Citation Nr: 18148888 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 12-10 632 DATE: November 9, 2018 ORDER Service connection for a lumbar spine disorder is denied. FINDING OF FACT 1. The evidence of record demonstrates that the Veteran’s thoracolumbar spine pain was noted on entrance into military service as due to a weightlifting injury that occurred prior service. 2. The Veteran is not presumed sound as to his thoracolumbar spine pain on entrance into military service. 3. The evidence does not demonstrate that the Veteran’s thoracolumbar spine pain increased in severity during military service; in fact, it appeared that the Veteran’s thoracolumbar spine pain improved and/or resolved completely during service. 4. The Veteran’s degenerative disc disease (DDD) of the lumbar spine is not shown to be diagnosed during or for many years after discharge from service. 5. The Veteran’s noted back pain during military service is shown to be related to the Veteran’s pre-existing condition and/or related to a pelvic tilt and shortening of the left leg, and is not shown to be an initial manifestation of the Veteran’s DDD of the lumbar spine. 6. The evidence of record does not demonstrate any disease, injury, or event during military service which could account for the Veteran’s DDD of the lumbar spine, and the evidence does not otherwise demonstrate a nexus to service in this case. CONCLUSION OF LAW The criteria for service connection for a thoracolumbar spine disorder, to include DDD of the lumbar spine, are not met. 38 U.S.C. §§ 1110, 1154, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from March 1966 to March 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in December 2015, at which time it was remanded in order to schedule the Veteran for a Board hearing. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in December 2017. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”—the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases, including arthritis, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a). The Veteran has claimed service connection for a lumbar spine disorder. Turning to the evidence of record, a review of the Veteran’s service treatment records demonstrates that he had a normal spine on examination during his November 1965 enlistment examination, although it was also noted that there was an attached consultation. In his report of medical history at that time, the Veteran reported that his health was “good,” and denied any history of rheumatism (arthritis), swollen or painful joints, cramps in his legs, arthritis or rheumatism, bone, joint or other deformity, neuritis, or paralysis; he also denied having worn a brace or back support. He did report having back trouble that caused him to miss work frequently and that he received treatment with Dr. T.F.M. for his back. The attached November 1965 consultation noted that the Veteran injured his back lifting weights 3 years prior to enlistment; over the next two years, the Veteran was noted to miss 15 to 20 days of school related to back pain, but never more than 1 day at a time. It was noted that after graduation, he had been working and had missed 10 days of work in the last 6 months. He complained of pain primarily in the upper part of his back between the shoulder blades and occasionally in the low back; it was aggravated by standing and sitting for long periods of time, or by bending and straining. The Veteran reported that a private doctor took x-rays and told him he had arthritis of the spine. After examination, the examiner noted that x-rays of the Veteran’s dorsal spine revealed no bony abnormalities or ossification of ligaments; the enlistment examiner noted that the history would suggest a possibility of early rheumatoid spondylitis, although there was nothing to base a diagnosis on at that time. Thus, at entrance into service it was noted that the Veteran reported then present pain of his back. Pain can be a disability. See Saunders v. Wilke, 886 F.3d 1356 (Fed. Cir. 2018). There was also an attached November 1965 letter from Dr. T.F.M., the Veteran’s private physician, noting that he treated the Veteran’s back pain in January 1964 and also noted a history of back pain on and off since that time when he would strain. Dr. T.F.M. examined the Veteran again in November 1965, noting that he had not seen the Veteran in approximately two years. The Veteran complained of continued backache and inability to perform his work most of the time, as well as pain in the intrascapular and low back regions. Dr. T.F.M. noted that examination was “not too remarkable.” The balance of the Veteran’s service treatment records demonstrates that while in service he initially was seen for complaints of back pain in April 1966, at which time he was noted to have a 3-year history of back pain following a weight lifting injury. Examination at that time showed full range of motion, and he was given light duty and referred for an orthopedic appointment. He was seen by the orthopedic department in May 1966, at which time he was noted to have a 3-year history of mid- and low-back pain. After examination, he was diagnosed with back strain with a history that suggested nerve root involvement. He was given back exercises to perform and scheduled for a follow-up. He was again seen in complaints of back pain in the same regions as previously noted in June 1966, and then again in July 1966. Eventually, the Veteran was seen for a consultation in September 1966 regarding his chronic back pain complaints. At that time, the examiner noted the history of intermittent back pain since injuring his back lifting weights in high school 4 years prior, with complaints of radiation of pain on 2-3 occasions to the right leg and constantly to the upper lumbar area. On examination, the Veteran had full range of motion of the lumbosacral spine, with a pelvic tilt to the left while standing. He was noted to have a left leg that was three-quarts of an inch shorter than the right leg and a half-inch lift leveled the Veteran’s pelvis while standing. X-rays of the lumbosacral and thoracic regions were normal at that time. The examiner diagnosed the Veteran with low back pain secondary to a short left leg; he was prescribed a half-inch left heel lift and found to be fit for continued military service at that time. In a letter to the Veteran’s commanding officer, the examiner noted that the Veteran was seen for examination in September 1966, resulting in an examination that revealed one leg shorter than the other leg, which was causing his back pain. The examiner noted that he prescribed the Veteran a special shoe with a built of heel, which would alleviate his condition. The examiner noted that there were no permanent disablements during the course of the examination and that he was physically qualified to continue military service. The examiner further noted that the Veteran had not had any back ailments or reports to sick call for his back pain since joining the unit in August 1966, and that the commander should be made aware of and monitor the Veteran’s daily duties to preclude any possible impairments. After the September 1966 consultation, the Veteran did not have any further complaints related to his lumbar spine during military service. In his November 1967 separation examination, the Veteran’s lumbar spine was found to be normal. In his report of medical history at that time, the Veteran reported that his health was “good,” and denied any history of rheumatism (arthritis), swollen or painful joints, cramps in his legs, arthritis or rheumatism, bone, joint or other deformity, neuritis, or paralysis; he also denied having worn a brace or back support. The Veteran, however, also reported having back trouble that he did “not have any trouble now. It’s been over a year since it bothered me.” After discharge from service, the first report of any lumbar spine problem was in November 1986. The Veteran sought treatment at a private hospital at that time with development of low back pain with radiation into his inguinum after moving furniture the day before. He was diagnosed with left inguinal and lumbosacral strain at that time. An x-ray from the following day revealed lumbar vertebral body heights, body alignment and intervertebral disc spaces were not remarkable except for minimal narrowing of the L4-5 disc space; all pedicles, spinous, and traverse processes were in tact without pars defects or slippage noted. There was some lipping and spurring anteriorly at the D12-L1 level; it was noted that the Veteran had a normal lumbar spine except for degenerative changes at the D12-L1 level and mild narrowing of the L4-5 disc space. No further complaints of the thoracolumbar spine are shown until the Veteran sought treatment in June 2001 for complaints of back pain associated with slipping on wet stones during rain, in which he wretched his back while turning to prevent falling; he denied any direct trauma to the back. No x-rays were obtained at that time. After examination, he was diagnosed with acute rhomboid muscle strain with spasm. In April 2002, the Veteran was seen for complaints of “acute back pain” which he had suffered on-and-off for 2-3 weeks, but which got acutely worse after moving furniture on the day he sought treatment at that time. X-rays demonstrated “some degenerative changes but no acute fractures” with mild scoliosis. He was diagnosed with acute lumbar strain with left lower extremity radicular symptoms at that time. Two years later, in April 2004, the Veteran was again seen complaints of back pain; he was noted to have a history of chronic low back pain at that time, although for about a week his back had flared-up and was progressively worsening. He also reported radiation to his right lower extremity with numbness at that time. He was diagnosed with acute lumbar strain at that time. Two months later, in June 2004, the Veteran sought an initial consultation with Dr. S.D.L. for his thoracolumbar spine. At that time, the Veteran was noted to have low back pain with radiation to his right hip and right posterior thigh. He reported a several year history of on and off low back pain with radiation to his right lower extremity, although he noticed an increase in symptoms over the past few months. Dr. S.D.L. noted a lumbar spine Magnetic Resonating Imaging (MRI) scan that noted an L4-5 diffuse disc protrusion with annular tear that is eccentric to the right in associated with the facet joint hypertrophic changes, mild to moderate right L4 lateral recess stenosis, mild bilateral L4 neural foraminal stenosis, and right L5-S1 conjoined nerve root sheath. After examination, the Veteran was diagnosed with L4 lumbar radiculopathy and low back pain; he was given steroid injections at that time. The Veteran had continued treatment through June 2005, at which time he had another MRI. The June 2005 private MRI scan revealed multilevel degenerative disc disease (DDD) and facet arthropathy producing lateral recess and neural foraminal stenosis and levocurvature of the lumbar spine. In a June 2005 follow-up letter, it was noted that the Veteran’s MRI showed multilevel DDD and facet arthropathy with posterior disc bulges at L1-2, L2-3, L3-4, and L5-S1, and a right posterior disc bulge at the L4-5, which produced moderate right lateral recess stenosis and bilateral neuro-foraminal stenosis. He was diagnosed with low back pain, lumbar radiculopathy, lumbar spondylosis, facet syndrome, and lumbar DDD. The Board reflects that a review of the other private and VA treatment records associated with the claims file demonstrate continued treatment for his thoracolumbar spine disorders noted above. The Board also reflects that the Social Security Administration (SSA) records associated with the claims file are merely duplicates of the Veteran’s private and VA treatment records noted above. The Veteran filed his claim for service connection in March 2010, and he underwent a VA lumbar spine examination in August 2010. During that examination, the examiner noted the Veteran’s enlistment and separation examinations, November 1965 consultation and letter, and treatment and consultation in service, particularly the September 1966 consultation. At that time, the Veteran reported that he has suffered from lower back pain since high school and denied any history of trauma; he felt his pain had worsened over the years. X-rays obtained at that time indicated lumbar DDD at the L4-5 and bilateral facet arthropathy at the L5-S1. After examination and review of the claims file, the examiner diagnosed the Veteran with DDD of the lumbar spine. The August 2010 VA examiner opined that the Veteran’s lumbar spine disorder was not caused by or a result of military service. He noted that the Veteran had well-documented low back pain prior to entering military service, as noted by the enlistment examination and letter from Dr. T.F.M. Moreover, in his separation examination, the examiner noted that the Veteran reported his back trouble had resolved. The examiner noted that the Veteran currently had DDD of the lumbar spine and that this was a normal part of the aging process and was multifactorial. He noted a WebMD article, that stated DDD is not really a disease but a term used to describe the normal changes of the discs in the spine as a person age[s]. . . . As we age, our spinal discs break down, or degenerate, which may result in [DDD] in some people. These changes are more likely to occur in people . . . who do heavy physical work (such as repeated heavy lifting). People who are obese are also more likely to have symptoms of [DDD]. The examiner concluded that the Veteran was obsess which likely contributed to his current thoracolumbar spine disorder. Additionally, the August 2010 examiner opined that the Veteran’s current thoracolumbar spine disorder was not permanently aggravated by his military service. The VA examiner noted that the Veteran “actually reported an improvement in his back symptoms at the separation exam[ination] from the time he entered the service. There is no evidence to suggest that his [thoracolumbar spine disorder] worsened during his service time.” The Veteran underwent another VA examination of his thoracolumbar spine disorder in December 2014, at which time he was diagnosed with DDD of the lumbar spine. During the examination, the Veteran reported a history of low back pain problems back to the 1960’s and admitted that his back problems “may have even predated entry into service.” The examiner noted that there were complaints of back pain in service, but the separation examination showed that his back pain had resolved at the time of separation, without any symptoms over the past year of his service. The examiner further noted that he was diagnosed with DDD of the lumbar spine in 1986 with continued back pain since that time. After examination, the examiner opined that the Veteran’s DDD of the lumbar spine was not caused by or the result of military service, as the Veteran’s own admissions establish that he had some problems with low back pain that predated his entrance into military service and such is supported by the November 1965 enlistment examination, consultation, and letter from Dr. T.F.M. The examiner noted that these problems recurred while the Veteran was in service in the 1960’s, as noted in his service treatment records from 1966 showing diagnoses of muscle strain and myalgia. “However, [the] Vet[eran]’s back symptoms seem to have resolved as at the time of [his] separation physicals,” noting the November 1967 separation examination and the Veteran’s statements therein. The examiner further noted that private treatment records form 1986 demonstrated that the Veteran developed DDD of the lumbar spine. “However, in the absence of clear causal association between [the] Vet[eran]’s past back pain episodes and in particular the presence of evidence indicating that [his] back pain condition had resolved as at the time of [his] leaving service,” he opined that the Veteran’s thoracolumbar spine disorder was “not causally related to active military service.” Additionally, the December 2014 examiner opined that the Veteran’s thoracolumbar spine disorder was not permanently aggravated by military service, because there was no evidence in his service treatment records to indicate that aggravation occurred. Finally, the Veteran and his representative have submitted a July 2018 private examination and medical opinion from Dr. F.A.G. Dr. F.A.G. indicated he reviewed the service treatment, private, and VA treatment records, as well as the August 2010 and December 2014 VA examination reports associated with the claims file and noted above. He noted that the Veteran’s current diagnosis was DDD of the lumbar spine. Based on review of the above noted records, Dr. F.A.G. opined that the Veteran’s service treatment records document a lumbosacral and thoracic condition that was present during military service. He noted that further medical records document low back pain with lumbar radiculopathy with degenerative changes in an April 2002 x-ray. He opined that the Veteran had documentation of the lesion of a low back condition dating prior to military service as well as within present within military service time with pain after lifting weights [sic]. This is more likely than not that the [Veteran]’s present condition of lumbosacral intervertebral disc syndrome . . . have a causal Nexus to military service by reason of aggravation during military service. On appeal, the Veteran contended in his June 2011 notice of disagreement that his service treatment records document a disability that was permanent in nature. In his April 2012 substantive appeal, VA Form 9, the Veteran stated that his back problem was aggravated by his military service and that once separated from the military it gradually worsened. The Veteran also testified in a December 2017 hearing that he had problems with his thoracolumbar spine prior to entrance into military service. He stated that he started lifting weights during high school and that led to back problems. The Veteran further testified that he went to sick call several times for back pain during military service, and that he performed heavy lifting. The Veteran further stated that at a certain point he was transferred to driving a jeep and he no longer had to do any heavy lifting and that was why he reported not having back pain for a while on his separation examination. The Veteran also testified that he continued to have back problems after he left service and that he has had problems his whole life. Finally, in an October 2018 informal hearing presentation, the Veteran’s representative indicated that the Veteran’s thoracolumbar spine disorder should be presumed as aggravated and that VA has not met its burden of demonstrating clear and convincing evidence that the Veteran’s aggravation was not due to military service. Based on the foregoing evidence, the Board must deny service connection for the Veteran’s thoracolumbar spine disorder at this time. As an initial matter, the Board reflects that the Veteran and his representative have argued that the Veteran’s thoracolumbar spine disorder has pre-existed military service and that such was aggravated by military service. A veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). In this case, in March 1966, the Veteran was accepted and enrolled into military service, and the military determined that the Veteran was fit for service at that time. However, in light of the above noted enlistment examination and the attached November 1965 consultation and November 1965 letter from Dr. T.F.M., the Board must find that the Veteran was not sound on entrance into military service as to his thoracolumbar spine pain, as he was very clearly noted to have low back pain issues on enlistment into military service. See 38 U.S.C. § 1111. Again, pain can be considered a disability. See Saunders v. Wilke, 886 F.3d 1356 (Fed. Cir. 2018). Here, his back pain was noted on entrance into service and is encompassed by the description of disorders, infirmities, defect listed at § 1111. He is therefore not presumed to have been sound at entrance as to back pain. Generally, a preexisting injury or disease will be considered to have been aggravated by active service where there was an increase in disability during such service, unless there is a specific finding that the increase in disability was due to the natural progress of the disease; however, aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. §3.306. If the disorder becomes worse during service and then improves due to in-service treatment to the point that it was no more disabling than it was at entrance into service, the disorder is not presumed to have been aggravated by service. Verdon v. Brown, 8 Vet. App. 529 (1996). Furthermore, during military service, it appears that the Veteran had several instances of treatment for low back pain and myalgia, as well as a diagnosis of a pelvic tilt due to a shortened left leg which was causing his back pain at that time. Insofar as the Veteran’s thoracolumbar spine claim encompasses a claim for a chronic low back pain disability during service, the Board finds that the evidence demonstrates that a disability was noted to pre-exist service in this case, as noted above. However, it does not appear that the Veteran has a current chronic low back disability which was aggravated by military service. In this case, the Board cannot find that the Veteran’s noted pre-existing chronic low back pain was increased during military service such that there can be a finding of aggravation in this case. First, the Board acknowledges the Veteran’s statements that he believes that his thoracolumbar spine pain was aggravated by military service; the Veteran, however, lacks the requisite medical training and experience to render such an opinion in this case. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Next, the Board notes that the Veteran was seen for back pain during military service; such back pain was noted on entrance into military service to be intermittent in nature. The back pain the Veteran suffered during military service was also shown to be intermittent in nature. Furthermore, it appears that during the course of treatment in service, the military doctor identified the cause of the Veteran’s low back pain—namely, the shortened left leg that led to a pelvic tilt which caused the back pain—and prescribed a heel left to alleviate the Veteran’s low back pain. The September 1966 consultation and letter to the military commander specifically indicated that “there were no permanent disablements” of the Veteran’s thoracolumbar spine at that time. During the following year of military service subsequent to prescription of the Veteran’s heel lift, the Veteran no longer suffered from low back pain, indicated that his low back pain had not bothered him in a year at separation from military service, and the Veteran’s thoracolumbar spine was shown to be normal on separation from service. Thus, it appears that the Veteran’s pre-existing back pain condition completely resolved during military service. In other words, the Veteran was actually left in an improved state from his entrance into military service. These are the findings of the August 2010 and December 2014 VA examiners, and the Board finds that such findings are consistent with the factual record in this case and are therefore the most probative evidence of record. The Board also acknowledges the Veteran’s statements that he continued to have chronic ongoing back pain after discharge from military service. However, the Board finds those statements by the Veteran to be not credible in light of his statements during his separation examination that he did not have and had not had any back trouble for a year at that time. The Board also acknowledges his hearing testimony that he when he was no longer doing heavy lifting and driving a jeep during service, that his back pain resolved. The Board, however, notes that these statements in fact bolster the finding that the Veteran’s pre-existing back condition was not aggravated during service in this case, as the pre-service evidence indicated that the Veteran’s back only bothered him when straining. The Veteran’s testimony that the lack of exertion during military service led to no back pain would therefore demonstrate consistency with the pre-existing low back pain condition that existed on entrance into military service. Finally, there is nearly 19 years after military service without any complaints of thoracolumbar spine problems, and a noted intervening injury in 1986 that precipitated onset of his back pain at that time. This evidence additionally contradicts the Veteran’s statements that he had chronic pain after discharge from service. The Board finally acknowledges Dr. F.A.G.’s findings and conclusions as noted in his July 2018 medical opinion. The Board, however, finds that Dr. F.A.G.’s findings and conclusions have little to no probative value as no rationale for those findings and conclusions was provided. See Guerrieri v. Brown, 4 Vet. App. 467 (1993) (the probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998) (the failure of the physician to provide a basis for his/her opinion affects the weight or credibility of the evidence). Dr. F.A.G.’s opinion is merely a conclusory statement that the Veteran’s low back condition was aggravated by military service without explanation of the evidence that compelled that conclusion. Such lack of a rationale in this case significantly decreases the probative value, particularly in light of the Veteran’s improvement in symptomatology during military service to the point that his back problems had completely resolved at separation from military service. Dr. F.A.G.’s opinion fails to engage any of these facts from the service treatment records that appear to contradict the conclusion that he arrived at. In short, none of the Veteran’s statements and testimony throughout the appeal period regarding his back pain during military service at all demonstrate any evidence of a chronic worsening or increase in severity of that pre-existing condition. Rather, his statements and hearing testimony document a substantially similar disability to that noted in the November 1965 service treatment records. Although Dr. F.A.G. found that there was aggravation of the Veteran’s back condition during military service, he failed to adequately explain that conclusion. Any probative value accruing to Dr. F.A.G.’s opinion is vastly outweighed in this case by the probative value of the August 2010 and December 2014 VA examiners’ opinions. Although the Veteran’s representative has contended that a presumption of aggravation has accrued to the Veteran in this case, the Board need not reach the merits of that argument at this time, as such a presumption only accrues when an increase in symptomatology has been shown to have occurred during military service. Such an initial showing of an increase in symptomatology is the burden of the Veteran to demonstrate, and the Veteran and his representative have not met that burden at this time. Accordingly, insofar as the Veteran and his representative have contended that there was a pre-existing thoracolumbar spine disorder that was aggravated by military service, the Board must deny service connection on that basis at this time, as the evidence of record does not demonstrate an increase in the severity of such pre-existing disability during military service. See 38 C.F.R. § 3.306; Wagner, supra. Turning next to the noted DDD of the lumbar spine, although the Veteran has a current disability, service connection for that disorder must also be denied at this time. Initially, the Board reflects that the evidence does not demonstrate any diagnosis of arthritis or DDD during military service; x-rays obtained during military service were negative for any arthritis or DDD, and the Veteran specifically denied any rheumatism or arthritis during military service and particularly at separation. Instead, the first evidence of DDD of the lumbar spine in the record is in 1986, several years after discharge from military service. Accordingly, the Board finds that an award of service connection on a presumptive basis in this case is not warranted. See 38 C.F.R. §§ 3.307, 3.309. Next, the Board reiterates that there is no evidence, including x-ray evidence, of arthritis or DDD shown during military service. The Veteran’s thoracolumbar spine was also noted to be normal on separation from military service, and he specifically denied any back trouble, arthritis, or rheumatism at that time. The first evidence of any DDD of the lumbar spine in the record is in 1986, many years after discharge from service. See Maxson v. West, 12 Vet. App. 453 (1999), aff’d, 230 F.3d 1330 (Fed. Cir. 2000) (a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim, which weighs against the claim). The Veteran is not competent to offer any medical opinion in this case as to the etiology of his DDD of the lumbar spine as such is a complex medical question. Additionally, the Board notes that Dr. F.A.G.’s opinion in this case does not address direct causation due to military service in this case, as his opinion clearly states that it is predicated on an aggravation theory of entitlement; the Board therefore finds that medical opinion has no probative value with regards to the direct causation theory of entitlement in this case. Consequently, the August 2010 and December 2014 VA examiners’ opinions are the sole probative evidence related to that direct causation in this case. Those examiners both agreed that the Veteran’s DDD of the lumbar spine were not related to military service, and the Board finds those medical opinions to be unrefuted by any other evidence of record and therefore the most probative evidence of record at this time. Moreover, the Veteran’s testimony during his hearing was that after discharge from service, he participated in a job in an antique business that required heavy lifting. The Board further notes that such complaint of low back pain and subsequent notation of DDD of the lumbar spine at that time followed an intervening heavy lifting injury the day before. In short, the Board reflects that there is no evidence during military service of any disease, injury, or event that could account for the Veteran’s DDD of the lumbar spine. Although the Board acknowledges the Veteran’s low back pain complaints during military service, as noted above, such complaints of low back pain pre-existed military service and stemmed from a weightlifting injury prior to service. Further, it was determined during military service that the Veteran’s back pain was related to a pelvic tilt and shortened left leg, and such pain resolved with the prescription of a left heel lift. (Continued on the next page)   Accordingly, the Board finds that the evidence does not demonstrate that there is any in-service disease, injury, or event on which to predicate a finding of service connection related to DDD of the lumbar spine in this case. Moreover, there is no evidence of a nexus to military service between the Veteran’s DDD of the lumbar spine and the noted back pain during military service. The Board must therefore deny service connection for DDD of the lumbar spine at this time based on the evidence of record at this time. See 38 C.F.R. § 3.303. In reaching the above conclusions, as the preponderance of the evidence is against the Veteran’s claims, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel