DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The veteran, who served from September 1993 to July 2005, appeals the denial of service connection for a cervical spine condition. The veteran contended that this condition, diagnosed as degenerative arthritis, left upper extremity cervical radiculopathy, and cervicalgia, was caused by or aggravated by his already service-connected lumbar spine disability. The Board reviewed the veteran's service treatment records, which showed no treatment for or complaints of a cervical spine condition during service. A VA examination shortly after separation also indicated a normal cervical spine. The veteran testified that his cervical spine condition began in 2014, nearly a decade after service. The Board found the evidence weighed against the claim, noting that the veteran's cervical spine condition is a separate entity from his lumbar spine disability and is not medically related. A November 2022 VA examiner attributed the cervical spine condition to a non-service-connected left shoulder condition and the natural aging process, finding no causal relationship or aggravation beyond natural progression. The Board gave more weight to the VA examiner's opinion, finding it well-reasoned and supported by the medical record, and concluded that the veteran's statements regarding nexus were not competent. As the evidence preponderated against the claim, the benefit-of-the-doubt rule was inapplicable. Service connection for the cervical spine condition was denied.

Rationale

No in-service treatment or complaints of cervical spine condition.; Post-service VA exam showed normal cervical spine.; Veteran testified condition began 10 years after service.; VA examiner found no causal relationship to lumbar spine disability.; VA examiner attributed condition to non-service-connected left shoulder and aging process.

Full Decision Text

Citation Nr: 23046542
Decision Date: 08/22/23	Archive Date: 08/22/23

DOCKET NO. 20-00 191
DATE: August 22, 2023

ORDER

Service connection for a cervical spine condition is denied.

FINDING OF FACT

The Veteran's current cervical spine condition diagnosed as degenerative arthritis, left upper extremity cervical radiculopathy, and cervicalgia is not secondary to his service-connected lumbar spine disability, and is not otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for a cervical spine condition proximately due to, or aggravated by, a service-connected disability, or otherwise due to service, are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1993 to July 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). 

In December 2021, the Veteran appeared before the undersigned Veterans Law Judge at a Board hearing. A transcript of the hearing has been associated with the claims file. In September 2022, the Board remanded this issue for additional development-a VA examination and medical opinion.  In November 2022, the Veteran appeared and was examined by a nurse practitioner who also provide an adequate medical opinion (explained more below). As such, there has been substantial compliance with the prior remand directive.

Service connection for a cervical spine condition is denied.

The Veteran contends that his cervical spine condition, which manifests with neck and shoulder pain, is caused by, or aggravated by his service connected back disability. See Hearing Transcript received 12/08/2021 at page 2. 

Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Id. Indeed, the Board has reviewed the Veteran's service treatment records, which show no treatment for, or complaints of, a cervical spine condition. Additionally, a VA examination in April 2006, shortly after separation from service, show a normal cervical spine. See VA Examination received 4/18/2006 at page 3. Lastly, at the December 2021 Board hearing, the Veteran testified that his cervical spine condition began in 2014, which is nearly 10 years after his active-duty service. Id. at page 3.   

Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury.  38 C.F.R. § 3.310.

The question for the Board is whether the Veteran's current cervical spine disability diagnosed as degenerative arthritis, left upper extremity cervical radiculopathy, and cervicalgia (cervical spine condition) was proximately due to, or aggravated beyond its natural progression by, the Veteran's service-connected lumbar spine disability. 

The Board concludes that, while the Veteran has a current cervical spine condition, the evidence of record persuasively weighs against finding that the Veteran's cervical spine condition is proximately due to, or the result of, or aggravated beyond its natural progression by a service-connected disability.  38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310.  

The November 2022 VA examiner opined that the Veteran's cervical spine condition is not medically related to his lumbar spine disability because the neck is a separate entity entirely from the lumbar spine. The VA examiner's review of the Veteran's medical record failed to show any causal relationship between the two conditions. The November 2022 VA examiner instead attributed the Veteran's cervical spine condition to his non service-connected left shoulder condition based on a file review that showed an indication that his left shoulder was causing his neck condition. Additionally, the Veteran was diagnosed with mild osteoarthritis in 2021, which the VA examiner found was indicative of the natural aging process. Accordingly, a nexus between the Veteran's cervical spine condition and his service-connected lumbar spine disability was not established.  

The November 2022 VA examiner also found that the Veteran's cervical spine condition was not aggravated beyond its natural progression by his service-connected lumbar spine disability since his cervical spine condition is related to his non service-connected left shoulder, which the VA examiner found was "playing a part in his neck pain issues". See C
 Veteran's cervical spine condition to his non service-connected left shoulder condition based on a file review that showed an indication that his left shoulder was causing his neck condition. Additionally, the Veteran was diagnosed with mild osteoarthritis in 2021, which the VA examiner found was indicative of the natural aging process. Accordingly, a nexus between the Veteran's cervical spine condition and his service-connected lumbar spine disability was not established.  

The November 2022 VA examiner also found that the Veteran's cervical spine condition was not aggravated beyond its natural progression by his service-connected lumbar spine disability since his cervical spine condition is related to his non service-connected left shoulder, which the VA examiner found was "playing a part in his neck pain issues". See C&P Exam received 11/15/2022 at page 3. Additionally, the November 2022 VA examiner attributed the Veteran's cervical spine condition to the normal aging process since he was diagnosed with mild osteoarthritis in 2021. 

Although the Veteran believes his cervical spine condition is proximately due to or aggravated beyond its natural progression by his service-connected lumbar spine disability, he is not competent to provide a nexus opinion regarding this issue.  The issue is medically complex, as it requires knowledge of the musculoskeletal systems and the disorders that affect the spine. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). As such, the Veteran's statements in this regard are not competent and lack weight.

Consequently, the Board gives more probative weight to the competent November 2022 VA examiner's opinion since the examiner reviewed the Veteran's file and conducted an in-person examination, which included the Veteran's lay statements about the onset of the condition in 2014. Particularly, the Board finds that the November 2022 VA examiner's medical opinion on secondary service connection and aggravation were well-reasoned and supported with adequate medical knowledge. Of great importance was the finding that there is no causal relationship between his cervical spine condition and his service-connected lumbar spine disability since the structures are distinct and not medically related. Additionally, the November 2022 VA examiner was able to provide an etiology for the Veteran's cervical spine condition based on the Veteran's medical file, which showed that the cervical spine condition was instead related to his non-service-connected left shoulder condition. 

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?

As most of the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable and the claim for service connection for a cervical spine condition as secondary to service-connected lumbar spine disability is denied. Lynch v. McDonough, 21 4th 776, 781-82 (Fed. Cir. 2021). 

 

 

Paul Sorisio

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Dixon, Sharla

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.