Citation Nr: 21066644 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 16-20 689 DATE: November 1, 2021 ORDER Service connection for a lumbar spine disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from October 1970 to October 1974 and from June 1979 to July 1996. 2. The Veteran complained of low back strain in service; symptoms of a low back strain were not chronic in service, were not continuous since service, and were not shown to a compensable degree within one year of service. A current lumbar spine disorder, diagnosed as degenerative joint disease (DJD) and lumbar spondylosis, is not causally or etiologically related to service. CONCLUSION OF LAW A chronic lumbar spine disorder was not incurred in service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION Most recently in July 2021, the Board remanded the issue for further development. The appeal has a lengthy procedural history which was thorough outlined in prior Board decisions, and they are incorporated by reference. There has been substantial compliance with the remand directives, and there is no bar to proceeding with the appeal. Stegall v. West, 11 Vet. App. 268, 271. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Initially, the Veteran was diagnosed with lumbar spondylosis and DJD of the spine in June 2012. Thus, current diagnoses are shown, and the first element of service connection is met. As to an in-service incurrence, the service treatment records (STRs) reflect back pain in October 1982, September 1985 and September 1988. The STRs reveal that he underwent physical therapy and was discharged at the end of September 1985 when his back pain resolved. Thereafter, and apart from the September 1988 notation, he continuously denied any recurrent back pain in periodic examinations, to include his separation examination in June 1992. Nonetheless, as in-service incurrences are shown, the second element of service connection is met. As to a medical nexus, at a June 2012 VA examination, the Veteran was diagnosed with sciatica and a lumbar strain. While this examination was found to be inadequate by the Court due to the examiners failure to address the Veteran's medication of Naprosyn, it will be discussed briefly. In this regard, the Veteran reported he had constant low back pain and that he was diagnosed with a pinched nerve in 2008, but denied any injury or trauma to the back. He stated that he took Tylenol daily as treatment. After examining the Veteran and reviewing the record, the examiner opined it was less likely than not that the Veteran's low back disorder was related to service. The examiner stated that the Veteran was treated for a muscle strain of the low back during service, but that additional record reflected improvement of the symptoms. The examiner reasoned that the Veteran was able to continue to serve for 11 years after the muscle strain and had surgery in 2008 for a pinched nerve. The examiner opined that it was less likely than not that an acute muscle strain which improved would lead to a pinched nerve requiring surgery more than 20 years later. At a June 2019 VA examination, the VA examiner once again reviewed the medical claims folder, examined and interviewed the Veteran. The examiner concluded that the Veteran's claimed condition was less likely than not incurred in or caused by active duty, observing that the Veteran's in-service muscle strains were acute and resolved shortly after his initial complaint. The examiner noted that the Veteran was prescribed naproxen during service to treat bilateral shoulder pain. He stated the Veteran did not have recurring complaints of low back pain. The Veteran denied experiencing recurrent back pain in March 1979, June 1979, July 1983, February 1988, January 1992, and June 1996. The examiner stated that a muscle strain, such as the Veteran's in-service strain, would often resolve without chronic ongoing issues. The examiner noted that the laminectomy due to impingement of his sciatic nerve in 2008 would not have been caused by a strain that occurred 20 years prior. Although the June 2019 VA examiner discussed and considered the Veteran's medication use as advised, another VA opinion was obtained in August 2021. Once again, the examiner reviewed the Veteran's entire claims file, considered his lay statements, and opined that it was less likely than not that the Veteran's current low back disorder was related to service. The examiner reasoned that despite the Veteran's claims to the contrary, there was no evidence of a chronic back condition while in service. In so finding, the examiner acknowledged the September 1985 low back strain and noted that it resolved. The examiner then stated that the Veteran went on to service 11 more years without evidence of a chronic back condition, and repeatedly denied recurrent back pain on his separation examination, Additionally, the examiner noted that these examinations, including the Veteran and physician answered RME, are notably thorough and include a history, which revealed he unequivocally did not have a back condition at separation by his own report. The examiner stated that there was no evidence of a back disorder until in or around 2008. Additionally, back strain did not cause degenerative spine disease as seen in the Veteran's spine. Any significant lumbar spine disease would have been evident at the time of its occurrence and certainly by separation, if it were in fact present. Thus, the examiner opined that no nexus was established in service, as the in-service event was acute and self-limited, and resolved by separation. Next, the examiner noted that degenerative spine disease, including DJD, were naturally occurring conditions, and that it was age-appropriate at the time of the Veteran's diagnosis. Specifically, greater than 50 percent of men 50 and older will have evidence of degenerative spine disease. Next, the examiner notes that the Veteran was taking Naprosyn at the time of separation. While the reason was not specified, the Veteran notably had other orthopedic complaints documented. Thus, it was unlikely that the Veteran could have served 11 more years in the military with a significant back condition, self-medicating, and without seeking care. Finally, the examiner state that chronicity was not supported by the medical documentation which put the onset after 2000, a timeline which considers the natural pathophysiology of degenerative spine disease. The Board finds that the examination was adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a physical examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Finally, despite a long procedural history, there is no contradicting medical evidence of record. Therefore, the Board finds the VA examiner's opinion to be of great probative value. Additionally, three separate evaluations concluded that there was no nexus between the Veteran's back complaints in service and current diagnosis. In this regard, the Veteran has repeatedly asserted that his back disorder began in service. However, while brief instances are noted, they resolved without chronic residuals and he continuously denies any back issues. While not dispositive, this fact weighs heavily against the claim, especially when considered in conjunction with the Veteran's voluminous STRs which contain many complaints for other orthopedic issues like shoulder, elbow and neck pain. With regard to the Naprosyn that the Court Clerk found compelling, it is noteworthy that by the Veteran's own admission, he was prescribed Naprosyn in 1984. His first low back complaint was not noted until 1985. Additionally, STRs from March 1996 show that Naprosyn prescription was discussed alongside elbow complaints. Again, while not dispositive, this evidence weighs heavily against the claims as his prescription preceded his low back strain which is at issue. Next, the medication is noted to be treatment for his elbow, but no such notation is given for his back. Next, the Veteran had many complaints for his neck, a condition for which he is in receipt of service-connected benefits. In this regard, it is reasonable to assume that while he continuously sought treatment for neck problems in service, and a chronic disorder was clearly established, that he would not have likewise reported lower back pain as well. Specifically, he repeatedly noted chronic shoulder and neck pain in the Reports of Medical history but continuously denied back issues. This evidence weighs against the finding of a chronic disability in service. Finally, by the Veteran's own admission in a May 2021 statement, he repeatedly describes his issues as ones with his neck. He admittedly states that many of his symptoms were neck symptoms. As noted, he already has service-connected benefits for this disorder, thus, this is not for consideration. Once more, this evidence weighs heavily against a medical nexus. Thus, the evidence does not support service connection on a direct basis. With regard to presumptive service connection, the Veteran currently has degenerative arthritis of the thoracolumbar spine (which is a chronic disease under 38 C.F.R. § 3.309), it did not manifest to a compensable degree within 1 year of separation from service and continuity of symptomatology is not established. The Veteran denied back pain in March 1979, June 1979, July 1983, February 1988, January 1992, and June 1996. He underwent a VA examination in October 1996 and did not complain of low back pain. He underwent a laminectomy in 2008, some 12 years after discharge from service. Further, there was no X-ray evidence of arthritis until January 2013, 17 years after discharge. Other than general statements that he experienced pain and was prescribed Naprosyn 500 mg, the Veteran did not submit any evidence indicating he was treated for low back pain or degenerative arthritis of the thoracolumbar spine since discharge. Thus, the medical evidence does not support presumptive service connection. The Board has also considered the Veteran's lay statements that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, 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.