BVA9502386 DOCKET NO. 91-51 983 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for residuals of low back injuries. ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The appellant had active duty for training from June 26, 1981, to November 19, 1981, from May 16 to May 27, 1983, from May 24 to June 8, 1986, from September 16 to September 18, 1986, and on September 22, 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 19, 1991, rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO committed error in failing to grant service connection for his currently manifested residuals of low back injuries because it did not take into account or properly weigh the medical and other evidence of record. It is contended that he initially injured his back in May 1983 while undergoing airborne school training and that he again injured his back in June 1986 while on two weeks' active duty as the result of doing sit-ups. He asserts that he did not report the injury which occurred in 1983 because he had failed to complete the course on a prior occasion and he did not want to fail again. 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 evidence supports the claim for entitlement to service connection for residuals of low back injuries. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained by the RO. 2. The claimant has low back pathology which is reasonably demonstrated to have resulted from injuries during active or inactive duty for training. CONCLUSION OF LAW Residuals of low back injuries were incurred during active or inactive duty for training. 38 U.S.C.A. §§ 101(24), 106, 1131 (West 1991); 38 C.F.R. § 3.303(b) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant's claim is plausible and thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), which mandates a duty to assist the claimant in developing all pertinent evidence. In this connection, we note that the case was remanded to the RO by Board decisions in March 1992 and in March 1994 for additional development of the medical and other evidence of record. On appellate review, we see no areas in which further development might be fruitful. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing active duty for training or injury incurred or aggravated while performing inactive duty training. 38 U.S.C.A. §§ 101(24), 106, 1110, 1131 (West 1991). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1993). Reports of medical history and medical examination in connection with Army Reserve service in January 1983 reflect no history or clinical findings of a back disorder. Service records confirm that the appellant attended an airborne training school and made numerous jumps during May 1983. Reports of medical history completed by the claimant and a report of medical examination in connection with National Guard enlistment, dated in October 1985, show no history or findings of a back disorder. Service medical records confirm that the appellant served on active duty for training for two weeks during May and June 1986 and that he sought treatment in June 1986 for back complaints. The claimant attributed his current complaints to doing sit-ups. Examination disclosed minimal tenderness with the possibility of some spasm in the area of the sacroiliac joint, right. The clinical assessment was mild muscle spasm. The service medical records do not indicate the presence of a chronic back disorder. Since a chronic back disorder was not shown during service, continuity of symp- tomatology after discharge is required to support the claim. 38 C.F.R. § 3.303(b) 1993). The claimant has submitted additional medical evidence in support of his claim. That evidence includes medical records from Nashville Orthopedic Associates, including those of M .R. Christofersen, M.D., and S. G. Hopp, M.D., dated from January 1991 to August 1991. The earliest post-service medical records in the claims file are dated in January 1991 and refer to X-rays from 1989 and from November 1990. The X-rays were interpreted as suggestive of some loss of disc space at L5 - S1, with mild anterior osteophyte formation. On interview and examination in January 1991, the claimant stated that he worked as a security guard and also part time as a process server. He stated that he injured his back while parachuting in 1982 and that he experienced some pain in the summer of 1985 during National Guard training. He dated the onset of relatively constant back pain to approximately the summer of 1989. His current symptoms included basic low back pain with occasional rare radiation down the left leg, worse in the morning. Recently, when he was asked to empty recycling trash bins at work, his pain had been somewhat worse. On examination, the claimant could bring his fingertips to mid-tibia and arise with some difficulty; and he could walk on heels and toes. There were some signs of lateralizing. The claimant was prescribed exercises for back pain and given pain medication. A subsequent report of interview and examination in January 1991 shows that the claimant reported three months' history of low back symptoms, with recent worsening, especially in the morning. He worked as a security guard, which involved sitting and being on his feet. He reported a history of exacerbations of back symptoms periodically since the onset following an injury in jump school. A patient history completed by the claimant in January 1991 cited his back complaints and indicated that the date of onset was in 1984. A May 1991 letter from D. E. Gremillion, M.D., stated that the appellant participated in a clinical study and had a neck injury. Private treatment records from D. S. Knapp, M.D., dated in June and July 1991, show that the appellant was seen for complaints of back stiffness and limitation of flexion. Magnetic resonance imaging (MRI) in June 1991 revealed evidence of degenerative disc disease and probable discitis at about the L5 - S1 level. Private treatment records from S. G. Hopp, M.D., dated in July 1991, show that the claimant was seen with complaints of constant and increasing low back pain and left inner thigh discomfort. He offered a history of jumping out of planes while in the military in 1984. Treatment with pain medication and physical therapy was reportedly unavailing. Findings on physical and radiographic examinations and on MRI in June 1991 were described. The clinical impressions were lumbar syndrome without objective radiculopathy, superimposed on degenerative disc disease, L5 - S1; and possible discitis. Private treatment records from Dr. Hopp, dated in September 1991, cite the claimant's statement that "He is working doing some recycling and having to bend over a lot for this," causing increased back pain. The claimant further stated that he was involved in a motor vehicle accident one month earlier, when his car was struck from the side and that he was sore all over for three days. X-ray examination disclosed no significant change. The claimant was advised to avoid bending at work. A report of VA orthopedic examination, conducted in July 1994, cited a history recounted by the appellant dating the onset of low back pain to physical exercise during Army Reserve service in 1981. He further reported back pain after landing on his back in a parachute jump while on Reserve training in 1983 and a history of low back pain after doing sit-ups in 1984, asserted that he was diagnosed as having a low back problem in 1985, and indicated that he experienced increased low back pain and numbness of the lower extremities throughout 1986, 1987, 1988, and 1989. His chief complaint was recurrent low back pain. He stated that he was employed as a security guard and that his duties did not require him to do any strenuous activities or heavy lifting. He further states that if he attempted to lift more than 20 pounds he experienced low back pain radiating into one extremity, then the other. Clinical findings on orthopedic, neurologic, and radiographic examinations were described. The diagnosis was degenerative lumbar disc disease and degenerative arthritis, L5 - S1. The VA examiner stated that the veteran's history indicated that the onset of symptoms occurred while he was serving on active duty and offered the opinion that his lumbosacral degenerative arthritis and degenerative disc disease were related to activities in which he participated while on active duty. The record amply documents that the claimant was a participant in jump school. Given the nature of those activities, his history of an injury which he was loathe to report is consistent with the evidence of record. The credibility of his history is further buttressed by the consistency with which he reports it. We do not find significant the fact that the precise date(s) of his jump injury vary, but are persuaded by the fact that the description of the nature of the injury has remained constant. And the exercise (sit-up) injury noted regularly in clinical records was documented in service. A VA orthopedic examiner has attributed the veteran's current low back pathology to the injuries on active/inactive duty for training. There is no medical evidence rebutting this opinion. Accordingly, we find that the veteran has residuals of low back injuries which were incurred during training service. ORDER Service connection for residuals of low back injuries is granted. GEORGE R. SENYK 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. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.