DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The Veteran, an Air Force Veteran who served from November 1997 to September 2002, appeals the denial of service connection for lumbar spine degenerative arthritis and degenerative disc disease (DDD), and for right and left lower extremity radiculopathy secondary to the lumbar spine condition. The Veteran's service records indicated a normal spine at enlistment, but the Veteran reported a history of low back pain dating back to a pre-service fall and experiencing pain during service due to heavy lifting as a fuel specialist. Although service treatment records did not document treatment for back pain, the Veteran's lay statements were found to be credible and consistent with in-service symptoms. The Board found the VA medical opinions from October 2019 and November 2020 to have limited probative weight because they relied heavily on the absence of treatment in service and did not fully address the Veteran's credible lay testimony about the onset of pain during service. The Board determined the evidence was in relative equipoise, applying the benefit of the doubt to grant service connection for lumbar spine degenerative arthritis and DDD. For the secondary conditions, the Board noted that while the Veteran had not explicitly claimed radiculopathy, the VA examinations associated these conditions with the lumbar spine DDD. Finding the evidence evenly balanced regarding the secondary causation, the Board resolved doubt in the Veteran's favor to grant service connection for right and left lower extremity radiculopathy secondary to the lumbar spine condition.

Rationale

Presumption of soundness attaches due to normal enlistment exam.; Veteran's lay testimony regarding in-service pain is credible.; VA opinions had limited probative weight due to reliance on absence of treatment and failure to address lay testimony.; Evidence in relative equipoise, doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A26040931
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210526-162444
DATE: April 30, 2026

ORDER

Entitlement to service connection for lumbar spine degenerative arthritis and degenerative disc disease (DDD) is granted.

Entitlement to service connection for right lower extremity radiculopathy, secondary to now service-connected lumbar spine degenerative arthritis and DDD, on a causation basis, is granted.

Entitlement to service connection for left lower extremity radiculopathy, secondary to now service-connected lumbar spine degenerative arthritis and DDD, on a causation basis, is granted.

FINDINGS OF FACT

1. The evidence is at least evenly balanced as to whether the Veteran's current lumbar spine degenerative arthritis and DDD is related to service.

2. The evidence is at least evenly balanced as to whether the Veteran's current right and left lower extremity neuropathy is caused by his now service-connected lumbar spine degenerative arthritis and DDD.

CONCLUSIONS OF LAW

1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for lumbar spine degenerative arthritis and DDD have been met.  38 U.S.C. §§ 1110, 1111, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(b).

2. The criteria for service connection for right and left lower extremity neuropathy, secondary to now service-connected lumbar spine degenerative arthritis and DDD, on a causation basis, are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in Air Force from November 1997 to September 2002.

This case was docketed by the Board of Veterans' Appeals (Board) of the Department of Veterans Affairs (VA) based on a VA Form 10182, Notice of Disagreement (NOD), filed by the Veteran on May 26, 2021.  In the NOD, the Veteran elected the Hearing docket.  He identified the appealed issue as chronic lower back pain with DDD and introverted disc disorder and abnormal gait,  claimed as lower back strain.  He cited a 2021 rating decision.  

The record includes a November 2020 rating decision and a March 2021 Higher-Level Review (HLR) rating decision, that confirmed and continued the previous denial of service connection for chronic low back pain with DDD and introverted disc disorder and abnormal gait.  The agency of original jurisdiction (AOJ) found that new and relevant evidence had been received for this claim.  This new and relevant evidence determination is a favorable finding that is binding upon the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).  

In November 2024, the Board notified the Veteran and his representative that he was scheduled for a Virtual Board hearing in January 2025.  The Veteran did not appear at the hearing and did not assert good cause for missing the hearing or postponement.  The hearing request is considered withdrawn.  38 C.F.R. § 20.704(d).  

Therefore, the Board may only consider the evidence of record at the time of the November 2020 AOJ rating decision, which was subsequently subject to March 2021 HLR, as well as any evidence submitted by the Veteran or representative within 90 days following the date of the scheduled hearing.  38 C.F.R. § 20.302(c).  If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to HLR and prior to the date of the scheduled Board hearing, or (2) more than 90 days following the date of the scheduled hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(c), 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
 90 days following the date of the scheduled hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(c), 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. 

Service connection

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two.  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).  Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Turning to the evidence, service records show that the Veteran worked as a fuel specialist in the Air Force. 

Service treatment records (STRs) include a July 1997 enlistment examination.  The Veteran's spine was clinically examined and deemed normal.  A medical history report accompanying the enlistment examination showed that the Veteran reported low back pain from a 1991 fall injury.  

A physical examination or medical history report contemporaneous to the Veteran's September 2002 separation is not of record.  

October 2010 private chiropractor records showed that the Veteran sought treatment for middle and low back pain.  The pain dated to 1997 work injuries.  The Veteran also noted a childhood back injury when he fell from a ladder.  

In October 2019, the Veteran had a VA back conditions examination.  The examiner diagnosed lumbar spine DDD.  The Veteran reported that his low back pain started during service while performing exertive activities as a fuel specialist.  His position involved chronic heavy, awkward lifting.  He did not seek treatment during service.  He sought orthopedic treatment in 2010 and was diagnosed with arthritis and DDD.  Physical findings were reported in detail.  The examiner furnished a negative medical opinion.  He cited the reported childhood back injury and absence of treatment during service.  The Veteran was not treated for back pain until approximately six years after separation.  The examiner explained that the current back condition was not diagnosed until 2018 and attributable to post service exertive activity.

In August 2020, the Veteran stated that his earliest memory of back pain was during his time in Air Force when he constantly worked moving very heavy aircraft fuel equipment.  He only sought formal medical care when he obtained employer sponsored health insurance several years after service.   

In November 2020, the Veteran had another VA back conditions examination.  The examiner diagnosed degenerative arthritis of the spine with an October 2008 onset.  The Veteran reported developing back pain in service while working on 12 hour long shifts.  He self-managed it during service, but it persisted.  The examiner detailed physical findings for the lumbar spine.  He issued a negative medical opinion.  He cited an absence of report in STRs.  Post service treatment records referenced a 2008 fall injury and exertive activities following service.  With this background, there was insufficient medical evidence to relate the current lumbar spine DDD to service.    

In the March 2026 brief, the representative objected to the VA medical opinions.  The examiner based their medical opinions on an absence of treatment in service and did not consider the Veteran's reports that he started experiencing back pain in service.  

For the following reasons, service connection for lumbar spine degenerative arthritis and DDD is warranted.

As a preliminary matter, the Board has considered the reports about back strain associated with a pre-service fall injury.  The July 1997 enlistment examination shows that the Veteran's spine was clinically evaluated and deemed normal.  Thus, the presumption of soundness attaches.  38 C.F.R. § 1111; 38 C.F.R. § 3.304(b).  The reports about a back injury prior to service are vague and do not satisfy the oner
  The examiner based their medical opinions on an absence of treatment in service and did not consider the Veteran's reports that he started experiencing back pain in service.  

For the following reasons, service connection for lumbar spine degenerative arthritis and DDD is warranted.

As a preliminary matter, the Board has considered the reports about back strain associated with a pre-service fall injury.  The July 1997 enlistment examination shows that the Veteran's spine was clinically evaluated and deemed normal.  Thus, the presumption of soundness attaches.  38 C.F.R. § 1111; 38 C.F.R. § 3.304(b).  The reports about a back injury prior to service are vague and do not satisfy the onerous clear and unmistakable evidentiary requirements to rebut the presumption of soundness.  See id.

The October 2019 and November 2020 VA examination reports confirm a current diagnosis for lumbar spine degenerative arthritis and DDD.  A current lumbar spine disability is demonstrated.

The Veteran reports that his back pain started in service with heavy exertive activities as a fuel specialist moving heavy equipment and working long shifts.  Although STRs do not include treatment for back pain, service records confirm that the Veteran worked as an Air Force fuel specialist.  His reports about in-service back pain associated with moving heavy aircraft fuel equipment and working long shifts are competent and credible.  An in-service injury is thus demonstrated.    

The remaining issue is a relationship to service.  The Veteran is competent to report observable symptoms, such as back pain and its history.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  He reported developing back pain in service with exertive activity and self-managing it.  He explained that he continued to experience back pain following service but did not seek treatment until he obtained employer sponsored health insurance.  October 2010 private chiropractic records support his account.  The Board considers the Veteran credible in his reports about back pain symptomatology starting in service.  

The October 2019 and November 2020 VA examiners furnished negative medical opinions.  However, as noted by the representative, the comments from their rationales imply that STRs or contemporaneous medical evidence is necessary for a positive medical opinion.  Buchanan v. Nicholson, 451 F.3d 1331, 1336, n.1 (Fed. Cir. 2006) (noting that VA's examiner's opinion, which relied on the absence of contemporaneous medical evidence, "failed to consider whether the lay statements presented sufficient evidence of the etiology of [the veteran's] disability such that his claim for service connection could be proven without contemporaneous medical evidence").  The examiners do not directly address the Veteran's reports about back pain symptoms starting in service.  With this background, the Board considers the October 2019 and November 2020 VA medical opinions to have limited probative weight.

For the foregoing reasons, the evidence of a relationship to service for lumbar spine degenerative arthritis and DDD is at least in a state of relative equipoise.  Buchanan, 451 F.3d at 1337 ("If the Board concludes that the lay evidence presented by a veteran is credible and ultimately competent, the lack of contemporaneous medical evidence should not be an absolute bar to the veteran's ability to prove his claim of entitlement to disability benefits based on that competent lay evidence").  As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for lumbar spine degenerative arthritis and DDD is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Right and left lower extremity lumbar radiculopathy

While the Veteran has not filed claims of service connection for lower extremity radiculopathy, the Court has indicated that such claims can be adjudicated by the Board even in the absence of explicit AOJ adjudication.  Grimes v. McDonough, 34 Vet. App. 84, 89 (2021) (a claim for service connection can include all diagnoses found during the claim's development that relate to the symptomatology asserted by the veteran).

As relevant, the October 2019 VA back conditions examination report assessed the Veteran as having right and left lower extremity radiculopathy as a condition associated with lumbar spine DDD and the November 2020 VA back conditions examination report assessed right lower extremity radiculopathy as an associated disorder.  While there is no clear and direct opinion that the Veteran's right and left lower extremity neurological disabilities are caused by his now service-connected back disability, the assessment from these back conditions examination in essence supports the conclusion that he
 34 Vet. App. 84, 89 (2021) (a claim for service connection can include all diagnoses found during the claim's development that relate to the symptomatology asserted by the veteran).

As relevant, the October 2019 VA back conditions examination report assessed the Veteran as having right and left lower extremity radiculopathy as a condition associated with lumbar spine DDD and the November 2020 VA back conditions examination report assessed right lower extremity radiculopathy as an associated disorder.  While there is no clear and direct opinion that the Veteran's right and left lower extremity neurological disabilities are caused by his now service-connected back disability, the assessment from these back conditions examination in essence supports the conclusion that he has current right and left lower extremity radiculopathy which is caused by his now service-connected lumbar spine disability.  See also 38 C.F.R. § 4.71a, Diagnostic Code 5242, Note 1.

For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran's right and left lower extremity radiculopathy was caused by his service-connected lumbar spine disability.  As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for right and left lower extremity radiculopathy, secondary to now service-connected lumbar spine disability, on a causation basis, is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  

 

 

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. D. Simpson, Counsel

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.