INTERVERTEBRAL DISC SYNDROME

Summary

The veteran, who served from September 1989 to October 1997, appeals the denial of service connection for a lumbosacral strain with degenerative arthritis. The veteran contends this condition is related to an in-service injury sustained in a motor vehicle accident in October 1995, and alternatively, that it was caused or aggravated by his service-connected knee and hip disabilities. The Board found that the veteran has a current diagnosis of lumbosacral strain with degenerative arthritis and experienced a qualifying in-service injury. The key evidence included a June 2025 private medical opinion that found the condition "at least as likely as not" related to service, citing research on traumatic injuries and degenerative cascades. This opinion was deemed probative and well-reasoned. A prior October 2020 private chiropractic opinion also supported a service connection. The Board found two VA nexus opinions from August 2020 and April 2021 inadequate, as they relied on an inaccurate premise of a twenty-one-year gap in treatment reports and did not adequately address the potential for chronic disability following acute injury. The Board found the evidence in approximate balance, affording the veteran the benefit of the doubt. Service connection for lumbosacral strain with degenerative arthritis is granted.

Rationale

Current diagnosis of lumbosacral strain with degenerative arthritis; In-service injury from motor vehicle accident in October 1995; Probative private medical opinion finding condition at least as likely as not related to service; Inadequate VA nexus opinions due to inaccurate premise and lack of rationale; Evidence in approximate balance, affording benefit of the doubt

Full Decision Text

Citation Nr: A26040949
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210913-184946
DATE: April 30, 2026

ORDER

Service connection for a back disability, to include a lumbosacral strain with degenerative arthritis, is granted.

FINDING OF FACT

Based on the probative medical evidence of record, the Veteran's lumbosacral strain with degenerative arthritis is related to his in-service back injury. 

CONCLUSION OF LAW

The criteria for service connection for a lumbosacral strain with degenerative arthritis have been met.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1989 to October 1997.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2021 rating decision of the 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 conducted by the undersigned Veterans Law Judge on May 13, 2025. 

Therefore, the Board may only consider the evidence of record at the time of the July 2021 RO decision, which was subsequently subject to higher-level review by the September 2021 RO decision on appeal, as well as any evidence submitted by the Veteran or 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 RO issued the decision, which was subsequently subject to higher-level review 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. 

Service connection for a back disability, to include a lumbosacral strain with degenerative arthritis, is granted.

The Veteran seeks entitlement to service connection for his diagnosed lumbosacral strain with degenerative arthritis, that he contends is related to his service, to include injury sustained during a motor vehicle accident in October 1995.  Alternatively, he contends that his disability has been caused and/or aggravated by his service-connected knee and hip disabilities.  See June 2020 VA Form 21-526EZ, Fully Developed Claim; see also, May 2025 Hearing Transcript.  

Law and Regulations

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 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.  See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a).  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b).  Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain.  Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 202
 service-connected disability. 38 C.F.R. § 3.310(a).  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b).  Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain.  Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted).  Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability.  Id. at 1364.  For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability.  Id.

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309.

When a disease under 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service.  See 38 C.F.R. § 3.303(b).  However, the use of continuity of symptomatology to establish service connection is limited only to those diseases listed under 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint.  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 

When considering the existence of a disability, VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009); 38 U.S.C. § 1154(a).  Lay evidence may 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.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  

When the evidence is in approximate balance in the veteran's favor or nearly equal regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Analysis

As a threshold matter, the RO has made several favorable findings which are binding on the Board absent clear and unmistakable error.  38 C.F.R. § 3.104.  First, that the Veteran has a current diagnosis of a lumbosacral strain with degenerative arthritis.  See September 2021 Rating Decision.  Second, that the Veteran experienced a qualifying event, injury, or disease in service, specifically, that he was treated for a back injury following a motor vehicle accident in service in October 1995.  Id.  Applying these favorable findings, the first and second elements of direct service connection are satisfied.

Turning to the nexus element of service connection, the record includes a June 2025 private medical opinion which found that the Veteran's condition was "at least as likely as not" related to his military service.  See June 2025 Medical Treatment Record Non-Government Facility.  In support of this conclusion, the provider addressed the nature of the Veteran's current diagnoses, the nature of his in-service injury, and acknowledged supporting lay statements from the Veteran suggesting ongoing symptomatology.  The provider further pointed to research studies that addressed the impact of a single acute traumatic event, like a motor vehicle accident,
 in service in October 1995.  Id.  Applying these favorable findings, the first and second elements of direct service connection are satisfied.

Turning to the nexus element of service connection, the record includes a June 2025 private medical opinion which found that the Veteran's condition was "at least as likely as not" related to his military service.  See June 2025 Medical Treatment Record Non-Government Facility.  In support of this conclusion, the provider addressed the nature of the Veteran's current diagnoses, the nature of his in-service injury, and acknowledged supporting lay statements from the Veteran suggesting ongoing symptomatology.  The provider further pointed to research studies that addressed the impact of a single acute traumatic event, like a motor vehicle accident, on the future development of lower back pain and disability.  Additionally, the examiner referenced research articles discussing "degenerative cascade" or the process by which acute injuries to the lower back can result in chronic pain and disability over a long-term period between ten and thirty years.  Applied to the Veteran's case, the provider found that the proffered evidence supported their conclusion that the Veteran's current back disabilities are directly related to his service.  Overall, the Board finds this opinion to be sufficiently well reasoned in its consideration of the evidence and supporting research, and notes that the examiner's conclusion provides a rationale that the Board can follow and weigh.  As such, this is an adequate opinion entitled to probative weight.

Notably, the Board observes that the findings and conclusions rendered by the June 2025 private medical examiner are generally consistent with the remainder of the record, including the Veteran's lay statements, hearing testimony, and an October 2020 medical opinion provided by the Veteran's chiropractor.  In the October 2020 opinion, the provider discussed the nature of the Veteran's in-service injury following his motor vehicle accident and noted his reports of continued pain following the incident.  See October 2020 Medical Treatment Record Non-Government Facility.  The provider opined, in pertinent part, that the Veteran's lower back pain was related to his service.  The provider included support for their conclusion, explaining that in both their experience and the medical literature they consulted, traumatic injury to the spine can lead to degenerative disability over time, including disc and joint degeneration, ankyloses, and stenosis.  

Conversely, the record contains negative VA nexus opinions in August 2020 and April 2021.  However, after review, the Board finds these opinions to be inadequate.  Initially, the Board notes that the Veteran was afforded medical examinations associated with the August 2020 and April 2021 opinions, during which time the Veteran's VA examiners documented diagnoses of a lumbosacral strain and degenerative arthritis.  See August 2020 VA Back Conditions Disability Benefits Questionnaire (DBQ); April 2021 VA Back Conditions DBQ.  The examiners also documented the Veteran's report that the onset of his back pain was in 1995, during service.  

In the subsequent August 2020 opinion, the Veteran's examiner found that the Veteran's back condition was "less likely than not...incurred in or caused by" the claimed in-service injury, event, or illness.  However, as part of the rationale to support their conclusion, the examiner impermissibly discounted the Veteran's lay reports of ongoing back pain, and instead placed significant weight on the absence of reported treatment between the Veteran's in-service reports of back pain in 1995, and what the examiner considered to be the first report of back pain post-service in 2016.  See Buchanan v. Nicholson, 451 F. 3d 1331, 1336-37 (Fed. Cir. 2006).  In fact, the Board observes that the Veteran's medical records reflect additional complaints of back pain between 1999 and 2005, following both his service and his October 1995 motor vehicle accident.  As a result, the Board finds that the examiner's reliance on the premise that there was a twenty-one year gap between his in-service injury and next report of back pain further renders this opinion inadequate, as this premise is factually inaccurate.  See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on incomplete or inaccurate factual premise are not probative).  

Turning to the April 2021 VA medical opinion, the Board observes that this opinion's rationale is largely the same as the August 2020 VA medical opinion in that it found it "unlikely" that the Veteran's current disabilities were related to his in-service injuries primarily due to the absence of ongoing reports of treatment in the Veteran's medical records.  See April 2021 VA Medical Opinion.  While this opinion acknowledged that the Veteran reported back pain in 1999
 further renders this opinion inadequate, as this premise is factually inaccurate.  See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on incomplete or inaccurate factual premise are not probative).  

Turning to the April 2021 VA medical opinion, the Board observes that this opinion's rationale is largely the same as the August 2020 VA medical opinion in that it found it "unlikely" that the Veteran's current disabilities were related to his in-service injuries primarily due to the absence of ongoing reports of treatment in the Veteran's medical records.  See April 2021 VA Medical Opinion.  While this opinion acknowledged that the Veteran reported back pain in 1999 following service (though not that he further reported it through 2005), the examiner's rationale still rests on the absence of reported treatment, and it does not explain the significance of their conclusion that the Veteran's in-service back injury was acute only without evidence of chronicity of care.  Id.  Notably, while the Veteran's current back disability includes degenerative arthritis, which is a chronic condition, continuity or chronicity of care is not a requirement when considering service connection for a disability on a direct basis.  As a result, the Board finds that the April 2021 VA medical opinion lacks sufficient rationale to support their overall conclusion and consequently, the opinion is also inadequate.

Finally, the Board acknowledges that the record contains a negative June 2021 VA medical opinion.  However, this opinion only addressed the Veteran's claim on the basis of secondary service connection, and it does not contradict the positive private medical evidence referenced above.

After review of the totality of the record, including the Veteran's May 2025 hearing testimony, and the probative June 2025 and October 2020 private medical opinions, which collectively provided a reasonable rationale explaining how injury sustained from the Veteran's in-service motor vehicle accident could result in the Veteran's current disabilities even after an extended period of time, the Board finds the evidence of record to be at least in approximate balance as to whether the Veteran's current back disabilities are related to his in-service injury and reports of back pain.  Accordingly, the Board finds that service connection for the Veteran's lumbosacral strain with degenerative arthritis is warranted. 

As the criteria necessary to grant service connection are met, service connection for the Veteran's lumbosacral strain with degenerative arthritis is granted.

 

 

M. Donohue

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Todd; Associate 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.