CERVICAL SPINE LIMITATION OF MOTION

S. B. MAYS · 2026 · Case ID: A26002100

GRANTED

Summary

The veteran, who served from February 1993 to June 1997, appeals the denial of service connection for cervical strain and bilateral upper extremity radiculopathy. The Board found that the veteran has a current diagnosis of cervical strain and is already service-connected for lumbar strain with spondylolisthesis and facet sclerosis. The primary issue for the cervical strain claim was whether it was secondary to the service-connected lumbar condition. The veteran's service treatment records were silent regarding cervical issues, but post-service records from 2008 noted neck pain. The veteran also provided lay testimony describing an in-service injury causing back and neck pain. Multiple VA examinations diagnosed cervical strain and cervical radiculopathy, but the examiners' opinions were deemed inadequate as they only addressed direct causation and not aggravation of the cervical strain by the lumbar condition. A private medical opinion from C.B., P.A., in March 2023, was given low probative weight as it relied solely on general medical literature without applying it to the veteran's specific circumstances. However, a subsequent private medical opinion from M.R., M.D., in March 2024, was found competent, credible, and persuasive. M.R. reviewed the entire claims file, considered the veteran's history and symptoms, and applied the kinetic link principle to conclude that the cervical strain and bilateral upper extremity radiculopathy were more likely than not secondary to the service-connected lumbar disability. The Board found the evidence in equipoise and resolved doubt in the veteran's favor, granting service connection for both conditions as secondary. The Board noted that the issue of bilateral upper extremity radiculopathy was reasonably raised by the evidence and also granted secondary service connection for this condition, finding it secondary to the newly granted cervical strain.

Rationale

Service treatment records silent on cervical issues.; Post-service records from 2008 noted neck pain.; VA examinations diagnosed cervical strain and radiculopathy.; VA opinions deemed inadequate for not addressing aggravation.; Private opinion from M.R., M.D. (March 2024) found competent, credible, and persuasive.; M.R. applied kinetic link principle and found cervical strain more likely than not secondary to service-connected lumbar strain.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250903-582442

Full Decision Text

Citation Nr: A26002100
Decision Date: 01/08/26 Archive Date: 01/08/26

DOCKET NO. 250903-582442
DATE: January 8, 2026

ORDER

Service connection for cervical strain, as secondary to the service-connected lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side, is granted.

Service connection for bilateral upper extremity radiculopathy, as secondary to the service-connected cervical strain, is granted.

FINDINGS OF FACT

1. Resolving reasonable doubt in favor of the Veteran, his currently diagnosed cervical strain was caused or aggravated by his service-connected lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side.

2. Resolving any reasonable doubt in the Veteran's favor, his currently diagnosed bilateral upper extremity radiculopathy was caused or aggravated by his service-connected cervical strain.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for cervical strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to service connection for bilateral upper extremity radiculopathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1993 to June 1997.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 Appeals Modernization Act (AMA) rating decision from a Department of Veterans Affairs (VA) Regional Office, the agency of original jurisdiction (AOJ), that denied the Veteran's claim for service connection for cervical strain, finding the evidence does not establish a nexus between his cervical strain and his service-connected lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side. The December 2024 rating decision noted favorable findings that the Veteran has a current diagnosis of cervical strain and that his lumbar strain is service connected. Furthermore, the AOJ's finding in the December 2024 rating decision that new and relevant evidence was received to allow reconsideration of the Veteran's previously denied service connection claim is a favorable finding that, absent clear and unmistakable evidence to the contrary, is binding on the Board. 38 U.S.C. § 5104A.

In September 2025, the Veteran, through his attorney, initiated this appeal to the Board with the filing of a Decision Review Request-Notice of Disagreement (VA Form 10182), requesting direct review by a Veterans Law Judge on the evidence of record at the time of the rating decision. In October 2025 correspondence, the Board acknowledged the appeal and informed the Veteran and his attorney that the appeal had been placed on the Board's direct review docket.

Therefore, the Board may only consider the evidence of record at the time of the AOJ's rating decision on appeal, here as of December 27, 2024. The Board cannot consider evidence submitted after the AOJ issued the decision on appeal. 38 C.F.R. § 20.301.

Preliminary Matters

The Board finds that the issue of secondary service connection for bilateral upper extremity radiculopathy has been reasonably raised by the evidence of record. See Wilson v. McDonough, 35 Vet. App. 103, 109 (2022) (holding that an issue is "reasonably raised" when there is evidence that the secondary disability is logically related to the primary disability). Accordingly, this issue has been added to the issues on appeal as reflected in the title section above. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a claim is determined by the claimant's description of the claim, the symptoms described, and the information submitted or developed in support of the claim).

The Board acknowledges the arguments reflected in the Veteran's September 2025 appeal brief asserting entitlement to effective dates and evaluations for cervical strain and bilateral upper extremity radiculopathy. However, as the Board does not assign disability ratings or effective dates in the first instance, these issues are not in appellate status. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of "downstream" elements such as the disability rating or effective date assigned).

Service Connection

's description of the claim, the symptoms described, and the information submitted or developed in support of the claim).

Service Connection

Applicable Laws and Regulations

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection is also warranted for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection under 38 C.F.R. § 3.310(a) is warranted where a non-service-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Spicer v. McDonough, 61 F.4th 1360, 1364-66 (2023) (invalidating the requirement of "proximate cause" and instead holding "but for" causation or aggravation is enough to show entitlement to secondary service connection).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or?unpersuasive and?provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7?Vet. App.?36, 39-40 (1994). Competency of evidence differs from weight and credibility.

A lay person is competent to report on the onset and reoccurrence of current symptomatology. See Layno v. Brown, 6?Vet. App.?465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge).? The Board must determine, on a?case-by-case?basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Nieves-Rodriguez v. Peake, 22?Vet. App. 295, 304 (2008).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776, 781 (2021); Ortiz?v.?Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001).

A claimant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282
.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776, 781 (2021); Ortiz?v.?Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001).

A claimant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

Cervical Strain

The Veteran seeks service connection for a cervical strain as secondary to his service-connected lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side. See, e.g., May 2024 Supplemental Claim; September 2025 Appeal Brief.

As an initial matter, the December 2024 rating decision reflects the favorable findings that the Veteran has a current diagnosis of cervical strain and that he is service-connected for lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side. The Board is bound by these favorable findings as they are not rebutted by clear and unmistakable error. 38 U.S.C. § 5104A; Shedden, supra.

Therefore, the dispositive issue is whether there is a nexus between the Veteran's currently diagnosed cervical strain and his service-connected lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side.

The Veteran's service treatment records are silent as to symptoms, complaints, or diagnosis of a cervical spine injury or disease. Notably, the service records include numerous references to low back pain and spondylolisthesis.

The earliest post-service evidence of neck pain is reflected in a 2008 VA treatment record. See May 2008 VA Addendum. Although the Veteran's treatment records reflect his endorsement of chronic low back and neck pain and diagnosis of cervical radiculopathy, the treatment records do not address the etiology of his cervical spine strain. See, e.g., April 2023 and October 2023 VA Primary Care Notes. Of note, a July 2017 VA physical therapy consult reflects that the Veteran had abnormal posture.

In a July 2022 statement, the Veteran described injuring his back during service, which caused back and neck pain as well as numbness in his arms and shoulders, and he stated that his neck pain continued to the present day.

In December 2022, April 2023, and August 2024, the Veteran underwent VA neck conditions examinations, reflecting diagnosis of cervical strain. The Veteran reported onset of neck pain during active duty service, which continued to the present day. The Board finds the medical findings in each of these VA examination reports probative as they are consistent with the Veteran's treatment records and lay statements. Notably, during the April 2023 VA examination, the Veteran was also diagnosed with left upper extremity radiculopathy involving nerve roots associated with the C7 and C8/T1 vertebrae, with bilateral involvement of the C5/C6 vertebrae, and during the August 2024 VA examination, he was also diagnosed with bilateral upper extremity radiculopathy involving nerve roots associated with the C5/C6, C7, and C8/T1 vertebrae. See April 2023 Disability Benefits Questionnaire (DBQ) at 2, 11; August 2024 VA Neck Conditions DBQ at 2, 10-11.

December 2022, May 2023, August 2024, and December 2024 VA medical opinions unfavorably conclude that the Veteran's cervical strain was not caused by his service-connected lumbar spine disability. However, all of these VA opinions address causation but not aggravation. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (opinion regarding secondary service connection is inadequate if it does not address both causation and aggravation of the nonservice-connected condition); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that a medical opinion that focuses solely on direct causation is insufficient to address the question of aggravation). For these reasons, the aforementioned VA medical opinions are inadequate for adjudication purposes, and accordingly, assigned no probative weight.

In March 2023, the Veteran submitted the favorable February 2024 private medical opinion of private
address causation but not aggravation. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (opinion regarding secondary service connection is inadequate if it does not address both causation and aggravation of the nonservice-connected condition); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that a medical opinion that focuses solely on direct causation is insufficient to address the question of aggravation). For these reasons, the aforementioned VA medical opinions are inadequate for adjudication purposes, and accordingly, assigned no probative weight.

In March 2023, the Veteran submitted the favorable February 2024 private medical opinion of private clinician C.B., P.A. C.B. diagnosed chronic cervical spine strain and acknowledged the Veteran's assertion that his neck pain onset during service. C.B.'s opinion assigns considerable weight to medical literature that addresses the etiology of neck pain in general; however, the opinion does not apply the medical literature to this Veteran's particular circumstances. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (a medical opinion based solely on general medical literature without discussion of the veteran's individual circumstances is inadequate). Accordingly, the Board assigns the March 2023 private opinion low probative weight.

While the Board could remand the claim for yet another attempt to schedule a VA examination, the current evidence is sufficient to decide the claim. A remand could therefore be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Mariano v. Principi, 17 Vet. App. 305, 312 (2003).

In May 2024, the Veteran submitted the favorable March 2024 private medical opinion of M.R., M.D., who noted that she reviewed the Veteran's entire claims file. M.R. acknowledged the Veteran's diagnosis of cervical strain and cervical radiculopathy of the left upper extremity and considered the Veteran's statements describing his in-service duties that involved marching and carrying heavy military gear, the onset of back and neck pain during service, his poor posture, and physical limitations, including difficulty turning his neck, stiffness, pain in all ranges of motion, and numbness and decreased sensation in his bilateral upper extremities. M.R. referenced medical literature describing the "kinetic link principle," that the human body can be considered in terms of a series of interrelated links or segments and that stress or injury to once segment can affect another segment of the body, such as the spine, hips, and knees, and that the principle also applied to the torso and upper extremities. M.R. concluded that this principle was directly applicable to the Veteran's cervical strain considering his military history, in-service and post-service symptoms, his poor posture, and peer-reviewed medical literature,

"it is more likely than not" that the Veteran's neck pain onset during service and is secondary to his service-connected low back disability. See March 2024 Clinical Evaluation and Medical Opinion by M.R., M.D. at 30.

M.R.'s March 2024 medical opinion is competent, credible and probative: It was authored by a licensed physician who reviewed the Veteran's claims file and considered the lay and medical history of the Veteran's neck complaints, treatment records, and VA examinations, and was therefore familiar with the Veteran's symptoms, diagnoses, and treatment of his cervical strain. The opinion is generally consistent with the medical evidence of record, and contains a clear conclusion connected by a reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 301-02. Notably, there are no probative medical opinions or other competent medical evidence of record that weighs against M.R.'s March 2024 opinion. Accordingly, the Board finds the March 2024 medical opinion probative, competent and persuasive medical evidence in this case.

For these reasons, the evidence is at the very least in equipoise as to whether the Veteran's currently diagnosed cervical strain was caused or aggravated by his service-connected lumbar strain with grade 1 spondylolisthesis L5-S1 and facet sclerosis left side. Resolving any reasonable doubt in the Veteran's favor, service connection for cervical strain is warranted. 38 U.S.C. §§ 5107, 1110; 38 C.F.R. §§ 3.102, 3.310; see Lynch, supra.

Bilateral Upper Extremity Radiculopathy

As discussed above, the
Board finds the March 2024 medical opinion probative, competent and persuasive medical evidence in this case.

Bilateral Upper Extremity Radiculopathy

As discussed above, the Veteran has been diagnosed with bilateral upper extremity radiculopathy involving nerve roots associated with his cervical spine. See, e.g., August 2024 VA Neck Conditions DBQ at 10-11. Furthermore, the issue of secondary service connection for bilateral upper extremity radiculopathy has been reasonably raised by the record on appeal. See Wilson, supra.

The Veteran has a current diagnosis of cervical strain and bilateral upper extremity radiculopathy associated with the Veteran's cervical spine vertebrae, initially diagnosed as left upper extremity cervical radiculopathy as reflected in the April 2023 VA examination report and thereafter as bilateral upper extremity cervical radiculopathy as shown in the August 2024 VA examination report. See April 2023 Neck Conditions DBQ at 2, 11; August 2024 Neck Conditions DBQ at 2, 10-11. The diagnoses are consistent with the Veteran's treatment notes reflecting diagnosis of cervical radiculopathy. See October 2023 VA Primary Care Note. Furthermore, the Board observes that radiculopathy of the cervical nerve roots often manifests as neck or shoulder pain. See Dorland's Illustrated Medical Dictionary at 1595 (31st ed. 2007). Notably, M.R.'s March 2024 medical opinion concludes, in part, that the Veteran's bilateral upper extremity radiculopathy is secondary to his neck disability. See March 2024 Clinical Evaluation and Medical Opinion by M.R., M.D. at 37. The M.R.'s March 2024 medical opinion is competent, credible and probative given that it is consistent with the aforementioned VA examination findings. See Nieves-Rodriguez, supra.

In sum, the evidence is at the very least in equipoise as to whether the Veteran's currently diagnosed bilateral upper extremity radiculopathy is secondary to the service-connected cervical strain. Resolving any reasonable doubt in the Veteran's favor, service connection for bilateral upper extremity radiculopathy as secondary to the service-connected cervical strain is warranted. 38 U.S.C. §§ 5107, 1110; 38 C.F.R. §§ 3.102, 3.310; see Lynch, supra.

S. B. MAYS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. Farrell, Counsel

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.

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