Citation Nr: 18131195
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 14-30 769
DATE:	August 31, 2018
Entitlement to service connection for lumbar spine degenerative joint disease is granted.
Back pain symptoms were chronic in service and continuous after service separation.
Resolving reasonable doubt in the Veteran’s favor, the criteria for lumbar spine degenerative joint disease have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. 3.307, 3.309 (2017).
The Veteran served in the United States Army from January 2003 to April 2006.
1. Entitlement to service connection for a low back condition
Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995).  The third element, that of “nexus” may also be demonstrated by a showing of continuity of symptomatology for certain enumerated chronic diseases.  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  Pertinent to this appeal, “arthritis” is considered a chronic disease, and the Veteran’s diagnosed degenerative joint disease is a form of arthritis.  See 38 C.F.R. § 3.309; DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1344 (32d ed. 2012) (reflecting that degenerative joint disease, osteoarthritis, arthritis, and degenerative arthritis are interchangeable terms).
With regard to a present disability, a July 2015 MRI showed lumbar degenerative joint disease with disc protrusions. Further, the May 2018 VA examiner diagnosed the Veteran was a lumbar strain. Thus, the first Shedden/Caluza element is met.
With regard to an in-service disease or injury, the Veteran’s service treatment records (STRs) show the veteran sought treatment for a back injury and pain several during active service. In November 2003, the Veteran reported his Humvee got hit by an improvised explosive device (IED) which threw him out of the vehicle and injured his back. In August 2004, December 2004, and January 2005, the Veteran reported ongoing back pain. Upon separation in February 2006, the examiner noted mechanical low back pain. Accordingly, the second Shedden/Caluza element is also met.
Turning to nexus, the evidence of record supports that the Veteran’s current low back disorder is etiologically related to his active service.
VA treatment records dated November 2007 to January 2018 reflect ongoing treatment for complaints of low back pain. In November 2007, the Veteran was noted to have musculoskeletal pain and was advised to take over the counter medicine. The Veteran also complained of back pain as an ongoing problem even when seeking treatment for other unrelated impairments. See e.g. VAMC treatment records dated August 19, 2015, November 14, 2016, August 3, 2017, and December 13, 2017. For example, upon VA examination for posttraumatic stress disorder in February 2016, the Veteran reported he has had back pain since service in Iraq, which has caused him difficulties at work due to pain. The Board finds that medical histories provided by a patient for treatment purposes are highly probative as they are made for the purpose of receiving proper medical care.
In January 2011, the Veteran’s wife provided a statement in support of his claim. She stated that the Veteran takes a significant amount of time to get out of bed due to his back pain. 
The Veteran has provided lay testimony identifying chronic back symptoms in service after the 2003 IED injury and continuous symptoms post-service, which included complaints of back pain within one year of separation. In April 2014, the Veteran provided a statement that following the injury in December 2003 he was told by Army doctors that there was nothing they could do for him and gave him Tylenol. Further, the Veteran stated, upon returning to Fort Riley, he attended physical therapy and was told he was going to be in pain for the rest of his life. In August 2014, the Veteran stated on his VA Form 9 that his back condition prevented him from obtaining certain jobs and has negatively affected his family life. 
The Board notes that there are two negative nexus opinions of record. In March 2013, a VA examiner opined that the Veteran’s back pain is most likely due to his obesity and noted a lack of ongoing treatment for back pain. The Board finds this opinion to lack probative value because when considering chronic conditions, “symptoms, not treatment, are the essence of any evidence of continuity of symptomatology,” Savage v. Gober, 10 Vet. App. 488, 496 (1997), and post-service treatment records contain evidence of ongoing symptomatology.  
In May 2018, a VA examiner opined it was less likely than not that the Veteran’s back impairment was due to his military service because although the STRs showed a back injury, he was not noted to have any objective signs of radiculopathy after the incident and was deemed fit for service after the injury. The Board finds this opinion to be of minimal probative value because although the Veteran was deemed fit for service, the record demonstrated ongoing issues with back pain since the initial 2003 injury. 
In contrast, the weight of the evidence shows that the Veteran experienced chronic symptoms of low back pain in service, and post-service treatment records, and competent and credible lay statements show continuous symptoms of low back pain after service separation.  The Board finds this evidence highly probative as to the issue of nexus.  
In sum, the Board finds that the evidence of nexus is, at a minimum, at least in equipoise, and the benefit of the doubt will be conferred in the Veteran’s favor.  The final Shedden/Caluza element is met.
Having satisfied the elements of service connection, service connection for lumbar spine degenerative joint disease is warranted.
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Laura A. Crawford, Associate Counsel 

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