DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

G. A. WASIK · 2026 · Case ID: A26039428

MIXED

Summary

The veteran, who served in the U.S. Army from March 1994 to March 1997, appeals the denial of service connection for thoracolumbar spine disability, bilateral hearing loss, gout, multiple painful joints, bilateral ankle disorder, bilateral knee disorder, and obstructive sleep apnea (OSA). The veteran claims the back injury occurred during service while lifting heavy materials, and that the joint, ankle, knee, and OSA conditions are secondary to gout. The Board granted service connection for the thoracolumbar spine disability, finding an approximate balance of evidence after considering the veteran's lay testimony, the missing service treatment records, and conflicting VA medical opinions. The Board ultimately found a February 2025 VA addendum opinion, which stated it was as likely as not that current back problems stemmed from the in-service injury, to be more persuasive. Service connection for hearing loss was denied, as the Board found the VA audiology reports from September and December 2024, which characterized test results as unreliable due to inconsistency, to be probative. The veteran's lay testimony regarding hearing loss was not considered credible on this complex issue. Gout was denied service connection, as the evidence showed no diagnosis or symptoms during service, and the earliest diagnosis was over 10 years post-service, with a VA examiner finding the in-service toe injury inconsistent with gout onset. The secondary claims for joint, ankle, knee disorders, and OSA were denied because gout, the alleged secondary cause, was not service-connected. The Board applied the benefit of the doubt doctrine to the thoracolumbar spine claim due to the approximate balance of evidence.

Rationale

Approximate balance of evidence; Conflicting VA medical opinions; Credible lay testimony regarding in-service injury; Missing service treatment records

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251105-604908

Full Decision Text

Citation Nr: A26039428
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 251105-604908
DATE: April 28, 2026

ORDER

Entitlement to service connection for thoracolumbar spine disability is granted.

Entitlement to service connection for a bilateral hearing loss disorder is denied.

Entitlement to service connection for gout is denied.

Entitlement to service connection for multiple painful joints is denied.

Entitlement to service connection for a bilateral ankle disorder is denied.

Entitlement to service connection for a bilateral knee disorder is denied.

Entitlement to service connection for obstructive sleep apnea (OSA) is denied.

FINDINGS OF FACT

1. There is an approximate balance of positive and negative evidence indicating that a thoracolumbar spine disability is related to service.

2. The evidence indicates that the Veteran does not have a bilateral hearing loss disability.

3. The evidence demonstrates that gout was not incurred in service.

4. A disorder involving multiple painful joints is not related to service-connected disability.

5. A bilateral ankle disorder is not related to service-connected disability.

6. A bilateral knee disorder is not related to service-connected disability.

7. OSA is not related to service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a thoracolumbar spine disability are met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a bilateral hearing loss disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.385.

3. The criteria for service connection for gout are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

4. The criteria for service connection for a disorder involving multiple painful joints are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

5. The criteria for service connection for a bilateral ankle disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

6. The criteria for service connection for a bilateral knee disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

7. The criteria for service connection for OSA are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1994 until March 1997.

This matter came to the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran appealed the matter to the Board by filing a VA Form 10182, notice of disagreement, against the rating decision. He has elected direct Board review of the decision. See 38 C.F.R. § 20.301.

In February 2018, the Veteran testified before a Board hearing. A transcript of the hearing is included in the claims file and has been reviewed.

This case has been subject to multiple Board remands, the most recent of which is dated in October 2024. The case is again before the Board for appellate review.

In the decision below, the Board may only consider the evidence that was relevant in the rating decision on appeal. See 38 C.F.R. § 20.301. If the Veteran wishes to pursue this matter further, information for doing so is included with this decision.

Service Connection

The Veteran asserts that he incurred back disability, hearing loss, and gout during service. He also asserts he developed joint, ankle, knee, and sleep disorders as the result of gout.

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

To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during active service. See Holton v. Shinseki, 557 F.
out during service. He also asserts he developed joint, ankle, knee, and sleep disorders as the result of gout.

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

Certain chronic disorders such as arthritis and sensorineural hearing loss are presumed to have been incurred in service if the disorder manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a), 3.309(a).

Service connection also may be established on a secondary basis for a disability related to service-connected disability. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by service-connected disability. 38 C.F.R. § 3.310.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. To deny a claim, the evidence must clearly weigh against the claim. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The relevant evidence consists of lay assertions, service treatment records (STRs), service personnel records (SPRs), private and VA treatment records, and multiple VA examination reports and opinions dated between October 2014 and March 2025.

Thoracolumbar spine

The Veteran claims that he incurred a back disorder during service as the result of injuring himself while lifting heavy materials.

For the following reasons, a grant of this claim is warranted.

First, the evidence shows that the Veteran has a thoracolumbar spine disability. This is detailed in a December 2021 VA report, which notes degenerative arthritis in the thoracolumbar spine.

Second, there is an approximate balance of positive and negative evidence indicating that the Veteran injured his back during service.

The STRs included in the claims file are negative for complaints, diagnosis, or treatment for a back problem. As indicated in the recent remand, however, certain STRs are missing from the claims file, and the discharge reports of medical examination and history have not been included in the claims file. In a letter to the Veteran in March 2025, the RO notified the Veteran that the missing documents could not be located despite VA's efforts to assist the Veteran. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991) (in a case in which a claimant's service records are unavailable through no fault of their own, there is a heightened obligation for VA to assist the claimant in the development of the claim and to provide reasons or bases for any adverse decision rendered without these records).

Statements from the Veteran tend to support his contention that he injured his back during service. During the Board hearing he described injuring his back lifting heavy equipment while working in a motor pool in December 1996, and that the pain has worsened over time since then. The Board has considered his statement because, as a layperson, he is competent to report observable matters such as pain and limitation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Tending to support the credibility of his statements, moreover, is the fact that he initially claimed entitlement to service connection for a back disorder in March 1997, the month of his discharge from service. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder).

Third, the evidence is divided with regard to whether the in-service injury relates to the current thoracolumbar disability. As the Board recently noted in the October 2024 remand, an October 2021 VA opinion addressing the claim
See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Tending to support the credibility of his statements, moreover, is the fact that he initially claimed entitlement to service connection for a back disorder in March 1997, the month of his discharge from service. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder).

Third, the evidence is divided with regard to whether the in-service injury relates to the current thoracolumbar disability. As the Board recently noted in the October 2024 remand, an October 2021 VA opinion addressing the claim is inadequate because it did not address relevant evidence. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). So, in the remand, the Board requested additional commentary into the claim. In response, the RO provided six opinions dated in December 2024, February 2025, and March 2025. Two address the question of whether back disability is secondary to gout. See 38 C.F.R. § 3.310. Four others address the question of direct service connection. See 38 C.F.R. § 3.303. The first two of these opinions state that it is unlikely that the in-service injury caused a chronic back disability. But the examiner appeared to base her opinions on the absence of evidence showing treatment following service, without addressing the lay evidence indicating ongoing symptoms, the missing STRs and discharge medical reports, and the claim filed the month of service discharge. So, the RO requested an addendum opinion. In the first of the addendum opinions, dated in February 2025, the examiner reversed her opinion, finding it as likely as not that current back problems are due to the reported injury in service. In support of the opinion, the examiner described the Veteran's report of injury and chronic symptoms as credible. Then, inexplicably, in March 2025, the same examiner issued another opinion, which repeated her initial opinion finding that service likely did not cause a chronic back problem.

None of these medical opinions is a model of clarity. But the supportive opinion tends to prevail against the unfavorable opinions given that it is based on what likely happened - an injury during service. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion).

Based on this evidentiary background, the Board cannot find that the evidence demonstrates that a thoracolumbar spine disability was not incurred in service. Rather, there is an approximate balance of positive and negative evidence on the issue. As such, this is an appropriate case in which to invoke VA's doctrine of reasonable doubt, grant the Veteran the benefit of the doubt, and grant the claim. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

Hearing Acuity

The Veteran asserts that loud noises during service caused him to develop a hearing loss disability.

Impaired hearing will be considered a disability under VA law when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The threshold for normal hearing is from 0 to 20 decibels. Higher threshold levels indicate some degree of hearing loss. Even though disabling hearing loss is not demonstrated at service separation, a veteran may nevertheless establish service connection for a current hearing disability by submitting evidence showing that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993).

The evidence shows that the Veteran was exposed to acoustic trauma during service in the U.S. Army as the result of weapons fire while working in field artillery, as documented in the SPRs. But a service connection finding is unwarranted under VA regulations. See 38 C.F.R. § 3.385.

None of the evidence in this case indicates the presence of a hearing loss disability under 38 C.F.R. § 3.385, neither the audiology reports of record nor the private
, a veteran may nevertheless establish service connection for a current hearing disability by submitting evidence showing that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993).

None of the evidence in this case indicates the presence of a hearing loss disability under 38 C.F.R. § 3.385, neither the audiology reports of record nor the private or VA treatment records. None of the evidence indicates three auditory thresholds of 26 decibels or higher, auditory thresholds of 40 decibels or higher, or speech recognition scores below 94 percent. Indeed, the only audiograms of record since service do not indicate a hearing loss disability under 38 C.F.R. § 3.385.

As indicated in the recent Board remand, a September 2021 VA audiology examination found unreliable test results due to inconsistency in scoring even after re-instruction to the Veteran. The examiner indicated that the Veteran's responses during testing indicated severe-to-profound hearing loss, but that the Veteran experienced no impairment at a conversational speech level during the interview portion of the examination while wearing a mask. So, the RO provided another examination, which was conducted in December 2024. This examiner arrived at the same results. After noting a review of the September 2021 results, the December 2024 examiner characterized the test results as unreliable due to inconsistency despite re-instruction. The examiner stated that the inconsistency between the test results and the Veteran's ability to engage in conversation without impairment was indicative of non-organicity. In the subsequent October 2024 opinion, the examiner stated that there was no pathology to warrant a diagnosis.

The Board finds the September and October 2024 VA reports probative. The reports are explained, are supported by the evidence, and refer to evidence in the claims file. See Bloom, supra.

In evaluating this claim, the Board has considered the Veteran's lay assertions. He is competent to describe observable symptomatology such as diminished hearing acuity. See Jandreau, supra. However, he is not competent to determine whether the degree of his hearing loss approximates the criteria under 38 C.F.R. § 3.385. This concerns an audiological matter beyond his capacity for observation. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). On this complex question, the medical evidence is more credible than the Veteran's that he has a diagnosed hearing loss disability. See Smith, supra.

In the absence of a disability, compensation may not be awarded. In the absence of evidence of a current disability, there can be no grant of service connection under the law. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (Congress specifically limited entitlement to service-connected benefits to cases where there is a current disability).

In sum, the evidence demonstrates that the Veteran does not have a hearing loss disability under 38 C.F.R. § 3.385. The reasonable doubt doctrine does not apply therefore and the claim must be denied. See 38 C.F.R. § 3.102.

Gout

The Veteran claims that he incurred gout during service.

The evidence demonstrates that he has been diagnosed with gout. This is shown in the treatment records and VA reports dated in October 2021, December 2021, and December 2024.

A service connection finding is unwarranted, however.

The Veteran asserts that toe pain during service noted in March 1996 STRs is evidence of gout during service. However, the STRs state that the pain was due to an injury to the foot. An examiner noted edema, but no erythema, warmth or severe pain, and no diagnosis of gout was given. Further, the remaining STRs are entirely negative for complaints, treatment, or diagnosis of gout. As noted earlier, certain records such as discharge reports of medical examination and history are missing from the claims file. See O'Hare, supra. This is to be considered here. But it is also relevant that the earliest diagnosis of gout is dated in the late 2010s, over 10 years after discharge from service. The record contains no medical evidence indicating gout during or in the years following service. See Horn v. Shinseki,
the foot. An examiner noted edema, but no erythema, warmth or severe pain, and no diagnosis of gout was given. Further, the remaining STRs are entirely negative for complaints, treatment, or diagnosis of gout. As noted earlier, certain records such as discharge reports of medical examination and history are missing from the claims file. See O'Hare, supra. This is to be considered here. But it is also relevant that the earliest diagnosis of gout is dated in the late 2010s, over 10 years after discharge from service. The record contains no medical evidence indicating gout during or in the years following service. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). So, the entirety of the evidence supports the conclusion that the Veteran did not experience gout or symptoms of gout during service.

The evidence addressing the issue of medical nexus also counters the claim. In the only medical opinion in the record addressing the claim of direct service connection for gout, the December 2021 VA examiner indicated that the Veteran's gout had an onset in the mid-2000s and did not manifest at any time earlier than that. In reference to the March 1996 toe injury, the examiner stated that a typical gout attack is characterized by the sudden onset of severe pain, redness, warmth, swelling, and disability - maximal severity of the flare is usually reached within 12 to 24 hours. The examiner stated that the in-service toe injury and exam were not consistent with an onset of gout during service. Rather, the examiner found the Veteran's complaints, symptoms noted, and examination results during service consistent with the Veteran's reported injury of hitting his toe. Further, the examiner noted that the Veteran's statements pursuant to his initial treatment for gout in the late 2000s indicate reported onset of possible symptoms in the mid-2000s, well after service. See Horn, supra.

The Board finds the December 2024 VA report probative. The report and findings are explained, are supported by the evidence, and refer to evidence in the claims file. See Bloom, supra.

In evaluating this claim, the Board has considered the Veteran's lay assertions. He is competent to describe observable symptomatology such as painful joints. See Jandreau, supra. He is not competent to determine whether the disease of gout is related to service, however. This concerns a question of etiology that is beyond his capacity to observe. See Woehlaert, supra. On this complex question, the medical evidence is more credible than the Veteran's assertions. See Smith, supra.

In sum, the evidence demonstrates that the Veteran's gout was not incurred in service. The reasonable doubt doctrine does not apply therefore and the claim must be denied. See 38 C.F.R. § 3.102.

Joints, Ankles, Knees, and OSA

The Veteran asserts that disorders involving the joints, ankles, and knees, and OSA are secondary to gout. Inasmuch as gout is not a service-connected disorder, a grant of entitlement to service connection for any of these disorders is not warranted. See 38 C.F.R. § 3.310. The reasonable doubt doctrine does not apply therefore and the claims must be denied. See 38 C.F.R. § 3.102.

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Christopher McEntee

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.

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