BVA9506278 DOCKET NO. 93-11 472 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Wilmington, Delaware THE ISSUES 1. Entitlement to service connection for degenerative disc/joint disease of the lumbar spine as secondary to service-connected chronic back strain. 2. Entitlement to an increased (compensable) evaluation for chronic back strain with degenerative disc/joint disease of the lumbar spine. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from January 1962 to January 1965, February 1973 to May 1973, and from June 1977 to February 1978. This appeal arose from a December 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Wilmington, Delaware. The RO denied entitlement to an increased (compensable) evaluation for chronic back strain. At the RO hearing held in July 1992, the veteran raised the issue of entitlement to service connection for degenerative disc/joint disease of the low back as causally related to his service- connected chronic back strain. The Board of Veterans' Appeals (Board) considers this issue to be intertwined with the issue of an increased (compensable) evaluation for chronic back strain. The Board construes the veteran's claim and appeal, based on his arguments and the testimony at his hearing to include entitlement to service connection for degenerative disc/joint disease of the lumbar spine as secondary to service-connected chronic back strain. The case has been forwarded to the Board for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has suffered from chronically disabling pain in his low back since service and that his symptoms have been diagnosed not only as chronic back pain but degenerative disease of the lumbar spine which should be considered as part of his overall low back disability. The appellant further contends that his low back disability is more disabling than currently evaluated and productive of compensable disablement thereby warranting a grant of an increased (compensable) evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the record supports a grant of entitlement to service connection for degenerative disc/joint disease of the lumbar spine as secondary to service-connected chronic back strain, thereby enlarging the grant of service connection for back strain to include the degenerative joint disease. FINDING OF FACT Degenerative disc/joint disease of the lumbar spine is causally related to service-connected chronic back strain. CONCLUSION OF LAW Degenerative disc/joint disease of the lumbar spine is proximately due to or the result of service-connected chronic back strain. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. § 3.310(a) (1994). REASONS AND BASES FOR FINDING AND CONCLUSION Initially the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that he has presented a claim which is plausible. The Board is satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). A review of the service medical records for the first period of active service from January 1962 to January 1965 shows the veteran was treated for low back pain on several occasions including inpatient care in 1964. A VA neurologic and orthopedic examination conducted in September 1965 concluded in a diagnosis of chronic back strain, slight. The RO granted entitlement to service connection for chronic back strain which was assigned a noncompensable evaluation when it issued a rating decision in October 1965. The service medical records for the second period of active service from February to May 1973 show the veteran was treated for low back pain and reported that running caused him considerable pain. VA outpatient treatment reports dated during 1991 show the veteran reported on several occasions for treatment of chronic low back pain said to have been in existence for 30 years. The diagnostic impressions to account for his low back symptomatic complaints were degenerative disc and joint disease of the lumbosacral spine. At an April 1992 VA general medical examination the veteran reported that he had begun having low back pain in 1964. Evaluation of the lumbosacral spine disclosed range of motion was restricted to 5 degrees in flexion and extension and side to side movement. VA outpatient treatment reports dated during 1992 show the veteran was seen on several occasions with complaints of low back pain said to have chronically worsened only recently. The veteran provided testimony at an RO hearing held in September 1992. He described the nature and extent of back pain said to have been experienced since service. At a September 1992 VA orthopedic examination the veteran complained of spinal pain. He reported having been under the care of VA physicians and chiropractors. Thoracolumbar spine forward flexion was to 25 degrees and extension was 0 degrees. Lateral bending to the right was 25 degrees and to the left was 15 degrees. The above motions were performed with complaints of pain. Palpation revealed tenderness over the lumbar paravertebral muscles, mostly on the left. Straight leg raising was to 90 degrees in the seated position and to 45 degrees in the supine position with complaints of low back pain. No neurological abnormality referable to the lower extremities was reported. However, the examiner requested a neurological examination based upon the veteran's symptoms in his lower extremities. The diagnosis included a finding of degenerative joint disease involving the spine. The appellant was hospitalized by VA in October 1992 with complaints of sharp pains in the neck and low back attributed to an Army injury in 1964. He complained of "shooting" low back pain to the posterior left thigh, hips and knee. A myelogram and computerized axial tomographic scan demonstrated a probable herniated nucleus pulposus at L1-L2; a herniated nucleus pulposus at L4-5 central and left; obliteration of the nerve root sleeve at left L5-S1, probably secondary herniated nucleus pulposus; and degenerative joint disease indenting the thecal sac at C4-C7. The Board's evaluation of the clinical history relative to the veteran's low back pain permits the conclusion that his low back symptomatology, however classified, is one disease process. There is no dispute that low back pain commenced during the appellant's first period of active service. It was initially diagnosed as lumbar strain, low back pain, etc. Essentially it was pain confined to the lumbar or lower region of the back. The record shows that the pain has been persistent since the first period of service, and was noted during the second period of service. The post service VA clinical reports show that the veteran's low back pain, persistent through the years, chronically worsened during the immediately preceding years, or in the early 1990's. Comprehensive diagnostic studies have revealed degenerative disc and joint disease of the lumbar spine. The Board views the degenerative disc/joint disease as a complication of the veteran's basic underlying chronic low back pain/strain which commenced in service. It would be unreasonable to dissociate the claimant's recently diagnosed degenerative disc/joint disease of the lumbar spine from his service connected chronic back pain. For the foregoing reasons it is the judgment of the Board that service connection is warranted for degenerative disc/joint disease as secondary to the service-connected chronic back pain. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.310(a). ORDER Entitlement to service connection for degenerative disc/joint disease of the lumbar spine as secondary to service-connected chronic back strain is granted. REMAND In view of the Board's grant of service connection for degenerative disc/joint disease, thereby enlarging the grant of service connection for the veteran's low back impairment, the case must be remanded for additional development and rating action: Accordingly, the case is REMANDED for the following: The veteran is to be given a neurological examination to determine the extent of disability present referable to his low back currently identified as low back strain with degenerative disc/joint disease. All indicated studies are to performed. The examiner is to review the prior medical studies in the claims folder before conducting the neurological examination. Afterwards, the RO is to readjudicate the issue of the entitlement to a compensable rating for the low back strain with degenerative disc/joint disease. The RO is to notify the veteran and representative of the decision. If appropriate, the case is to be returned to the Board for further appellate review. BRUCE KANNEE Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).