CERVICAL SPINE LIMITATION OF MOTION

THOMAS ENGLISH · 2024 · Case ID: A24086011

MIXED

Summary

The veteran, who served from July 1990 to July 1995, appeals the denial of service connection for several conditions and the remand of others. The Board granted service connection for a neck condition, a right shoulder condition, headaches secondary to the neck condition, and hypertension secondary to the neck condition. The veteran reported developing neck and shoulder pain during service due to the physical demands of his job as a cable runner on a ship, experiencing awkward contortions and progressive worsening of symptoms. He also reported that his neck pain led to debilitating migraines and hypertension. The Board found the veteran competent and credible regarding the onset and progression of his neck and shoulder symptoms, noting the lack of negative nexus opinions and the presence of medical evidence supporting the claims. For the secondary conditions, the Board relied on the veteran's statements and medical treatises linking chronic pain to headaches and hypertension, finding the VA examiner's opinion on hypertension inadequate as it focused only on the shoulder and not the neck. The Board remanded claims for rapid heartbeat and left hip sciatic nerve condition secondary to the neck condition, citing a duty to assist error for failing to provide adequate VA examinations to address the etiology and nexus for these conditions. The Board found the veteran competent and credible regarding the onset of rapid heartbeat and noted medical treatment records and treatises supporting a link to chronic pain, but a VA examination was missing. Similarly, for the hip condition, the Board noted the veteran's reports of gait changes and submitted treatises on lower back pain affecting hip movement, but a VA examination was lacking.

Rationale

Veteran reported onset during service due to awkward positions while running cables.; Symptoms persisted and progressively worsened since service.; Veteran found competent and credible regarding onset and worsening.; Lack of negative nexus opinion.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

221228-308778

Full Decision Text

Citation Nr: A24086011
Decision Date: 12/26/24 Archive Date: 12/26/24

DOCKET NO. 221228-308778
DATE: December 26, 2024

ORDER

Service connection for a neck condition is granted.

Service connection for a right shoulder condition is granted.

Service connection for headaches secondary to service-connected neck condition is granted.

Service connection for hypertension secondary to service-connected neck condition is granted.

REMANDED

Service connection for a rapid heartbeat secondary to service-connected neck condition is remanded.

Service connection for left hip sciatic nerve condition secondary to service-connected neck condition is remanded.

FINDINGS OF FACT

1. The probative evidence of record, including competent and credible statements provided by the Veteran, supports a finding that the Veteran experienced symptoms of neck pain during and immediately following service and that these symptoms have persisted since then.

2. The probative evidence of record, including competent and credible statements provided by the Veteran, supports a finding that the Veteran experienced symptoms of right shoulder pain during and immediately following service and that these symptoms have persisted since then.

3. The probative evidence of record, including a VA examination, supports a finding that the Veteran's headaches condition is causally related to his service-connected neck condition.

4. The probative evidence of record, including a medical treatise, supports a finding that the Veteran's hypertension is causally related to his service-connected neck condition.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a neck condition have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307.

2. The criteria for entitlement to service connection for a right shoulder condition have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307.

3. The criteria for entitlement to service connection for headaches secondary to service-connected neck condition have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for entitlement to service connection for hypertension secondary to service-connected neck condition have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active-duty service from July 1990 to July 1995. This appeal arises before the?Board of Veterans' Appeals?(Board) from a June 2022 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In December 2022, the Veteran, submitted a VA Form 10182 Notice of Disagreement (NOD), seeking?direct?review by a Veterans Law Judge (VLJ) under the Appeals Modernization Act (AMA). Under?Direct?Review, all evidence available at the time of the decision on appeal is considered.

1. Service connection for a neck condition is granted.

Legal Criteria

Service connection may be granted for a disability arising from a disease or injury incurred in or aggravated by active service.?38?U.S.C. §?1131;?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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a causal relationship or nexus between the current disability and any injury or disease during service.

Service?connection?can?also?be established on the basis of continuation of symptomatology. Continuity?of?symptomatology?may be shown by demonstrating "(1) that a condition was 'noted' during?service?or any applicable presumption period; (2) evidence of post-service?continuity?of the same?symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service?symptom
disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a causal relationship or nexus between the current disability and any injury or disease during service.

Service?connection?can?also?be established on the basis of continuation of symptomatology. Continuity?of?symptomatology?may be shown by demonstrating "(1) that a condition was 'noted' during?service?or any applicable presumption period; (2) evidence of post-service?continuity?of the same?symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service?symptomatology." Barr v. Nicholson,?21?Vet. App.?303, 307?(2007).

Factual Background

The Veteran reported that his neck pain started during service in 1994. The Veteran explained that he ran cables to the computers on his ship. The Veteran further explained that he spent countless hours on top of ladders in heavily trafficked passageways and contorted his body into awkward positions. The Veteran noted that he did not seek medical attention because the pain was initially manageable, and the military encouraged veterans to push through their pain. The Veteran reported that he received several MRIs on his neck which indicates that his injury is degenerative and has been progressively worsening since service. See statement in support of claim.

The Veteran was diagnosed with cervicalgia at a November 2018 medical treatment. The conducting examiner indicated that the Veteran was seeing a cervical spine specialist who recommended surgery.

Analysis

The evidence of record supports a finding that the Veteran has a diagnosis of a neck condition. See November 2018 medical treatment. Thus, the first element for establishing service connection has been satisfied.

What remains for consideration is whether the Veteran's neck condition is causally related to service.

The Board finds the Veteran to be competent and credible that he developed neck pain during service as a result of contorting his body into awkward positions because these symptoms are readily observable. See Jandreau?v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

The Board also finds the Veteran to be competent and credible to report that his neck pain has gradually gotten worse since exiting from service. Id.

Considering the above and the lack of a negative nexus opinion, the Board finds that the probative evidence of record supports a finding that the Veteran's neck condition is causally related to service.

As such, service connection is granted.

2. Service connection for a right shoulder condition is granted.

Factual Background

The Veteran reported that his right shoulder pain started during service in 1994 while running cables to the computers on his ship. The Veteran reported that he received several MRIs on his shoulder which indicates that his injury is degenerative and has progressively worsened since service. See statement in support of claim.

The Veteran was afforded a January 2021 VA examination during which the conducting examiner noted that he had a diagnosis of right shoulder degenerative joint disease. The Veteran reported that he noticed that his right shoulder was weakening and would pop during service. The Veteran further reported that his right shoulder became worse through the years with more intensity and frequency of aching pain with range of motion and weight bearing.

Analysis

The record supports a finding that the Veteran has a diagnosis of a right shoulder condition. See January 2021 VA examination. Thus, the first element for establishing service connection has been satisfied.

What remains for consideration is whether the Veteran's right shoulder condition is causally related to service.

The Board finds the Veteran to be competent and credible that he developed right shoulder pain, weakness, and popping during service because these symptoms are readily observable. See Jandreau?supra.

The Board also finds the Veteran to be competent and credible to report that his right shoulder symptoms have gradually gotten worse since exiting from service. Id.

Considering the above and the lack of a negative nexus opinion, the Board finds that the probative evidence of record supports a finding that the Veteran's right shoulder condition is causally related to service.

As such, service connection is granted.

3. Service connection for headaches secondary to service-connected neck condition is granted.

Legal Criteria

Establishing secondary service connection requires evidence: (1) of a current disability (for which secondary service connection is sought); (2) of a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995).

Factual Background

The Veteran reported that his neck and shoulder pain cause migraines which are debilitating to the point that nothing
the Veteran's right shoulder condition is causally related to service.

As such, service connection is granted.

3. Service connection for headaches secondary to service-connected neck condition is granted.

Legal Criteria

Factual Background

The Veteran reported that his neck and shoulder pain cause migraines which are debilitating to the point that nothing will alleviate them except for sleeping until the next day. See statement in support of claim.

The Veteran was afforded a January 2021 VA examination for his headaches during which the conducting examiner noted that he has a long history of chronic neck pain since 1995. The examiner noted that the Veteran developed severe radiating headaches in 1995 as a result of his severe neck pain episodes. The examiner explained that the Veteran's neck pain will radiate to his posterior head extending to his left parietal area and left temporal area with stabbing pain.

Analysis

The evidence of record supports a finding that the Veteran has a diagnosis of a headaches condition. See January 2021 VA examination. Thus, the first element for establishing service connection has been satisfied.

What remains for consideration is whether the Veteran's headaches condition is causally related to his service-connected neck condition.

The Board finds the Veteran to be competent and credible that he suffers from severe migraine headaches following an onset of neck pain because these symptoms are readily observable. See Jandreau?supra.

The Board also assigns probative value to the January 2021 VA examiner who indicated that the Veteran developed severe radiating headaches as a result of his neck pain episodes.

Considering the above and the lack of a negative nexus opinion, the Board finds that the probative evidence of record supports a finding that the Veteran's headaches condition is causally related to service-connected neck condition.

As such, service connection is granted.

4. Service connection for hypertension secondary to service-connected neck condition is granted.

Factual Background

The Veteran reported that his chronic pain from his neck condition caused his hypertension and high blood pressure.

In support of his claim, the Veteran submitted a medical treatise which indicates that individuals who suffer from chronic pain are more likely to have high blood pressure than those who do not experience chronic pain. Additionally, the treatise indicated that these individuals have a diminished ability to experience the natural pain-relieving effects that usually occur when blood pressure changes.

The Veteran was afforded a June 2021 VA examination during which the conducting examiner opined that it is less likely than not that his hypertension is causally related to his service-connected right shoulder condition. As a rationale, the examiner explained that the Veteran's right shoulder condition was not incurred while in active-duty service.

Analysis

The Veteran has a diagnosis of hypertension. See June 2020 treatment note.

The Board assigns probative value to the medical treatise which indicates that chronic pain is linked to a higher risk of hypertension and a reduced ability to feel less pain as their blood pressure fluctuates. The Board notes that the medical treatise cited several medical studies pertaining to hypertension and pain.

The Board finds June 2021 VA examiner's opinion to be inadequate because the examiner limited their scope as to whether the Veteran's right shoulder condition was causally related to service rather than whether the Veteran's hypertension was causally related to his neck or right shoulder condition. As such, the Board does not assign probative value to this opinion.

Resolving all benefit of the doubt in favor of the Veteran, the Board finds that the probative evidence of record supports a finding that the Veteran's hypertension is causally related to his service-connected neck condition.

As such, service connection is granted.

REASONS FOR REMAND

1. Service connection for rapid heartbeat secondary to service-connected neck condition is remanded.

The Board finds the Veteran to be competent and credible to report a rapid heartbeat such symptoms are readily observable. See Jandreau supra. Additionally, the Veteran's medical treatment records indicate that he has been prescribed heart medication. See September 2020 medical treatment note.

In support of his claim, the Veteran submitted a medical treatise indicating that chronic pain can cause cardiac issues.

The Board notes that the Veteran has not been provided with a VA examination to determinate the etiology of his rapid heartbeat.

The Board finds that this evidence is sufficient to trigger VA's duty to assist and to provide a VA examination to address whether the Veteran's rapid heartbeat is secondary to his now service-connected neck condition. Because the McLendon elements requiring examinations were met prior to the June 2022 rating decision
to report a rapid heartbeat such symptoms are readily observable. See Jandreau supra. Additionally, the Veteran's medical treatment records indicate that he has been prescribed heart medication. See September 2020 medical treatment note.

In support of his claim, the Veteran submitted a medical treatise indicating that chronic pain can cause cardiac issues.

The Board notes that the Veteran has not been provided with a VA examination to determinate the etiology of his rapid heartbeat.

The Board finds that this evidence is sufficient to trigger VA's duty to assist and to provide a VA examination to address whether the Veteran's rapid heartbeat is secondary to his now service-connected neck condition. Because the McLendon elements requiring examinations were met prior to the June 2022 rating decision, the Board finds a duty to assist error occurred prior to the rating decision and a remand is warranted to correct these deficiencies. See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

2. Service connection for left hip sciatic nerve condition secondary to service-connected neck condition is remanded.

The Veteran has a diagnosis of sciatica of the left hip. See June 2020 medical treatment note.

The Veteran reports that his neck and shoulder pain has affected his gait and caused injury to his hip. See May 2021 correspondence.

The Veteran submitted a medical treatise indicating that individuals with lower back pain have impaired trunk muscle control, which may compromise the control of trunk and hip movements during postural adjustments.

The Board notes that the Veteran has not been provided with a VA examination to determine the etiology of his left hip condition.

The Board finds that this evidence is sufficient to trigger VA's duty to assist and to provide a VA examination to address whether the Veteran's left hip condition is secondary to his now service-connected neck condition. Because the McLendon elements requiring examinations were met prior to the June 2022 rating decision, the Board finds a duty to assist error occurred prior to the rating decision and a remand is warranted to correct these deficiencies. See McLendon supra.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination to determine the etiology of his rapid heartbeat. Any indicated tests and/or studies should be completed. The examiner should answer the following questions:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's rapid heartbeat is caused by his service-connected neck disorder?

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's rapid heartbeat was aggravated (made worse) by his service-connected neck condition?

If aggravation is found, the examiner should identify the baseline level of severity of the rapid heartbeat created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the rapid heartbeat. If such cannot be done, then it should be explained why.

2. Schedule the Veteran for a VA examination to determine the etiology of his left hip sciatic nerve condition. Any indicated tests and/or studies should be completed. The examiner should answer the following questions:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left hip sciatic nerve condition is caused by his service-connected neck disability?

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left hip sciatic nerve condition was aggravated (made worse) by his service-connected neck condition?

If aggravation is found, the examiner should identify the baseline level of severity of the left hip sciatic nerve condition created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the left sciatic nerve connection. If such cannot be done, then it should be explained why.

A comprehensive rationale for all opinions is to be provided.

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bahus, Alexander

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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