Citation Nr: 21027582 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-33 384 DATE: May 6, 2021 ORDER Entitlement to service connection for degenerative joint disease (arthritis) of the lumbar spine is denied. REMANDED Entitlement to service connection for degenerative joint disease in all joints except for the lumbar spine is remanded. FINDING OF FACT The Veteran's lumbar spine arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for lumbar spine arthritis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Air Force from October 1964 to October 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO); this case is in VA's legacy appeals system. In February 2011, the Veteran filed his claim in this matter for "DJD for all joints." In August 2020 the Board of Veteran's Appeals (Board) remanded the claim to obtain an examination. At that time the Veteran's only diagnosed arthritis was of the lumbar spine. The RO provided an examination of the Veteran's back but no other joints. Because the evidence is sufficient to support a decision on the issue of entitlement to service connection for lumbar spine arthritis the Board has issued the decision below. However, the Veteran's medical records show he was recently diagnosed with right knee arthritis. The claim for service connection for joints other than the lumbar spine is therefore addressed in the remand section. 1. Entitlement to service connection for degenerative joint disease of the lumbar spine The Veteran contends that his currently diagnosed lumbar spine arthritis is related to his active military service. Alternatively, he contends that it is a chronic condition which should be presumptively connected to service. 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). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of degenerative arthritis of the lumbar spine as evidenced by a May 2011 x-ray and confirmed by November 2020 VA examination. Degenerative arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records show the Veteran was not diagnosed with lumbar spine arthritis until May 2011, four decades after his separation from service and four decades outside of the applicable presumptive period. The Veteran's service treatment records, including his June 1968 separation examination, are silent for complaint, diagnosis, or treatment of any back condition. In November 2020 VA provided an examination to determine the cause and severity of any back condition. The Veteran stated that he developed back pain from heavy lifting in service, but he did not seek medical treatment for back pain until sometime in 2020. He did not explicitly state whether this limited his range of motion or continued after service. His post service treatment records are silent for any diagnosed back condition before a May 2011 chest x-ray noted mild degenerative changes of the spine. The VA examiner diagnosed degenerative arthritis of the lumbar spine and opined that it was less likely than not related to service. The rationale provided was that there was no indication of a chronic condition during service or on the Veteran's separation examination and that he worked as a trucker, making the more likely cause of his lumbar spine arthritis his age and "heavy-duty" civilian employment. While the Veteran is competent to report having experienced symptoms of back pain during service and consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of lumbar spine arthritis as the Veteran has not demonstrated the necessary medical expertise. This issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). While the Board finds his statement that he had back pain during service credible, the Veteran has not described, and his medical records do not reflect, continuous symptoms from the year after separation until his diagnosis. The Board gives more probative weight to competent medical evidence, which establishes that these symptoms, once they developed, were instead attributable to the Veteran's age and heavy-duty civilian job. Because the Veteran's back symptoms were not noted as chronic during service, did not manifest to a compensable degree within a one-year presumptive period, and were not noted in service with attributable continuity of symptomatology, service connection for lumbar spine arthritis as a presumptively service-connected chronic condition is not warranted. Service connection for lumbar spine arthritis may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran's lumbar spine arthritis and an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. As discussed above, the November 2020 VA examiner opined that the Veteran's lumbar spine arthritis is less likely than not related to his active service and more likely related to his age and civilian employment. While the Veteran believes his lumbar spine arthritis is related to an in-service injury, event, or disease, including heavy lifting and marching during service, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence, specifically the opinion of the November 2020 VA examiner. Because the preponderance of the evidence is against the Veteran's claim that his lumbar spine arthritis began during service or is related to an in-service injury, event, or disease, service connection on a direct basis is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for degenerative joint disease in all joints except for the lumbar spine is remanded The Board cannot make a fully-informed decision on the issue of entitlement to service connection for degenrative arthritis of all joints except the lumbar spine because no VA examiner has opined whether the Veteran has one or more qualifying condition which is related to his active military service. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for all joints. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. For each joint with a diagnosed condition, the examiner is asked to provide a response to the following: Is this condition at least as likely as not related to service, including heavy lifting and marching with body armor? Provide a rationale to support the opinions. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Is it at least as likely as not that the Veteran has arthritis which (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.