Citation Nr: 20021484 Decision Date: 03/26/20 Archive Date: 03/25/20 DOCKET NO. 16-03 177 DATE: March 26, 2020 ORDER Service connection for a back condition is granted. REMANDED Service connection for a foot condition is remanded. FINDING OF FACT The Veteran has experienced back pain related to degenerative arthritis since her separation from service. CONCLUSION OF LAW The criteria for service connection for a back condition have been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1975 to December 1982 in the U.S. Army. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision. This case was previously before the Board in April 2019, at which time the issues on appeal were remanded for further development. This case has now been returned to the Board for appellate consideration. Service connection for a back condition The Veteran contends that her back condition is related to her in-service treatment for back pain. The Board concludes that there is continuity of symptomatology since service that is attributable to degenerative arthritis of the spine. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases, including arthritis, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. The Veteran has a current diagnosis of degenerative arthritis of the spine as established during a February 2014 VA examination. Additionally, her service treatment records (STRs) show significant history of back pain throughout her military service. As such, the Board finds that the first two elements of service connection are established. Regarding the third element, the Veteran was afforded VA examinations in February 2014 and December 2019. The February 2014 examiner opined that the Veteran’s back condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner reasoned that while the Veteran may have strained her back in service, there is no evidence or records showing that this became a chronic disabling condition. Additionally, the examiner stated at separation she had a normal examination and did not report recurrent back pain. The December 2019 examiner opined that it is less likely as not that the Veteran’s back condition is related to military service and more likely as not related to natural aging processes and genetic factors. The examiner reasoned that the Veteran does not have a current diagnosis of back strain and while the Veteran has a diagnosis of degenerative joint disease (DJD), she was not diagnosed with it until 2014 and noted that DJD is a separate condition from a back strain. The examiner stated that the STRs note normal lumbar imaging and the Veteran had a normal separation examination, which was negative for recurrent back symptoms. Additionally, the examiner reasoned that there are no medical records available demonstrating a continuous back strain from military service and no records immediately after service noting ongoing back issues or treatment. The examiner also indicated that smoking is considered a risk factor for development of DJD. The Board affords the VA examinations little probative weight because the examiners do not consider the Veteran’s lay statements regarding her symptoms. The Veteran stated that her back has given her pain ever since service. See February 2013 Statement in Support of Claim. The Veteran’s statements are consistent with the record. Furthermore, the Veteran’s sister stated that the Veteran has complained about back pain since service. See December 2015 Buddy Statement. The Board finds the lay statements competent and credible. The Board thus concludes that continuity of symptomatology has been established. The Board finds the evidence to be in relative equipoise. If the evidence is supportive or is in relative equipoise, then the veteran prevails. See 38 C.F.R. § 3.102. Accordingly, service connection for a back condition is granted. REASONS FOR REMAND Service connection for a foot condition is remanded. The Board regrets further delay, however additional development is necessary before a decision may be rendered on this issue. The Veteran contends that her current foot condition is related to her in-service treatment for foot pain. Her VA treatment records show that she was assessed with hyperkeratosis and metatarsalgia in June 2015. However, an opinion regarding these conditions has not been obtained. Remand is necessary. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Thereafter, obtain an addendum opinion to determine the etiology of the Veteran’s hyperkeratosis and metatarsalgia. The need for another examination is left to the discretion of the physician offering the addendum opinion. (Continued on the next page)   The examiner is asked to opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hyperkeratosis and metatarsalgia had its onset during service or is otherwise related to service. The examiner should address the Veteran’s lay statements, including that she has had foot pain since service. A complete rationale must be provided. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kernen, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.