Citation Nr: 18146060 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 17-33 000 DATE: October 30, 2018 ORDER Entitlement to service connection for a lumbar spine disability is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his lumbar spine disability is at least as likely as not related to active military service. CONCLUSION OF LAW The criteria for service connection for a lumbar spine disability are 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 in the United States Air force from November 1967 to November 1971. During his period of service, the Veteran earned the National Defense Service Medal, Vietnam Service Medal with 1 Bronze Service Star, Air Force Outstanding Unit Award, Air Force Good Conduct Medal, Republic of Vietnam Campaign Medal, and Small Arms Expert Marksmanship Ribbon. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran appeared for a VA back examination in September 2015. At that time, the examiner indicated diagnoses for back strain, intervertebral disc syndrome (IVDS) of the thoracolumbar spine with bilateral lower extremity radiculopathy, degenerative disc disease (DJD), osteoarthritis of the lumbar spine, and lumbar spinal stenosis of the back. Thus, the current-disability criterion for service connection is met. See Shedden, supra. Next, the Board must consider whether the Veteran sustained a disease or injury in service. A review of the Veteran’s service treatment records shows complaints and treatment for low back pain. The Veteran received a diagnosis of paravertebral muscle spasm and lumbar sprain in October 1968. He was subsequently placed on temporary duty restriction. During his October 2018 Travel Board hearing, the Veteran testified that he injured his back in the course of loading 500-pound bombs. The Board finds the Veteran’s testimony regarding the injury he sustained to be credible, as the available documentation in the service treatment records corroborates treatment for a muscle strain. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). Further, the Veteran’s DD-214 confirms that his military occupational specialty (MOS) was Weapons Mechanic. Thus, the Veteran’s injury is consistent with the circumstances of his service. As such, the second element of service-connection is met. See Shedden, supra. As to the third element of service connection, medical evidence must establish a nexus between the current disability and the in-service disease or injury. A private opinion was submitted by Dr. J. M. in May 2015. The physician diagnosed lumbosacral spondylosis, lumbar radiculitis, lumbago of the low back, spondylolisthesis. The physician opined that the Veteran’s diagnosed lumbar spine disabilities were related to service. In support of his opinion, the physician stated that lumbosacral spondylosis and spondylolisthesis with pars defect were caused by axial loading of the spine, which could progress into lumbar radiculitis and lumbago of the lumbosacral spine. The physician indicated that the Veteran’s duties as a bomb loader would cause significant axial loading to the spine and noted in-service treatment for a lumbar spine injury. As such, the examiner opined that the Veteran’s in-service injuries were related to the current condition for which the Veteran was being treated. As indicated above, the Veteran appeared for a VA back examination in September 2015. The Veteran reported that he sprained his back in the course of loading 500- pound bombs during service. He further reported intermittent back pain since his separation from service. The examiner opined that it was less likely than not that the Veteran’s lumbar spine disability incurred in or caused by the in-service injury. In support of his opinion, the examiner stated that the Veteran was seen for multiple back complaints in October 1968 and once in May 1969. Upon separation from service, the Veteran did not complain of a back problem. The examiner noted that the Veteran’s complaints appeared to be short-term, as there were no additional records after service to show a chronic problem until 2002. As there was a 31-year gap during which continual or ongoing back problems were not documented, the examiner concluded that the original injury was healed and that it was less likely than not that the Veteran’s currently diagnosed back disability occurred in service. In October 2018, a private opinion was submitted by Dr. R. R. The physician indicated that the Veteran had diagnoses of lumbar spine defects. She further noted that the Veteran’s service treatment records reflected a lumbosacral injury during service. Dr. R. R. explained that spondylolysis referred to a defect in the posterior vertebral body at the pars interarticularis, which is caused by trauma. This process requires a fracture or deformation of the posterior spine elements creating an elongation of the pars. The physician explained that failure to diagnose a pars stress fracture or early spondylolysis can be common and a misdiagnosis of lumbosacral strain is often made. Dr. R. R. opined that this was most likely the situation that occurred in 1968, as the Veteran’s service treatment records documented a “change in posture,” lumbosacral pain, and a change in the Veteran’s profile due to lumbosacral pain. Dr. R. R. further explained that low-grade slips may decompress and relieve pain with leaning forward; thus, according to research, it is important to note patient comments, such as increased pain within the spinal column in forward flexion. The physician indicated that the Veteran’s service treatment records documented the Veteran’s inability to stand erect, including the ability to only stand with forward flexion posture, which is an indication for vertebral slippage. In consideration of the evidence of record, the Board finds that the evidence for and against the Veteran’s claim for service connection for a lumbar spine disability is in a state of relative equipoise. The probative values of medical opinions provided by the Veteran’s private physicians in May 2015 and October 2018, as well as the opinion provided by the VA examiner in September 2015 are of equal probative value, in that the examiners based their opinions on an examination of the Veteran and review of his records. As there is no reason shown to value one opinion over the other, the evidence is relatively equally balanced in this regard. (Continued on the next page)   Given that the Veteran has a current diagnosis of a lumbar spine disability, had in-service complaints regarding the lumbar spine, and the opinions being in relative equipoise as to whether the Veteran’s current lumbar spine disability is related to his period of service, reasonable doubt will be resolved in favor of the Veteran. Accordingly, the Board finds that service connection for a lumbar spine disability is granted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Joseph, Associate Counsel