DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

Summary

The Veteran, who served from January 1979 to January 1983, appeals the denial of service connection for a cervical spine disorder and bilateral upper extremity radiculopathy. The Veteran claims the cervical spine disorder originated during service due to a fall from a ship and that the radiculopathy is secondary to the cervical spine disorder. The Board considered the Veteran's lay statements regarding the in-service event and symptoms, but found them non-probative for the complex medical causation issue. The Board also reviewed post-service treatment records showing diagnoses of degenerative arthritis and cervical radiculopathy, but found no evidence of these conditions manifesting during service or within the presumptive period for arthritis. The primary evidence considered was a June 2024 VA etiology opinion. The examiner concluded that the Veteran's cervical spine disorder and bilateral upper extremity radiculopathy were less likely than not related to service, citing the lack of in-service documentation and the multifactorial nature of degenerative arthritis. The examiner also opined that these conditions were less likely than not related to or aggravated by the Veteran's service-connected PTSD with traumatic brain injury, citing a lack of medical literature supporting such a link. The Board found the VA opinion adequate and persuasive, leading to the denial of service connection for the cervical spine disorder and, consequently, the denial of the secondary claim for bilateral upper extremity radiculopathy.

Rationale

No in-service diagnosis or complaints of cervical spine disorder.; Post-service diagnosis of degenerative arthritis occurred over 30 years after service.; VA opinion found condition less likely than not related to service or PTSD/TBI.

Full Decision Text

Citation Nr: 26004240
Decision Date: 04/07/26	Archive Date: 04/07/26

DOCKET NO. 16-60 598
DATE: April 7, 2026

ORDER

Entitlement to service connection for a cervical spine disorder, to include as secondary to service connected posttraumatic stress disorder (PTSD) with traumatic brain injury, is denied. 

Entitlement to service connection for bilateral upper extremity radiculopathy as secondary to nonservice-connected cervical spine disorder is denied. 

FINDINGS OF FACT

1. The Veteran's cervical spine disorder is not etiologically related to his active service, did not have its onset in service and is not caused or aggravated by his service connected PTSD with traumatic brain injury.

2. The Veteran is not service connected for a cervical spine disorder and hence cannot be awarded service connection for bilateral upper extremity radiculopathy on a secondary basis.

CONCLUSIONS OF LAW

1. The criteria for service connection for a cervical spine disorder, to include as secondary to service connected PTSD with traumatic brain injury, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for bilateral upper extremity radiculopathy as secondary to nonservice-connected cervical spine disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1979 to January 1983. 

These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in September 2015 issued by a Department of Veterans Affairs (VA) Regional Office (RO). 

The Board notes that the Veteran requested a hearing in the Appeal to Board of Veterans' Appeals (VA Form 9) submitted in November 2016. In February 2021 correspondence, the Veteran, through his representative, withdrew the hearing request. Thus, the Board finds that this hearing request has been withdrawn.

These matters were previously remanded by the Board in August 2021, January 2022 and October 2022.

These matters were most recently before the Board in January 2023, at which time the Veteran's service connection claims were remanded to the Agency of Original Jurisdiction (AOJ) for further development, to include verifying the Veteran's dates of service and obtaining an etiology opinion for his cervical spine disorder. A June 2024 Information Report listed the Veteran's service periods. VA etiology opinions for the Veteran's cervical spine disorder were provided in April 2024. The Board therefore finds that there has been substantial compliance with its previous remand.

Following the February 2025 docketing of the appeal at the Board, the Veteran submitted an Appointment of Individual as Claimant's Representative (VA Form 21-22a) in March 2025 that appointed a new attorney as the Veteran's representative. The law firm representing the Veteran remains unchanged. Furthermore, the Veteran's current attorney is listed as an authorized representative on the previous September 2015 VA Form 21-22a. As the same law firm represents the Veteran, the Board finds that it is not necessary to provide the current attorney with an opportunity to submit argument in support of the appeals and there is no prejudice to the Veteran by proceeding with adjudication. Therefore, the Board shall proceed with adjudication.

Finally, the Board notes that new VA generated evidence was submitted after issuance of the October 2024 supplemental statement of the case (SSOC) for the claims of service connection for a cervical spine disorder and bilateral upper extremity radiculopathy. However, the Board finds that the evidence is not pertinent as it does not relate to or have a bearing on the appellate issues. Therefore, it is not necessary to seek a waiver from the Veteran and/or his representative for the AOJ to have the opportunity to review the newly associated VA generated evidence. 38 C.F.R. § 20.1305(c).

1. Entitlement to service connection for a cervical spine disorder, to include as secondary to service connected PTSD with traumatic brain injury, is denied.

2. Entitlement to service connection for bilateral upper extremity radiculopathy as secondary to nonservice-connected cervical spine disorder is denied.

The Veteran asserts that he has a cervical spine disorder with onset during his military service. See February 2021 Correspondence. Specifically, he contends that during service he injured his neck from falling off a ship. See February 2016 Statement in Support of Claim (VA Form 21-4138). The
 for the AOJ to have the opportunity to review the newly associated VA generated evidence. 38 C.F.R. § 20.1305(c).

1. Entitlement to service connection for a cervical spine disorder, to include as secondary to service connected PTSD with traumatic brain injury, is denied.

2. Entitlement to service connection for bilateral upper extremity radiculopathy as secondary to nonservice-connected cervical spine disorder is denied.

The Veteran asserts that he has a cervical spine disorder with onset during his military service. See February 2021 Correspondence. Specifically, he contends that during service he injured his neck from falling off a ship. See February 2016 Statement in Support of Claim (VA Form 21-4138). The Veteran also states that his bilateral upper extremity radiculopathy is secondary to his cervical spine disorder. See February 2021 Correspondence.  

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases such as arthritis become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a).  

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established with evidence created prior to any aggravation. 38 C.F.R. § 3.310(b).

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991).

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id.; see also Davidson v. Shinseki
1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id.; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999).

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Veteran's service treatment records are negative for complaints of, treatment for, or diagnoses related to a cervical spine disorder and/or bilateral upper extremity radiculopathy. However, the Board in an October 2022 remand, accepted that the claimed in-service event of falling off the ship occurred. Post-service treatment records show diagnoses of degenerative arthritis, spinal fusion and cervical radiculopathy of the bilateral upper extremities. See April 2024 VA examination. 

The Board has first considered whether presumptive service connection for arthritis is warranted. In this regard, the clinical evidence of record fails to show that the Veteran manifested such disease to a compensable degree within the year following his discharge from active duty service. Post-service treatment records did not reflect a diagnosis of arthritis until 2015, which is more than 30 years after separation from service. The Board notes that the passage of many years between discharge from active service and the medical documentation of a claimed disability may be considered as evidence against a claim of entitlement to service connection. See Maxon v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Therefore, the Board finds that presumptive service connection for arthritis, to include on the basis of continuity of symptomatology, is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.

An October 2021 VA opinion was obtained. The Board notes that it previously found the VA etiology opinion to be inadequate in January 2022. 

An October 2022 VA opinion was obtained. The Board notes that it previously found the VA etiology opinion to be inadequate in January 2023. 

The Veteran was afforded a VA examination in April 2024. The examiner noted the Veteran's report that his cervical spine disorder and bilateral upper extremity radiculopathy had their onset in 1981 or 1982 after falling off a ship during service. The examiner noted a review of the claims file. The examiner opined that the Veteran's cervical spine disorder and bilateral upper extremity radiculopathy were less likely than not due to service. The examiner acknowledged the Veteran's statement of falling from the ship with a reported injury to his neck and upper back. The examiner noted that no service treatment records confirm the injury or report of neck and upper back pain. The examiner referenced a June 1985 annual health assessment revealing that the Veteran was able to run and perform sit-ups with a score of excellent. The examiner opined that the likely cause of the Veteran's neck and upper back pain would be a muscle strain. The examiner stated that a muscular strain is an acute injury, self-limiting in nature and not in any way a contributing factor to degenerative arthritis of the spine. The examiner discussed that the etiology of degenerative arthritis is multifactorial with the greatest contributors to include age, genetics, epigenetics and lifestyle factors. The examiner opined that the Veteran's cervical radiculopathy was the result of his degenerative arthritis of the spine. The examiner concluded that the lack of documentation of a cervical spine disorder and/or bilateral upper extremity radiculopathy while on active duty, active duty for training and inactive duty for training; the absence of report of neck pain on the
 Veteran's neck and upper back pain would be a muscle strain. The examiner stated that a muscular strain is an acute injury, self-limiting in nature and not in any way a contributing factor to degenerative arthritis of the spine. The examiner discussed that the etiology of degenerative arthritis is multifactorial with the greatest contributors to include age, genetics, epigenetics and lifestyle factors. The examiner opined that the Veteran's cervical radiculopathy was the result of his degenerative arthritis of the spine. The examiner concluded that the lack of documentation of a cervical spine disorder and/or bilateral upper extremity radiculopathy while on active duty, active duty for training and inactive duty for training; the absence of report of neck pain on the Veteran's separation examination and annual health assessment; and the absence of a diagnosis of a cervical spine and/or bilateral upper extremity radiculopathy disorder for 30 years after final reserve duty suggests that the cervical spine disorder and/or bilateral upper extremity radiculopathy did not exist during active and reserve duty and did not prevent the Veteran from performing the physical demands of his military occupational specialty. 

The April 2024 examiner then opined that the Veteran's cervical spine disorder and bilateral upper extremity radiculopathy were less likely than not proximately due to or the result of his service connected PTSD with traumatic brain injury. The rationale provided was that there is no evidence in the medical literature indicating that degenerative arthritis, a multi-factorial metabolic process, or cervical radiculopathy, which is the direct result of degenerative arthritis, is caused by either PTSD or traumatic brain injury. The examiner also opined that the Veteran's cervical spine disorder and bilateral upper extremity radiculopathy were less likely than not aggravated beyond its natural progression by his service connected PTSD with traumatic brain injury. The rationale provided was that the medical literature is absent of any indication that degenerative arthritis and cervical radiculopathy are aggravated by PTSD or traumatic brain injury. 

Taken together, the Board finds the April 2024 VA medical opinions adequate to decide the claims. In this regard, the VA examiner reviewed the claims file, discussed relevant medical literature and provided a supporting rationale for the conclusions reached. The VA examiner noted the Veteran's contentions that his cervical spine disorder was related to service and/or his service connected PTSD with traumatic brain injury and that his bilateral upper extremity radiculopathy was secondary to his nonservice-connected cervical spine disorder. In addition, the VA examiner adequately considered the statements and contentions of the Veteran, to include the circumstances of his service, and the onset and continuity of his symptoms. The opinions also have clear conclusions and supporting data, as well as reasoned medical explanations. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21?Vet. App.?120, 124 (2007).  

Upon reviewing the aforementioned opinions, the Board finds that the only probative opinions of record determined that the Veteran's cervical spine disorder was not related to service and/or service connected PTSD with traumatic brain injury. 

The Veteran argued that he suffers from bilateral upper extremity radiculopathy that is secondary to a cervical spine disorder. As service connection for a cervical spine disorder is being denied herein, there simply is no legal basis to award service connection for bilateral upper extremity radiculopathy on a secondary basis. 38 C.F.R. § 3.310. See also Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

The Board notes that lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465 (1994). 

In the instant case, the Board finds that the question regarding the potential relationship between the Veteran's cervical spine disorder and any instance of his service and/or service connected PTSD with traumatic brain injury to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran was competent to describe his symptoms, the Board accords his statements regarding the etiology of such claimed disorder little probative value as he was not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and
 be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran was competent to describe his symptoms, the Board accords his statements regarding the etiology of such claimed disorder little probative value as he was not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and requires the administration and interpretation of diagnostic testing. In the instant case, there is no suggestion that the Veteran has had any medical training. Hence, the Board finds that he was not competent to provide a medical opinion to support the claim on the basis of his assertions alone. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinions of the Veteran are nonprobative evidence.

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Accordingly, the Board finds that entitlement to service connection for a cervical spine disorder, to include as secondary to service connected PTSD with traumatic brain injury and entitlement to service connection for bilateral upper extremity radiculopathy as secondary to nonservice-connected cervical spine disorder is not warranted. The appeals are denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

 

 

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Kuhn, Associate 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.