Citation Nr: 18160125 Decision Date: 12/21/18 Archive Date: 12/21/18 DOCKET NO. 15-30 984 DATE: December 21, 2018 ORDER Entitlement to service connection for lumbar degenerative disc disease, claimed as a back disability, to include as secondary to service-connected right knee disability is denied. FINDING OF FACT The Veteran’s lumbar degenerative disc disease back disability did not manifest or have its onset during active service, or within one year of his discharge from service, and the disability is not otherwise related to active service, to include as secondary to service-connected right knee disability. CONCLUSION OF LAW The criteria for service connection for degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 11135107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1978 to May 1979. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision by the San Juan, Commonwealth of Puerto Rico Regional Office (RO) of the United States Department of Veterans Affairs. Service connection for back disability Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C.A. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Arthritis, with a presumptive period of one year following separation from service, is a listed condition. Finally, a disability which is proximately due to or the result of a service-connected disease or injury shall be service-connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The Veteran is seeking service connection for a back disability, to include as secondary to his service-connected right knee disability. The Veteran’s service treatment records (STRs) are negative for treatment for back symptoms as well as for a back injury. The Veteran was discharged on the basis of a medical board for his right knee disability; examination in connection with that discharge showed no back problems or complaints at separation. VA examination and treatment records reveal that the Veteran reported and no limp or altered gait at numerous work-ups of his service-connected right knee over the years. Back problems, diagnosed as degenerative disc and joint disease, are noted as established in October 2011; the exact date of diagnosis is not reported, though in December 2013 the Veteran described the problems as chronic and present for years. Private medical records include results of a November 2014 MRI of the Veteran’s lumbar spine which revealed the following: small left paracentral disc extrusion; moderate to advanced chronic discogenic disease at L5-S1; minimal multilevel circumferential bulging; and mild multilevel facet joint arthropathy. In April 2015, the Veteran underwent a VA back examination. Subjective complaints included constant low back pain, increased pain after prolonged sitting or standing, and flare-ups which cause the Veteran to stay in bed for one day. Some improvement in symptoms was reported after physical therapy. Physical examination revealed range of motion of the lumbar spine was outside the normal range of motion. The Veteran reported occasional use of a knee braces and a lumbar brace. The examiner determined that it was less likely than not that the Veteran’s back disability was due to or the result of the Veteran’s service-connected knee disability. The examiner found that the Veteran’s lumbar spine and knee condition were not related pathophysiologically or anatomically to each other; noting that there was no evidence of antalgic gait pattern (no weight shifting) present. The examiner further stated that it is well documented in medical literature that lumbar degenerative disc disease is considered part of the normal aging process in patients older than 40 years. Although the Veteran has expressed his belief in a connection, he lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, he has simply asserted his opinion, without a clear rationale or support; no probative value is given his statements beyond their worth as physical observations. Direct service connection for lumbar degenerative disc disease must be denied because the competent evidence of record shows that this disability was neither caused nor aggravated by service; nor does it show that the Veteran experienced symptoms of such a condition that continued from service until the present. As there is no evidence of the condition within the first post-service year, presumptive service connection is not available. Additionally, the Board finds that lumbar degenerative disc disease is not related to the Veteran’s service-connected right knee disability. Notably, the VA examiner opined that there is no relationship between the Veteran’s lumbar spine symptoms and his service-connected right knee disability, as the mechanism that would be needed to cause such (a limp) is missing. Furthermore, the examiner noted that lumbar degenerative disc disease is considered part of the normal aging process in patients older than 40 years, as is the Veteran. Service connection for a lumbar spine disability, including service connection on a secondary basis, is not warranted. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990). WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. M. Lunger, Associate Counsel