lumbosacral Entitlement To Service Connection For A Low Back Disability.

[allan]

92 Decision Citation: BVA 92-26148

Y92

BOARD OF VETERANS' APPEALS

WASHINGTON, D.C. 20420

DOCKET NO. 92-53 970 ) DATE

)

)

)

THE ISSUE

Entitlement to service connection for a low back

disability.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

T. H. Tousley, Associate Counsel

INTRODUCTION

The veteran had active military service from July 1968 to

December 1990.

This matter came before the Board of Veterans' Appeals

(Board) from an appeal of a rating decision in July 1991 by

the Department of Veterans Affairs (VA) regional office (RO)

in Phoenix, Arizona. The veteran submitted a notice of

disagreement in September 1991. The RO issued a statement

of the case in October 1991. The veteran submitted a

substantive appeal in November 1991. The case was docketed

at the Board in January 1992. The veteran's representative,

the Disabled American Veterans, submitted additional written

argument in April 1992.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that he has a chronic low back

disability that began during service. He asserts that he

has experienced mild to extreme pain in his back for almost

20 years. He contends that he cannot do any heavy lifting,

bending, or sitting the wrong way for fear of hurting his

back again. He states that he only sought medical treatment

during service when he had extreme back pain because he

wanted to stay at his job as an air traffic controller.

DECISION OF THE BOARD

In accordance with the provisions of 38 U.S.C.A. § 7104

(West 1991), following review and consideration of all

evidence and material of record in the veteran's claims

file, and for the following reasons and bases, it is the

decision of the Board that the evidence supports a grant of

service connection for a low back disorder.

FINDINGS OF FACT

1. The RO has obtained all evidence necessary for an

equitable disposition of the veteran's claim.

2. The veteran received treatment during service on

mulitple occasions for low back strain.

3. Degenerative joint disease of the lumbosacral spine was

shown within one year after separation from service.

CONCLUSION OF LAW

A low back disability was incurred while in active military

service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R.

§§ 3.102, 3.303, 3.304, 3.307, 3.309 (1991).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board finds that the veteran's claim is well grounded

within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). We

are satisfied that all the relevant facts have been properly

and sufficiently developed for an equitable disposition of

this claim.

The service medical records reveal the veteran was

conservatively treated on several occasions for episodes of

low back pain that were often diagnosed as a lumbosacral

strain. In reference to lumbosacral strain:

The true joints of the spine are the

apophyseal joints formed by the superior

and the inferior articular processes of

the posterior neural arch. During

flexion, extension, and rotation of the

spine, gliding motions take place between

the apposed flat facets, which are

covered with hyaline cartilage. The

articulation is surrounded by a

ligamentous capsular structure that is

loose enough to permit motion but becomes

taut at the extremes of each movement.

Like other ligaments it is subject to

stretching and tearing, particularly by

hyperextension, as a result of which the

facets subluxate on each other. 2 Turek,

Orthopedics Principles and Their

Application, at 1512 (4th ed. 1984).

Predisposing factors encourage tearing of

the capsule and subluxation

include the following:...Chronic

occupational strains require excessive

bending and lifting. Id.

At the outset, tearing of ligaments and

subluxation are manifest by local

symptoms of low back pain accentuated by

motion that stretched the ligaments,

namely, hyperextension. Later, as the

nerve root is compressed, sciatica and

neurological findings referrable to the

fifth lumbar nerve root become

prominent. Eventually, symptoms of

localized degenerative arthritis are

super imposed. Id. at 1513.

Clinical Picture. A history is often

given of repeated episodes of acute low

back pain caused by forceful

hyperextension. Between attacks,

hyperextension movement of the back

increased pain whereas flexion reduces

it....As time goes on symptoms of nerve

root irritation appear, including

sciatica, paresthesias, numbness over the

dorsomedial aspect of the foot, and

weakness of dorsiflexion of the large

toe....Id.

On examination,...[l]ocalized tenderness

is observed about the lumbosacral

junction. In the acute stage the back

muscles are in spasm, and motions are

restricted in all directions....An

increased lumbar lordosis and any

rounding of the dorsal spine should be

noted. The straight leg raising test may

accentuate the low back pain at the

extreme point of the maneuver, because

the capsular structures are

stretched....Id. at 1513-114.

Chronic Stage....Arduous occupational

activities are prohibited....Exercises

[Williams] are aimed at developing the

flexor muscles of the lumbosacral spine.

Id. at 1515.

The pertinent regulation provides:

Service connection connotes many factors

but it basically means that the facts,

shown by evidence, establish that a

particular injury or disease resulting in

a disability was incurred coincident with

service in the Armed Forces....38 C.F.R.

§ 3.303(a) (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 of a diagnosis

including the word "Chronic." 38 C.F.R.

3.303(b) (1991).

Service medical records reveal the veteran experienced

repeated traumas to the low back during the early 1970's.

The first episode of low back pain for which he received

treatment was in May 1971. In August 1971, he received

conservative treatment for low back pain after falling while

waterskiing and after falling down a flight of stairs. His

next episode of low back pain was in April 1972 after

falling on a step. He could not bend over due to low back

pain in March 1973 after lifting the tongue of a horse

trailer. In May 1973 he fell off a horse and in August 1973

he fell down a flight of stairs. Each time he was grounded

from his duties as an air traffic controller and treated

conservatively.

In September 1973, he displayed on examination a positive

straight leg raising on the left, paravertebral muscle spasm

in the lumbosacral area, and decreased sensation over the

dorsum area of the left foot after a co-worker pulled his

chair out from under the veteran. He was briefly

hospitalized at the end of September 1973 and in May 1974

for persistent low back pain.

The service medical records show he then began to sometimes

experience low back pain without any significant trauma to

the back. He felt low back pain in August 1974 after

bending over a table. By August 1976, he complained of

radiating pain into the left leg. On examination, he

exhibited positive straight leg raising, bilaterally, and

decreased ankle and knee jerks.

The veteran did not receive treatment for low back pain

again until February 1982 when he reported that he had

experienced low back pain for three weeks after moving some

furniture. He described it as a dull, nagging pain. He

related at the examination for physical therapy where he was

instructed in the use of Williams exercises that he had

experienced episodes of low back pain since 1970 that

usually resolved themselves in 3 to 6 days, but that his

pain was increased by prolonged walking or sitting. He

sought treatment in February 1984 where there was noted

paraspinal muscle spasm on the left and decreased deep

tendon reflexes, bilaterally. He reported a sudden onset of

low back pain radiating into the left buttock after bowling

in March 1988. There was detected numbness of the left big

toe and positive straight leg raising, bilaterally. The

last reported episode of treatment for low back pain was in

January 1989 when he related he had experienced pain for

12 hours after twisting his back while shaving.

A VA examination for disability determination purposes in

March 1991 noted multiple disorders including "history of

low back injury, no residuals noted except mild pain at

times..." Outpatient medical records from September 1991

from a service medical facility indicate that the veteran

received conservative treatment for complaints of low back

pain that had lasted for four days. An X-ray showed

decreased lordosis of the lumbosacral spine with mild

anterior spurring. The diagnoses were lumbar muscle strain

and degenerative joint disease of the lumbosacral spine.

Although the active service medical records fail to reveal a

diagnosis of a chronic lumbosacral strain, an overall review

of these records indicate the clinical findings support a

determination that the veteran initially injured the

supporting structures of the lumbosacral spine that

predisposed him to subsequent lumbosacral strains. The

veteran initially experienced episodes of low back pain

associated with significant in-service incidents of trauma

to the back. At that time, he displayed the typical

symptomatology of acute lumbosacral strains such as

paravertebral muscle spasm and pain on motion of the back.

Gradually, though, the episodes of low back pain occurred

unrelated to any significant trauma and his pain became

exacerbated by prolonged sitting or walking. He

increasingly began to display signs of nerve root

involvement as evidenced by findings of pain on straight leg

raising and decreased sensation in the left foot. Within a

year after service, service department examiners did

diagnose lumbar muscle strain, early degenerative changes in

the lumbosacral spine and lordosis of the spine were found,

findings reflective of a progressive, chronic low back

disorder.

The numerous reports of grounding of the veteran during the

1970's from his duties as an air traffic controller because

of treatment for his low back pain and his efforts to return

to duty as soon as possible supports his contention that he

often did not seek treatment for chronic low back pain

because he did not want to miss additional time from his

duties. The reported clinical findings are consistent with

a determination that the veteran has a chronic lumbosacral

strain with degenerative joint disease of the lumbosacral

spine that began while in service. Thus, the evidence

establishes service connection for a low back disability.

ORDER

Entitlement to service connection for a low back disability

is granted.

BOARD OF VETERANS' APPEALS

WASHINGTON, D.C. 20420

WARREN W. RICE, JR. ROBERT D. PHILIPP

FRANCIS F. TALBOT

(CONTINUED ON NEXT PAGE)

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.

SOURCE: http://www.va.gov/vetapp92/files3/9226148.txt

Edited June 6, 2009 by allan