Citation Nr: 21065852 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 13-35 114 DATE: October 27, 2021 ORDER Service connection for a lumbar spine disability, to include as due to service-connected disabilities, is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran's current back condition is secondary to service-connected plantar fasciitis or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a lumbar spine disability due to service or service-connected plantar fasciitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1973 to March 1976. This case is before the Board of Veteran's Appeals (Board) on appeal from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing in his substantive appeals; however, he later withdrew his request for a hearing in April 2017. 38C.F.R. §20.704(d). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. To establish a service connection for a disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. Similarly, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service-connected. In the latter instance, the nonservice-connected disease or injury is said to have been aggravated by the service-connected disease or injury. In cases of aggravation of a nonservice-connected disability by a service-connected disability, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. §§ 3.310, 3.322; Allen v. Brown, 7 Vet. App. 439 (1995). A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 519 (1996). The Veteran contends that he has a lower back disability that is related to service. In the alternative, the Veteran has claimed that the lower back disability is related to service-connected plantar fasciitis. Medical evidence of record, including VA examinations, indicate that the Veteran has a current diagnosis of intermittent low back strain and mild degenerative joint disease of the thoracic spine. Therefore, the Veteran has a current lumbar spine disability. Service treatment records (STRs) indicate that at enlistment the Veteran had a normal spine examination. In April 1973, the Veteran complained of a pulled muscle in the back after falling. The Veteran described experiencing muscle spasms and pain when bending over to touch h tisoes. The examiner noted a history of compacted lower back vertebrae about two years prior, prior to joining service. X-rays of the lumbar spine were negative at that time. At a separation in December 1975, the Veteran had a clinically normal spine on examination. VA and private treatment evidence of record indicate no complaints related to the lower back until April 2012. At that time, the Veteran complained of straining the mid-back region while lifting heavy wood. Examination of the spine revealed no obvious spasm or tenderness. At a May 2012 general VA examination, the Veteran reported straining his back while lifting wood in April 2012. On examination, the back was normal, and the Veteran was able to perform all range of motion movements without pain. In December 2012, VA medical records show that the Veteran again complained of back pain. The provider noted degenerative changes in the thoracic spine. At an April 2014 VA examination, the Veteran reported intermittent pain in the lower back with prolonged standing or sitting, occurring several times per week. The Veteran stated he may have injured his back during a motorcycle accident in 1970 or 1971, when he fractured his right femur. The examiner noted that the Veteran claimed the current back pain began bothering him several months ago, not prior. The examiner diagnosed intermittent low back strain and mild degenerative joint disease of the thoracic spine. The examiner also noted two instances of acute low back strain, in April 1973 and in April 2012. The examiner noted that there were no complaints related to the lower back shown in the record after service until 2012, when the Veteran complained of strain while lifting wood. Based on the Veteran's reports and the evidence of record, the examiner opined that it was less likely than not that the Veteran's current lower back problems were caused by or incurred in service. The examiner explained that there was only a single episode of back strain due to a pulled muscle in service, with no subsequent mention of back in the records until 2012. The examiner found that the Veteran's current intermittent lower back strain was most likely caused by the lifting injury noted in 2012, combined with a leg length discrepancy resulting from the pre-service accident. At a December 2020 VA examination, the Veteran reported lower and mid-back pain and spasms. The Veteran also reported that recent right hip degeneration and surgery had affected the lower back. The examiner diagnosed lumbosacral strain, noting a history of insidious onset in the 1990s with no inciting event. The examiner opined that the current back condition was not caused by or incurred in service, explaining that the in-service lumbar strain was acute only, and that current lumbosacral strain was not caused by a pulled muscle in service. The examiner further pointed to no evidence of chronicity of care or symptoms between in-service muscle strain and the current back complaints. In July 2021, a VA examiner provided an opinion regarding secondary service connection. The examiner opined that the Veteran's current back condition was not proximately due to or the result of service-connected plantar fasciitis; nor had the service-connected plantar fasciitis aggravated any back condition beyond its natural course. The examiner explained that a condition of the foot or feet would not cause or aggravate conditions of the back, and that degenerative spine disease is considered a naturally occurring age-related condition due to wear and tear over a lifetime. There were rare exceptions to this, which the examiner found were not present in this case. Regarding aggravation, the examiner explained that degenerative spine disease tends to progress often requiring medical intervention, injections, or surgery. Intermittent strain occurs with acute events or overuse and there was no evidence of any aggravation of these back conditions beyond its natural course, including by plantar fasciitis. After review of the record, the Board finds that the preponderance of the evidence is against a finding that the Veteran's current lumbar spine conditions were caused by or incurred in service. While STRs document a complaint of lumbar strain in April 1973, this episode was found to be an acute event resulting from falling. The evidence does not indicate any residuals from this injury or other sequelae. The Veteran reported no back problems at separation and examination of the spine at that time was normal. Notably, the record does not sure further complaints related to the back until 2012. By his own admission, the Veteran told the April 2014 VA examiner that his current back problems began several months prior. He also reported that he believed he may have injured his back prior to service in a motorcycle accident. Both April 2014 and December 2020 VA examiners opined that the current back conditions were less likely than not related to the in-service incident, with the April 2014 VA examiner explicitly relating the back conditions to a combination of residuals of a pre-service accident and a post-service injury more contemporaneous to the time of claim and VA examination. Regarding secondary service connection, the Board finds that the preponderance of the evidence is against a finding that the Veteran's current back conditions were caused by or aggravated beyond their natural progression by service-connected plantar fasciitis. The July 2021 VA opinion explicitly found that plantar fasciitis would not medically cause or aggravate a back condition, and that the Veteran's back conditions were explained by normal wear and tear and/or acute events in the record. In either case, these were not related to any other condition, including plantar fasciitis. The Veteran has not provided any argument or evidence indicating why he believes his back condition is related to service-connected plantar fasciitis. The Board acknowledges the Veteran's report of back pain and spasms and his belief that current back conditions are related to service. While the Veteran is competent to report having experienced these symptoms since service, the issue in this case is outside the realm of common knowledge of a lay person, as a nexus is not obvious merely through observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds the VA examiners' opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for a lumbar spine disability. Therefore, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Ahmad 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.