Citation Nr: 21024252 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-20 536 DATE: April 22, 2021 ORDER Entitlement to service connection for a back disability is denied. FINDING OF FACT A back disability did not have its onset during the Veteran’s active service and is not otherwise etiologically related to such service, and thoracolumbar spine arthritis was not present to a compensable degree within a year of his separation from active service CONCLUSION OF LAW The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from January 1986 to July 1991. He also served in the Florida Army National Guard from August 1991 to August 1993. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In March 2019, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is of record. This case was previously before the Board in October 2020, at which time the issues currently before the Board were remanded for additional development. The case has now been returned to the Board for appellate review. Service Connection – Back Disability The Veteran asserts that he has a back disability that is related to his active service. Specifically, he asserts that he had to lift heavy mail bags during active service and has continued to have worsening back problems since his in-service lumbar strain. Service treatment records (STRs) show that the Veteran was seen in January 1991 for complaints on intermittent low back pain over the prior two years. The examining clinician at that time found that the symptoms were indicative of scoliosis, and the Veteran was sent for diagnostic imaging and physical therapy. A January 1991 lumbar spine imaging study revealed no evidence of fracture or dislocation, and the sacroiliac joints appeared normal. There was no confirmation of scoliosis, or any other abnormal curvature of the spine, at that time. In January 1991, the Veteran was seen by physical therapy. The physical therapist noted that the Veteran had an increase of his symptoms due to heavy lifting, and diagnosed mechanical back with kyphosis. Again, as noted, kyphosis was not confirmed by diagnostic imaging. In February 1991, the Veteran was afforded a periodic examination, which ended up serving as his separation examination. At that time, the Veteran specifically reported recurrent back pain on his Report of Medical History, and reported experiencing lower back problems for which he was being seen for physical therapy. The examining clinician noted low back pain which was thought to be secondary to dextro-scoliosis. Again, the finding of scoliosis was not confirmed by diagnostic imaging. In October 1991, the Veteran was afforded a VA examination. At that time, the Veteran reported that he had first started to experience back pain in 1988. He denied specific trauma at that time. He was provided treatment and he reported that his pain resolved. He then reported that he began to experience back pain again in February 1991 while shoveling snow. He was treated with over-the-counter medication and massage, and advised on exercises to improve his back. After two months, the Veteran was returned to fill duty. He reported that his back pain had continued after his separation from service, but that he was not receiving treatment or taking medication. X-rays taken of the spine at that time revealed a normal lumbosacral spine. The examiner diagnosed lumbosacral strain. In November 2009, the Veteran was seen at the VA Medical Center emergency room for complaints of chronic low back pain that had worsened over the past few weeks when he started working in manual labor again. The Veteran was prescribed pain medication for treatment and told to follow-up with a primary care physician. There is no indication from the emergency department records that the Veteran reported persistent back pain since active service at that time. In January 2010, the Veteran was seen at the VA Medical Center for reports of low back pain with exacerbation. At that time, the Veteran was assigned a provisional diagnosis of low back pain with muscle spasm and he was prescribed medication for treatment. There is no indication from the treatment note that the Veteran reported back pain since service at that time. A March 2010 lumbar spine imaging study revealed degenerative arthrosis of the facet joints at L4-S1. A September 2012 magnetic resonance imaging scan (MRI) revealed mild, multi-level, degenerative changes, and facet osteoarthritis. At a January 2014 VA examination, the Veteran reported that he had experienced acute back pain during service. The examiner noted that there was no documentation of chronic lumbar problems following service separation until November 2009. The examiner diagnosed intervertebral disc syndrome. The examiner opined that the Veteran’s back disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner noted that that the Veteran was diagnosed with mild/acute lumbar strain in 1991, which resolved without residual. The examiner further noted that October 1991 VA examination documented a normal lumbar spine, and X-rays were negative at that time. The examiner further reported that there was no documentation of treatment for back complaints until November 2009, 18 years following the Veteran’s separation from service. In May 2014, the Veteran was seen at the VA Medical Center for a chiropractic consultation. At that time, the Veteran reported that he had been experiencing back pain since approximately 1991, when he injured himself while shoveling snow. He reported that he continued to experience back pain following his separation from service, and that he sought treatment from a Chicago area chiropractor in the late 1990’s, after which his back pain eventually subsided. He reported intermittent pain since that time, until 2008 when he moved to Florida and his back pain increased in severity. An August 2015 lumbar spine MRI revealed moderate L4-5 canal stenosis, without any significant changes from prior imaging. A September 2018 lumbar spine MRI revealed moderate lumbar spondylosis at L4-5 with moderate to severe spinal canal narrowing, that was slightly worse from prior imaging in 2015. In December 2020, the Veteran was afforded another VA examination of his back. At that time, the examiner confirmed a diagnosis of lumbar spine degenerative joint disease with degenerative disc disease. The examiner opined that it was less likely as not that the Veteran’s back disability was related to his active service. In so finding, the VA examiner noted that the medical literature did not support a finding that heavy object lifting that the Veteran performed as a part of his in-service duties would have resulted in the development of his degenerative arthritis or degenerative disc disease. The examiner explained that those types of activities ate not associated with enough forceful trauma to injure his lumbar spine and cause degenerative changes later in life. Specifically, the examiner cited to literature that among persons with known risk factors for degenerative lumbar disc disease, but with no history of serious lower back pain, minor trauma does not appeal to increase the risk of serious low back pain episodes or disability. The examiner continued that major trauma would include that of traffic accidents at greater than 30 miles per hour, falls from heights greater than three feet, and lifting injuries with awkward posture and greater than 50 pounds. Further, the examiner noted that the Veteran has had since his separation from active service reflect the cumulative effects of wear and tear over the 27 years following the Veteran’s service separation. The examiner noted that imaging studies did indicate that the impression was that of a gradual process. The examiner further noted that the medical literature supported a finding that when the Veteran first developed degenerative changes at age 43, there would have been a high likelihood of having such findings by that time. Specifically, the examiner cited to literature showing that disc degeneration and accompanying arthritis is a common development, and age related changes are present in 40 percent of adults over age 35, and in almost all individuals over age 50. Additionally, the examiner noted that while the Veteran has reported continued back pain since his lumbar strain in 1991, and that his condition has worsened over time, the examiner noted that imaging studies and medical literature do not support that those observations would have been sufficient to demonstrate a causal relationship with the activities he did while on active duty, to include lifting heavy mail bags, and his current lumbar spine disability. The examiner also commented on the in-service findings of kyphosis and scoliosis. Specifically, the examiner noted that those findings were not confirmed by serial imaging studies while in active service, or after he left active service, to include the most recent MRI conducted in September 2018. The Board finds that the December 2020 VA medical opinion is adequate because the examiner thoroughly reviewed the claims file and discussed the relevant evidence, considered the contentions of the Veteran, and provided a thorough supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, there is no medical opinion of record to the contrary. As such, the VA medical opinion of record is the most probative evidence of record. While the Veteran is competent to report symptoms of a back disability, he is not competent to link his current diagnosis of a back disability to his active service. An opinion of that nature requires medical expertise and is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. Further, the Veteran has not been found to have a diagnosis of arthritis of the spine that was manifest to a compensable degree within a year of his separation from active service. In fact, post-service diagnostic imaging conducted within one year of the Veteran’s separation was service was negative for any abnormalities. Therefore, presumptive service connection for arthritis of the spine is not applicable in this case. 38 C.F.R. § 3.309(a). In sum, while the Veteran did have treatment for back pain during service, the post-service medical evidence of record does not show that the Veteran has a current back disability that had its onset during his active service, or is otherwise related to his active service. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to entitlement to service connection for a back disability is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. Umez-Eronini, 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.