Citation Nr: 18123729 Decision Date: 08/02/18 Archive Date: 08/02/18 DOCKET NO. 15-23 439 DATE: August 2, 2018 ORDER Service connection for recurrent thoracolumbar strain with radiculopathy is granted. FINDING OF FACT Recurrent thoracolumbar strain with radiculopathy was caused by the Veteran’s service-connected pyelonephritis with recurrent urinary tract infections (UTIs). CONCLUSION OF LAW The criteria for service connection for recurrent thoracolumbar strain with radiculopathy have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.326(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Navy from August 1995 to October 2001. The Veteran has been in receipt of a 100 percent schedular rating since July 28, 2014. Entitlement to service connection for a lumbar spine disorder Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. 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 generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder has caused or aggravated a nonservice connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran’s pyelonephritis with recurrent UTIs is service connected. Her service and post-service treatment records indicate frequent treatment for pyelonephritis and UTIs with associated back or flank pain. On her July 2001 report of medical history at service separation, she indicated that she had recurrent back pain and the examining physician wrote that it was associated with her UTIs. Post-service treatment records also indicate lumbar degenerative changes. An April 2012 VA treatment record indicates diagnoses of lumbar facet arthropathy, lumbar spondylosis, and myofascial overlay. In August 2013, the Veteran was afforded a VA examination. The examiner diagnosed lumbar spine spondylosis and lumbar intervertebral disc syndrome (IVDS) with mild bilateral sciatic nerve disorder. The examiner stated that he did not have sufficient service treatment records indicating back pain to provide an opinion without resort to mere speculation. Despite this, the examiner still concluded that the lumbar spine disorders were not caused by service. It is not evident from the record that the examiner’s use of the phrase “without resorting to mere speculation” reflects “the limitations of knowledge in the medical community at large” rather than solely his own. Therefore, this opinion is inadequate. See Jones v. Shinseki, 23 Vet. App. 382, 393-94 (2010); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examiner also opined that the Veteran’s lumbar degenerative disorders were not caused by her service-connected pyelonephritis with recurrent UTIs. The examiner stated that although the symptoms of flank pain due to pyelonephritis with recurrent UTIs may overlap with back degenerative disorders, the two “have separate pathophysiology in generating back pain.” No opinion as to whether pyelonephritis with recurrent UTIs aggravated the back disorders was provided. Given the inadequacies in this opinion and the fact that the examiner appears to not have had the Veteran’s complete service treatment records when the opinions were written, these opinions are of low probative value. November 2016 and May 2018 letters from the Veteran’s VA physician state that the Veteran had recurrent thoracolumbar strain with radiculopathy which was caused by her service-connected pyelonephritis with recurrent UTIs. The physician wrote that there was “radiographic evidence of her pyelonephritis causing inflammation and abscess formation in the area near the spine.” She further opined that the pressure on the nerves caused the radiculopathy and the inflammation caused muscular strain. She noted that the back pain episodes occurred in conjunction with flare-ups of the kidney infections. The evidence is at least in equipoise as to whether Veteran’s recurrent thoracolumbar strain with radiculopathy was caused by her service-connected pyelonephritis with recurrent UTIs. Therefore, service connection for this disorder is warranted and the claim is granted. No competent medical professional has opined, however, that the additionally diagnosed facet arthropathy, spondylosis, myofascial overlay, and IVDS were caused by service or caused or aggravated by any service-connected disorder. These additional diagnoses are, therefore, not included in the service connected disorder. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. E. Miller, Associate Counsel