Citation Nr: 21022230 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 17-67 141 DATE: April 15, 2021 ORDER Entitlement to service connection for a back strain is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s current back strain began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a back strain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 2003 to July 2007. This case is before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a Board video conference hearing. The transcript of the hearing has been associated with the record. The Board remanded this case in January 2020 to determine whether the Veteran has a current low back disability. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that he has had chronic lower back pain since separation from active duty. Service connection will be granted for a current disability that resulted from an injury, disease, or aggravation while in active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the evidence demonstrates the Veteran has had a back strain during the pendency of the claim, and evidence shows that in-service injury occurred in 2006, the preponderance of the evidence weighs against finding that the Veteran’s current back strain began during service or is otherwise related to an in-service injury. The Veteran denied the presence of back pain in a May 2007 report of medical history conducted a couple of months prior to his separation from service. A July 2011 VA treatment record notes the in-service injury and that no treatment or physical therapy was done, and the pain subsided after rest. In March 2015, within a month after the Veteran filed his claim, a VA physical therapy outpatient evaluation note stated the Veteran presents with chronic low back pain due to a muscular imbalance of lower extremity musculature as the Veteran presents with weakness of glutes and core, which contribute to his impaired body mechanics and impaired posture. The note demonstrates the VA physical therapist conducted diagnostic testing. In August 2019, a private chiropractor I.V. opined it is with reasonable medical probability (greater than 50 percent) that the Veteran’s chronic low back pain is directly correlated to the April 2006 service-related injury as there was no notation or prior history of trauma until this incident, and the Veteran reported no significant subsequent trauma since the April 2006 service-related injury. A February 2020 VA examiner evaluated the Veteran, reviewed the record, and opined the back strain was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury. The examiner noted that the chiropractic record indicates ongoing lower back pain attributable to his injury, though no in-service records are otherwise available, and an x-ray of the lumbar spine was not done at the time of his injury, though for lower back strains in 22 year-olds, x-rays are usually not indicated. In September 2020, the examiner clarified his opinion, stating that the record has inconsistencies in the documentation of events regarding history, treatment, and imaging studies of the Veteran’s in-service injury and back disability; therefore, it is less likely than not that the lumbar strain is a result of the Veteran’s in-service injury. While the Veteran is competent to report having experienced back pain symptoms since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his current back strain. The issue is medically complex, as it requires knowledge of the interaction between the musculoskeletal system in the body. Jandreau, 492 F.3d at 1377, 1377 n.4. The March 2015 VA physical therapist’s finding that the back pain was due to the muscular imbalance of his lower extremity, not an injury, is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board agrees with the February 2020 VA examiner’s observation that the August 2019 private chiropractor’s opinion is not based on an accurate reflection of the record. The private chiropractor I.V.’s opinion is less probative than March 2015 VA physical therapist’s finding. There is no indication that I.V. reviewed the pertinent medical evidence in the claims file. Instead, the opinion appears to be based on the Veteran’s self-reported medical history, which is inconsistent with VA treatment records that show the residual pain associated with injury subsided with rest and that low back pain returned due to muscular imbalance of the lower extremity. Id.; Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Consequently, the Board gives more probative weight to the March 2015 physical therapist’s finding. The Veteran believes his current back strain is related to an in-service injury. The Veteran, in this case, is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of musculoskeletal system relationships. Therefore, it is outside the Veteran’s competence in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the March 2015 VA physical therapist’s finding. (Continued on the next page)   In deciding to deny the claim for service connection for the back strain, the applicability of the benefit of the doubt doctrine has been considered; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56; 38 C.F.R. § 3.102. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Costa, 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.