Citation Nr: 22019945 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 14-02 504 DATE: April 3, 2022 ORDER Entitlement to service connection for low back pain (hereinafter back disability) is granted. FINDING OF FACT Resolving all reasonable doubt in the Veteran's favor, the Veteran's back disability had its onset in service and has continued since that time. CONCLUSION OF LAW The criteria for service connection for a back disability have been met. 38 U.S.C. §§ 1110, 1111, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for training (ACDUTRA) from March 1989 to May 1989 and had active-duty service in the U.S. Army from November 2009 to June 2010. She also had service with the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that this case has a lengthy appeal stream, as it was previously remanded for further development in July 2015, November 2018, November 2020, August 2021, and December 2021. Following the December 2021 Board remand, an addendum medical opinion was obtained. Therefore, the issue is again before the Board. Entitlement to service connection for a back disability. The Veteran contends that her current back disability manifested during active service and continued since 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). The Veteran has a current diagnosis of lumbosacral strain and low back pain. See November 2016 VA Examination; September 2018 Women's Health Note, Leavenworth VAMC Division. During service, the Veteran was diagnosed with back strain in the sacroiliac region due to back pain with sit-ups in January 2010. The Board notes that the Veteran has underwent several VA examinations regarding her back disability. Each of these examinations were deemed inadequate, warranting remands to obtain addendum opinions. In the most recent addendum opinion from January 2022, 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 reaching this rationale, the examiner noted there was no evidence of an ongoing back condition until 2016, at which time the lumbar strain was diagnosed. Moreover, the examiner opined that it is more likely than not that the back strain occurring in October 2010 was acute, self-limited, and resolved. The very nature of lumbar strain would lead to intervention prior to a span of 6 years, had the condition been continuous. Therefore, any reports regarding the onset of the Veteran's back disability during service with continuity since service are not consistent with the natural pathophysiology of the condition and related symptoms. Furthermore, the examiner noted that the Veteran clearly did not have an ongoing back condition in August 2012. Therefore, the Veteran's lumbar strain likely had its nexus in or around 2016. While the specific cause cannot be delineated from the available records, it is likely due to overuse, lifting, or an acute irregular motion. Overall, it is less likely than not that the Veteran's lumbar strain had its nexus in service or is due to or incurred in, or related to events in service, including the strain identified in 2010. The Board finds the January 2022 examination to be in contrast with the medical evidence of record, therefore providing it to be of minimal probative weight. Initially, the Board recognizes the extensive, detailed, and numerous medical records available in this case. However, in contrast with the January 2022 opinion, the Veteran continually reported back pain and back issues since service. See, e.g., October 2010 Radiology Reports (showing no definite decrease in the height of the vertebral bodies after the Veteran complained of low back pain and pain with sit-ups); October 2010 and December 2010 St. John's Therapy Notes (showing a diagnosis of low back instability with difficulty performing sit-ups); August 2011 Statement of Medical Examination and Duty Status (reporting lower lumbar pain with sit-ups); August 2012 Physical Profile (noting chronic back pain); July 2013 Chronological Record of Medical Care (reporting low back pain and being unable to run or do sit-ups); April 2014 Primary Care Note (showing complaints of low back pain). The Board finds the Veteran's service and post-service medical treatment records, statements made by treating physicians in the record, as well as lay statements made by the Veteran of her symptoms, to be competent, credible and highly probative in this matter. After resolving all reasonable doubt in the Veteran's favor, the Veteran's back disability had its onset in service and has continued since that time. Therefore, entitlement to service connection for a back disability is granted. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laura Cochran, 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.