How the Board ruled on low back (lumbar spine) claims, 2021–2025

Low back (lumbar spine) (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

49.7% granted of 9,078 decided cases (margin of error 48.7–50.8%). 4,516 granted, 4,562 denied, 13,047 sent back to VA (remanded, not decided), 1,468 dismissed.

What convinced the Board in granted cases

• The Board accepted the veteran's credible, consistent account of back pain that began in service (heavy loads, parachuting, repetitive strain in his job) and continued since, sometimes backed by a service record or a family member. (10 of 17 decisions read; e.g. 22003840, 22042352, 21077139)
• The Board gave little or no weight to VA opinions that relied only on the lack of back records in service or right after service, ignored the veteran's account of ongoing symptoms, or rested on a wrong reading of the history. (7 of 17 decisions read; e.g. A24018467, 23019044, A24032283)
• The Board favored private or treating doctors' opinions that reviewed the record, described the veteran's in-service duties and injuries, cited studies, and gave clear reasons, over the VA opinions. (4 of 17 decisions read; e.g. 22036469, 22024236, 22051560)

Common reasons in denied cases

• The Board relied on thorough VA opinions that reviewed the file and explained why the current condition was not from service (for example, that a strain does not lead to later disc disease or narrowing of the spinal canal, or that a later injury was the more likely cause), with no medical opinion to the contrary. (9 of 20 decisions read; e.g. 23058300, 21000214, A25001351)
• The Board denied when the records showed no back problem in service, a long gap before treatment, or post-service injuries (car or work accidents, a fall from a horse), and found claims of continuous symptoms not credible against those records. (8 of 20 decisions read; e.g. 21006920, 22049377, 22023905)
• The Board found the veteran's own opinion that his back condition came from service not competent medical evidence, because the cause of spine disease is a complex medical question. (8 of 20 decisions read; e.g. A25015989, 21030783, 23005459)

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Low back (lumbar spine) (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

13.3% granted of 30 decided cases (margin of error 5.3–29.7%). 4 granted, 26 denied, 107 sent back to VA (remanded, not decided), 3 dismissed.

What convinced the Board in granted cases

• For Gulf War veterans, the Board granted when clinicians could not attribute ongoing back pain to any known diagnosis, so it qualified as an undiagnosed illness. (2 of 3 decisions read, few decisions; e.g. A25000334, 21072138)
• Credible, consistent statements from the veteran or a fellow servicemember about back pain during service supported the claim. (2 of 3 decisions read, few decisions; e.g. A25000334, 23035047)

Common reasons in denied cases

• A thorough VA opinion that reviewed the file, the veteran's history and contentions, and in some cases medical literature, found no link to service or the exposure, and nothing rebutted it. (3 of 11 decisions read; e.g. 23019747, 21044842, 23019262)
• For Gulf War claims, the back symptoms were explained by a known diagnosis such as disc disease or wear-and-tear arthritis, so the undiagnosed illness rules did not apply. (3 of 11 decisions read; e.g. A21001377, 23035605, 23019262)
• No back problem was shown in service or within a year after, back trouble was first diagnosed years later, and the veteran's own belief about cause was not accepted as competent medical evidence. (4 of 11 decisions read; e.g. 24031234, 21044842, 21052858)

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Low back (lumbar spine) secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

48.2% granted of 824 decided cases (margin of error 44.8–51.6%). 397 granted, 427 denied, 1,733 sent back to VA (remanded, not decided), 56 dismissed.

What convinced the Board in granted cases

• The Board granted when a private or treating doctor explained how a service-connected knee, foot, ankle, or leg condition changed the veteran's gait and strained the back, often citing literature and the veteran's history. (6 of 9 decisions read; e.g. 22040568, 21053123, A25035687)
• VA opinions lost weight when they did not address aggravation, ignored the veteran's reports of pain, or contradicted themselves. (4 of 9 decisions read; e.g. A24000747, 21053123, 23005668)
• The Board also credited the veteran's own reports of compensating for pain in a service-connected joint. (2 of 9 decisions read, few decisions; e.g. 21053123, A24059086)

Common reasons in denied cases

• A thorough VA opinion against the claim, based on exam, file review and the veteran's statements, outweighed everything else or went unrebutted. (8 of 12 decisions read; e.g. 21059899, A21015133, 23051626)
• The only support was the veteran's own belief, or a private opinion that lacked rationale, used a general article, or relied on a history the Board did not find credible. (5 of 12 decisions read; e.g. 23003273, 21024256, 21014652)
• Another cause was found more likely, such as post-service injuries or heavy civilian work, or back problems first appeared many years after service. (6 of 12 decisions read; e.g. A21008267, 21023351, 21011687)

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Low back (lumbar spine) secondary to knee

Secondary (caused or worsened by a service-connected condition)

56.6% granted of 311 decided cases (margin of error 51.0–62.0%). 176 granted, 135 denied, 587 sent back to VA (remanded, not decided), 20 dismissed.

What convinced the Board in granted cases

• VA examiner opinions lost weight when they did not address whether the knee made the back worse, ignored altered gait, gave no rationale, used one rationale for both cause and worsening, or cited no medical literature. (7 of 12 decisions read; e.g. A25014974, 21053123, 23041190)
• Private opinions were favored when they were based on examining or treating the veteran, reviewed the full record and lay statements, and gave a detailed rationale, often with medical literature. (7 of 12 decisions read; e.g. 21013948, A25014974, A21015417)
• Winning opinions explained how the knee affected the back, such as a limp or altered gait shifting pressure onto the spine, or repeated strain with each step speeding up degeneration. (5 of 12 decisions read; e.g. 23041190, 21013948, A21002830)

Common reasons in denied cases

• The Board relied on VA opinions finding the back condition came from something else, such as age-related wear, a separate injury (car accident, lifting, work injury), or the view that arthritis does not spread from one joint to another. (6 of 14 decisions read; e.g. 22022059, 22054691, 23046346)
• VA examiners found the veteran's gait was normal or the limp too mild or brief to cause or worsen the back, and the Board found these opinions well reasoned. (5 of 14 decisions read; e.g. 23011307, 21053306, 21012202)
• No medical opinion supported the link; the only support was the veteran's own belief, which the Board found not competent on this medical question. (5 of 14 decisions read; e.g. A24048891, 22022059, 21039175)

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Low back (lumbar spine) secondary to foot (flat feet / plantar fasciitis)

Secondary (caused or worsened by a service-connected condition)

47.1% granted of 87 decided cases (margin of error 37.0–57.5%). 41 granted, 46 denied, 180 sent back to VA (remanded, not decided), 4 dismissed.

What convinced the Board in granted cases

• The Board granted when a doctor explained how foot pain made the veteran walk differently for years and how that altered gait strained or wore down the lower back. (6 of 12 decisions read; e.g. 21027687, A21005445, 23027322)
• Negative VA opinions lost weight when they gave no real rationale, brushed aside known research on gait changes, or simply said one joint's disease cannot spread to another. (5 of 12 decisions read; e.g. 21027687, A24057581, A24020526)
• A private or treating provider's opinion that was at least as persuasive as the VA opinion put the evidence in balance, which favors the veteran. (4 of 12 decisions read; e.g. A24009155, 21066974, 21031100)

Common reasons in denied cases

• The Board denied when VA examiners gave reasoned opinions that the back was not caused or worsened by the feet, citing records of a normal gait, back problems that came first, or aging and weight. (5 of 9 decisions read; e.g. 21046740, 21054643, 24016451)
• Private opinions got little or no weight when they gave no rationale, relied on the veteran's inconsistent account, or ignored records showing a normal gait. (2 of 9 decisions read, few decisions; e.g. A25018788, 23001868)
• Some claims failed because the only link was the veteran's own belief that walking differently hurt the back, which the Board did not treat as medical evidence. (3 of 9 decisions read; e.g. 21038693, 23003273, A25018788)

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Low back (lumbar spine) secondary to ankle

Secondary (caused or worsened by a service-connected condition)

63.3% granted of 60 decided cases (margin of error 50.7–74.4%). 38 granted, 22 denied, 133 sent back to VA (remanded, not decided), 3 dismissed.

What convinced the Board in granted cases

• The Board gave more weight to private medical opinions that explained how the ankle condition changed the veteran's gait and how that altered gait strained or wore down the low back. (8 of 15 decisions read; e.g. 24001286, 21057998, A24068822)
• VA examiner opinions lost weight when they gave no rationale, discounted the veteran's reports of pain, rested on an inaccurate fact, or never addressed whether the ankle worsened the back. (6 of 15 decisions read; e.g. 21018360, 21015163, A24068822)
• Private opinions were credited when the doctor reviewed the medical records or claims file and interviewed the veteran, and their facts were accurate. (4 of 15 decisions read; e.g. 21063387, 23027480, A21005445)

Common reasons in denied cases

• The Board denied when a VA examiner gave a reasoned negative opinion that the ankle did not cause or worsen the back, and no competent opinion contradicted it. (5 of 15 decisions read; e.g. 21023351, 22046774, 23050067)
• The veteran's own belief that the ankle caused the back problem was not enough, because a layperson is not competent to give a medical opinion on cause. (3 of 15 decisions read; e.g. 21067789, 23001551, 21034639)
• Other denials rested on years-long gaps with no back complaints after service, or a private opinion written without access to key service records. (3 of 15 decisions read; e.g. 21023351, 22046685, 22041445)

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Low back (lumbar spine) secondary to hip

Secondary (caused or worsened by a service-connected condition)

Small sample: 24 decided cases, too few for a reliable percentage. 8 granted, 16 denied, 50 sent back to VA (remanded, not decided), 3 dismissed.

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Low back (lumbar spine) secondary to neck (cervical spine)

Secondary (caused or worsened by a service-connected condition)

Small sample: 13 decided cases, too few for a reliable percentage. 7 granted, 6 denied, 49 sent back to VA (remanded, not decided), 1 dismissed.

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Low back (lumbar spine) secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

Small sample: 12 decided cases, too few for a reliable percentage. 7 granted, 5 denied, 30 sent back to VA (remanded, not decided), 3 dismissed.

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Low back (lumbar spine) secondary to depression / psychiatric disorder

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 5 granted, 6 denied, 23 sent back to VA (remanded, not decided), 2 dismissed.

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Low back (lumbar spine) secondary to leg (other)

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 7 granted, 4 denied, 17 sent back to VA (remanded, not decided), 0 dismissed.

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Low back (lumbar spine) secondary to radiculopathy / peripheral neuropathy

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 1 granted, 10 denied, 13 sent back to VA (remanded, not decided), 2 dismissed.

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Low back (lumbar spine) secondary to lower leg (incl. shin splints)

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 5 granted, 5 denied, 20 sent back to VA (remanded, not decided), 0 dismissed.

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