INTERVERTEBRAL DISC SYNDROME

Summary

The Veteran, an Army veteran who served from September 1994 to September 1997, appeals the denial of service connection for a back condition claimed as secondary to his service-connected left knee replacement residuals. The Veteran presented evidence including private treatment records from March 2021, which indicated his gait changes due to bilateral knee osteoarthritis and left knee replacement exacerbated his lower back pain. A VA examination in July 2021 diagnosed degenerative arthritis, degenerative disc disease, spinal stenosis, and left lower extremity radiculopathy, but the examiner opined these were unrelated to service or due to aging, failing to address aggravation. The Veteran testified at a Board hearing in April 2025 that his altered gait from the knee condition strained his lower back and that a physician had previously linked his back pain to the knee replacement. The Board found the VA opinion inadequate for failing to address aggravation. However, the Board found the private treatment note persuasive, noting the physician's explicit finding that gait changes exacerbated the back pain. The Board also considered the Veteran's hearing testimony about gait strain. Finding the evidence in approximate balance, the Board resolved all reasonable doubt in the Veteran's favor, establishing a positive nexus. Service connection for the back condition as secondary to the left knee replacement residuals was granted.

Rationale

VA opinion inadequate for failing to address aggravation; Private treatment note persuasive regarding gait changes exacerbating back pain; Veteran testimony supported gait strain on lower back; Evidence in approximate balance, doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: A26037707
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 210915-185833
DATE: April 22, 2026

ORDER

Entitlement to service connection for a back condition as secondary to service-connected residuals of a left knee replacement is granted.

FINDING OF FACT

The persuasive weight of the evidence is in approximate balance that the Veteran's back condition is related to his service-connected left knee total replacement residuals.

CONCLUSION OF LAW

The criteria for service connection for a back condition as secondary to service-connected residuals of a left knee replacement have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Army from September 1994 to September 1997.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2021 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 28, 2025. Therefore, the Board may only consider the evidence of record at the time of the August 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative 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. 

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. 

1. Entitlement to service connection for a back condition as secondary to service-connected residuals of a left knee replacement is granted. 

Service connection will be granted if the evidence in the record demonstrates that a current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) an in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) Evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. 38 C.F.R. § 3.310.

38 U.S.C. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).

The Veteran contends that his back condition is secondary to his service-connected left knee replacement
Fed. Cir. 2009). Specifically, "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).

The Veteran contends that his back condition is secondary to his service-connected left knee replacement residuals. 

The Veteran was service connected for left knee replacement residuals at the time of the August 2021 rating decision. Additionally, private treatment records from March 2021 show that the Veteran reported experiencing low back pain since separating from service. The treating physician also noted that the Veteran had bilateral knee osteoarthritis, status post left knee replacement, which was exacerbating the Veteran's lower lumbar symptoms due to gait changes.

The Veteran was afforded a VA examination in July 2021, at which time he was diagnosed with degenerative arthritis, degenerative disc disease, spinal stenosis, and left lower extremity radiculopathy. The Veteran reported that his symptoms began several years prior, and he continued to experience daily lower back pain with occasional numbness in his left leg and tingling down to his toes. The examiner ultimately concluded that the Veteran's back conditions were not related to his service-connected left knee replacement residuals or scars because knee conditions have not been shown to cause either degenerative joint disease or degenerative disc disease. Instead, the examiner found that these conditions were due to normal wear and tear associated with aging. 

During his April 2025 Board hearing testimony, the Veteran explained that he believed that his left knee issues have caused him to walk with an altered gait that has placed additional strain on his lower back. He also stated that he had been previously told by his physician that his lower back pain was due to his left knee replacement. While he was receiving treatment through VA now, he first sought pain management from a private physician at Memorial Hospital. To that end, the Board notes that a March 2021 private treatment note is in the evidentiary record.

After reviewing the record, the Board finds that the persuasive weight of the evidence is in approximate balance that the Veteran's back condition is aggravated by his service-connected left knee replacement residuals.

While the July 2021 examiner found that the Veteran's left knee residuals and scars did not cause his back conditions because (1) knee conditions have not been shown to cause degenerative disc disease or degenerative joint disease and (2) these conditions were most likely the result of aging, the examiner failed to provide an opinion regarding aggravation. Thus, the July 2021 opinion is inadequate. See Atencio v. O'Rourke, 30 Vet. App. 74, 90 (2018) (holding that, in claims involving service connection on a secondary basis, VA medical opinions must provide separate findings and rationales regarding both causation and aggravation); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (a medical opinion is inadequate when it fails to adequately address the question of aggravation).

As for the March 2021 private treatment note, the Board finds this to be highly persuasive. The treating physician explicitly found that the Veteran's gait changes were related to his bilateral knee osteoarthritis and left knee replacement, and these changes exacerbated his lower back pain symptoms. Additionally, the Veteran reiterated that he experienced difficulty with walking that caused additional strain on his back in his April 2025 hearing testimony.  Thus, after resolving all reasonable doubt in favor of the Veteran, the Board finds that a positive nexus exists between the Veteran's back condition and his service-connected left knee replacement residuals.

Accordingly, for the reasons above, the Board finds that the persuasive weight of the evidence is in approximate balance that the Veteran's back condition is related to his service-connected left knee replacement residuals. Thus, service connection for a back condition as secondary to left knee replacement residuals is warranted.  

 

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ongies, Gabrielle 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. 


 balance that the Veteran's back condition is related to his service-connected left knee replacement residuals. Thus, service connection for a back condition as secondary to left knee replacement residuals is warranted.  

 

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ongies, Gabrielle 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.