Citation Nr: 18141441 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 15-32 244 DATE: October 10, 2018 ORDER Entitlement to a lumbar spine disorder claimed as secondary to right knee degenerative joint disease is denied. REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. FINDING OF FACT The Veteran first developed lumbar spine degenerative joint disease many years after discharge from service, the current lumbar spine degenerative joint disease is unrelated to service, and is not caused or aggravated by service-connected disability. CONCLUSION OF LAW The criteria for service connection for a lumbar spine disorder, including as secondary to a right knee disorder, have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1969 to January 1972. The Board notes that VA medical records added to the file after the August 2015 statement of the case are duplicative of prior evidence of record, or are not relevant to the Veteran’s claim for service connection for a lumbar spine disorder. Accordingly, the Veteran’s lumbar spine claim is ready for Board review. 1. Entitlement to a lumbar spine disorder as secondary to right knee degenerative joint disease. The Veteran submitted his claim for service connection for a back condition in October 2010. He asserted that it was secondary to his service-connected right knee disability. The Board concludes that, while the Veteran has a current diagnosis of lumbar spine degenerative joint disease, the preponderance of the evidence weighs against finding that the lumbar spine degenerative joint disease began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The record does not indicate that the Veteran was shown to have lumbar spine degenerative joint disease within a year of discharge from service. The record does not reveal any reference to lumbar spine degenerative joint disease for more than 35 years after discharge from service. VA treatment records first show complaints of low back pain in September 2008. X-rays of the lumbar spine in September 2008 were interpreted as revealing no degenerative changes. Consequently, the Veteran is not entitled to service connection for lumbar spine degenerative joint disease on a presumptive basis for a chronic disease (arthritis) that is noted within a year of discharge from service. 38 C.F.R. §§ 3.307, 3.309(a) (2017). While the Veteran believes he has lumbar spine degenerative joint disease due to service, including as secondary to service-connected right knee disability, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires medical knowledge and the interpretation of x-rays. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to VA medical opinions of record. On VA examination in December 2010, the Veteran was noted to have degenerative joint disease of the lumbar spine. The VA examiner opined that the lumbar spine condition was not related to the Veteran's service connected knee condition. The examiner attributed the Veteran’s lumbar spine condition to age. In September 2011, a VA physician stated that she had reviewed the Veteran’s medical history and it was her opinion that the Veteran’s current back and left knee conditions are as likely as not, or at least possibly, secondary to service connected right knee condition or the airborne injury he received in the service. In August 2015, a VA physician reviewed the Veteran’s claims file. He opined that it was less likely than not that the Veteran’s current lumbar spine degenerative joint disease was caused by an airborne injury during service. He pointed out that there were no reports of injuries during service that resulted from an airborne incident. He noted that there were no reports of any back complaints when the Veteran complained of knee pain during airborne training. He further noted that, in December 1971 near the Veteran’s separation from service, the Veteran indicated on his Report of Medical History that he had not had swollen or painful joints, no arthritis and no recurrent back pain. The VA physician further opined that the Veteran’s lumbar degenerative joint disease is less likely than not caused or aggravated by his service-connected right knee disability. He pointed out that a prior VA examination showed that the Veteran had a normal gait. This meant that there was no weight shift to the lumbar spine area and thus no extra stresses imposed on the lumbar spine from the right knee. Here there are two VA medical opinions against the Veteran’s claim and one VA medical opinion in favor of his claim. Not only are there more medical opinions against the Veteran’s claim, but the negative medical opinions are of more probative value. This is because the September 2011 examiner did not provide a substantial rationale for her opinion. She also hedged her opinion indicating that the Veteran’s lumbar spine was at least “possibly” related to service or to the service-connected right knee. See Obert v. Brown, 5 Vet. App. 30, 33 (1993). The December 2010 and August 2015 VA examiners’ opinions are the most probative evidence of record. In particular, the August 2015 VA examiner gave extensive rationale for his opinions and referenced medical literature. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion); Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the preponderance of the evidence is against the Veteran’s claim and service connection for a lumbar spine disorder, including as secondary to a right knee disorder, is not warranted. REASONS FOR REMAND 1. Entitlement to a rating in excess of 50 percent for PTSD is remanded. The Veteran asserts that he is entitled to a rating in excess of 50 percent for his PTSD. In July 2015, the RO issued a statement of the case (SOC) regarding the Veteran’s PTSD claim. Afterward, in August 2015, and prior to transfer of the case to the Board in September 2015, additional VA treatment records pertinent to the Veteran’s PTSD claim were obtained. Consequently, the Veteran’s claim for an increased rating for PTSD must be remanded to the RO for issuance of a supplemental statement of the case (SSOC). 38 C.F.R. §§ 19.31, 19.37(a) (2017). The Board further notes that on remand the agency of original jurisdiction (AOJ) will have the opportunity to consider a March 2018 VA psychiatric examination report and a September 2018 private psychiatric examination report. The matters are REMANDED for the following action: 1. Obtain the copies of the Veteran’s updated VA medical records and associate them with the claims file. 2. Upon completion of the above development and any additional development deemed appropriate, readjudicate the issue on appeal. If the benefit sought on appeal is not decided to the Veteran’s satisfaction, the Veteran and his representative should be provided a supplemental statement of the case that includes review of all evidence obtained since the July 2015 statement of the case. This must include review of the VA treatment records, the March 2018 VA psychiatric examination report and a September 2018 private psychiatric examination report. Thereafter, the case should be returned to the Board for further appellate consideration, if in order. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. E. Jones, Counsel