Citation Nr: 18149087 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 13-01 273 DATE: November 8, 2018 ORDER Service connection for a back disability is denied. FINDING OF FACT The weight of evidence is against the finding that the Veteran’s back disability either began during, or within a year of separation from service, or was otherwise caused by his military service, or was caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a back disability have not been met. 38 U.S.C. §§1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1972 to August 1980. His military records show that he served overseas in Germany. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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 (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). In addition, service connection can be established on a secondary basis for a disability which is proximately due to, or the result of a service-connected disability. 38 C.F.R. § 3.310 (a). The Veteran is seeking service connection for his back disability, which he initially argued was the result of an in-service back injury in 1974. His representative has since argued that the Veteran’s back disability was caused or aggravated by his service-connected knee disabilities. In June 2011, the Veteran was afforded a VA examination, at which he reported that his back pain started approximately 4-5 years earlier (around 2006 or 2007) without any precipitating event. He denied any injury or trauma prior to the onset of his current back pain. The examiner reviewed the file, noting that the Veteran had injured his lower back in May 1974 while in service, but observing that x-rays at that time showed the back to be normal. X-rays in June 2011 showed mild lumbar spondylosis at L4-5 and L5-S1. The examiner opined that the Veteran’s back condition was less likely than not a result of his military service, reasoning that while the Veteran was treated once in service for back pain, his current back pain started around 2006 or 2007, more than 2 decades after separation of service, and x-rays reveals mild spondylosis which was most likely age-related. In June 2016 the Veteran was afforded another VA examination, at which the examiner found diagnosis of degenerative arthritis of the spine and spinal stenosis. In November 2013 and June 2017, the Board remanded the claim for additional development to obtain a VA medical addendum opinion on whether the Veteran’s back disability was caused or aggravated by his service-connected bilateral knee disabilities. In August 2017, a VA examiner opined that the Veteran’s back condition was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected knee disability. The examiner reasoned that the Veteran’s degenerative disc disease and stenosis were caused by age and genetics/body habitus, adding that the Veteran’s knee conditions could not cause these back conditions or make his back conditions worse. The examiner added that because the Veteran’s knee disabilities limited his walking, less stress was actually placed on his back. Service treatment records (STRs) show that the Veteran specifically denied any recurrent back pain on a medical history survey completed in conjunction with his separation physical in May 1980. Of note, the Veteran clearly took time to review the survey as he reported having several conditions such as knee problem and hay fever at that time. As such, it is reasonable to assume that had the Veteran been experiencing back problems at that time, he would have reported them as he showed a willingness to report other problems such as his knees pain and hay fever. Moreover, even if the Veteran initially experienced a back injury in 1974, he served for another approximately six years without complaint and denied any back problems at separation. Following service, the evidence show that the Veteran had not have any back issues until 2006/2007, which is more than two decades after separation of service. The Veteran has not submitted any evidence other than his own statement to link his back condition with his active service. Additionally, the Veteran’s representative has not submitted any evidence other than his own opinion to suggest that the Veteran’s back condition was proximately due to, or the result of a service-connected knee disability. The Board finds that determining the etiology of a back disability (either in relation to the Veteran’s service or a service-connected disability) is a medically complex question which is not the type of issue that is readily amenable to lay knowledge, and there is no evidence showing that either the Veteran or his representative has the medical training or expertise to address such a question. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, these lay statements regarding the cause or etiology of the Veteran’s back condition do not constitute competent medical evidence and lack probative value. Turning to the Veteran’s representative’s argument that the August 2017 VA medical opinion is insufficient because the VA examiner only opined that the knee disabilities did not “cause” back problem without addressing whether the Veteran’s back condition is “related to” or is the “residual” of a knee disability. The Board finds that the examiner’s opinion is clear that the Veteran’s knee disabilities are less likely than not to have either caused or aggravated his back disability, on the contrary, the examiner opined that if there was any relationship between the back and knee, it was likely that his knee disabilities may cause less stress on his back. The examiner was very clear that the Veteran’s knee disabilities did not make his back worse, meaning that the examiner fully addressed the question of aggravation as make worse is synonymous with aggravate in this context. In sum, as the evidence is against the finding that the Veteran’s back disability either began during, or within a year of separation from service, or was otherwise caused by his military service, or was caused or aggravated by a service-connected disability, service connection for a back disability is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Q. Wang, Associate Counsel