Citation Nr: 18147723 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 14-43 759 DATE: November 7, 2018 ORDER Entitlement to service connection for a lower back disorder is denied. Entitlement to service connection for a right hip disorder as secondary to a lower back disorder is denied. Entitlement to service connection for a right knee disorder as secondary to a lower back disorder is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a lower back disorder due to a disease, injury or event in service. 2. The preponderance of the evidence is against finding that the Veteran has a right hip disorder secondary to a service-connected disability. 3. The preponderance of the evidence is against finding that the Veteran has a right knee disorder secondary to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a lower back disorder have not been met. 38 U.S.C. §§ 1110, 5103(a); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 2. The criteria for service connection for a right hip disorder as secondary to a lower back disorder have not been met. 38 U.S.C. §§ 1110, 5103(a); 38 C.F.R. §§ 3.159, 3.310. 3. The criteria for service connection for a right knee disorder as secondary to a lower back disorder have not been met. 38 U.S.C. §§ 1110, 5103(a); 38 C.F.R. §§ 3.159, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1976 to July 1979. Duty to Notify and Assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of evidence that could not be obtained. Although the Veteran stated in his appeal that he feels as if VA did not exhaust all attempts to obtain his service treatment records, VA made a “Formal Finding on the Unavailability of Records” in February 2013 that details the efforts made to obtain the service treatment records, including submitting a request to the National Personnel Records Center. The Board finds these actions to be a sufficient attempt to obtain the Veteran’s service treatment records, and that further efforts to obtain such records would prove futile. The Veteran has not referred to any additional, unobtained, relevant, available evidence. Also of record is a VA examination conducted in June 2017. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 1. Entitlement to service connection for a lower back disorder. The Veteran seeks service connection for a lower back disorder. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his claimed lower back disorder. A formal finding of the unavailability of service treatment records was entered in the record in February 2013. However, the Veteran served in the National Guard after his tour of active duty, and medical records from his National Guard duty are associated with the Veteran’s claims file. A July 1990 Report of Medical History shows the Veteran checked the box “no” when asked if he had recurrent back pain and wrote he was in “good health” and takes “no medication.” An April 1994 Report of Medical Examination reflects the Veteran had a normal examination of his spine and lower extremities; there were no defects or diagnoses noted, and he was deemed qualified for service at that time. The companion April 1994 Report of Medical History reflects the Veteran checked the box “no” when asked if he had recurrent back pain, and he again wrote that he was in “good health” and takes “no medication.” Post service treatment records from the Washington VAMC and Salem VAMC are associated with the Veteran’s file. In summary, these records show that in January 2007, the Veteran reported he was never in combat and had pain in his left knee from surgery and “no other medical issues.” The earliest record documenting the Veteran’s complaint of lower back pain is dated in November 2010; X-rays taken at that time showed the Veteran had lumbar spondylosis with degenerative disc disease. Records show that he underwent lumbar injections in March 2011 and again in August 2013. None of these records show a nexus or link between the Veteran’s lower back disorder and his military service. In June 2017, the Veteran underwent a VA examination for his lower back disorder. In his written report, the examiner confirmed that he interviewed and examined the Veteran; reviewed the Veteran’s claims file and all pertinent records; and, considered and accepted the Veteran’s lay statement. The examiner opined that the Veteran’s low back disorder is not at least as likely as not incurred in or caused by the in-service injury. The examiner stated that the Veteran’s back condition is, rather, degenerative, the result of chronic wear and tear, a genetic predisposition, and the loss of fluid in the disk spaces. As rationale, the examiner noted that at a treatment visit in November 2010 the Veteran reported his back pain had been present for about 6 months. The examiner also acknowledged the Veteran’s report that he had a lifting injury in 1979 while in service. The examiner found that the Veteran’s contention that his in-service lifting injury led to the development of DDD “is not medically correct or plausible.” By way of rationale, the examiner explained that lifting injuries such as that experienced by the Veteran during service “would cause so called back strains or non-specific lower back pain. It may cause disc herniation.” As noted above, the examiner found the Veteran’s current DDD to be due not to a lifting injury but instead to chronic wear and tear, genetic predisposition, and loss of fluid in disk space. The examiner further noted that following the in-service lifting injury, the Veteran was physically qualified for entry into the National Guard and remained so for 10 years after active service, a fact which he found argued strongly against any chronic disability resulting from the in-service lifting injury. The Board concludes that, while the Veteran has a diagnosis of a lower back disorder and credibly reports having injured his back in service, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. Thus, while the first and second Holton elements are met, the third element has not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). Here, while the Veteran believes his lower back disorder is related to service, the Board reiterates that the preponderance of the competent and credible evidence weighs against finding that his current lower back disorder is related to any event, incident, or injury in service. In so finding, the Board has considered the Veteran’s lay statements in which he reported that he injured his back lifting 206-pound artillery, damaging discs in his lower back, as well as the buddy statement in which a fellow serviceman stated that he saw the Veteran return from the field with a lower back injury. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of a thoracolumbar spine disability, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). While the Veteran is competent to report having experienced symptoms of back pain, he is not competent to provide a diagnosis in this case or determine the etiology of his symptoms. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing. Id. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. There is no nexus or link between the Veteran’s service and his current complaints of lower back pain. As such, the appeal is denied. 2. Entitlement to service connection for a right hip disorder as secondary to a lower back disorder. 3. Entitlement to service connection for a right knee disorder as secondary to a lower back disorder. The Veteran seeks service condition for a right hip disorder and a right knee disorder as secondary to a lower back disorder. As discussed in detail above, the evidence of record reflects the Veteran does not have a lower back disorder that is attributed to his military service, and the claim for service connection for a lower back disorder is herein denied. There are no additional service connection theories to consider, based on the Veteran’s contentions, which focused solely on his belief that his right hip and right knee disorders developed or were aggravated due not directly to service but to his lower back disorder. As the Veteran is not service-connected for a low back disorder, his secondary service connection claims for a right knee disorder and a right hip disorder must be denied as a matter of law. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310; see also Sabonis v. Brown, 6 Vet. App. 426 (1994). CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel