Citation Nr: 21076430 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 14-21 320 DATE: December 23, 2021 ORDER Entitlement to service connection for a back disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that a back disorder is etiologically related to active service. CONCLUSION OF LAW The criteria for service connection for a back disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the Air Force from January 1986 to September 1993. The appeal originates from an August 2012 decision of a Department of Veterans Affairs (VA) Regional Office. The matter was remanded in December 2015, March 2018, February 2020, January 2021, and August 2021 to obtain a VA examination with opinion. The record reflects that an examination was obtained in April 2021 and an opinion in September 2021. There has been substantial compliance with the Remand directives. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases, such as arthritis, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran contends that he has had back pain continuously since service which has resulted in arthritis. See June 2014 Form 9. The April 2021 examination indicates osteoarthritis based on imaging, while the September 2021 opinion confirms a diagnosis of degenerative spine disease (including degenerative disc disease, degenerative joint disease, and bilateral sciatica). Element (1) of Shedden is met. Service treatment records show that the Veteran was seen for a one-year history of occasional back pain in June 1988. He was assessed with hyperventilation and his symptoms resolved after bag breathing. A periodic examination in November 1991 was normal for the back, with the Veteran denying any significant medical history. In August 1992, he was diagnosed with lower back strain in connection with a motor vehicle accident and was seen for lower back pain in October 1992 after shoveling snow. At separation in July 1993, the back was evaluated as normal, though the Veteran reported a history of recurrent back pain. The preceding is sufficient to meet Shedden element (2) with respect to in-service symptomology. Regarding Shedden element (3) or a nexus, the September 2021 examiner opined that a back disorder is less likely as not related to service. The examiner found that the Veteran had chronic strain in service but no evidence of continuity since service. Rather, his in-service back problems likely resolved as evidenced by a long gap in care for more than a decade thereafter. The examiner determined it is less likely as not that the Veteran has current back strain but rather degenerative spine disease and that the prior examiners appeared to render a default diagnosis of strain due to being unaware of the latter. The examiner explained that an absence of care is significant due to degenerative spine disease being progressive, and that any claim of onset in service with continuity is not supported by medical records or the pathophysiology of the disease. The examiner noted that degenerative spine disease is a naturally occurring age-related condition that was age appropriate at the time of diagnosis, and that lumbar strain does not cause or aggravate degenerative spine disease based on established medical knowledge and practice. The examiner indicated that lumbar strain seldom causes bilateral sciatica and usually requires central impingement due to disc disease, foraminal impingement due to arthritis or disc disease, local impingement, or pressure at the sciatic notch, none of which were evidenced. The Board notes that the examiner described a 19-year gap in treatment for the back (until approximately 2012) whereas there is evidence of treatment for the back beginning in approximately 2004. However, this is immaterial to the opinion as it remains the case that there is a long treatment gap for the back since service consistent with the rationale. As such, remand for clarification is unnecessary. As to presumptive service connection, the record does not reflect a diagnosis of arthritis within one year of separation. The Veteran does not necessarily contend otherwise. Rather, he asserts that he has had continuous back problems since service that developed into arthritis. The lay history of continuous symptomology was a primary reason for the Board's repeated remand of the appeal. While it is true that the Veteran reported a history of recurrent back pain in August 1993 proximate to separation, he denied having back pain just a few months later at a general medical examination in December 1993. VA treatment records show that the Veteran was seen for emergency care for a right-hand injury in April 2003. At that time, he was specified to be "healthy" with no indication of back pain. He was seen a few months later in September 2003 following a nasal injury and did not report back pain or taking medication for it. The first objective report of back pain was in June 2004, which the Veteran described as occurring occasionally when performing certain movements, with no reference to a history since service. Indeed, he did not report continuity of symptomatology until approximately a decade later. See June 2014 Form 9. Therefore, taken together with the examiner's explanation as to the absence of a medical relationship between lumbar strain and degenerative spine disease, the weight of the evidence tends to indicate that the reported history is not credible. (Continued on the next page) The Board has also considered the Veteran's personal assertions that his back disorder is due to service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The disability at issue is not readily amenable to probative lay comment regarding etiology. The Veteran is competent to report observable symptoms, but there is no indication that he is competent to etiologically link any such symptoms to a current diagnosis. He is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating his disorder. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). As such, the lay evidence does not constitute competent medical evidence and lacks probative value. The lay opinion is also outweighed by the September 2021 opinion. Accordingly, the claim of service connection for a back disorder must be denied. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alhinnawi 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.