Citation Nr: 18119024 Decision Date: 07/17/18 Archive Date: 07/17/18 DOCKET NO. 13-18 982 DATE: July 17, 2018 ORDER Entitlement to service connection for a back condition is denied. Entitlement to service connection for a neck condition is denied. FINDINGS OF FACT 1. The competent and credible evidence of record shows that a back disability is not causally related to the Veteran’s active military service. 2. The competent and credible evidence of record shows that there is no current diagnosis of a neck condition. CONCLUSIONS OF LAW 1. The criteria for service connection for a back condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for a neck condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1988 to May 1991. The Veteran was afforded a Board hearing in June 2015 before the undersigned Veterans Law Judge. The transcript is of record. Following remand development, the Board finds that this appeal is ready for adjudication upon the merits. Service Connection In order to prevail on the issue of direct service connection, there must be competent and credible evidence of (1) a current disability, (2) in-service occurrence or aggravation of a disease or injury; and (3) a nexus between an in-service injury or disease and the current disability. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Additionally, service connection can be established by competent and credible evidence of a continuity of symptomatology between current disability and military service. 38 C.F.R. § 3.303; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (holding that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic 38 C.F.R. § 3.309(a), such as arthritis). 1. Entitlement to service connection for a back condition The Veteran seeks entitlement to service connection for a back condition. The Veteran’s service treatment records (STR) reflect that in November 1989, the Veteran received emergency care and treatment after falling “2-3 to deck.” The Veteran reported a dull ache to the lower back and sciatica. The Veteran was treated with heat and Ecotrin. Several STRs, including records dated in August 1990, reflect the Veteran was experiencing recurrent neck pain and that he was referred to a physical therapist for back pain. In addition, a September 1990 physical therapy record showed an assessment of posture strain. Thus, the record reflects an in-service back injury. The Veteran testified that he has been continually treated for back problems since his in-service injury. See Board hearing transcript at 4. The evidence of record includes a March 2004 Primary Care Note in which the Veteran reported back pain which was exacerbated by a move to a different apartment 3 weeks prior. The Veteran was diagnosed with lumbosacral strain, mild. In a July 2005 Physical Therapy Treatment Plan Note, the Veteran reported back pain which has compounded over the years. The Veteran reported that an MRI in 2000 was within normal limits but indicated “back problems.” The Veteran expressed that he sometimes uses heat for relief. In January 2016, the Veteran was afforded a VA examination. The examiner indicated that the Veteran has or has been diagnosed with lumbosacral strain and chronic low back pain. The examiner opined that the it is “less likely as not that any diagnosed back or neck condition, including spondylosis, is related to the Veteran’s service, to include a fall in about November 1989 and in-service treatment for neck pain.” The examiner expressed that a review of the Veteran’s post-service records are “silent for back-related complaints” until November 2003 when the “Veteran reported back pain without specific location at the initial pain assessment visit.” The examiner noted that the physician for that visit reported no neck or back pain on the musculoskeletal review of systems and there was no diagnosis of a back condition. The examiner noted that in December 2003, the Veteran returned for a follow-up with his primary care physician “without any neck or back complaints.” The examiner stated that the next back-related issue was not until March 2004, when the Veteran presented with a “chief complaint of back pain that was exacerbated by a move to a different apartment 3 weeks ago.” The examiner expressed that the Veteran was diagnosed with mild lumbosacral strain and was advised to take over-the-counter Ibuprofen or Tylenol. The examiner reported that degenerative changes were noted on a thoracic spine MRI taken in March 2015. The examiner stated that the MRI had been ordered by the Veteran’s primary care physician for an indication of worsening back pain and his diagnosis was chronic low back pain. The examiner expressed that upon evaluation, full range of motion with mild tenderness was noted in the lumbar, not thoracic spine. There was mildly decreased range of motion of the cervical spine without tenderness. The examiner indicated that the evidence in the STR and immediate post-service records do not support a chronic neck or back condition including spondylosis. The examiner stated that “spondylosis is not a disease but rather a descriptive radiographic term regarding degenerative changes in the spine.” The examiner indicated that degenerative changes in the spine are related to aging as well as chronic wear and tear. The examiner opined that the evidence does not support that the spondylolysis described on a thoracic MRI from March 2015 is related to military service. As noted above, in order to prevail on the issue of direct service connection, there must be competent and credible evidence of a nexus between an in-service injury or disease and the current disability. After review of the medical and lay evidence, the Board finds that competent and credible evidence of record shows that a back disability is not causally related to the Veteran’s active military service, thus service connection must be denied. The Board finds that the January 2016 opinion is highly probative as the examiner reviewed the claims folder, considered the Veteran’s reported history, and provided an adequate rationale for the opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Board has considered the Veteran’s lay statements that his back condition is a result of his in-service injury. However, in the present case, the Board does not find the Veteran is competent to provide etiological evidence regarding a nexus with service. He does not have the requisite medical training or credentials to be able to render a competent medical opinion regarding the cause of any current disability involving his back. The etiology of an orthopedic disability is a complex medical etiological question dealing with internal elements, and such a disability is diagnosed primarily on clinical findings and testing. In sum, after careful consideration of the lay and medical evidence of record and the lack of a positive medical nexus opinion relating a back disability to the Veteran’s military service, the Board finds that the preponderance of the evidence indicates that the Veteran’s back condition has not been shown by competent and probative medical evidence to be etiologically related to his active service. Accordingly, service connection for a back condition is not warranted. See 38 C.F.R. § 3.303. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt doctrine is not for application. 38 C.F.R. § 3.102. 2. Entitlement to service connection for a neck condition The Veteran seeks entitlement to service connection for a neck condition. Upon review of the record, the Board finds that the weight of the evidence is against a finding that the Veteran has a current neck condition. Although there is evidence of an in-service injury and recurrent neck pain throughout service, the record does not reflect a current diagnosis for a neck disability. The Veteran was afforded a VA examination in January 2016. The examiner indicated that the Veteran does not have or has ever been diagnosed with a cervical (neck) condition. In addition, the examiner noted that the Veteran expressed he was never diagnosed with a neck condition but did describe pain that began in the posterior neck that was related to his headaches. VA treatment records do not show current diagnoses involving the Veteran’s neck. As noted above, service connection may only be granted for a current disability. See Brammer, 3 Vet. App. at 225. As there is no current diagnosis of a disorder involving the neck at any time during the pendency of this appeal, service connection for this claimed disorder must be denied. While the Veteran has reported pain in his neck, the record does not reflect that there is a disability that causes functional impairment or limitation. In this regard, during the January 2016 VA examination, the examiner documented that there was no functional loss and there was no pain noted on the examination. Saunders v. Wilkie, 2017-1466, 2018 U.S. App. LEXIS 8467, at * 21 (Fed. Cir. Apr. 3, 2018). The Board has considered the Veteran’s lay statements that he has a current disability involving his neck due to injuries incurred during active duty service. At times, laypersons are competent to provide medical conclusions, including with regard to etiology and diagnosis. Jandreau, 492 F.3d at 1377. In addition, laypersons are competent to report symptomatology and medical history. However, in the present case, the Board does not find the Veteran is competent to provide etiological evidence regarding either a current diagnosis or a nexus with service. He does not have the requisite medical training or credentials to be able to render a competent medical opinion regarding the cause of any current disability involving his neck. The etiology of an orthopedic is a complex medical etiological question dealing with internal elements, and such a disability is diagnosed primarily on clinical findings and testing.   In sum, the preponderance of the evidence is against the award of service connection for a neck condition. With the preponderance of the evidence against the claims there is no doubt to be otherwise resolved. As such, the appeal is denied. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Monica Dermarkar, Associate Counsel