INTERVERTEBRAL DISC SYNDROME

Summary

The Veteran, who served from March 1971 to December 1972, appeals the denial of service connection for a lower back condition claimed as secondary to his service-connected right knee disability. The Veteran has a service-connected right knee condition for which he received a total knee replacement and a temporary 100% rating in February 2011. The primary issue is the nexus between the current lower back disability and the service-connected knee condition. The Board reviewed conflicting medical opinions. A VA examiner in April 2022 opined that the lower back condition was less likely than not proximately due to the right knee condition, attributing the back issues to age-related degenerative changes and the Veteran's obesity and physically demanding job. However, the Board found this opinion less probative as it did not adequately explain the causal link or address the Veteran's history of antalgic gait. In contrast, a private nexus opinion from April 2022 found the lower back condition to be at least as likely as not related to the service-connected right knee, citing medical literature on compensatory trunk motion and degenerative changes caused by varus gait secondary to knee pain. The Board found this private opinion more probative, as it was supported by a consistent medical history and detailed rationale. Given the relative equipoise between the conflicting opinions, the Board applied the benefit of the doubt. Service connection for the lower back condition as secondary to the right knee disability is granted.

Rationale

Conflicting medical opinions regarding nexus; VA examiner: less likely than not related to knee condition; Private provider: at least as likely as not related to knee condition; Board found private opinion more probative due to rationale and consistency

Full Decision Text

Citation Nr: A26039145
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 220810-267335
DATE: April 27, 2026

ORDER

Service connection for a lower back condition, as secondary to service-connected right knee disability is granted.

FINDING OF FACT

The evidence of record is at least at relative equipoise as to whether the Veteran's low back disability is proximately due to or the result of his service-connected right knee disability

CONCLUSION OF LAW

The criteria for service connection for a low back disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from March 1971 to December 1972.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2022 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).  

In the August 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 7, 2026. Therefore, the Board may only consider the evidence of record at the time of the July 2022 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). 

Service connection for lower back condition

The Veteran contends his low back condition is due to his right knee disability.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.  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, 1166 -67 (Fed. Cir. 2004).

Service connection may be granted on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be granted for aggravation of a disease or injury by a service-connected disability. Id.

The evidence of record shows that the Veteran was diagnosed with degenerative disc disease (DDD), lumbosacral strain, and intervertebral disc syndrome (IVDS) and lumbosacral radiculopathy. See April 2022 VA examination. Therefore, there is evidence of a current disability. 

The Veteran has also been service connected for a right knee disability since 1973, and was awarded a temporary 100 percent rating in February 2011, following a total right knee replacement. 

As to a nexus between the current torn left bicep muscle and the Veteran's service-connected right knee disability, the Board notes that the record contains conflicting medical opinions.

In an April 2022 VA examination, the Veteran reported that his low back condition began in 2011, when he had a total knee replacement, and continued since. The examiner noted that it is uncertain as to whether or not the lower back pain is related to the right knee condition. At the time of examination, the examiner stated the Veteran was presenting with a degenerative spine issue that is superimposed on the right knee pain. He explained that the knee pain can cause antalgic gait, which can put a strain on the back causing pain. Likewise, a degenerative spine can cause knee pain that can also result in an antalgic gait, which is the what the examiner believed to be in the case of the Veteran. The examiner opined that the Veteran's back condition is less likely than not proximately due to his right knee. He reasoned that the Veteran's conditions are due to the natural progression of a degenerative spine, as by the 6th decade of life, greater than 90 percent of people will have evidence of disc degeneration at some level. This is greatly associated with age-related wear and tear. Other factors include falling, obesity, smoking and working a physically demanding job. The examiner noted the Veteran is obese and has been working at a physically demanding job for several decades. Here, the Veteran's first indication of a lower back abnormality was in
 gait, which is the what the examiner believed to be in the case of the Veteran. The examiner opined that the Veteran's back condition is less likely than not proximately due to his right knee. He reasoned that the Veteran's conditions are due to the natural progression of a degenerative spine, as by the 6th decade of life, greater than 90 percent of people will have evidence of disc degeneration at some level. This is greatly associated with age-related wear and tear. Other factors include falling, obesity, smoking and working a physically demanding job. The examiner noted the Veteran is obese and has been working at a physically demanding job for several decades. Here, the Veteran's first indication of a lower back abnormality was in 2011, when the Veteran was 60 years old. The examiner also noted there were gaps of time when the Veteran did not have a gait abnormality or knee pain, therefore it cannot be assumed that the Veteran had persistent knee pain or antalgic gait that caused his low back pain.

The Veteran submitted a private nexus opinion from a private provider. She noted that the Veteran's right knee pain resulted in antalgic gait that never improved, and he consequently developed chronic low back pain. She opined that his back condition is at least as likely s not related to his service-connected right knee condition. She explained that according to medical literature, there is a higher prevalence of lower back pain in patients with varus gait secondary to knee pain. It causes compensatory trunk motion such as lateral trunk leaning, due to avoiding pain and minimizing knee stress. The compensatory trunk motion demands more trunk muscle contraction, which can initiate or aggravate lower back pain. The increased pull can cause degenerative changes of the disc and facet joints. 

The August 2022 VA examiner's opinion is given lower probative value as the examiner did not explain why he believed the Veteran's lower back condition caused or aggravated his right knee pain, as opposed to the other way around. On the other hand, the private doctor's opinion is based on a medical history taken from the Veteran that is consistent with the other evidence of record. The opinion is supported by rationale demonstrating medical knowledge and judgment, as well as an understanding of the Veteran's particular low back disability. In short, the Board finds the April 2022 private opinion to be probative in showing that the Veteran's low back condition is causally related to his service-connected right knee disability.

In view of the foregoing, the Board finds that the probative evidence of record is at least at relative equipoise. Accordingly, service connection for a low back condition, as secondary to service-connected right knee condition, is granted. 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jaigirdar, 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.