Citation Nr: 21068566 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-64 979 DATE: November 10, 2021 ORDER Service connection for a low back disability is denied. THE VETERAN'S CONTENTIONS The Veteran asserts that he hurt his back during service when he stepped in a hole and twisted his ankle. See July 2018 Board hearing transcript, pp. 6-7; October 2019 VA examination report. He also reported that he injured his back again when he fell off the roof of his home. See October 2019 VA examination report. The Veteran further contends that his low back pain is due to falls associated with his symptoms of his service-connected diabetic peripheral neuropathy. See May 2014 notice of disagreement (NOD). For these reasons, he believes he is entitled to service connection. FINDING OF FACT The Veteran's low back disability did not have its clinical onset during his active service, and the evidence of record does not demonstrate that it is otherwise related to an in-service injury or disease, or a service-connected condition. CONCLUSION OF LAW The criteria for entitlement to service connection for a low back disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1969 to August 1970. He was awarded the National Defense Service Medal, Vietnam Service Medal, and Vietnam Campaign Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2018, the Veteran testified at testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. In October 2018, July 2020, February 2021, and July 2021, this case was remanded by the Board. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The November 2020 VA examiner diagnosed degenerative arthritis of the spine. Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as arthritis, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The Veteran has a current low back disability. Post-service treatment records and examination reports document recurrent back pain and that the Veteran has suffered numerous falls. See March 2000 VA examination; September to November 2000 medical records; March 2003 private treatment record; October 2013 VA treatment record; June 2018 VA treatment record. The October 2019 and November 2020 VA examinations show diagnoses of lumbosacral strain, degenerative arthritis of the spine, and intervertebral disc syndrome. The service treatment records (STRs) do not show complaints or a diagnosis of a low back condition during service. They also do not show evidence of a fall or ankle injury during service. There is also no evidence that the Veteran had a diagnosis of arthritis to a degree of 10 percent disabling within one year from the date of termination of such service. The September 1970 VA examination noted that the Veteran's musculoskeletal system is normal. The February 1971 VA examination also did not show arthritis and noted that the spine has normal range of motion. The Veteran's spine was also marked as normal on a September 1974 examination report. VA medical opinions were obtained in July 2017, October 2019, October 2020, April 2021, and September 2021 to determine whether there was a relationship between the Veteran's low back disability and his service or his service-connected peripheral neuropathy. The July 2017 VA examiner determined that the Veteran did not have a diagnosis of degenerative disc disease. The October 2019 VA examiner diagnosed lumbosacral strain and intervertebral disc syndrome; however, he provided a negative nexus opinion regarding the relationship between the Veteran's low back conditions and his service. An additional VA medical opinion was obtained in October 2020 in order to address secondary service connection. See October 2020 Medical Opinion Disability Benefits Questionnaire (DBQ). In October 2020, a VA clinician provided a negative nexus opinion regarding whether the Veteran's low back disability was caused or aggravated by his service-connected peripheral neuropathy of the lower extremities. In April 2021, a VA clinician again provided a negative nexus opinion regarding both direct service connection and secondary service connection. In order to address the inadequacies in the October 2020 and April 2021 VA clinicians' rationales for their negative nexus opinions, an additional VA medical opinion was obtained in September 2021. See July 2021 Board remand; September 2021 Medical Opinion DBQ. In September 2021, the VA clinician also provided a negative nexus opinion regarding both direct and secondary service connection. The clinician determined that the Veteran had degenerative spine disease, which more likely than not arose in the mid to late 1990s. He determined that it was less likely than not incurred in service, to include due to his reported fall in service in which he twisted his ankle. He noted that it was almost a certainty that the Veteran did not have a back condition on September 5, 1974, thereby negating his claim of pain arising in service with continuity since service as due to stepping in a hole. The September 2021 VA clinician also determined that the Veteran's back condition was not caused or aggravated by the Veteran's service-connected peripheral neuropathy. See September 2021 Medical Opinion DBQ. In his rationale, the clinician explained that peripheral neuropathy does not cause degenerative spine disease, nor would falls related to peripheral neuropathy cause degenerative spine disease. He also stated that it was not documented that the Veteran's falls were due to neuropathy. He found that although back symptoms might increase during the immediate post-fall time frame, the symptoms would subsequently return to baseline and there was no evidence of aggravation beyond the natural course of the Veteran's back condition. The Board finds that the September 2021 VA clinician's opinion is the most probative evidence of record. The clinician reviewed the medical records and provided adequate rationale for his conclusions. Further, there are no contrary competent medical opinions of record. The only contrary evidence of record are the Veteran's contentions that his low back disability is related to his service and/or his service-connected condition. However, the Board finds that there is no evidence in the record indicating that the Veteran is qualified to provide a medical diagnosis or opinion. While the Veteran, as a lay person, is competent to provide evidence regarding the symptoms he observed, he is not competent to offer an opinion as to the etiology of his low back disability as this matter falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Based on the foregoing, the Veteran's claim of entitlement to service connection for low back disability is denied. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Samuelson, 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.