Citation Nr: 21000781 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 13-13 275 DATE: January 6, 2021 ORDER Entitlement to service connection for an upper back disorder is denied. FINDING OF FACT The Veteran's cervical and thoracic spine disorder (upper back disorder) is not directly due to service or secondary to or aggravated by a service-connected disorder. CONCLUSIONS OF LAW The criteria for entitlement to service connection for an upper back disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1983 to August 1990 and from January 1991 to September 1995. This issue was remanded by the Board in July 2017, and has been returned to the Board. Entitlement to service connection for an upper back disorder Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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). Service connection may be granted for a disability that is proximately due to, the result of, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current upper back disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability or is otherwise related to service. The Veteran was afforded a VA examination in February 2009. The VA examiner opined: Regarding the veteran’s lumbar spine, he is service-connected for degenerative joint and disc disease of his lumbar spine. Imaging studies of the thoracic spine show mild and age-appropriate degenerative changes that are likely unrelated to his lumbar spine pathology. Pursuant to Board remand, the Veteran was afforded another VA examination in August 2018 to obtain an adequate opinion. That examiner opined that the Veteran’s thoracic spine disorder was less likely than not incurred in or caused by the claimed in-service event. The following rationale was provided: The Veteran’s upper back (thoracic spine) diagnoses as thoracic DDD and compression fracture of T8 is (sic) less likely than not related to in-service event or secondary to his DJD of lumbar spine. Thoracic disc disease and compression fractures come from injuries, usually falls or MVA and chronic pain is associated with this condition. The veteran’s STR reviewed and they are silent for any injury that would be associated with this condition, and they are silent for any complaints of thoracic pain. The thoracic spine disc disease is a separate diagnosis and entity from Lumbar DDD/DJD and has less prevalence due to the protection of the rib cage and bone structures that can stabilize the spine. The veteran does have a history of multiple motor vehicle accidents after service, which could explain the thoracic herniated discs and compression fracture. In a November 2019 VA opinion, the examiner indicated that the Veteran’s upper back disorder was both at least as likely as not caused by the in-service injury or event and that it was at least as likely as not proximately due to or the result of the Veteran’s service-connected condition. However, as a rationale, the examiner stated “Upper back DBQ was not ordered, unable to determine. Therefore, cannot comment on veteran’s upper back pain. This claim for upper back is not appropriate for claimed cervical spine pain. A nexus has not been established.” A VA examination was conducted in July 2020 and a clarifying opinion was provided. Regarding direct service connection, the examiner stated “the STRs are silent for treatment, complaints, or diagnoses related to the neck. Therefore, the current degenerative disc and joint diseases, and stenosis are less likely than not caused by the in service pain/injury.” Regarding secondary service connection, the examiner stated “there is no medical evidence or peer-reviewed literature that supports a lumbar spine condition causing a cervical spine condition. Therefore, the current degenerative disc and joint diseases, and stenosis are less likely than not caused by the service connected condition.” Regarding aggravation by a service-connected disorder, the examiner stated that there was insufficient evidence to establish a baseline and that there is no medical evidence or literature that supports a lumbar spine condition aggravating a cervical spine condition. Upon review of the record, the Board concludes that, while the Veteran has a current disability of degenerative disc disease of the cervical spine, the preponderance of the evidence is against finding that the Veteran’s disability is proximately due to or the result of, or aggravated beyond its natural progression by his service-connected lumbar spine disorder. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310. While the Veteran believes that his cervical and thoracic spine disorders are related to his service-connected lumbar spine disorder, the medical evidence does not support this conclusion. The expert VA opinions weigh against this finding a nexus of secondary causation or aggravation. While the Veteran is competent to provide evidence of his symptoms, the issue is medically complex, as it requires specialized knowledge of anatomical relationships and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiners’ opinions. For these reasons and based on the objective medical evidence, the Board finds an upper back disorder is not caused by an event, injury or illness during active service, nor is it proximately due to, the result of or permanently made worse beyond its natural progression by a service-connected disorder. Consequently, service connection, direct or secondary, is denied. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shana Z. Siesser, 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.