and then slipped and fell in a restaurant, and re-ignited her lumbar back pain with no swelling, edema or tingling. In June 2017, she sought a profile due to low back pain from the fall. See May 2017 record, September 2019 STR - Reserve STR.

On her May 2018 PHA, the Veteran reported that she had back pain in July 2016 but was no longer under treatment or follow-up from the back condition.
duty for the 2016 back pain. See May 2018 record, September 2019 STR - Reserve STR.

On her May 2018 PHA, the Veteran reported that she had back pain in July 2016 but was no longer under treatment or follow-up from the back condition. See May 2018 PHA, September 2019 STR - Reserve STR.

Service records show that from June 6 to 19, 2021, the Veteran had her Reserve active duty training, a period which, if other requirements are met, can be the basis for service connection of a disability.

A September 2021 private record shows the Veteran underwent magnetic resonance imaging (MRI) of the spine on September 3, 2021, which showed significant progression of the lower back condition including disc bulge, facet degeneration, spinal canal stenosis, bilateral foraminal stenosis, and bilateral impingement of the S1 nerve roots. See September 2021 MRI results, November 2024 MTR - NGF.

An October 2024 private MRI similarly shows narrowing on the L4-5 spinal canal and on L5-S1 some nerve impingement. See October 2024 medical record, November 2024 Correspondence.

Resolving doubt in the Veteran's favor, the Board finds that the evidence supports a finding that the Veteran had a pre-existing lower back disorder diagnosed in 2016 as lower back pain that worsened during active service in June 2021, beyond the natural progress of the diagnosed condition of lower back pain. Records in 2018 show the Veteran reported chronic pain had resolved. However, 2021 records show the lower back disability had progressed to include significant lower spine disorders not contemplated by a chronic back pain diagnosis treated with physical therapy. 38 U.S.C. § 5107(a); Donnellan v. Shinseki, 24 Vet. App. at 174-75.

Resolving doubt in the Veteran's favor, the Board finds that service connection of lower back disability is warranted. 38 U.S.C. § 101(2), (24); 38 C.F.R. §§ 3.1(d), 3.6(c); Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). This appeal is granted.

The Board notes that more recent medical evidence developed as part of the March 2024 Board remand, which is beyond the evidentiary period on appeal here, may indicate further progression and other disabilities associated with the now-service-connected lower spine disability, which should be taken into consideration in rating the disability.

2. Entitlement to service connection for left foot metatarsalgia is granted.

The Veteran contends that her current left foot pain has continued from an injury related to service either in 2018 (See September 2019 VA Form 21-4138) or due to training in 2019, or on January 1, 2019 (See September 2019 VA Form 21-526EZ) or during annual training in 2019 (See December 2020 VA examination).

The Veteran has a current diagnosis of left foot metatarsalgia, as conceded in the May 2021 rating decision.

The questions for the Board are whether the in-service incurrence and nexus elements are met. The Board finds that, resolving doubt in the Veteran's favor, the evidence supports finding that the Veteran's left foot disability began during active service or is otherwise related to an in-service injury, event, or disease.

The Veteran's STRs during active duty and post-deployment are silent for this condition.

In December 2020, the Veteran underwent a VA examination. The examiner reviewed the STRs and found that there was no evidence that could be the basis for a diagnosis of chronic left metatarsal pain. Imaging taken on September 20, 2019 showed no acute abnormalities. The examiner opined that it was less likely than not the disability was incurred in or caused by an event or injury during service. The Board notes that the examination addressed only a direct service connection, however,
Veteran's favor, the evidence supports finding that the Veteran's left foot disability began during active service or is otherwise related to an in-service injury, event, or disease.

The Veteran's STRs during active duty and post-deployment are silent for this condition.

In December 2020, the Veteran underwent a VA examination. The examiner reviewed the STRs and found that there was no evidence that could be the basis for a diagnosis of chronic left metatarsal pain. Imaging taken on September 20, 2019 showed no acute abnormalities. The examiner opined that it was less likely than not the disability was incurred in or caused by an event or injury during service. The Board notes that the examination addressed only a direct service connection, however, thereby failing to explore the possibility of in-service aggravation of a pre-existing injury.

A private treatment record shows that on September 20, 2019, the Veteran sought treatment for left foot pain. The clinician ordered the imaging noted above and diagnosed left metatarsalgia. The record notes that the primary cause of the metatarsalgia is repetitive application of excessive force to one metatarsal area more than others. See September 2019 record, MTR - NGF.

The Veteran's service record shows she served on active service for training from August 5, 2019 to August 23, 2019, a period which, if other requirements are met, can be the basis for service connection of a disability.

The Board finds that the medical evidence, which immediately follows a period of active service during which the Veteran has stated she incurred the injury, and is consistent with the circumstances of the described injury and known physical demands of training, demonstrates the injury was incurred during active duty training. As such, the Board finds service connection for the left foot metatarsalgia is warranted. 38 U.S.C. § 101(2), (24); 38 C.F.R. §§ 3.1(d), 3.6(c); Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). This appeal is granted.

3. Entitlement to service connection for ophthalmic migraine is dismissed.

The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. As a general matter, the grant of a claim of service connection constitutes an award of full benefits sought on appeal of a denial of a service connection claim. Seri v. Nicholson, 21 Vet. App. 441, 447 (2007).

In a March 2023 rating decision, the AOJ granted service connection for ophthalmic migraine and assigned a rating of 30 percent disabling from October 29, 2019; therefore, no case or controversy remains regarding the benefit sought on appeal. This constituted a full grant of the benefits sought on appeal. Further, no "downstream" issues such as effective date or initial rating assigned to the disability are before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of such issues).

Considering the foregoing, there is nothing for the Board to adjudicate concerning that particular issue. Accordingly, as to that issue, the appeal is dismissed. 38 U.S.C. § 7105 (d).

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jaeger, L

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.

Analyze in VA Law Explorer