Citation Nr: 21074563 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 16-24 847 DATE: December 15, 2021 ORDER Service connection for a low back disability, to include as secondary to arthritis of the metacarpophalangeal joint, left little finger (left little finger disability), is denied. FINDINGS OF FACT 1. The Veteran served on active duty in the United States Air Force from September 1980 to October 1982. 2. During the claim period, the Veteran was diagnosed with degenerative joint disease, or degenerative arthritis, of the lumbar spine. 3. Symptoms of a lumbar spine disability or injury are not documented in the Veteran's service treatment records (STRs). In addition, the Veteran has not contended that her current lumbar spine symptoms had an in-service onset. 4. A preponderance of the evidence indicates that the Veteran's current degenerative joint disease of the lumbar spine was not caused by or otherwise related to the Veteran's active duty service, to include as due to her duties in the United States Air Force. 5. A preponderance of the evidence also indicates that the Veteran's current degenerative joint disease of the lumbar spine was not proximately caused or aggravated by her service-connected left little finger disability. CONCLUSION OF LAW The criteria for service connection for a low back disability are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Jurisdiction of the Veteran's claims file currently resides with the San Juan, the Commonwealth of Puerto Rico RO. In December 2019, the Veteran testified at a Board hearing before the undersigned. A transcript of the hearing is of record. In September 2020, the Board found that new and material evidence had been received to reopen the previously denied claim of service connection for bilateral hearing loss. The Board then remanded that issue for its initial adjudication on the merits as well as the issues of: entitlement to service connection for hyperuricemia, claimed as gout; entitlement to service connection for a low back disability; entitlement to a disability rating greater than 10 percent for a left little finger disability; and entitlement to a total disability rating based on individual unemployability (TDIU). Thereafter, in February 2021, a VA RO issued a rating decision granting the Veteran service connection for bilateral hearing loss. The Board finds that this grant of service connection constituted a full award of the benefit sought on appeal with respect to that issue. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues, such as the compensation level assigned for the disability and the effective date). Accordingly, the issue of entitlement to service connection for bilateral hearing loss no longer remained in appellate status. The case returned to the Board in June 2021. On that occasion, the Board denied service connection for gout, a disability rating greater than 10 percent for a left little finger disability, and entitlement to a TDIU. The Board then remanded the issue of service connection for a low back disability for additional development. The case has once again returned to the Board for appellate review. Service Connection for a Low Back Disability The Veteran has contended that she has a current disability of the low back that (1) was caused by or related to her duties in the United States Air Force, or (2) was caused or aggravated by her service-connected left little finger disability. After reviewing the evidence of record, the Board finds that service connection is not warranted under either direct or secondary theories of entitlement. Accordingly, the Board denies the Veteran's claim. In support of this determination, the Board first notes that, generally, establishing service connection requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. 38 C.F.R. § 3.303(a); Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). Additionally, service connection may also be established for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). To substantiate secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). Turning to the evidence of record in the instant case, the Board first notes that the Veteran has a current disability of the low back. Specifically, she has received diagnoses of degenerative joint disease of the lumbar spine and degenerative arthritis of the spinesubstantiated by x-ray reportsduring the claim period. See August 2021 VA Back Conditions Examination Report; July 2013 VA Back Conditions Examination Report; July 2011 VA Radiology Report. Accordingly, the Board finds the first service connection requirement of a current disability to be satisfied. See 38 C.F.R. §§ 3.303, 3.310. Next, in regard to service connection on a direct basis, an injury to the lumbar spine or the onset of degenerative arthritis of the lumbar spine was not documented in the Veteran's service treatment records (STRs). However, during the December 2019 Board hearing, the Veteran described her duties in service and their effects on her body. Specifically, she testified that, as a riveter in structure repair, she would climb into jets and maneuver her body in confined areas. Board Hearing Tr. at 9. She elaborated that she was constantly on the ground, beneath planes, and lifting items. Id. Lastly, the Veteran testified that, in service, she experienced muscle spasms and was given medication. Id. at 8. The Board notes that the Veteran's Department of Defense Form 214 (DD214) lists airframe repair specialist as the Veteran's primary specialty. As the Veteran is competent to testify about things she experienced with her own sensesincluding her service experiencethe Board finds the Veteran's testimony regarding her in-service duties to be credible. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Accordingly, for the purpose of service connection on a direct basis, the Board finds the in-service incurrence of injury requirement to be satisfied. See 38 C.F.R. § 3.303. Regarding entitlement to service connection on a secondary basis, the Board notes that the Veteran is already service-connected for a left little finger disability. Accordingly, the Board finds this next requirement of an already service-connected disability to also be satisfied in the instant case. See 38 C.F.R. § 3.310. Lastly, regarding the remaining requirements of a nexus (1) between the current lumbar spine disability and service, or (2) between the current lumbar spine disability and the already service-connected left little finger disability, the Board finds that the record contains on adequate, competent medical opinion for each theory of entitlement. Specifically, in August 2021, the Veteran was provided a VA back conditions examination. After physically evaluating the Veteran and reviewing his entire claims file, the August 2021 examiner opined that it was less likely than not that the Veteran's current lumbar spine disability was incurred in or caused by service. In support of this conclusion, the examiner first noted that that the Veteran's STRsincluding her separation examinationwere silent for treatment or complaints of lower back pain. The examiner then stated that the Veteran's post-service medical records did not contain any complaints regarding the lower back until 2011, about 30 years after service, when the Veteran was found to have degenerative arthritis on a pelvic x-ray. The examiner acknowledged the Veteran's December 2019 Board hearing testimony concerning the Veteran's service experience, but indicated that there was no objective evidence of a low back disability until 2011. Lastly, the examiner remarked (1) that the onset of the Veteran's degenerative arthritis of the lumbar spine occurred when the Veteran was 51 years old; (2) that age was the greatest risk factor for developing arthritis, particularly after the age of 40; and (3) the Veteran's development of arthritis around the age of 51 was not an uncommon finding. In August 2021, the VA examiner also addressed service connection for a low back disability as secondary to the left little finger. The examiner opined that it was less likely than not that the Veteran's current lumbar spine disability was proximately caused or aggravated by the already service-connected left little finger disability. In support of these conclusions, the examiner remarked that there was no medical literature that supported (1) a causal relationship between a finger fracture and the development of degenerative arthritis of the spine, and (2) the existence of a finger disability aggravating degenerative arthritis of the spine. With respect to both direct and secondary service connection, the Board finds the August 2021 examiner's opinions to be adequate for adjudicative purposes. Specifically, the examiner based his opinion on a consideration of the Veteran's entire medical history, including the Veteran's lay description of her in-service experience; described the Veteran's lumbar spine condition in detail; supported the conclusions with reasoned analyses. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Further, regarding service connection on a secondary basis, the opinion addressed both causation and aggravation. See Atencio v. O'Rourke, 30 Vet. App. 74, 90 (2018). Accordingly, as all of the requirements for service connection on direct or secondary bases have not been satisfied, the Board denies the Veteran's claim. Lastly, the Board acknowledges the Veteran's December 2019 testimony that her providers told her that her in-service duties caused her current lumbar spine disability. See Board Hearing Tr. at 8. The Veteran is certainly competent to report about what medical professionals may have told her because such a report of a contemporaneous diagnosis would be within her personal knowledge. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). However, to the extent that the Veteran provided this information as evidence of a positive nexus between her current disability and service, the Board cannot determine the factual premise and reasoning underpinning such opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, any such statements have little probative value and are outweighed by the August 2021 VA examiner's opinion discussed above. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.S. Pettine, 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.