CERVICAL SPINE LIMITATION OF MOTION

J.M. ESTES · 2025 · Case ID: A25071553

GRANTED

Summary

The Veteran, who served from July 24, 1996, to November 20, 2009, with a dishonorable discharge, appeals the denial of service connection for multiple musculoskeletal conditions. The Veteran sought service connection for cervical spine, right and left hip, right and left knee, right ankle, and right and left foot disabilities, alleging they were aggravated by his service-connected lumbar spine and left ankle conditions. The Board reviewed the August 2024 private medical opinions, which found that the Veteran's claimed conditions were at least as likely as not aggravated by his service-connected lumbar spine and left ankle disabilities. These opinions cited medical literature supporting the interconnectedness of the spine and lower extremities in maintaining posture, station, and gait, and how pathology in one area can lead to aggravation in others. The Board found these private opinions persuasive due to their detailed rationale and use of medical literature. The Board also noted that the September 2024 VA medical opinions were insufficient because they only addressed causation and failed to address aggravation, a necessary component for secondary service connection. Consequently, the Board found the weight of the evidence supported secondary service connection for all claimed disabilities, granting entitlement to service connection for the cervical spine, right and left hip, right and left knee, right ankle, and right and left foot disabilities.

Rationale

Aggravated by service-connected lumbar spine disability; Private medical opinion found at least as likely as not aggravated; Benefit of the doubt applied

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250212-518008

Full Decision Text

Citation Nr: A25071553
Decision Date: 08/25/25 Archive Date: 08/25/25

DOCKET NO. 250212-518008
DATE: August 25, 2025

ORDER

Entitlement to service connection for a cervical spine disability is granted.

Entitlement to service connection for a right hip disability is granted.

Entitlement to service connection for a left hip disability is granted.

Entitlement to service connection for a right knee disability is granted.

Entitlement to service connection for a left knee disability is granted.

Entitlement to service connection for a right ankle disability is granted.

Entitlement to service connection for a right foot disability is granted.

Entitlement to service connection for a left foot disability is granted.

FINDINGS OF FACT

1. The Veteran's cervical spine disability was aggravated by his service-connected lumbar spine disability.

2. The Veteran's right hip disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

3. The Veteran's left hip disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

4. The Veteran's right knee disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

5. The Veteran's left knee disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

6. The Veteran's right ankle disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

7. The Veteran's right foot disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

8. The Veteran's left foot disability was aggravated by his service-connected lumbar spine and left ankle disabilities.

CONCLUSIONS OF LAW

1. The criteria for service connection for a cervical spine disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for a right hip disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for a left hip disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for service connection for a right knee disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for service connection for a left knee disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

6. The criteria for service connection for a right ankle disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

7. The criteria for service connection for a right foot disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

8. The criteria for service connection for a left foot disability on a secondary basis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 24, 1996, to December 23, 2007. He also had service from December 24, 2007, to November 20, 2009, which resulted in a dishonorable discharge.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office.

In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered
24, 2007, to November 20, 2009, which resulted in a dishonorable discharge.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office.

In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes the Veteran has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); see Williams v. McDonough, 37 Vet. App. 305 (2024). Although the period to change dockets per 38 C.F.R. § 20.202(c)(2) has not elapsed, the Veteran, through their authorized representative, explicitly waived their right to select a different Board review option and requested that a decision be expedited on the claim. See May 2025 Due Process Waiver. As such, there is no prejudice to the Veteran in proceeding to adjudicate the appeal.

Service Connection

The Veteran seeks entitlement to service connection for the issues on appeal, which he alleges were aggravated by his service-connected lumbar spine and/or left ankle disabilities. See August 2024 Statement.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present 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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury, shown by evidence of (1) a current disability 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); Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability"). The but-for causation standard in a secondary service-connected case is not limited to a single cause and effect, but rather contemplates multi-causal links. Id.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. §5107(b). It follows that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

In this case, after a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the weight of the evidence supports service connection on a secondary basis for all claimed disabilities on appeal.

Favorable findings noted in the January 2025 rating decision include current diagnoses of cervical strain, left and right hip trochanteric bursitis, left and right knee tendinitis, bilateral pes planus, and a right ankle strain. The Veteran is service-connected for lumbar spine and left ankle disabilities. See March 2018 and April 2020 Rating Decisions. Thus, the first and second elements of secondary service connection are met for each claim. See Spicer, 61 F.4th at 1360. The remaining questions are whether the current disabilities resulted from his service-connected lumbar spine and/or left ankle disabilities. Aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment in earning capacity, worsening of functionality) resulting from service-connected conditions. Id. Any "incremental increase in disability" need not be permanent.

Prior to addressing all claims, the Board acknowledges the Veteran underwent multiple September 2024 VA examinations for his claimed disabilities. The same VA examiner rendered negative nexus opinions for each disability based on the "caused by" prong of secondary service connection. Specifically, the examiner opined whether the claimed disability was "proximately due to or the result of" his service-connected disabilities. However, the examiner did not provide a medical opinion for the "aggravation prong" of secondary service connection for any claim. See El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013) (an opinion regarding secondary service connection is inadequate if it does not address both causation and aggravation). In light of the above, the Board finds the September 2024 VA medical opinions are insufficient and the Board will afford them minimal probative weight.

Nonetheless, the Board finds the August 2024 private opinions submitted are adequate and probative to warrant adjudication of the claims.

As to the cervical spine disability, utilizing the Veteran's lay statements and medical records and citing to medical literature, the medical professional determined the lumbar and cervical spine do not "function independently" and "dysfunction in one area affects the other." Moreover, that his service-connected lumbar spine affected his entire spine to include "posture, station, and gait" which aggravated his cervical spine disorder. Ultimately, the medical professional determined his cervical spine disability was at least as likely as not aggravated by his lumbar spine disability.

As to the right and left hip disabilities, utilizing the Veteran's lay statements and medical records and citing to medical literature, the medical professional determined that it is common for individuals with hip disorders to be significantly affected by comorbid back and lower extremity disorders, as each of the these play a crucial role in the biomechanics of posture, station and gait. Furthermore, when the kinematic chain is disrupted by pathology in one or more joints, including the back, the resulting overcompensating leads to alterations in biomechanics and aggravation of dysfunction and pain in other joints from disabling comorbid disorders. The medical literature supports a relationship between the hips and back in regard to pelvic tilt and its role in hip motion and dysfunction. Moreover, that the ankle serves a foundational role in station, posture, and gait in managing hip function. Ultimately, the medical professional determined his right and left hip disabilities were at least as likely as not aggravated by his lumbar spine and left ankle disabilities.

As to the right and left knee disabilities, utilizing the Veteran's lay statements and medical records and citing to medical literature, the medical professional determined that it is common for people with knee disorders to be significantly affected by comorbid back and lower extremity disorders, as each of the these play a crucial role in the biomechanics of posture, station and gait. Moreover, overcompensating leads to alterations in biomechanics and aggravation, dysfunction and pain in other joints. Furthermore, since the ankle serves a foundational role in station, posture, and gait, it aggravated the Veteran's bilateral knee disabilities. Ultimately, the medical professional determined his right and left knee disabilities were at least as likely as not aggravated by his lumbar spine and left ankle disabilities.

As to the right ankle disability, utilizing the Veteran's lay statements and medical records and citing to medical literature, the medical professional determined that an injury in one ankle can lead to overcompensation which can further lead to alterations in biomechanics and aggravation, dysfunction, and
role in the biomechanics of posture, station and gait. Moreover, overcompensating leads to alterations in biomechanics and aggravation, dysfunction and pain in other joints. Furthermore, since the ankle serves a foundational role in station, posture, and gait, it aggravated the Veteran's bilateral knee disabilities. Ultimately, the medical professional determined his right and left knee disabilities were at least as likely as not aggravated by his lumbar spine and left ankle disabilities.

As to the right ankle disability, utilizing the Veteran's lay statements and medical records and citing to medical literature, the medical professional determined that an injury in one ankle can lead to overcompensation which can further lead to alterations in biomechanics and aggravation, dysfunction, and pain in the opposite joint. Furthermore, his service-connected left ankle disability likely altered his gait resulting in overpronation, increasing the likelihood of injuring his right ankle. Ultimately, the medical professional determined his right ankle disability was at least as likely as not aggravated by his left ankle disability.

As to the right and left foot disabilities, utilizing the Veteran's lay statements and medical records and citing to medical literature, the medical professional determined that lower extremity biomechanics change as a result of other joint dysfunction which can cause aggravation of other joints including the feet. Furthermore, his feet are forced to bear more than normal loads and stress due to his other injuries. Ultimately, the medical professional determined his right and left foot disabilities were at least as likely as not aggravated by his lumbar spine and left ankle disabilities.

The Board affords the August 2024 private medical opinion significant probative value as it included a detailed overview of the Veteran's medical history, and the opinions were supported by extensive medical rationale and medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (adequate examination report must contain "not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two").

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In light of the above, the Board finds the persuasive medical evidence indicates the Veteran's cervical spine, right and left hip, right and left knee, right ankle, and right and left foot disabilities are aggravated by his service-connected lumbar spine and/or left ankle disabilities, and the benefit of the doubt rule applies to all claims. 38 U.S.C. § 5107; See Lynch, 21 F.4th at 776. Thus, the claims are all granted.

J.M. ESTES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Masters, Tyler

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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