Citation Nr: 21005944 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 16-34 887 DATE: February 2, 2021 ORDER Entitlement to service connection for low back pain is granted. FINDING OF FACT The probative evidence of record establishes that the Veteran’s low back pain is etiologically related to his service-connected right total knee replacement, and its consequent leg length discrepancy. CONCLUSION OF LAW The criteria for service connection for low back pain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Army from March 1974 to March 1994. In June 2019, the Veteran testified during a hearing from St. Petersburg, Florida before the undersigned Veteran’s Law Judge (VLJ). A transcript of this hearing has been associated with the claims file. In August 2019, the Board of Veterans’ Appeals (Board) remanded the Veteran’s claim to the agency of original jurisdiction (AOJ) for additional development. This development was completed and the Veteran’s claim has returned to the Board. Service Connection Entitlement to service connection for low back pain The Veteran contends that he has low back pain that has been aggravated by his service-connected right knee condition. The Veteran asserts that either because of the limp from his right knee, which has been present for some time, or due to the leg length discrepancy, it has worsened his back pain. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition to direct service connection, service connection may be established on a secondary basis for a disability which is caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310. Turning first to the Veteran’s current diagnosis/diagnoses, the medical records consistently note a diagnosis of lumbar degenerative disc disease, including the December 2019 VA examination. The only other “diagnosis” is low back pain. Considering this, the December 2019 VA examination provided an opinion on the relationship between “degenerative lower back spine disease to leg length discrepancy issues; however, a difference of leg lengths can contribute to lower back pain due to muscle, tendons, and ligaments over-exertion and strain.” From this opinion, the Board infers that the medical evidence cannot support an etiological relationship between a leg-length discrepancy and degenerative disc disease; however, it does support a relationship between a leg-length discrepancy and low back pain. Therefore, the Board finds that the Veteran has a diagnosis of low back pain and is service-connected for a right knee condition. The question now turns to whether the right knee condition could cause or aggravate his low back strain. The Veteran has consistently contended that after his right knee surgery, he was left with a leg length discrepancy, but the record was unclear as to whether one existed and, if so, whether it was severe enough to cause the symptomology the Veteran experienced. A December 2019 RAD Bone Length Study was conducted, and found that the right lower extremity was 85.1 centimeters and the left lower extremity was 88.5 centimeters. It was noted that the leg length discrepancy was found after the Veteran’s right total knee replacement. Notably, clinical records prior to the knee replacement confirm a lack of gait disturbances due to the knee disability. These records also do not note a length discrepancy prior to the surgery. The December 2019 VA clinician stated the following: “a difference of leg lengths greater than 5 millimeters (1/4 inch) can contribute to lower back pain due to muscle, tendons and ligaments over-exertion and strain.” The clinician measured the leg length discrepancy and found a 3.4-centimeter difference between the right leg (shorter) and left leg – that is, roughly a 1.3 inch difference. The Board gives great probative weight to the clinician’s findings of the Veteran’s leg length discrepancy and the opinion that such a discrepancy can contribute to low back pain/strain. The clinician has the medical expertise to make such a determination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Therefore, the Veteran’s low back pain is related to the leg-length discrepancy caused by the Veteran’s right total knee replacement. Given the above, the Board finds that the criteria for service connection for low back pain have been met. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. M. Hitchcock 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.