Citation Nr: 21012202 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 15-12 459 DATE: March 3, 2021 ORDER Service connection for a lumbar spine disability to include as due to service-connected knee disabilities, is denied. FINDING OF FACT The Veteran’s lumbar spine disability is not related to an in-service event, disease, or injury; the Veteran’s lumbar spine disability is also not caused or aggravated by his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for lumbar spine disability are not 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 on active duty with the U.S. Navy from May 1988 to February 2006. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The matter was last remanded in August 2020 and has since been returned to the Board for appellate review. As the requested development has been completed, no further action is necessary to comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection The Veteran asserts that his back disability is due to service-connected knee disabilities or from a boating injury in 1990 while in service. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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 or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Veteran has a current lumbar spine disability. For example, at his November 2019 VA examination he was diagnosed with lumbosacral strain. Thus, the remaining question is whether the current lumbar spine disability is related to service or a service-connected disability. Service treatment records show no complaints, diagnosis, or treatment related to a lumbar spine disability. As the Veteran reported other ailments during service, and back problems are the type that a reasonable person would report, if the Veteran was experiencing problems with back during service the Board would expect that he would have reported these problems to medical professionals. While there is no separation examination on file, during the October 2005 report of medical history, the Veteran specifically denied having had recurrent back pain or any back problem. The Veteran was also found fit for separation in October 2005. If back pain was present during service, the Board would expect the Veteran would have responded “yes” when asked if he had recurrent back pain at separation because a reasonable person would have interpreted the question to include symptoms of back pain. Moreover, the Veteran responded affirmatively when asked whether he had other conditions at separation and the Board would thus expect the Veteran to have also responded affirmatively to having back pain. A lumbar spine disability is not shown by medical evidence until approximately 2011, several years after the Veteran’s separation from service. The Veteran presented for VA examinations in January 2013 and November 2019, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. Addendum VA opinions were obtained in October 2014 and August 2020. The January 2013 VA examiner opined that the claimed lumbar spine disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. However, the examiner’s rationale only explained that the Veteran’s back disability could not be related to or aggravated by meniscal tears or previous degenerative joint diseases in the knees. In the October 2014 addendum opinion, the examiner supported the January 2013 VA examination opinion with the rationale that the lower leg knee joint conditions do not affect the upper trunk lower back region. The Veteran’s lumbar spine diagnosis was related to his age. The examiner also explained that the lumbar spine is not a joint but a stationary anatomy in the upper body trunk area, and that the knee and spine conditions are separate and distinct anatomy. Therefore, the examiner ultimately opined that the Veteran’s knee conditions did not cause leg length discrepancy so gross to cause upper body malalignment or altered change, and the Veteran does not have such antalgic gait to affect or cause a back condition. In the November 2019 VA examination, the examiner opined that the claimed lumbar spine disability was less likely as not incurred in or caused by the complaints during service. In support of this conclusion, the examiner provided that the records are silent for any in-service back injury or treatment for back. The examiner also opined that the Veteran gave multiple history regarding the onset of his back injury. The Veteran has reported a history of back injury to a boating accident; however, during the examination, the Veteran reported to lifting a freezer. The examiner explained ultimately that medical evidence does not support a finding of an injury, complaints, or listing in the multiple medical records until 2011, 5 years post discharge and a history of heavy physical work post service. The examiner opined that the listed spinal stenosis listed is mostly related to the degenerative disc disease and some portion of his spinal issues being congenital as supported by the 2016 MRI. The examiner explained that the knee injuries include a tear and osteoarthritis which are separate and distinct. The examiner agreed with the previous examiner in that there is no causative relationship between the lumbar spine disability and knee disability. However, the examiner also provided that obesity and family history may be risk factors for progressive disc degenerations. Therefore, upon remand, the VA examiner was directed to address whether obesity as an intermediate step supported a finding that the Veteran’s knee disabilities caused or aggravated the Veteran’s back disability. The August 2020 VA examiner opined that the lumbar spine disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner explained that records do not support back injury in service, and the boating accident while mentioned, did not document any back injuries. Although the Veteran stated to falling in 1997, he did not have any back problem until 2011, post-service, at which point, his work had been mostly heavy labor for years. The examiner also explained that the Veteran’s obesity is not an intermediate step in the relationship between the Veteran’s service connected knee disabilities and the Veteran’s lumbar spine disability. In support, the examiner explained that the Veteran’s weight gain did not seem to increase the Veteran’s back pain. The examiner stated that the Veteran’s MRI finding showed results consistent with aging and not obesity or any injuries as this involved multiple levels. Ultimately, the examiner opined that the Veteran’s knee problems cannot have caused the Veteran’s back problems as there are no problems walking that could have caused the Veteran’s back problems. Although the VA examiners above did not specifically use the word aggravation, the VA examiner did explain that the Veteran’s knee disabilities, to include weight gain could not have worsened the Veteran’s back conditions. The Board finds these opinions highly probative as they were made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinions are also supported by other evidence of record. For example, during the Veteran’s active duty service, he reported for several physicals and examinations. However, at each of those physicals, the Veteran denied any recurrent back pain or problems. Notably, in the May 2001 report of medical examination, the Veteran’s back was found to be normal, with the Veteran affirming no recurrent back pain. Specifically, the Veteran reported to multiple possible causes for his back pain, to include lifting a freezer prior to the November 2019 VA examination. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. The Board has considered the Veteran’s statements, to include his assertions that his lumbar spine disability is related to service or related to the Veteran’s service-connected knee disabilities. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., back pain; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s report of medical history at separation from service where he denied back pain. The Board finds the report of medical history at separation from service to be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. J. Kim, Associate 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.