Citation Nr: 1322965 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 07-22 406 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for low back disability, diagnosed as degenerative joint disease of the lumbar spine. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Barone, Counsel INTRODUCTION The Veteran had active service from January 1968 to December 1969, and from December 1990 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2005 rating determination of a Regional Office (RO) of the Department of Veterans Affairs (VA). This matter was previously before the Board in February 2009 and in September 2011, when it was remanded for additional development. The Veteran testified at a Board hearing in December 2008. A transcript of that hearing is associated with the claims file. The Board finds that there has been substantial compliance with the directives of the Board's February 2009 and September 2011 remands. In any event, as the Board now finds that a grant of the full benefits sought in this appeal is warranted, there is no possible prejudice to the Veteran from proceeding to a final decision at this time. FINDING OF FACT The Veteran's degenerative joint disease of the lumbar spine is etiologically linked to the Veteran's active duty military service. CONCLUSION OF LAW The criteria for service connection for degenerative joint disease of the lumbar spine have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran claims entitlement to service connection for a low back disability. Essentially, the Veteran contends that he currently suffers from a low back disability as a result of one or more back injuries suffered during military service. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease in line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived, that is, experienced, were directly through the senses. 38 C.F.R. § 3.159 (competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience; lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.); Layno, 6 Vet. App. at 469-71 (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge; personal knowledge is that which comes to the witness through the use of the senses; lay testimony is competent only so long as it is within the knowledge and personal observations of the witness, but lay testimony is not competent to prove a particular injury or illness); see Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an 'absolute bar' to the service connection claim); Barr, 21 Vet. App. 303 ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Also, a veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau). VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus; however, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the lay person is competent and does not otherwise require specialized medical training and expertise to do so, i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. See Davidson, 581 F. 3d at 1316 (recognizing that, under 38 U.S.C.A. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition; he is reporting a contemporaneous medical diagnosis; or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board further notes that it has reviewed all of the evidence in the Veteran's claims file and in "Virtual VA" (VA's electronic data storage system), with an emphasis on the evidence relevant to the matter on appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. It is the responsibility of the Board to weigh the evidence, including the medical evidence, and determine where to give credit and where to withhold the same and, in so doing; the Board may accept one medical opinion and reject others. Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board may not make its own independent medical determinations; the Board must have plausible reasons, based upon medical evidence in the record, for favoring one medical opinion over another. Evans v. West, supra; see also Rucker v. Brown, 10 Vet. App. 67, 74 (1997), citing Colvin v. Derwinski, 1 Vet. App. 171 (1991). Thus, the weight to be accorded the various items of evidence in this case must be determined by the quality of the evidence, and not necessarily by its quantity or source. Pursuant to 38 U.S.C.A. § 1154(b), with respect to combat Veterans, "The Secretary shall accept as sufficient proof of service-connection . . . satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions and hardships of such service . . . Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary." See also 38 C.F.R. § 3.304(d). However, the Court has further held that 38 U.S.C.A. § 1154(b) can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to the current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522-23 (1996). Section 1154(b) does not establish service connection for a combat Veteran; it aids him by relaxing the adjudicative evidentiary requirements for determining what happened in service. A Veteran must still generally establish his claim by competent medical evidence tending to show a current disability and a nexus between that disability and those service events. See Gregory v. Brown, 8 Vet. App. 563, 567 (1996). In Kessel v. West, 13 Vet. App. 9 (1999), the Court affirmed that the 38 U.S.C.A. § 1154(b) presumption only relates to the question of service incurrence, it does not relate to questions of whether the Veteran has a current disability or whether there was a nexus between the in- service event and the current disability. With regard to the question of whether the Veteran engaged in combat, the phrase "engaged in combat with the enemy," as used in 38 U.S.C. § 1154(b), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. Mere service in a combat area or combat zone does not in itself lead to the conclusion that an individual engaged in combat. VAOPGCPREC 12-99 (October 18, 1999). The issue of whether any particular set of circumstances constitutes engagement in combat with the enemy for purposes of section 1154(b) must be resolved on a case- by-case basis. See id. The Veteran has claimed entitlement to service connection for a low back disability. The Veteran contends that his current back disability is the product of injury during military service. The Veteran's December 2008 Board hearing testimony described that he suffered a back injury "in a rocket attack" while he was "moving a trailer in Vietnam." The Veteran described: "I twisted my back and I laid in a bed for 2 or 3 days and then the doctor there gave me some muscle relaxers and pain pills and I hobbled around for a week or so." The Veteran recalled that after this "my back really didn't bother me anymore until ... 10 years ago." The Veteran then clarified, however, that during his second period of active duty (1990-91) he "re-injured" his back when "running one morning at Fort Jackson and I fell on some ice and hit on a railroad track." He recalled: "My back really started bothering me. So they send me to the hospital and they did this cold pack / heat pack thing on my back while I was there." The Board observes that the Veteran has been granted service connection for PTSD on a basis that essentially acknowledges that the Veteran participated in combat during his period of service in Vietnam. The Board finds that there is no need for further analysis concerning the question of whether the Veteran was a combat veteran and thus entitled to the 38 U.S.C.A. § 1154(b) presumption with regard to that period of service. In this regard, the Board accepts the Veteran's testimony with regard to having suffered an injury to his back during a combat event in Vietnam during his first period of active duty service. Service treatment records from the first period of active duty service, dated in February 1965, June 1966, January 1968, and December 1969, feature medical history questionnaires showing, in pertinent part, that the Veteran denied having any history of any "back trouble of any kind" in three of the reports (with the June 1966 questionnaire not including a question expressly about the back, but showing that the Veteran denied any history of "swollen or painful joints," "arthritis," or "bone, joint, or other deformity"). A July 1969 service treatment record shows that the Veteran injured his back lifting mail pouches and reported having back pain aggravated by movement and relieved by rest. The medical impression, after X-ray imaging, was low back pain that was probably muscular in nature. Reserve service treatment reports dated in January 1985 and April 1989 show that the Veteran was medically assessed to be clinically normal in all respects, including with regard to his spine. A May 1991 service treatment report during active duty service, just prior to the conclusion of the Veteran's final period of active duty service, shows that the Veteran requested evaluation of his lower back, noting a history of four to five years and recently experiencing an increase in back pain while playing golf. An associated May 1991 report from a physical therapy clinic shows that the Veteran described "intermittent pain x 4-5 years" with "no specific onset." The assessment at that time was mechanic low back pain. A February 1996 periodic reserve service medical examination report shows that the Veteran was medically assessed to be clinically normal in all respects, including with regard to his spine. A 2006 report from the U.S. Armed Services Center for Unit Records Research (CURR), developed in connection with a separate claim, essentially confirms that the Veteran's service in Vietnam included participation in combat. The Veteran was afforded a VA spinal examination in April 2006. The April 2006 VA examiner confirmed a diagnosis of degenerative joint disease of the lumbar spine. The medical opinion presented in the April 2006 VA examination report does not support the Veteran's claim, but the Board finds that the medical opinion is not probative evidence because it is not adequately informed by the facts currently of record. The Board observes that the April 2006 VA examiner expressly presented a rationale which cites "I do not find any service treatment records indicating any injuries from Vietnam or during the 1990-91 active duty status." Significantly, more recently obtained service treatment records from the Veteran's earlier period of service do expressly document a back injury. Moreover, the Veteran has recently been established to have served in combat in Vietnam through corroborating evidence in a CURR report developed in connection with the separate grant of service connection for PTSD; his credible December 2008 Board hearing testimony also indicated that he suffered a back injury during combat in Vietnam. Additionally, the Board observes that the Veteran's service treatment records from his more recent period of service also show another instance of treatment for back pain which was not expressly addressed by the April 2006 VA examination report's etiology analysis. The Board remanded this issue in February 2009 and a new VA examination was performed in March 2009. The March 2009 VA examiner concluded that the Veteran's back disability "is not related to the service as there was no injury during his first tour showing a chronic condition, and the pain that he was seen for during his second tour he reported to be 4 to 5 years prior which would have been before his second tour." In this regard, the examiner cites pertinent service treatment records to support his findings, including a May 1991 service treatment record showing that the Veteran had back complaints during his second period of active duty service. The only rationale provided by the examiner for finding that the current chronic back disability is not related to the back pain complaints that manifested during the 1990-1991 period of active duty service is that "the pain that he was seen for during his second tour he reported to be 4 to 5 years prior which would have been before his second tour." In this regard, the examiner does not clearly indicate whether the documented in-service back symptoms in May 1991 are likely manifestations of the current chronic back disability. The lack of such an indication is crucial in this case as the examiner's articulated rationale suggests that although the 1991 back symptoms did not have original onset during service, they may have been manifestations of a chronic pathology during service. The examiner's report only indicates finding that the back symptoms that manifested during service in 1991 had onset prior to the second period of active service, but the critical question is whether the back symptoms during service in 1991 were manifestations of his current chronic back disability regardless of when their original onset may have been. The question is an essential one because the Veteran may be entitled to a presumption of sound condition upon entry to his second period of active duty service in 1990; it is possible that the Veteran could be entitled to service connection for a current chronic back disability if the 1991 in-service symptoms were manifestations of that chronic disability, even if there is evidence suggesting that the original onset of the disability was prior to the period of active duty service. VA law provides that a veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C.A. §§ 1111, 1132, 1137. The presumption of soundness attaches only where there has been an induction examination during which the disability about which the veteran later complains was not detected. See Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). The regulations provide expressly that the term "noted" denotes "[o]nly such conditions as are recorded in examination reports," 38 C.F.R. § 3.304(b), and that "[h]istory of pre-service existence of conditions recorded at the time of examination does not constitute a notation of such conditions." Id. at (b)(1). Although there is no documentation of an entrance examination from the beginning of the Veteran's second period of active duty service in December 1990, the Board observes that a reserve service medical examination report from April 1989 shows that the Veteran's back was examined and found to be clinically normal at that time. Although this April 1989 reserve service medical examination may not be sufficiently proximate to service to attach the presumption of soundness in this case, the Board finds that the April 1989 reserve service medical examination report is at least sufficient to indicate that the 1991 back symptoms were not part of a chronic disability with onset four or five years earlier. The Board briefly observes that, if the presumption of soundness applies, then the suggestion of pre-entrance back pain is not sufficient to rebut the presumption that the Veteran's back was in sound health at the beginning of the period of active duty. In any event, regardless of whether the presumption of soundness attaches in this case, the Board finds that the only suggestion that the Veteran's May 1991 back symptoms were part of a chronic back disability that pre-dated that period of active service is in the notation that the Veteran recalled some intermittent back symptoms dating back four or five years; the Board finds that the April 1989 reserve service medical examination report is competent contemporaneous medical evidence that any such symptoms were not part of a diagnosed chronic back disability. The April 1989 report indicates that no chronic diagnosed back disability existed at that time. Furthermore, the new additional back pain incurred by the Veteran at the time of his May 1991 sports injury may represent manifestation of a new back disability during service. The Board turns its attention, then, to determining whether the Veteran's current back disability may be shown to be related to the May 1991 onset of new additional back pain such that the current back disability may be found to have had onset during active duty service. The Board's February 2009 remand directives specifically asked the examiner to "state whether it is at least as likely as not (a 50% or higher degree of probability) that [any currently diagnosed back] disability manifested during the Veteran's active duty service ...." To the extent that the March 2009 VA examination report did not indicate whether the 1991 in-service back symptoms were manifestations of a current chronic back disability, an essential medical question at the core of this case continued to be unaddressed by the probative competent medical evidence. The Board remanded the issue again to ensure that clear and adequate answers to the pertinent medical questions were presented prior to final appellate review. The Board also notes that the earlier April 2006 VA examination report does not otherwise provide a basis for informed appellate review on this matter. The April 2006 VA examination report presented the opinion that "[t]he mild degenerative joint disease is an expected finding in a person of his age and cannot be linked to the injury of 1991" while also noting that "I do not find any service medical records indicating any injuries ... during the 1990-1991 active duty status." The April 2006 VA examination report does acknowledge that the service treatment records show treatment for back pain in May 1991 with a 4 or 5 year history that had been recently exacerbated while playing golf. It appears that the April 2006 examiner found that the Veteran's chronic back disability was not etiologically linked to "injury" in 1991, but it remains unclear whether the Veteran's chronic back disability manifested during service. The Board emphasizes the potentially critical importance of the question of whether the 1991 in-service back symptoms were manifestations of the current back disability, regardless of whether they marked the original onset of such disability. The Veteran may be entitled to a presumption of sound condition upon entry to his second period of active duty service in 1990, and could be entitled to service connection for a current chronic back disability if the 1991 in-service symptoms were manifestations of that chronic disability. The Board remanded this issue again in September 2011, and another VA examination was performed in December 2011. The December 2011 VA examination report confirms that the Veteran is currently diagnosed with "Degenerative Joint disease at L1-L5 .... Moderate degenerative joint disease throughout." The December 2011 VA examination report presents a medical opinion informed by review of the claims-file that supports the Veteran's claim: the examiner checked the box to indicate "The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness." The rationale offered in support of this conclusion focuses upon the Veteran's more recent period of active service, as the examiner noted that the Veteran appeared to have "recovered" from any cited back injuries in the earlier period of service. The December 2011 VA examiner discussed the Veteran's description of an injury in his 1990-91 period of service involving falling across railroad tracks and the examiner also discussed the fact that the Veteran was documented to have complained of back pain around the time of his separation from active duty service. The December 2011 VA examiner indicates that the Veteran's description of "continuous history of intermittent medical treatment since the injury" is consistent with a finding that the current back disability is linked to in-service injury. The examiner concludes that "it is more likely than not that his current back symptoms are the sequellae of the injuries incurred during his military service." Although the Board has made multiple attempts to obtain clear medical resolution of the medical etiological questions in this case, there remains uncertainty concerning key elements of this appeal. With particular interest in avoiding further delay to the Veteran awaiting final resolution of this appeal, the Board has given careful consideration to whether the evidence now of record might allow the Board to grant service connection for the Veteran's low back disability with resolution of reasonable doubt in the Veteran's favor. The Board finds that despite the remaining uncertainty of record, a grant of service connection is warranted in this case. The Board has considered that there is some difficulty presented by the fact that the December 2011 VA examination report, although providing a positive etiology opinion linking current back disability to military service, presents a supporting rationale that largely relies upon accepting an undocumented injury during the most recent active duty service (specifically, falling upon railroad tracks) and relies upon undocumented "continuous history of intermittent medical treatment since the injury." However, the Board finds that at least one back injury during the Veteran's most recent active duty service is documented by the service treatment records. In this regard the Board notes that the Veteran's May 1991 treatment for back pain was described to have been brought on by a specific exacerbation of back pain while playing golf. The Board finds that this is reasonably understood to indicate that during the performance of the physical actions associated with playing golf (specifically, the swinging of a golf club) the Veteran incurred new or worsened back pain; the Board believes this reasonably indicates an event of back injury with associated symptoms documented to have occurred during his active service. The Board also finds that the Veteran's testimony concerning his experience of intermittent back symptoms and treatment following active service, a fact relied upon by the December 2011 VA examination report's rationale, is competent testimony; the Board finds no persuasive reason to doubt the credibility of the Veteran's testimony in this regard. The Board acknowledges that a February 1996 periodic Reserve service medical examination report shows that the Veteran was medically assessed to be clinically normal in all respects, including with regard to his spine, at that time. However, this report was of record and presumably considered by the December 2011 VA examiner when he formed his opinion that the current back disability is etiologically linked to service. The Board notes that the December 2011 VA examiner's rationale merely relies upon a citation to "intermittent" medical treatment in the years following service; the Board finds that the single February 1996 examination report in which the Veteran's back was not diagnosed with a chronic disability does not necessarily contradict the factual premise of the December 2011 VA examiner's analysis. Thus, the Board finds that the December 2011 VA examination report's positive etiology opinion, despite the fact that its rationale is based on facts that are not clearly demonstrated, is at least well enough supported by the shown facts of record to hold some probative value. The Board has been particularly interested in the question of whether the current back disability is shown to have manifested during the Veteran's active duty service. Development efforts have failed to yield an entirely clear adequate medical opinion addressing whether the Veteran's shown in-service back symptoms were manifestations of his current chronic back disability on appeal. However, the Board notes that the December 2011 VA examiner's conclusion that the current back disability is at least as likely as not linked to some in-service injury at least reasonably implies that the documented in-service back complaints in May 1991, near the end of the Veteran's active duty service, may be considered manifestations of the same back disability that is currently diagnosed and on appeal. There is no medical opinion of record which probatively outweighs this indication of nexus. The April 2006 VA examination report is not probative because it was not informed by the complete correct set of pertinent information currently of record. The March 2009 VA examination report presents a negative etiology opinion, but offers an inadequate rationale in merely citing that "the pain that he was seen for during his second tour he reported to be 4 to 5 years prior which would have been before his second tour." The Board is not persuaded that the suggestion of a history of intermittent back pain from outside of active service resolves the question of whether the current disability had onset during service. The Board reads the May 1991 service treatment record as indicating that the Veteran was experiencing new additional symptoms of back pain associated with a recent sports injury beyond any suggestion of prior back pain; the indication of additional May 1991 back injury is pertinent to the Veteran's service-connected claim and is not negated by his report at that time of prior back pain. Thus, even acknowledging that the December 2011 VA examination report does not entirely resolve the uncertainty regarding key medical questions in this case, the Board finds that the December 2011 VA examination report's indication that the Veteran's current back disability is etiologically related to in-service back problems is the most probative evidence of record on this point. The Board finds that it is reasonable to conclude, resolving reasonable doubt in the Veteran's favor, that the Veteran's current back disability is etiologically linked to the Veteran's service. The Board finds that the December 2011 VA examination report confirms a diagnosis of degenerative joint disease of the lumbar spine and reasonably indicates that this disability is linked to the back symptoms shown during military service. After multiple prior Board remands seeking to develop more adequate medical evidence in this case, the Board finds that the December 2011 VA examination report presents somewhat probative support of the Veteran's claim and there is no adequate contrary medical opinion of record. After careful consideration, resolving reasonable doubt in the Veteran's favor, the Board finds that service connection may be granted in this case. There is notable uncertainty in this matter presented by the evidence of record, and the evidence does not clearly preponderate in favor of the Veteran's claim; however, the Board finds no significant evidence presenting a competent medical opinion regarding nexus or current diagnosis that is contrary to the December 2011 VA examination report. The Board considers the occurrence of the Veteran's back symptoms, increasing in connection with an injury in May 1991, to be reasonably established by contemporaneous medical documentation. The Board finds that the evidence now reasonably establishes the occurrence of the pertinent in-service event/disability manifestations, the pertinent current diagnosis, and nexus (at least as likely as not) between the two. The evidence reasonably establishes the elements required for entitlement to service connection for degenerative joint disease of the lumbar spine; service connection for degenerative joint disease of the lumbar spine is warranted. In sum, after weighing the positive evidence with the negative evidence, the reasonable doubt raised by the evidence must be resolved in favor of the Veteran. 38 U.S.C.A. § 5107(b), 38 C.F.R. § 3.102. Resolving reasonable doubt in the appellant's favor, the Board finds that a grant of service connection for the Veteran's degenerative joint disease of the lumbar spine is appropriate in this case. Veterans Claims Assistance Act of 2000 (VCAA) There is no need to undertake any review of compliance with the Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations in this case since there is no detriment to the veteran as a result of any VCAA deficiency in view of the fact that the full benefit sought by the veteran is being granted by this decision of the Board. See generally 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). By letter dated in March 2006, the Veteran was furnished notice of the manner of assigning a disability evaluation and an effective date. He will have the opportunity to initiate an appeal from these "downstream" issues if he disagrees with the determinations which will be made by the RO in giving effect to the Board's grant of service connection. ORDER Service connection for degenerative joint disease of the lumbar spine is warranted. The appeal is granted. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs