Citation Nr: 18140583 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 14-36 876 DATE: October 3, 2018 ORDER Entitlement to service connection for midthoracic ankylosis spondylitis is granted. FINDING OF FACT The Veteran has a current diagnosis of midthoracic ankylosing spondylitis which is related to his active service. CONCLUSION OF LAW The criteria for service connection for midthoracic ankylosis spondylitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from December 1987 to December 2008. This matter came to the Board of Veterans Appeals (Board) from a June 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) denying service connection for midthoracic ankylosis spondylitis. A video conference hearing was held before the undersigned Veterans Law Judge in June of 2018 and a transcript of the hearing has been associated with the file. 1. Service connection for midthoracic ankylosis spondylitis Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). In relevant part, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran asserts that his current condition is related to his active service and indicated his back pain was a result of his job as an egress technician which required that he lift heavy objects in confined spaces routinely. He also reported that he sought treatment numerous times while in service and has continued to receive treatment in the form of prescriptions and a TENS unit after service. The Board finds that the Veteran’s midthoracic ankylosis spondylitis is service connected for the following reasons. The Veteran’s medical exam upon entry noted no spinal abnormalities. The Veteran sought treatment for back pain within 3 years of entering service, specifically in May 1990 after falling at work. The Veteran sought treatment numerous other times for back pain issues. As noted in the contemporaneous medical examinations and the Veteran’s testimony he often sought treatment for back conditions that occurred as result of his job duties during service. In addition, the Board finds the testimony of the Veteran to be highly probative as to the onset and continuous nature of his back condition and its connection with the performance of his job duties. He began receiving regular physical therapy for his back in 2008 and received a diagnosis of mild early midthoracic spondylosis. The VA examination of November 2010 did show a mild midthoracic spondylosis but no objective evidence of ankylosing spondylosis according to the examiner. The examiner did not render an opinion regarding ankylosis spondylitis because it was not indicated. The examiner further noted the HLA-B27 genotype, which the Veteran had previously tested positive for, had a strong genetic association with ankylosing spondylitis, with approximately 90% of patients with ankylosing spondylitis expressing the HLA-B27 genotype. The examiner at that time found the mild thoracic spondylosis was at least as likely as not caused by or a result of or related to treatment during service. The examiner included 2008 diagnosis of mild early midthoracic spondylosis in the rationale and noted that it was during a period of active service for the Veteran. The Board finds the examiner’s results to be competent. A Compensation and Pension examination was conducted in May 2017. The Veteran’s service treatment records were reviewed and an in-person examination was performed. The examiner found that the Veteran’s ankylosing spondylitis/chronic thoracolumbar strain was at least as likely as not due to or caused by military service. The examiner also noted the presence of the positive HLA-B27 test confirms the diagnosis of ankylosing spondylitis. In substantiating service connection, the examiner noted the ongoing nature of the Veteran’s problems, the Veteran’s chronic mid and lower back issues dating back to the 1990’s, and that the 2008 lab studies confirmed the diagnosis of ankylosing spondylitis during the Veteran’s active service. The Board finds the examiner’s results to be competent and credible. The Compensation and Pension examinations noted above provide contradicting opinions as to whether there is service connection for the Veteran’s ankylosis spondylitis, but both provided positive opinions that there was service connection regarding a back issue. The Board has found both opinions are competent and credible as to their findings, but places greater weight on the 2017 examination. In determining the weight assigned, the Board finds the 2017 examination findings to be more consistent with the prior exam results from 2008 and finds that it also addresses the Veteran’s chronic thoracolumbar strain. For these reasons it is the opinion of the Board, based upon a review of all the relevant evidence, that the Veteran’s current disability is service connected. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Middleton, Associate Counsel