Citation Nr: 21020953 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 12-12 954 DATE: April 8, 2021 ORDER Service connection for a lumbar spine disorder is denied. Service connection for a cervical spine disorder is denied. Service connection for a left hip disorder is denied. Service connection for a bilateral knee disorder is denied. FINDINGS OF FACT 1. The Veteran’s lumbar spine disorder manifested many years after service and was unrelated to the in-service back pain. 2. The Veteran’s cervical spine disorder manifested many years after service and was unrelated to the in-service back pain. 3. The Veteran’s left hip disorder manifested many years after service and was unrelated to the in-service back pain. 4. The Veteran’s bilateral knee disorder did not manifest in service or shortly after service, there was no continuity of symptomatology, and the condition was otherwise unrelated to service, to include the in-service back injury. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar spine disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a cervical spine disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left hip disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a bilateral knee disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from March 1970 to July 1970. The matter is on appeal from an October 2009 rating decision. The Veteran passed away in December 2016 while the matter was on appeal and the Appellant, the Veteran’s widow, was properly substituted as the claimant in December 2017. In August 2020, the Board remanded for an addendum medical opinion. The Board finds that the obtained opinion is adequate, and further remand is unnecessary. 1. Service connection for a lumbar spine disorder is denied. The Appellant, as the substitute claimant, seeks service connection for a lumbar spine disorder. The Veteran’s medical records show chronic low back pain status post lumbar spine fusion and subsequent surgeries for degenerative disc disease. The Veteran’s service treatment records are associated with the claims file and appear to be complete. He was treated for back complaints twice in March 1970 and again in June 1970. In June 1970, he was diagnosed with a lumbosacral strain and scheduled to undergo an x-ray a few days after treatment, but he overdosed on aspirin. In July 1970, discharge was recommended due to a personality disorder and he separated from service that month. His separation examination was normal for the spine and lower extremities, but he reported back trouble on his report of medical history. The private treatment records associated with the claims file show back treatment post-spinal fusion beginning in 1995. The records do not address etiology or when symptoms began, but the Veteran reported during a September 2014 VA medical visit that he stopped smoking in 1993 when he “first need back surgery.” Thus, the available evidence shows that he underwent back surgery approximately 23 years after separation from service. In November 2020, a VA medical opinion was obtained on remand. The examiner concluded that the Veteran’s back disorder was less likely than not related to service. He noted that the Veteran’s service records showed a lumbosacral strain and private treatment records from 1995 showed degenerative disc disease as evidenced by the history of spinal fusion. The examiner theorized that “strain does not cause degenerative disc disease” which is “accepted medical knowledge and practice supported by standard texts.” He further opined that “it is virtually impossible that the Veteran could have gone from 1970 until the 1990s with significant disc disease, without seeking necessary care.” He also opined that “disc disease and strain are two separate entities/conditions,” and “if an acute injury significant enough to ultimately require intervention approximately 20 years later had occurred in service, it would have been self-evident.” Instead, the examiner opined that “it is far more likely than not that the Veteran had an event, post-service, leading to surgery in the 1990s, or developed DDD secondary to natural desiccation of the discs, leading to surgery in the 1990s.” The Board finds that his opinion is highly probative because the examiner reviewed the relevant factual history and provided an adequate rationale that supported his conclusion, including an explanation why the significant period between service and the spinal fusion was probative. The Board considered the Veteran’s hearing testimony that x-rays in service showed herniated discs at that time but finds that the contemporaneous evidence outweighs and expressly contradicts this testimony. Specifically, his service treatment records show that he was supposed to undergo an x-ray a few days after his June 15, 1970 back visit, but he overdosed on June 18, 1970 and x-rays were not taken. A physical profile from June 15, 1970 shows that he was diagnosed with a lumbosacral strain (pending x-ray results). The records also show a normal back examination at separation and otherwise no evidence of herniated discs in service. Although he reported back trouble on his report of medical history, he denied arthritis and bone, joint, or other deformity, and it is reasonable to expect that if he had had x-rays that showed herniated discs during service, this is the type of fact one would report on the separation exam. This is especially so considering the separation exam was done just a few weeks after the lumbosacral strain diagnosis, during which the Veteran alleges x-rays were done. The physician’s summary shows an explanation that he was treated for “back trouble,” and, again, if herniated discs had, in fact, been shown during service, it is reasonable to expect the Veteran would have reported such to the separation examiner. Accordingly, the Board did not find this testimony to be probative evidence. The Board also considered the Veteran’s testimony that he had back pain after service and that he developed herniated discs as a “delayed condition” associated with his in-service injury, as well as the supporting lay statements submitted in July 2009. The Board finds that the VA examiner’s opinion that the Veteran’s in-service lumbar strain simply would not lead to disc desiccation or disease outweighs these contentions. Moreover, while the Veteran is competent to attest to back symptoms he experienced, he is not competent to opine that his in-service injury caused his lumbar spine conditions, particularly considering their delayed manifestation. The VA examiner clearly stated a strain, which was the in-service diagnosis, does not cause disc disease. After reviewing the lay and medical evidence, the Board finds that the evidence weighs against service connection for a lumbar spine disorder, and the claim is denied. 2. Service connection for a cervical spine disorder is denied. The Appellant, as the substitute claimant, seeks service connection for a cervical spine disorder due to the Veteran’s in-service back injury. The Veteran’s medical records show complaints of cervical spine pain status post diskectomy and fusion for herniated discs and degenerative disc disease. The Veteran’s service treatment records are associated with the claims file and appear to be complete. While the Veteran was treated several times for back pain, there were no complaints of or treatment for neck pain. His separation examination was normal, and he reported back trouble on his report of medical history but denied arthritis and bone, joint, or other deformity. The private treatment records associated with the claims file show cervical spine treatment beginning in 2000. In February 2000, the Veteran underwent a cervical spine x-ray for nerve pain. The x-ray showed no acute fracture, subluxation, destructive process, or disc space height narrowing, and neural foramen appeared patent. In January 2001, he underwent a cervical spine MRI due to persistent neck pain following a motor vehicle accident in September 2000. He underwent a diskectomy and fusion in September 2005 and experienced worse pain after that surgery. In February 2007, he underwent further surgery for pseudoarthrosis and persistent neck pain. In June 2020, VA obtained a medical opinion. The examiner opined that the cervical spine disorder was not related to service because the Veteran’s service treatment records and medical records did not show complaints or treatment for a cervical spine condition in service or shortly after service. The examiner also opined that the Veteran’s cervical spine was unrelated to the in-service back injury because orthopedic literature indicates that an injury to one joint would not have any significant impact on another unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis. Instead, the examiner opined that the cervical spine condition is due to something intrinsic to the cervical spine. The Board finds that this is adequate because the examiner considered the Veteran’s contentions that his “delayed” cervical spine condition was related to the in-service back injury and, using his expertise and orthopedic literature, thoroughly explained why this was not possible. Furthermore, his opinion is supported by the evidence, including the service treatment records, which show no evidence of cervical spine complaints or treatment, and post-service treatment records, which show a normal cervical spine structure until the motor vehicle accident in 2000. The Board considered the Veteran’s contentions that he developed herniated discs as a delayed condition associated with his in-service injury, as well as the supporting lay statements submitted in July 2009. The Board finds that, as a layperson, the Veteran is not competent to relate his cervical spine conditions to the in-service back complaints, particularly considering their delayed manifestation. To the extent the Veteran contended his lumbar spine disorder caused or aggravated his cervical spine disorder, secondary service connection is not warranted because the lumbar spine disorder is not service connected. After reviewing the lay and medical evidence, the Board finds that the evidence weighs against service connection for a cervical spine disorder, and the claim is denied. 3. Service connection for a left hip disorder is denied. The Appellant, as the substitute claimant, seeks service connection for a left hip disorder. In a March 2009 statement, the Veteran contended that he had a pre-existing hip injury which was aggravated in service by his back injury and that his hip condition was further aggravated by his back and neck disorders. The Veteran’s service records, which appear to be complete, show a normal entrance examination and that he denied all relevant conditions on his report of medical history. Further, there are no complaints or treatment for a left hip condition in service. A June 1970 record does note an old right hip injury, but nothing related to the left hip. He separated from service with normal spine and lower extremities examinations and he denied all relevant conditions on his report of medical history. Accordingly, the Veteran is presumed sound at entrance. Private and VA treatment records associated with the claims file date to 1995 but do not show complaints of a left hip condition until November 2010, when the Veteran complained of left hip pain. He complained of left hip pain again in November 2012. In June 2020, VA obtained a medical opinion. The examiner opined that the Veteran’s left hip disorder was not related to service because the Veteran’s service treatment records and medical records did not show complaints or treatment for a relevant condition in service or shortly after service. The examiner also opined that the hip disorder was unrelated to the in-service back injury because the orthopedic literature indicates that an injury to one joint would not have any significant impact on another unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis. Instead, the examiner opined that the hip condition was due to something intrinsic to the hip itself. The Board finds that this is adequate because the examiner considered the Veteran’s contentions that his hip condition was related to the in-service back injury and, using his expertise and orthopedic literature, thoroughly explained why this was not possible. Furthermore, his opinion is supported by the evidence, including the service treatment records, which show no evidence of hip complaints or treatment, and post-service treatment records, which do not show complaints of hip pain until 2010, 40 years after separation from service. The Board considered the Veteran’s contentions that he entered service with a preexisting hip disability that was worsened in service. The Board finds, however, that these statements are contradicted and outweighed by the contemporaneous evidence, which shows that he had a normal examination and that he denied all relevant conditions at entrance. The Board further finds that, as a layperson, the Veteran is not competent to relate his post-service hip condition to the in-service back complaints, particularly considering their delayed manifestation. To the extent the Veteran contended his lumbar and cervical spine disorders caused or aggravated his left hip disorder, secondary service connection is not warranted because the disorders are not service connected. After reviewing the lay and medical evidence, the Board finds that the evidence weighs against service connection for a left hip disorder, and the claim is denied. 4. Service connection for a bilateral knee disorder is denied. The Appellant, as the substitute claimant, seeks service connection for a bilateral knee disorder. In his November 2009 notice of disagreement, the Veteran contended that he had right and left knee disorders secondary to his numerous lumbar and cervical spine surgeries. In the October 2016 VA examination, the Veteran reported that he experienced left knee pain since the in-service back injury. As the back and neck disorders are not service connected, secondary service connection is not available on that basis. As the evidence shows the Veteran was diagnosed with bilateral knee osteoarthritis, the Board considered presumptive service connection under 38 C.F.R. § 3.303(b) but finds that it is not warranted. The Board further finds that service connection is not warranted for the knees on a direct basis. The Veteran’s service records, which appear to be complete, show one complaint of left knee pain in April 1970, separate from the Veteran’s complaints of back pain in March and June 1970. There was no treatment or complaints for the right knee. His separation examination was normal, and he denied a trick or locked knee, arthritis, and bone, joint, or other deformity on his report of medical history. The Veteran’s contention he experienced knee pain from service to when he filed his claim is contradictory to his initial contentions that his knee pain was related to his back and neck surgeries, which he underwent more than 30 years after service. Private and VA treatment records associated with the claims file show that the Veteran underwent knee surgery in 2000 or 2001. Osteoarthritis is not documented until August 2015. Thus, the evidence does not show that the Veteran’s knee arthritis manifested in service or shortly after service, and the credible and competent evidence does not show a continuity of symptomatology. Accordingly, presumptive service connection is not warranted. The Board further finds that direct service connection is not warranted. In addition to the service treatment records, which show one acute episode of left knee pain that resolved by separation from service (as he had no complaints at separation), and the significant period between separation and knee surgery, the Board relied on the June 2020 VA medical opinion. The examiner opined that the Veteran’s right and left knee disorders were not related to service because the Veteran’s service treatment records and medical records did not show complaints or treatment for a relevant condition in service or shortly after service. The examiner also opined that the knee disorder was unrelated to the in-service back injury because the orthopedic literature indicates that an injury to one joint would not have any significant impact on another unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis. Instead, the examiner opined that the knee condition was due to something intrinsic to the right knee itself. The Board finds that this is adequate because the examiner considered the Veteran’s contentions that his knee conditions were related to the in-service back injury and, using his expertise and orthopedic literature, thoroughly explained why this was not possible. The Board notes that the examiner missed the one episode of left knee pain in service but finds that this would not change the overall opinion because the evidence shows the Veteran did not seek follow-up treatment and it resolved by separation (again, as he denied relevant symptoms at that time). Furthermore, his opinion is otherwise supported by the evidence, including the service treatment records, which show no evidence of right knee complaints or treatment, and post-service treatment records, which show that the Veteran underwent knee surgery many years after separation from service. Finally, the Board found that the Veteran’s contentions that he experienced knee pain since service were not credible as he initially contended his knee conditions began after his back and neck surgeries in the mid-1990s. Thus, the evidence simply does not demonstrate the Veteran’s knee arthritis, documented 45 years after separation from service, is directly related to one episode of left knee pain such that a remand is warranted for a new opinion. After reviewing the lay and medical evidence, the Board finds that the evidence weighs against service connection for left and right knee disorders, and the claim is denied. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lavan 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.