ARM IMPAIRMENT OF

D. MARTZ AMES · 2026 · Case ID: 26001324

GRANTED

Summary

The veteran, who served in the Army National Guard via active duty for training (ACDUTRA) from November 1982 to May 1983 and June 1991 to March 1992, appeals the denial of service connection for a right arm disability, including elbow and wrist conditions, claimed as secondary to service-connected radiculopathy and lumbar spine disability. The Board found that the veteran had achieved veteran status for the June 1991 to March 1992 ACDUTRA period due to a prior grant of service connection for a back disability. The primary issue was establishing secondary service connection for the right arm disability. The Board afforded low probative value to several VA examinations, noting inadequacies such as failure to address prior treatment records, statements made at hearings, or specific diagnoses. One VA examiner opined that the Veteran's symptoms were subjective and a nexus was not established, while another noted right shoulder impingement syndrome as the likely source of arm pain but did not diagnose a separate right arm disability. However, the Board afforded high probative value to a January 2018 private medical statement from clinician M.K., who opined that the Veteran's right-sided pain was secondary to an in-service injury, and a September 2021 opinion from chiropractor M.K. linking upper extremity complaints to MRIs. The Board found the evidence supported secondary service connection for the right arm disability due to the service-connected lumbar spine and right-sided radiculopathy, consistent with VA policy. Service connection for the right arm disability, secondary to radiculopathy and lumbar spine disability, is granted.

Rationale

Evidence of record supports a finding that the Veteran's right arm disability is secondary to her service-connected lumbar spine and right-sided radiculopathy disabilities.; High probative value afforded to private medical opinions linking right-sided pain to in-service injury and MRIs.; Low probative value given to VA examinations for inadequacy in addressing all evidence and providing clear nexus opinions.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-42 986

Full Decision Text

Citation Nr: 26001324
Decision Date: 01/30/26 Archive Date: 01/30/26

DOCKET NO. 17-42 986
DATE: January 30, 2026

ORDER

Entitlement to service connection for a right arm disability (to include a right elbow and wrist disability), as secondary to radiculopathy of the right upper extremity and a lumbar spine disability, is granted.

FINDING OF FACT

The Veteran's right arm disability is proximately due to her service-connected right upper extremity and a lumbar spine disability.

CONCLUSION OF LAW

With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a right arm disability secondary to service-connected right upper extremity and a lumbar spine disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty for training (ACDUTRA) from November 1982 to May 1983 and from June 1991 to March 1992, with additional service in the United States Army Reserves (USAR).

This matter is before the Board of Veterans Appeals (Board) from the September 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In a September 2014 rating decision, the RO denied the Veteran's claim seeking entitlement to service connection for a right elbow disability. The Veteran filed a Notice of Disagreement in September 2015. A Statement of the Case was issued in July 2017. The Veteran filed an Appeal to the Board with a request for a hearing that same month. A Supplemental Statement of the Case was issued in April 2018.

A Board hearing before the undersigned Veterans Law Judge took place in February 2020. In April 2020, the Board remanded the Veteran's claim seeking entitlement to service connection for a right arm disability to include right elbow and wrist disabilities (right arm disability.) The matter was remanded so that the Veteran may be afforded a VA examination, and so that her service treatment records may be obtained.

In February 2021, a Supplemental Statement of the Case was issued. In May 2021, the Board remanded the matter again so that an addendum medical opinion may be issued. Additional Supplemental Statements of the Case were issued in January 2023 and November 2024.

The Board finds that there has been substantial compliance with its prior remand directives as an addendum opinion has been issued. Stegall v. West, 11 Vet. App. 268, 271 (1998.)

Entitlement to service connection for a right arm disability, including as secondary to radiculopathy of the right upper extremity and a lumbar spine disability, is granted.

The Veteran is of the position that she is entitled to service connection for a right arm disability, including as secondary to her service-connected right upper extremity and lumbar spine disabilities.

To award service connection, the claimant must first be deemed a "veteran" to qualify for VA compensation benefits. Dingess v. Nicholson, 19?Vet. App.?473, 484 (2006).? The term "veteran" is defined in 38?U.S.C. §?101 (2) as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable."

Veterans can achieve "veteran" status in other ways beyond serving on activity duty. Active duty for training (ACDUTRA) includes full-time duty with the Army National Guard of any State under sections 316, 502, 503, 504, or 505 of title 32, or the prior corresponding provisions of law. See 38 U.S.C. § 101(22)(C); 38 C.F.R. § 3.6(c). To establish status as a "veteran" based upon a period of ACDUTRA, the record must establish that the veteran was disabled from an injury that occurred or was aggravated in the line of duty. 38?U.S.C. §§?101 (2), (22), (24); 38?C.F.R. §?3.6 (a); Donnellan v. Shinseki, 24?Vet. App.?167, 172 (2010); Acciola v. Peake, 22?Vet. App.?320, 324 (2008).
.S.C. § 101(22)(C); 38 C.F.R. § 3.6(c). To establish status as a "veteran" based upon a period of ACDUTRA, the record must establish that the veteran was disabled from an injury that occurred or was aggravated in the line of duty. 38?U.S.C. §§?101 (2), (22), (24); 38?C.F.R. §?3.6 (a); Donnellan v. Shinseki, 24?Vet. App.?167, 172 (2010); Acciola v. Peake, 22?Vet. App.?320, 324 (2008).?

In the absence of such evidence, the period of ACDUTRA would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" for that period of ACDUTRA service alone.? 38?U.S.C. §?101(2), (24); Acciola, 22 Vet. App. at 324.

In its February 2024 decision, the Board granted service connection for the Veteran's back disability based upon an injury that occurred during her period of ACDTURA from June 1991 to March 1992. Therefore, the achieved veteran status for that period of ACDUTRA, and is now considered a Veteran for the purposes of all other claims based upon that same period of ACDUTRA. Hill v. McDonald, 28 Vet. App. 243, 252 (2016).

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Davidson v. Shinseki,?581 F.3d 1313?(Fed. Cir. 2009); Hickson v. West,?12?Vet. App.?247, 253?(1999).

Service connection may also be granted on a secondary basis if the record contains evidence sufficient to establish: (1) a current disability; (2) a service-connected disability; and (3) that the current disability was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310.

Secondary causation exists when, but for the service-connected disability, the nonservice-connected disorder was caused by the service-connected disability in either a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citation omitted).

Secondary aggravation exists when the nonservice-connected disability is not caused by a service-connected disability but would be less severe if not for the service-connected disability. Id. at 1364. For example, secondary aggravation may be established when the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

The evidence includes a December 2015 medical record where it was noted that the Veteran has right elbow pain. As such, the first element of secondary service connection has been met.

The Veteran is service-connected for a lumbar spine disability and right-sided radiculopathy. As such, the second element of secondary service connection has also been met.

The evidence includes a July 2013 private medical record. In a diagram, it is noted that the Veteran has right-sided elbow pain. In September 2013, the Veteran stated that she has right-sided body pain. At another private medical facility in December 2015, the Veteran reported right-sided pain from her neck to her toes.

In January 2018, a private medical statement was issued by clinician, M.K. He stated that he treated the Veteran for pain on her entire right side due to an injury that she sustained during active service in 1991.

During a February 2020 Board hearing, the Veteran stated that she injured her right elbow when a cadet fell in 1982.

The Veteran was afforded a VA examination in January 2021. The examiner indicated that the Veteran's right arm was normal. The Veteran reported pain that shoots from her neck and down her right arm. She reported that her right arm pain has gotten worse over time. She denied any surgery, fractures, or injections of the arm. The examiner indicated that the Veteran denied any specific injury of the right arm.

The examiner opined that the Veteran has no chronic diagnosis for a right arm disability. There was also no
injury that she sustained during active service in 1991.

During a February 2020 Board hearing, the Veteran stated that she injured her right elbow when a cadet fell in 1982.

The examiner opined that the Veteran has no chronic diagnosis for a right arm disability. There was also no functional impairment to the right elbow. The objective examination was normal. The examiner opined that the Veteran's symptoms are subjective and a nexus has not been established.

The Board affords low probative value to the January 2021 VA examination. The examiner failed to address the Veteran's statements during the Board hearing as well as her treatment records in 2013.

A VA opinion was also issued in February 2021 for the Veteran's right shoulder. In the opinion, the examiner noted that the Veteran's right shoulder impingement is likely the source of the pain and symptoms in her right arm. There was no separate diagnosis noted for the Veteran's right arm.

The Veteran appeared for a VA examination for Wrist Conditions in January 2021 for a right arm disability. The Veteran stated that she has pain in her neck that shoots down her right arm. The examiner indicated that the Veteran had a normal physical examination, and there was no objective evidence to warrant a wrist diagnosis.

In May 2021, the Board remanded the matter, finding that the examiner's opinion was inadequate because the examiner advised that the Veteran did not have a diagnosis for her disability. In the remand, the Board noted that pain may constitute a disability if the pain causes functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018.)

In September 2021, an addendum opinion was issued. The examiner opined that Veteran's medical records do not support that any currently diagnosed conditions of the right arm elbow and wrist are at least as likely as not to have been caused by the Veteran's period of ACDUTRA.

In September 2021, M.K., a chiropractor, issued an opinion finding that the Veteran's upper extremity complaints are related to her September 2021 cervical and lumbar spine MRIs.

An October 2022 VA medical record noted that the Veteran has longstanding right sided pain.

The Veteran appeared for a VA examination for Shoulder and Arm Conditions in May 2024. She was diagnosed with right shoulder strain and impingement of the right shoulder. The examiner did not note a right arm disability. The Veteran reported constant burning, stabbing and aching right shoulder pain that radiated down to her elbow. She stated that in 1982, during training, she was in full gear consisting of rucksack, heavy boots and at times a wooden foot locker was placed over her head. It all weighed approximately 60-70 pounds and she was tasked with running around in formation and hiking. She started experiencing arm pain. She did not have issues related to her right arm prior to military service.

The VA examiner gave an opinion as to the right shoulder but did not address the Veteran's right arm disability, to include her right arm and wrist. The examiner did, however, quote a study noting that the physiological costs and biomechanical responses to loads, while varying with the contexts in which they are carried, have led to soldier injuries. These injuries can range from musculoskeletal injuries (e.g., joint/ligamentous injuries and stress fractures) to neurological injuries (e.g., paresthesias), and impact on both the soldier and the army in which they serve. Injuries in general have a greater impact on the health and readiness of the US military than any other category of medical complaint, and training injuries treated on an outpatient basis may have the biggest single impact on readiness. As a consequence of their intense physical training, both basic training and combat unit populations have a high incidence of exercise-related injuries.

An addendum opinion was issued in November 2024 because the examiner did not address the right arm disability. The examiner indicated that the Veteran's diagnosis remains as right shoulder impingement syndrome, and right upper extremity radiculopathy. The examiner noted that right upper extremity radiculopathy was inadvertently omitted in the diagnosis tab and in the medical opinion. The Veterans' symptoms that consist of constant burning, stabbing pain and an aching right shoulder that
military than any other category of medical complaint, and training injuries treated on an outpatient basis may have the biggest single impact on readiness. As a consequence of their intense physical training, both basic training and combat unit populations have a high incidence of exercise-related injuries.

An addendum opinion was issued in November 2024 because the examiner did not address the right arm disability. The examiner indicated that the Veteran's diagnosis remains as right shoulder impingement syndrome, and right upper extremity radiculopathy. The examiner noted that right upper extremity radiculopathy was inadvertently omitted in the diagnosis tab and in the medical opinion. The Veterans' symptoms that consist of constant burning, stabbing pain and an aching right shoulder that radiates to the neck, elbows, wrist and fingers is secondary to the right upper extremity radiculopathy. The Veteran does not have a new right arm condition secondary to aggravation of a current service-condition, or a new diagnosis separate from the service-connected condition.

The Board affords low probative value to this opinion as well. The examiner failed to address the Veteran's elbow pain that she has been advising her clinicians about since July 2013.

The Board affords high probative value to the January 2018 and September 2021 medical opinions. M.K. opined that the Veteran's right-sided-pain was secondary to her service-connected disabilities. This opinion is supported by the research that is quoted in the May 2024 VA examination.

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The Board finds that here the evidence is in support of the claim. The evidence of record supports a finding that the Veteran's right arm disability is secondary to her service-connected lumbar spine and right sided radiculopathy disabilities. Accordingly, the Board finds that granting service connection for a right arm disability on a secondary basis is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case. 38 C.F.R. § 3.303(a).

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Sanders, Danielle A.

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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