Citation Nr: 18121237 Decision Date: 07/25/18 Archive Date: 07/25/18 DOCKET NO. 14-38 463A DATE: July 25, 2018 ORDER Entitlement to service connection for a disability of the thoracolumbar spine is denied. Entitlement to service connection for a disability of the cervical spine is denied is denied. REMANDED Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The objective medical evidence does not show that the Veteran’s disability of the thoracolumbar spine is caused by or a result of an event, injury or illness during his periods of active duty service. Arthritis was first shown years post-service. 2. The objective medical evidence does not show that the Veteran’s disability of the cervical spine is caused by or a result of an event, injury or illness during his periods of active duty service. Arthritis was first shown years post-service. CONCLUSIONS OF LAW 1. The criteria for service connection for a disability of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for a disability of the cervical spine have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Army from August 1974 to August 1977 and from August 1990 to June 1991. The Board acknowledges that the Veteran submitted a signed and dated Rapid Appeals Modernization Program (RAMP) in July 2018, opting in and electing higher-level review. However, the current appeal had already been activated at the Board and therefore RAMP elections are no longer available for this appeal. If not yet received, the Veteran can expect a letter of notification to this effect. Service Connection Generally, service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may 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). Service connection for a disability requires evidence of: (1) The existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). See also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Certain chronic diseases, including arthritis, may be service connected on a presumptive basis if manifested to a compensable degree within a specified period after service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. That period is usually one year. 38 C.F.R. § 3.307 (a)(3). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303 (b). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing and in-service disease or injury and a nexus for chronic diseases is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303 (b). 1. Entitlement to service connection for a disability of the thoracolumbar spine. 2. Entitlement to service connection for a disability of the cervical spine. Thoracolumbar Spine The Veteran’s service treatment records (STRs) show that during his first period of active duty service, the Veteran complained of low-back pain on October 1974. In November 1974, the Veteran complained of pain throughout the thoracic spine area. In a further evaluation that month, the Veteran was assessed with mild spinal spasms and tenderness. He continued to complain of low-back pain and a November 1974 consultation sheet made a referral to the orthopedic department for persistent back pain. No additional timely entry is found. In July 1975, the Veteran presented with a sore throat, but also complained of neck and back pain, as well as achiness “all over.” He was assessed with a viral syndrome. In May 1976, he presented with back pain. He was assessed with a strain and prescribed Tylenol. The Veteran’s April 1977 separation examination for his first period of active duty service showed “normal” for spine and other musculoskeletal areas. He recorded no pertinent historical complaints. During the Veteran’s second period of active duty service, the Veteran underwent a May 1991 post-overseas deployment examination, which noted neither normal nor abnormal findings for spine and other musculoskeletal areas. He was found qualified for separation. At this point, the Board notes that the May 2017 medical statement of Dr. W.J.B. asserts that the Veteran’s condition worsened during his second tour of service as, his pain score increased to 7/10. Dr. W.J.B.’s medical statement is discussed at length below. May 1996 addiction program notes state the Veteran’s problems as including “LBP [low-back pain] ---arthritis.” In June 1996, neck and back pain are noted as “physical problems.” In September 1996, when presenting for group psychiatric therapy, the Veteran complained of back pain. In October 1996, the Veteran presented with a stiff and painful lower back, for which he was prescribed heat and stretches and given a booklet of exercises. Also in October 1996, the Veteran requested a heating pad. In November 1996, the Veteran described his back pain as throbbing and “shooting” pain down to his right leg when standing, turning and lifting. He was assessed with low-back pain. In October 1997, low-back pain was noted. A January 1998 VA treatment note included in its diagnostic impression degenerative disc disease, lumbar spine. The treatment providers only prescribed work limitations were to avoid frequent stooping and bending and to use pain medication. February 1998 and September 1998 stated low-back pain. An October 1999 diagnostic impression stated chronic back pain. August 1998 x-rays of the Veteran’s lumbosacral spine revealed “no evidence of acute injury or destructive process;” there is minimal degenerative anterior spurring noted at all levels; and there are no other significant abnormalities seen. An August 1998 General Medical VA examination at the outset noted the Veteran’s report that, although he started having back pain in 1974 during initial training and was treated with medications, he did not seek any medical help for his lower back from 1974 to 1990. Moreover, the Veteran denied any known or indirect injury; he added that he has since been evaluated for his back at VA three times, but was not prescribed any medications; in late 1997, he was then prescribed ibuprofen; the Veteran reported has only seen a physician for the lower back those three times and later in 1996 during alcoholism rehabilitation; and he has never undergone a CT scan, an MRI, a myelogram, or surgery for the lower back. Upon examination, the August 1998 VA examiner found the Veteran had intact repetitive full range of motion of the cervical and dorsal spine without any pain, discomfort or hesitancy or slowness. He diagnosed the Veteran with back, low-back pain syndrome, objectively and functionally normal. September 1998 treatment notes show a diagnosis of chronic low-back pain, with exercises prescribed. Between January 2002 and March 2005, primary care physician notes state the Veteran’s reports of back pain radiating variously to his right and left legs. December 2009 x-rays revealed lumbar spondylosis and degenerative disease. The Veteran was assessed with chronic low-back pain. In January 2010, he was assessed with chronic low-back pain with lumbar degenerative disc disease and prescribed exercises, weight reduction and medications. In a February 2010 General Medical VA examination, the VA examiner noted the Veteran’s report that his low back pain began after doing heavy lifting during his second period of service in 1991. Findings included the thoraco-lumbar spine is limited in forward flexion and lateral bending, and straight leg raises bilateral are limited. Further general findings showed: No tenderness in palpation of cervical spine, thoracolumbar spine or lumbosacral spine. No muscle spasms. No CVT. The assessment included degenerative disease of the thoracolumbar spine, improved with current treatment. February 2012 x-rays showed multilevel degenerative discogenic disease and facet arthropathy of the thoracolumbar spine. In July 2014, after a back examination, the Veteran’s assessment included the following: Low back pain. Radiographic evidence of mild degenerative disc disease and facet arthropathy in lower lumbar spine. The Veteran describes intermittent radicular symptoms, but non-specific and no signs on exam. Continue exercises/stretches. Encouraged weight loss goals. An August 2014 MRI revealed multilevel degenerative change in the lumbar spine with varying degrees of stenosis. August 2014 x-rays were negative. In August 2014, the Veteran underwent a VA examination for thoracolumbar spine, in which his diagnosis was stated as lumbar strain. Among her findings, she found no signs or symptoms whatsoever of radiculopathy. She opined that the Veteran’s lumbar disorder was least likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She explained: The claim is not consistent with the medical records. The June 1974 entrance examination does not show any claimed pre-existing condition. At separation on in April 1977, no claimed problem was noted. No pain was noted during the physical examination. STRs show the Veteran was treated for recurrent low-back pain in March 1973, October 1974 and November 1974. STRs show the Veteran was treated for neck and low-back pain/ body aches, which was a viral syndrome in March 1975. The August 1998 VA examination gave no diagnosis for the lumbar spine. He was seen only a few times during service, but not before that episode or after, based on the medical records. The Veteran denied any back problem upon retirement from service. There is no evidence of a lumbar condition in the records after service. Based on the lack of evidence to support the claim, the Veteran’s current lumbar strain is less likely than not service connected. In December 2015, the Veteran presented with low-back pain, reporting that it radiated into his posterior left leg and foot. A physical examination revealed normal range of motion and intact sensory responses. His assessment included: Lumbar MI, significant for probable impingement of left L4 nerve root, as well as possible impingement of left L5 and S1 nerve roots. Exam consistent with these findings In April 2016, the Veteran’s treatment provider noted his report that although he has dull and achy pain at the lumbar midline, his previously reported radiating pain had now stopped since the Veteran stopped taking his cholesterol medication. The treatment provider’s assessment included the following: Low back pain. Radiographic evidence of mild degenerative disc disease, facet arthropathy and disc protrusions in lower lumbar spine causing varying degrees of SC, lateral recess, and NF stenosis, most significant at L4-5 with possible impingement at L4, L5, and S1 nerve roots. No longer describing radicular symptoms and no signs of radiculopathy on examination in the past. Continue weight loss goals. In October 2016, the Veteran presented complaining of neck and back pain after automobile accident two months earlier. Cervical Spine In July 1975, the Veteran presented with a sore throat, but also complained of neck and back pain. He was assessed with a viral syndrome. In December 2009, the Veteran reported neck pain after his furnace went out that month. X-rays revealed normal alignment of the cervical spine. The February 2010 General Medical VA examination made note of the Veteran’s report that he developed neck pain in March 2009, after an accident while driving a truck. His x-rays revealed “degenerative disease.” Findings included the cervical spine is limited in extension, lateral bending, and rotation. The February 2010 VA examiner’s assessment included cervicalgia (neck pain) and degenerative disease of the cervical spine: Improved with current treatment. August 2014 x-rays of the cervical spine revealed degenerative changes, but were otherwise normal. In August 2014, the Veteran underwent a VA examination for cervical spine, in which his diagnosis was stated as cervical spine, degenerative joint disease. It was noted that he gave a history of problems since his second period of service, but that such was not documented. She found that the cervical spinal disorder was less likely as not related to service. She said this was consistent with the medical records. She explained: The claim is not consistent with the medical records. The June 1974 entrance examination dos not show any claimed pre-existing condition. At separation on in April 1977, no claimed problem was noted. No pain was noted during the physical examination. STRs show the Veteran was treated for recurrent low-back pain in March 1973, October 1974 and November 1974. STRs show the Veteran was treated for neck and low-back pain/ body aches, which was a viral syndrome in March 1975. The August 1998 VA examination gave no diagnosis for the lumbar spine. No medical records were found for a cervical condition during service. The Veteran denied any cervical problem upon retirement from service. There is no evidence of a cervical condition in the records after service. Based on the lack of evidence to support the claim, the Veteran’s current cervical condition is less likely than not service connected. In October 2016, the Veteran presented complaining of neck and back pain after an automobile accident two months earlier. Medical Statement of Dr. W.J.B. A May 2017 medical statement of Dr. W.J.B. summarizes the above treatment record, discusses the Veteran’s medical history and renders the following opinions. 1. It is more likely than not that [the Veteran’s] chronic cervical. condition began during his first. term of-service. The Veteran’s service entrance exam on 6-17-74 revealed no orthopedic abnormalities. During his first tour of service, the records show that he complained and was repeatedly treated for cervical and thoracolumbar-pain on numerous occasions including 10/29/1974, 11/19/1974, 11/21/1974, 11/29/1974, 03/15/1975, 03/1-1/1976. It is clear that the symptoms of his current spinal disability first arose in service. The sudden onset of pain and the persistent chronic condition that caused four different treatments within a single month, and the fact that [the Veteran’s] was only twenty years old, is highly suggestive of trauma or injury to the back while in service. The cervical disease at this point in time would have caused intermittent, occasional pain and limitation of motion which is consistent with the record. His condition worsened during his second tour of service as his pain score increased to 7/10. [The Veteran] was again repeatedly treated for cervical and lumbar pain on numerous occasions throughout the years that followed his, service. Dates of treatment include 12/21/2009, 12/29/2009, 01/14/2010, 02/16/2010, 11/15/2010, 06/17/2011, 02/02/2012, 05/18/2012, 11/0 1/2012, 10/24/2013, 02/21/2014, 08/22/2014). X-rays showed worsening of degenerative disc disease. The cervical disease at this point in time was moderate to severe, and would have. caused continuous pain and limitation of motion. It would cause a decrease in his ability to drive, perform physical tasks and lifting. Therefore, based on a well-documented progression from no apparent abnormalities upon entering the service, to a persistent condition, that was treated on numerous occasions during his service years, it is more likely than not that that [The Veteran’s] cervical spine disability began during his service years. It is also more likely than not that [The Veteran’s] condition was the result of trauma or injury caused by his in-service duties which is evidenced by his young age combined with the sudden onset of pain and repeated treatments in a short window of time. Based upon [the Veteran’s] medical records and my interpretation of the VA disability rating scale, it is my opinion that the Veteran’s cervical spine disability is severe and has been since at least 2010. This is based on [the Veteran’s] symptoms dating back to 2010, the increase in severity of pain and his functional limitations that impair his ability to perform his occupation. His pain is chronic and severe. It causes physical limitations, as well as significant sleep disturbance. Further, he has difficulty turning his head, which impacted his ability to work as a truck driver. 2. It is more likely than not that [the Veteran’s] chronic thoracolumbar began during his first term of service. The Veteran’s service entrance exam on 6-17-74 revealed no abnormalities. During his first tout of service, he complained and was treated for thoracolumbar pain on numerous occasions. His condition was exacerbated during his second tour of service, as evidenced by the progression of disease on x-rays, as the increase in his pain score to 7/10. An MRI of [the Veteran’s] back shows multilevel degenerative changes in lumbar spine with varying degrees of stenosis. In layman’s terms this means increased degeneration of the discs in the lower back with pinching of the spinal nerves. Since [the Veteran’s] cervical spine disability is closely related to his thoracolumbar condition, the information presented. in question one (cervical) is highly relevant to this thoracolumbar question 2. Therefore, based on a well-documented progression from no apparent abnormalities upon entering the service, to a persistent condition that was treated on numerous occasions during his service years, it is more likely than not that the Veteran’s present thoracolumbar spine condition began during his service years. I believe it is, more likely than not that the Veteran’s thoracolumbar spine disability was caused by his inservice duties. As shown on x-ray and MRI, there was a progressive wear over time of the discs in the lumbar spine as well as pinching of some of the lumbar nerves. Additionally, [the Veteran’s] pain score of 7/10 shows increased pain from the lumbar spine. Based on the Veteran’s medical records and the VA disability rating scale, it is my opinion that the Veteran’s lumbar spine disability is severe and has been since at least 2010. The rating is based on [the Veteran’s] symptoms dating back to 2010, the increase in severity of pain and his functional limitations that impair his ability to perform his occupation. Due to his lumbar pain, he has sleep disturbance, must use a cane for ambulation, and is unable to walk more than ¼ of a mile without severe, chronic unremitting pain. He also must utilize a back brace. At the outset, Dr. W.J.B. notes that the Veteran was initially evaluated for low back pain in October 1974, “four months after he joined the army. From this point forward, a review of the Veteran’s service medical records reveal[s] persistent complaints and numerous treatments for cervical and thoracolumbar pain.” Yet, the Board’s review of the same record and the conclusions it draws from it are at variance with Dr. W.J.B. As stated earlier in this decision, the Veteran presented only once in July 1975 with a complaint of “neck pain.” The Board can find no other instances of in-service complaints even possibly relating to the cervical spine and consequently does not view the STRs as containing “persistent” complaints and “numerous” treatments for a cervical spine disorder. Indeed, the July 1975 in-service examiner phrased his finding as “sore throat, [with] neck and back pain: ‘Ach[e]s all over;’” and, as perceiving the Veteran’s neck and back complaints to be included in the Veteran’s reports of pervasive aches, the examiner appears to have therefore concluded that each and all the complaints are symptomatic of a “viral syndrome” ---in other words, something like the flu, with its attendant aches and pains. Dr. W.J.B. on this point further states that “[i]t is clear that the symptoms of [the Veteran’s] current spinal disability first arose in service. The sudden onset of pain and the persistent chronic condition that caused four different treatments within a single month, and the fact that [the Veteran] was only twenty years old, is highly suggestive of trauma or injury to the back while in service.” The Board at this point notes that the “four different treatments” revealed that when the Veteran first presented in October 1974 with low-back pain, the prescriptions included heat, aspirin and Williams flexion exercises (usually prescribed for back pain of an unknown cause). Although the Veteran’s first complaint in November 1974 was for pain throughout his thoracolumbar spine, the examiner nonetheless, noted that his physical examination was within normal limits for full range of motion. He added that the Veteran should be referred for evaluation. The same day his pain was characterized by another in-service examiner as “mild” paraspinal spasm with tenderness, for which he was prescribed Robaxin, a muscle relaxant. Three days later the Veteran presented again with low-back pain. His prescription of Robaxin was noted and he was again referred; however, to where and to whom the Board cannot discern from the in-service examiner’s handwritten abbreviation. Yet, at the end of the month, persistent back pain was noted and the Veteran was referred to “orthopedics.” Three times it appears referrals were made. Yet, the record contains no visit to “orthopedics.” A document may have been lost, the Veteran may not have presented to where he should have or the referral was canceled. What is clear from the record is that, if the July 1975 “viral syndrome” visit to an in-service examiner discussed above is excluded for the reasons already discussed, the Veteran did not present again with back pain until May 1976. From the foregoing, the November 1974 STRs show not four, but one single treatment for back strain and pain, which appears to have resolved within the month. Moreover, although Dr. W.J.B. characterizes the November 1974 treatment as symptoms of the Veteran’s “current spinal disability,” the symptoms identified in the several visits were pain, tenderness and spasms, for which aspirin, heat, exercises, and a muscle relaxant were prescribed. It is not clear from this record of treatment that anything points to a later disability. In fact, although Dr. W.J.B. notes the Veteran’s age at this time as twenty-years old and asserts that the November 1974 treatment is highly suggestive of trauma or injury to the back while in service, the later post-service record from August 1998, as set forth earlier in this decision, contains x-ray findings of the Veteran’s lumbosacral spine showing “no evidence of acute injury or destructive process,” as well as indicating “no other significant abnormalities seen.” Dr. W.J.B. adds that “[t]he cervical disease at this point in time [November 1974] would have caused intermittent, occasional pain and limitation of motion which is consistent with the record.” For the reasons just stated, nothing of the sort is consistent with the record; there are simply no findings from the month of ongoing in-service treatment just discussed which support this statement. Dr. W.J.B. states the Veteran’s condition worsened during his second tour of service, as his pain score increased to 7/10. Yet, Dr. W.J.B. fails to address those other parts of the record, some of which have been set forth earlier, which show that the Veteran’s April 1977 separation examination for his first period of active duty service showed “normal” for spine and other musculoskeletal areas; in his second period of active duty service, the Veteran’s May 1991 post-overseas deployment examination, although it did not have any entries for “normal” in the clinical evaluation categories, did not in turn identify abnormal findings for spine and other musculoskeletal areas either; and, as the Board notes in passing, subsequent periods of non-active duty reserve service showed no indication of back or neck problems, for example, in the his July 1981 enlistment examination, the Veteran answered “no” to having current or past recurrent back pain and his second enlistment examination for reserve duty in November 1989 shows “normal” for spine and other musculoskeletal areas. Dr. W.J.B. states the Veteran was treated for lower back pain on multiple occasions from September 1995 through September 1998. Set forth earlier in this decision are the series of notes between May 1996 and October 1999 in which the Veteran’s back pain is noted. However, the August 1998 VA examination, also set forth earlier, contains the Veteran’s own reports which provide details which challenge what Dr. W.J.B. takes to be consistency and continuity in the Veteran’s post-service treatment. For example, the Veteran reported during their examination that he has been evaluated for his back at VA only three times, but was not prescribed any medications; in late 1997, he was then prescribed ibuprofen; the Veteran reported has only seen a physician for the lower back those three times and later in 1996 during alcoholism rehabilitation; and he further reported that has never undergone a CT scan, an MRI, a myelogram, or surgery for the lower back. From the foregoing summary of the record, as well as the discussion of Dr. W.J.B.’s medical statement and opinions, the Board notes that it was only in a January 1998 “diagnostic impression” and later in August 1998 x-rays that the Veteran’s disorder was characterized as spinal degeneration. Prior to that, assessments, impressions and findings variously referred to low-back pain, low-back pain syndrome, strain, lumbar strain, and the like. After 1998, the disorder is again identified as back pain, not as a spinal disability. However, resuming in December 2009, the record consistently reflects the Veteran current disability as revealed in x-rays showing lumbar spondylosis and degenerative disease. Treatment notes following in January 2010 refer to chronic low-back pain, but with degenerative disc disease. Significantly, weight reduction is prescribed in conjunction with exercises. By February 2010, x-rays findings are interpreted as multilevel degenerative discogenic disease and facet arthropathy of the thoracolumbar spine. Other findings from the record have been set forth above and are too numerous to repeat, but all speak to degenerative disease of the spine associated with aging. August 2014 x-rays of the cervical spine showed “degenerative changes,” but were otherwise normal and an August 2014 MRI revealed multilevel degenerative change in the lumbar spine with varying degrees of stenosis. Moreover, the Veteran’s own reports to the February 2010 VA examiner were that he developed neck pain in March 2009 after an accident while driving a truck. He further reported as recently as October 2016 that he developed neck and back pain after an automobile accident two months earlier. As stated by the August 2014 VA examiner, the STRs from 1974 show that the Veteran was seen and treated for low-back pain only a few times during service, but neither before that episode nor after; no injury was identified, consistent with the Veteran’s own reports of being unable to point to a in particular event; significantly, the Veteran denied any back problem upon separation from his first period of active duty service; and, as just stated, no actual degenerative spinal disability was identified until 1998 and then again in 2009. Consequently, the Board does not discern in the record direct lines of causation linking the Veteran current disabilities to any circumstances of his active duty service periods. For the reasons already stated, the Board finds the medical statement and opinions of Dr. W.J.B. to be of less probative value and, in turn, finds the findings and opinions of the August 2014 examiner of the Veteran to be of substantial probative weight. The Board has reviewed and carefully considered not only the Veteran’s reports to treatment providers as they have appeared throughout the record, but also the Veteran’s statements in his May 2016 affidavit, in which he describes in detail his duties and tasks during active duty service, which, he believes, caused his current spinal disorders. These have helped the Board in understanding better how the Veteran’s disorders have affected him. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran and is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that he is not competent to interpret accurately clinical findings pertaining to orthopedic disorders, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Moreover, the Board cannot render its own independent medical judgments; it does not have the expertise. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board must look to the medical evidence when there are contradictory findings or statements inconsistent with the record and it must rely on clinical findings and opinions to determine the level of severity of service-connected disabilities or establish the connection of current disabilities with service-related events, injuries or illnesses. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). As stated earlier in this decision, certain chronic diseases may be service connected on a presumptive basis if manifested to a compensable degree, usually within one year. The August 2014 VA examiner found that arthritis had been documented in imaging studies. Additionally, assessments of degenerative disc disease appear throughout the record. Arthritis is included among the chronic diseases listed under 38 C.F.R. § 3.309 (a). However, no findings or diagnoses were made concerning arthritis, as associated with the Veteran’s lumbar disorder, within a year of separation from active duty service. Consequently, the presumption of service connection for arthritis as a chronic disease is not available to the Veteran. Additionally, because arthritis was never identified in service, it is impossible to establish continuity of symptomatology following upon service, nor does the subsequent record reflect this. For all the foregoing reasons and based on the record as a whole and the findings and opinions of the August 2014 examiner in particular, the Board finds the Veteran’s disability of the thoracolumbar spine is not caused by or a result of an event, injury or illness during his periods of active duty service. The Board further finds the Veteran’s disability of the cervical spine is not caused by or a result of an event, injury or illness during his periods of active duty service. The Board also finds the Veteran’s arthritis, associated with his spine disorders, did not manifest at a compensable rate within one year of separation from active duty service and, therefore, no presumption of service connection is available to the Veteran. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claims, the doctrine is not applicable and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. REASONS FOR REMAND 3. Entitlement to a TDIU. Since the issuance of the October 2014 Statement of the Case (SOC), an April 2018 VA examination report for eye conditions has been associated with the claims file. The Veteran’s sole service-connected disability is vertical diplopia, secondary to left superior oblique paresis. Therefore, the April 2018 VA examination report could be determinative for the TDIU claim. For this reason, the claim for entitlement to a TDIU is remanded. The matter is REMANDED for the following action: 1. Contact the Veteran and/or his representative for information pertaining to any current treatment for his eye disability at any VA facility and by any private treatment provider. Obtain any records of the above treatments not yet associated with the claims file and associate them with the claims file. The assistance of the Veteran and/or his representative should be requested in obtaining any records of recent treatment as indicated. All attempts to obtain records should be documented in the claims file. 2. After all additional records have been obtained and associated with the claims file, but whether or not records are obtained, review the evidence associated with the claims file and readjudicate the TDIU issue. 3. If the benefits sought are not granted, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate opportunity to respond before returning the case to the Board. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Franke, Associate Counsel