Citation Nr: 18128294 Decision Date: 08/21/18 Archive Date: 08/21/18 DOCKET NO. 15-27 965 DATE: August 21, 2018 ORDER Entitlement to service connection for multilevel spondyloarthropathy with disc bulging (claimed as low back pain) is denied. REMANDED Entitlement to a temporary total evaluation due to treatment for a service-connected condition requiring convalescence is remanded. FINDING OF FACT The Veteran’s multilevel spondyloarthropathy with disc bulging (claimed as low back pain) did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and, the disability is not otherwise etiologically related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for multilevel spondyloarthropathy with disc bulging (claimed as low back pain) are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marines Corps from April 1983 to April 2003. These matters are on appeal from June 2012, January 2013, and March 2013 rating decisions. In October 2015, the Veteran testified at a Board videoconference hearing. 1. Entitlement to service connection for multilevel spondyloarthropathy with disc bulging (claimed as low back pain). 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 service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The Veteran contends that his back disability was caused by performing heavy tank maintenance, search and seizure operations, and other physical tasks during active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of moderate multilevel spondyloarthropathy with disc bulging, and evidence shows that he was treated for back pain during his active service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of moderate multilevel spondyloarthropathy with disc bulging began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran was afforded a VA back examination in May 2012. The VA examiner diagnosed moderate multilevel spondyloarthropathy with disc bulging. The VA examiner opined that it was less likely than not that the Veteran’s low back condition was caused by active service. The VA examiner explained that the Veteran sought treatment for back pain once in service and did not seek treatment after service until 2009. The VA examiner concluded that because there was no finding of a chronic problem on active duty or continuity post-service there was no nexus. In January 2013, the Veteran was afforded another VA back examination. The VA examiner confirmed the Veteran’s diagnosis of lumbar multilevel spondyloarthropathy with disc bulging. The VA examiner opined that it was less likely than not that the Veteran’s low back disability was incurred in or caused by the claimed in-service injury, event, or illness. The Veteran was treated once for back pain in service that was associated with an upper respiratory illness. He mentioned recurrent back pain on his retirement history, but his physical examination and X-ray of the lumbar spine were normal. The Veteran left service in March 2003 and was treated for acute back pain in January 2004 after moving a refrigerator. In February 2006, he was seen again for acute back pain. The Veteran’s current diagnosis was not made until August 2011. The Veteran worked as a fire fighter after he left the military service. The VA examiner concluded that the Veteran’s current back disability could be related to age, physical labor as a firefighter, and minor overuse injuries. She reiterated that the Veteran’s separation X-ray was normal. There are no positive medical opinions of record. The Board concludes that, while the Veteran has spondyloarthropathy (a form of arthritis), which is a chronic disease under 38 U.S.C. § 1101(3), it was not chronic in service, did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. While the Veteran was treated for acute back pain in 2004, the Veteran was not diagnosed with spondyloarthropathy until 2011, years after his separation from service and outside of the applicable presumptive period. Moreover, X-ray studies during service do not show arthritis and the evidence does not show any X-ray findings of arthritis within one year of service separation. While the Veteran is competent to report having experienced symptoms of back pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis. This issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are instead attributable to age and the Veteran’s post-service work as a fire fighter. In summary, the preponderance of the probative evidence indicates that lumbar multilevel spondyloarthropathy with disc bulging was not shown in service or for many years thereafter, and is not related to service. Accordingly, the preponderance of the evidence is against the claim, and service connection is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b).   REASONS FOR REMAND Entitlement to a temporary total evaluation due to treatment for a service-connected condition requiring convalescence is remanded. A total rating (100 percent) for convalescence will be assigned following hospital discharge, effective from the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release, if the hospital treatment of the service-connected disability resulted in: (1) surgery necessitating at least one month of convalescence; (2) surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps or recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight bearing prohibited); or, (3) immobilization by cast, without surgery, of one major joint or more. See 38 C.F.R. § 4.30. Extensions of 1, 2, or 3 months beyond the initial 3 months may be made for a total of six months. 38 C.F.R. § 4.30(b)(1). The Veteran is not currently service-connected for his right knee meniscal tear. He underwent a partial medial meniscectomy in December 2011 and he filed his claim in January 2012. While service connection for a right knee meniscal tear is not currently established, the record reflects that service connection has been awarded for right knee instability and status post right proximal femur surgical repair. On remand, the Board feels that an opinion would be helpful in ascertaining whether the Veteran’s meniscal tear is related to his service connected knee disabilities. While a VA examiner opined that the Veteran’s meniscal tear was not related to the repair of his femur in 1978, it is unclear as to whether any of his service connected lower right extremities may have contributed to, or aggravated, his meniscal tear. Based upon the forgoing, a remand is required to afford the Veteran a VA examination to determine the nature and etiology of his right knee meniscal tear. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his right knee meniscal tear. The examiner must opine whether it is at least as likely as not the Veteran’s right knee meniscal tear is related to an in-service injury, event, or disease. If the VA examiner provides a negative directive service connection opinion, he or she must opine as to whether it is at least as likely as not that the Veteran’s right knee meniscal tear (1) proximately due to the service-connected status post right proximal femur surgical repair or right knee instability, or (2) aggravated beyond its natural progression by the service-connected status post right proximal femur surgical repair or right knee instability. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If   necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. R. Watkins, Counsel