Citation Nr: 21040071 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 13-03 443A DATE: July 2, 2021 ORDER Entitlement to service connection for a back disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that a back disorder began during active service or is otherwise related to service. CONCLUSION OF LAW The criteria for service connection for a back disorder 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 served on active duty for training (ACDUTRA) from July 1988 to October 1988. She also had prior and subsequent service in the Army National Guard and subsequent service in the Reserves. The matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. The Board remanded the matter for further development in June 2015, June 2020, and December 2021. The Veteran asserts that she has a back disorder related to an incident in basic training in 1987 where she sustained a laceration to her tailbone when performing sit-ups. Per the Veteran's contentions and private medical treatment records, she indicated that this laceration developed into a pilonidal cyst for which she obtained treatment starting in May 1990. See, e.g., April 2015 Hearing Testimony. Service connection may be granted on a direct basis 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). 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 the preponderance of the evidence weighs against finding that the Veteran's back disorder began during service or is otherwise related to service by virtue of the pilonidal cyst. Private treatment records indicated that the Veteran did have an infected pilonidal cyst and had sought treatment in the 1990s that resulted in the cyst being removed. The March 2021 VA examiner opined that the Veteran's diagnosed lumbar strain and degenerative joint disease were not as least as likely as not related to the skin laceration during basic training nor the pilonidal cyst. The examiner explained that there was no association between the superficial injury to the skin overlying the tailbone sustained by the veteran during basic training and the subsequent lumbar strain or degenerative joint disease. The examiner provided that the injury to the skin was a separate condition from her current back disorders, and there was no medical literature describing an association between a skin laceration or pilonidal cyst and the development of a lumbar strain or degenerative joint disease of the lumbar spine. The examiner provided that he had considered the Veteran's statements but based on the absence of medical literature supporting an etiological relationship and his personal medical experience of practicing for almost forty years and encountering musculoskeletal disorders weighed against the Veteran's contentions. The Board finds the examiner's opinions probative to the question at hand. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). While the Veteran is competent to report having experienced symptoms of back pain, she is not competent to provide an etiology opinion in this case or determine that these symptoms were manifestations of her back disorders. The issue is medically complex, as it requires knowledge of anatomical relationships, an understanding of different body systems, and knowledge of disease progression. Therefore, it is outside the competence of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the opinion of the March 2021 VA examiner. The Board also acknowledges that the Veteran received a diagnosis of arthritis in her spine beginning around 2015. VA treatment records indicated that a November 2015 lumbar spine MRI showed a transitional lumbosacral segment with mild lower lumbar degenerative change, while the xrays taken showed a normal spine. Although arthritis is a chronic disease, there is no basis to grant service connection for arthritis on a presumptive basis. See Walker v. Shinseki, 708 F.3d 1336 (Fed. Cir. 2013). There is absolutely no evidence that arthritis manifested in service or to a compensable degree within one year of discharge from her period of active duty where she sustained the laceration to her tailbone. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Therefore, entitlement to service connection on a presumptive basis is also not warranted. For the foregoing reasons, the Board finds that the claim for service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AD 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.