BACK DISORDER

Summary

The veteran served on active duty from October 1985 to April 1989, with subsequent periods of service including ACDUTRA in May 2005. The veteran appealed the denial of service connection for Crohn's disease, a right knee disorder, and an acquired psychiatric disorder, and also appealed the denial of service connection for a back disorder. The Board granted service connection for lumbosacral strain and disc herniation, finding the conditions related to in-service injuries and ACDUTRA aggravation, resolving doubt in the veteran's favor due to unavailable service treatment records. Service connection for Crohn's disease and a right knee disorder was denied, as the available service records were silent regarding these conditions, and the veteran's post-service claims and lay statements did not establish a nexus to service. The Board found no pre-decisional duty to assist error in not obtaining a VA examination for these denied claims, as the claims and supporting evidence were not presented until after the rating decision. The claim for an acquired psychiatric disorder, potentially secondary to the back condition or Crohn's disease, was remanded. The Board noted the veteran's service in security roles and his reports of stress and anxiety during service after 9/11, as well as his current diagnosis of an acquired psychiatric disorder. A remand was ordered for a VA examination to determine the nature and etiology of the psychiatric disorder, and to assess its relationship to service, including the possibility of it being secondary to the newly service-connected back condition.

Full Decision Text

Citation Nr: A26038295
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 210713-171830
DATE: April 23, 2026

ORDER

Service connection for lumbosacral strain and disc herniation is granted. 

Service connection for Crohn's disease is denied.

Service connection for a right knee disorder is denied. 

REMANDED

Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected lumbosacral strain and disc herniation, is remanded.

FINDINGS OF FACT

1. Resolving all doubt in the Veteran's favor, his currently diagnosed lumbosacral strain and disc herniation is related to an injuries incurred during a period of active duty from October 1985 to April 1989 as well as his period of active duty for training (ACDUTRA) in May 2005. 

2. Crohn's disease is not shown to be causally or etiologically related to any disease, injury, or incident during service.

3. A right knee disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service.

CONCLUSIONS OF LAW

1. The criteria for service connection for lumbosacral strain and disc herniation have been met.  38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303.

2. The criteria for service connection for Crohn's disease have not been met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303.

3. The criteria for service connection for a right knee disorder 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 Veteran served on active duty from October 1985 to April 1989, July 1990 to September 1996, and November 2001 to November 2002, with additional service in the Reserve and National Guard, which includes periods of ACDUTRA. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in February 2021, which performed a higher level review of a May 2020 rating decision and denied service connection for Crohn's disease, a right knee disorder, and an acquired psychiatric disorder, and April 2021, which denied service connection for a back disorder, by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA). In May 2021, the Veteran timely appealed such decisions to the Board of Veterans' Appeals (Board) by filing a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) wherein he requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ). However, the Veteran submitted a second VA Form 10182 in July 2021, wherein he requested to switch dockets by asking for a hearing before a Veterans Law Judge, which was subsequently granted. 38 C.F.R. § 20.202(c)(2). Thereafter, a Board hearing was held before the undersigned Veterans Law Judge in February 2025. A transcript of the hearing is associated with the record.  

Therefore, the Board may only consider the evidence of record at the time of the May 2020 AOJ decision, which was subsequently subject to a higher level review, and April 2021 AOJ decision, 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 aforementioned decisions 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. However, based on the evidence the Board may consider, service connection for lumbosacral strain is awarded herein, which is a full grant of the benefit sought on appeal.

With respect to the claims denied herein, if the Veteran would like
 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 aforementioned decisions 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. However, based on the evidence the Board may consider, service connection for lumbosacral strain is awarded herein, which is a full grant of the benefit sought on appeal.

With respect to the claims denied herein, if the Veteran 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 claim for 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

A veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions "other than dishonorable." 38 C.F.R. § 3.1 (d). The term "active military, naval, or air service" includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of inactive duty for training during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 U.S.C. § 101 (22)-(24); 38 C.F.R. § 3.6 (a). ACDUTRA includes full-time duty performed by members of the National Guard of any State or the Reserve. 38 C.F.R. § 3.6 (c). 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.  Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

As an initial matter, the Board notes that the Veteran's complete service treatment records (STRs) are unavailable, which he was advised of in an April 2020 letter.  In such cases, VA has a heightened duty to explain its findings and conclusions, and to consider carefully the benefit of the doubt rule.  38 U.S.C. § 5107(b); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991).  However, there is no presumption, either in favor of the claimant or against VA, arising from missing records.  Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005).  Also, such does not lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all the evidence that may be favorable to the veteran.  Russo v. Brown, 9 Vet. App. 46 (1996).

1. Entitlement to service connection for a back disorder.

The Veteran contends that he has a back disorder that is directly related to his miliary service. Specifically, at his February 2025 Board hearing, he testified that, during his first period of active duty, he injured his back when he fell off a repelling wall when the rope broke, causing him
19 Vet. App. 215, 217-18 (2005).  Also, such does not lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all the evidence that may be favorable to the veteran.  Russo v. Brown, 9 Vet. App. 46 (1996).

1. Entitlement to service connection for a back disorder.

The Veteran contends that he has a back disorder that is directly related to his miliary service. Specifically, at his February 2025 Board hearing, he testified that, during his first period of active duty, he injured his back when he fell off a repelling wall when the rope broke, causing him to fall approximately 7 to 9 feet to the ground. The Veteran indicated that he had a second injury when he fell off the back of a truck while serving in Honduras in 1999 and when serving on ACDUTRA in May 2005, which aggravated the initial injury.

While the Veteran's STRs from his first period of active duty are not available, subsequent STRs reveal that, in May 2005, he complained of lower back pain since the prior Sunday after he jumped from a dock to the boat. He was diagnosed with low back strain. In this regard, he testified that, in May 2005, he was an individual mobilization augmentee (IMA) reservist, which meant that instead of doing one weekend a month of ACDUTRA, he did one week every 3 months and believed that he was probably on IMA status during the May 2005 incident. The Board notes that the May 2005 STR indicated that the Veteran was on IMA status as it noted IMA under reason for visit.   

Furthermore, at a January 2020 VA examination, a diagnosis of lumbosacral strain and disc herniation was noted. Additionally, the Veteran reported injuries to his back when he fell off a repelling wall when the rope broke in 1998 (which he reported actually occurred in 1989 at his Board hearing) and when he fell off a truck bed in 1999, and indicated that he had ongoing progressively worsening low back pain since such time. At such time, examiner opined that such disorders were at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, he indicated that the foregoing specific injuries noted during the Veteran's periods of service led to lumbar sprain and progressively worsening symptoms, to include as reflected in clinical records from March 2000 to March 2008 that noted low back strain/low back pain, which notably includes his period of ACDUTRA in May 2005. There is no medical opinion to the contrary. 

Consequently, in light of the fact that the Veteran's STRs from his first period of active duty, which may potentially document his fall in 1989, are unavailable, the Board resolves any remaining doubt in favor of the Veteran and finds that his currently diagnosed lumbosacral strain and herniation is related to injuries incurred during such period of service as well as his period of ACDUTRA in May 2005. Thus, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  

2. Entitlement to service connection for Crohn's disease.

3. Entitlement to service connection for a right knee disorder.

The Veteran is seeking service connection for Crohn's disease and a right knee disorder. Specifically, during his February 2025 Board hearing, he testified that he was diagnosed with Crohn's disease prior to his separation from service, which led to his decision to leave the military. He also stated that he started to experience symptoms in 2001 or 2002, which he believe could have been due to exposure to contaminated water during his service at Wurtsmith Air Force Base (AFB). With regard to his right knee disorder, the Veteran testified that such was due to an injury that occurred during his period of active duty from November 2001 to November 2002 after he exited a vehicle that had not completely stopped. He also stated that he had to have knee surgery after service, and has continued to wear a knee brace to the present time. 

In this regard, the Veteran's available STRs are silent as to any complaints, treatment, or diagnoses referrable to Crohn's disease and/or a right knee disorder. Nonetheless, his post-service treatment records indicate that he was diagnosed with, and treated for, Crohn's disease. However, while the Veteran is competent to report his current symptomatology, his post-service treatment records do not suggest a relationship between his Crohn's disease and/or a right knee disorder, and his military service
 active duty from November 2001 to November 2002 after he exited a vehicle that had not completely stopped. He also stated that he had to have knee surgery after service, and has continued to wear a knee brace to the present time. 

In this regard, the Veteran's available STRs are silent as to any complaints, treatment, or diagnoses referrable to Crohn's disease and/or a right knee disorder. Nonetheless, his post-service treatment records indicate that he was diagnosed with, and treated for, Crohn's disease. However, while the Veteran is competent to report his current symptomatology, his post-service treatment records do not suggest a relationship between his Crohn's disease and/or a right knee disorder, and his military service. In fact, a May 2017 private treatment record reflects that the former disease had been present for 8 years, i.e., 2009, which is 7 years after his separation from his last period of active duty and a year after his retirement from the Reserve.

In this regard, the Board notes the Veteran was not afforded a VA examination and/or opinion in connection with his claims for service connection for Crohn's disease and a right knee disorder. However, at the time of the rating decision on appeal, there was no evidence of an event, injury, or disease in service, or an indication that such disorders may be related to service. Bardwell v. Shinseki, 24, Vet. App. 36 (2010); Waters v. Shinseki, 601 F.3d 1274, 1278 (2010); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Rather, the Veteran first claimed that his Crohn's disease had its onset in service and indicated that such may be due to contaminated waters at Wurtsmith AFB, and his right knee disorder was due to an injury during a period of active duty after he exited a vehicle that was still moving, during his February 2025 Board hearing, which was after the issuance of the rating decision on appeal. 

Therefore, the Board finds that there was no pre-decisional duty to assist error in the AOJ's determination not to afford him a VA examination and/or opinion. Moreover, there is no medical opinion of record demonstrating that the Veteran's Crohn's disease and/or right knee disorder is related to his military service. Furthermore, the Board further notes that, at the February 2025 hearing, the Veteran reported that he received post-service private treatment for his right knee as he underwent knee surgery. However, as such records were first identified after the issuance of the rating decision on appeal, such allegation cannot serve to support a pre-decisional duty to assist error and, thus, there is no obligation to remand the case in order for VA to obtain such private treatment records. 

The Board has also considered the Veteran's assertions as to the etiology of his Crohn's disease and right knee disorder. While he is competent to report relevant symptomatology, as a lay person, he does not have the requisite training and experience necessary to offer an opinion addressing the etiology of such disorders as such is a complex medical question. See Jandreau, v. Nicholson,?491 F.3d 1372 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of Crohn's disease and a right knee disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Therefore, such matter may not be competently addressed by lay statements. See 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). Thus, the Veteran's opinion as to the etiology of his Crohn's disease and right knee disorder is not competent evidence and, consequently, is afforded no probative weight.

Thus, based on the foregoing, the Board finds that the Veteran's Crohn's disease and right knee disorder are not shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for such disorders is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claims for service connection for Crohn's disease and a right knee disorder, such doctrine is not applicable in the instant appeal and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3
, is afforded no probative weight.

Thus, based on the foregoing, the Board finds that the Veteran's Crohn's disease and right knee disorder are not shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for such disorders is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claims for service connection for Crohn's disease and a right knee disorder, such doctrine is not applicable in the instant appeal and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

4. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected lumbosacral strain and disc herniation.

The Veteran contends that he has an acquired psychiatric disorder related to his military service. Specifically, in a February 2020 statement, he indicated that he was called to return to active duty service after 9/11, which resulted in leaving his family abruptly. The Veteran also noted that he believed his separation from his family and uncertainty of future employment upon his return led to his disorder. Additionally, during the February 2025 Board hearing, he testified that his acquired psychiatric disorder had its onset during his military service and/or is secondary to his Crohn's disease. Furthermore, the Board notes that his military occupational specialty (MOS) during his periods of active duty included security specialist, security police craftsman, and security forces, respectively. 

As an initial matter, the Board notes that, pursuant to the decision herein, the Veteran is not currently service-connected for Crohn's disease. Therefore, under the law, he lacks legal grounds to establish entitlement to service connection for an acquired psychiatric disorder as secondary to such disorder. See Sabonis v. Brown, 6 Vet. App. 426 (1994) (in cases in which the law and not the evidence is dispositive, a claim for entitlement to VA benefits should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law).

Nonetheless, the Veteran's post-service treatment records reveal that, in September 2009, he reported he had been feeling some increased stress and anger related to the variety of his medical conditions and had a recent episode during his duty as a police officer when he experienced anxiety and discomfort in his chest. In October 2009, he had a normal stress test, but admitted to being under a lot of stress and anxiety. He also wanted to be on acute anxiety medication or pursue cognitive behavioral therapy. In February 2016, he had a positive depression screen and his assessment included anxiety. The clinician also noted that the Veteran seemed frustrated with his chronic back pain to the point where it was starting to affect his mental health. In March 2016, April 2016, and August 2016, his active problems included anxiety. Additionally, in April 2017, the clinician noted that he believed the Veteran had a good amount of anxiety to begin with, but, he was feeling overwhelmed with hospital bills and potential multiple specialty follow-ups, as well as essentially undiagnosed hospitalization. 

Thus, given that the evidence of record indicates that the Veteran has a current diagnosis of an acquired psychiatric disorder, and his reports that such was due to his active duty service after 9/11, which includes a period of active duty from November 2001 to November 2002, and his MOS in security, the Board finds that a remand is necessary to cure a pre-decisional error by affording him a VA examination so as to determine the nature and etiology of his claimed acquired psychiatric disorder. 

The Board also observes that post-service treatment records indicate that the Veteran's acquired psychiatric disorder may be related to his now service-connected back disability. Therefore, such claim is inextricably intertwined with implementation of the award of service connection for his lumbosacral strain and disc herniation. Consequently, consideration of the former issue must be deferred pending the resolution of the latter matter. Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Thus, such claim must likewise be remanded. However, as service connection for the Veteran's back disability had not been established at the time of the issuance of the rating decision, there was no pre-decisional duty to assist error in the AOJ's failure to
. Consequently, consideration of the former issue must be deferred pending the resolution of the latter matter. Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Thus, such claim must likewise be remanded. However, as service connection for the Veteran's back disability had not been established at the time of the issuance of the rating decision, there was no pre-decisional duty to assist error in the AOJ's failure to obtain an opinion addressing such matter.

The matters are REMANDED for the following action:

1. Afford the Veteran an appropriate VA examination to determine the current nature and etiology of his claimed acquired psychiatric disorder. The record, including a copy of this Remand, must be made available for review in connection with the examination, and all indicated tests and studies should be undertaken. Thereafter, the examiner should address the below inquiries:

(A) Identify all of the Veteran's acquired psychiatric disorders, including anxiety and/or depression, that meet, or have met, the DSM-5 diagnostic criteria at any time since August 2018, even if such is asymptomatic or resolved.  

(B) For each diagnosed acquired psychiatric disorder, the examiner should offer an opinion as to whether it is at least as likely as not that such disorder had its onset in, or is otherwise related to, the Veteran's active duty military service, to include the anxiety he reportedly experienced during his active duty service after 9/11 from November 2001 to November 2002 where he served in security forces. 

In offering such opinion, the examiner should consider and address the Veteran's reports regarding the onset of his acquired psychiatric disorder during service and the continuity of symptomatology of such disorder. However, the Board makes no determination as to the credibility of the Veteran's reports regarding the onset of symptomatology, or the continuity thereof.

The examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran's STRs are silent as to such disorder, or complaints thereof, or the lack of post-service treatment records demonstrating a continuity of care. 

In this regard, if the examiner rejects the Veteran's lay statements as to onset and/or a continuity of symptomatology, he or she should provide a reason for doing so beyond the mere lack of corroborating records.

A rationale for any opinion offered should be provided.

2. After completion of the above, and the implementation of the Board's award of service connection for lumbosacral stain and disc herniation, adjudicate the Veteran's claim for service connection for an acquired psychiatric disorder, to include as secondary to such now service-connected back disability.

 

 

A. JAEGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Clark

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.