DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

RAY BARTO SLABBEKORN, JR. · 2025 · Case ID: A25099695

MIXED

Summary

The Veteran, an Air Force Veteran who served from October 1987 to February 1988, with additional service in the Air Force National Guard, appeals the denial of service connection for gastroesophageal reflux disease (GERD) and left upper extremity radiculopathy, and seeks service connection for cervical strain with degenerative disc disease, right shoulder tendinopathy, and right upper extremity radiculopathy. The Veteran's claims stem from alleged in-service injuries during physical training and TERA exposure. The Board granted service connection for cervical strain with degenerative disc disease, right shoulder tendinopathy, and right upper extremity radiculopathy, finding the evidence in approximate balance and resolving doubt in the Veteran's favor, citing Lynch v. McDonough. The Board found that while the Veteran's lay statements and private chiropractic opinions supported a link to service, the VA DBQ opinions were inadequate. Service connection for left upper extremity radiculopathy was denied due to a lack of current diagnosis and insufficient evidence of an in-service event or continuity of symptomatology. The GERD claim was denied due to multiple negative nexus opinions from VA examiners and TERA specialists, who found no sufficient link between GERD and the Veteran's TERA exposure, despite the Veteran's TERA participation and GERD diagnosis. The Board found the evidence persuasively favored a denial for GERD, rendering the benefit-of-the-doubt rule inapplicable.

Rationale

Favorable finding of diagnosis from RO decision; Lay statements regarding pain during physical training in service; Private chiropractic opinion linking condition to service; Benefit of the doubt applied due to approximate balance of evidence

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250724-567862

Full Decision Text

Citation Nr: A25099695
Decision Date: 11/17/25 Archive Date: 11/17/25

DOCKET NO. 250724-567862
DATE: November 17, 2025

ORDER

Entitlement to service connection for cervical strain with degenerative disc disease is granted.

Entitlement to service connection for right shoulder tendinopathy is granted.

Entitlement to service connection for a left shoulder condition is granted.

Entitlement to service connection for right upper extremity radiculopathy, to include as secondary to a cervical strain, is granted.

Entitlement to service connection for left upper extremity radiculopathy is denied.

Entitlement to service connection for gastroesophageal reflux disease is denied.

FINDINGS OF FACT

1. The Veteran's cervical strain with degenerative disc disease is related to the strain and stress of military service.

2. The Veteran's right shoulder tendinopathy is related to the strain and stress of military service.

3. The Veteran's left shoulder condition is related to the strain and stress of military service.

4. The Veteran's right upper extremity radiculopathy is related to the Veteran's cervical strain or to the strain and stress of military service.

5. The Veteran does not suffer from left upper extremity radiculopathy that began during active service or otherwise resulted from an in-service injury or disease.

6. The Veteran does not suffer from gastroesophageal reflux disease that began during active service or otherwise resulted from an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a cervical strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for right shoulder tendinopathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a left shoulder condition are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for right upper extremity radiculopathy as secondary to a cervical strain are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for left upper extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for gastroesophageal reflux disease are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from October 1987 to February 1988 with additional active service in the Air Force National Guard.

On March 18, 2024, an intent to file was received. In April 2024, the Veteran submitted a fully developed claim seeking service connection for gastroesophageal reflux disease (GERD), cervical pain, cervical radiculopathy, and bilateral shoulder pain. In April 2024, a toxic exposure risk activity (TERA) memorandum found that based on the location of the Veteran's service she had participated in TERA. In August 2024, a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) denied cervical connection for the cervical strain, left shoulder, left upper extremity radiculopathy, and right shoulder. The cervical strain was denied based on a negative nexus opinion and the lack of any complaints in the Veteran's service treatment records (STRs). The RO did include the favorable finding that the Veteran had been diagnosed with a cervical strain. The RO denied the left shoulder, left upper extremity radiculopathy, and right shoulder due to negative nexus opinions and lack of complaints in the STRs. For the right shoulder, the RO included the favorable finding that a disability had been diagnosed. The RO deferred a finding on GERD and right upper extremity radiculopathy pending further development. In August 2024, an additional RO decision denied service connection for both GERD and right upper extremity radiculopathy.

In September 2024, the Veteran requested higher-level review (HLR) of these two rating decisions denying service connection. In December 2024, a H
RO did include the favorable finding that the Veteran had been diagnosed with a cervical strain. The RO denied the left shoulder, left upper extremity radiculopathy, and right shoulder due to negative nexus opinions and lack of complaints in the STRs. For the right shoulder, the RO included the favorable finding that a disability had been diagnosed. The RO deferred a finding on GERD and right upper extremity radiculopathy pending further development. In August 2024, an additional RO decision denied service connection for both GERD and right upper extremity radiculopathy.

In September 2024, the Veteran requested higher-level review (HLR) of these two rating decisions denying service connection. In December 2024, a HLR RO rating decision found multiple duty-to-assist errors in the prior decisions. For the cervical strain, GERD, left shoulder, and right shoulder the RO found that additional medical examinations/opinions were necessary and that the failure to obtain these decisions was a duty-to-assist error. The RO denied service connection for the bilateral upper extremity radiculopathy finding no evidence of a current disability for either extremity. In April 2025, following completion of new examinations and opinions, an RO rating decision denied service connection for the cervical strain, left shoulder, and right shoulder. The RO stated that while new and relevant evidence had been received the evidence did not support a change in the prior decision. For the left shoulder the RO found there was no currently diagnosed disability. For the right shoulder the RO confirmed the favorable finding of a diagnosis. The RO also deferred a finding on GERD stating that an additional medical opinion was needed. In April 2025, the RO continued the denial of service connection for GERD. In July 2025, the Veteran appealed the August 2024 rating decisions to the Board of Veterans' Appeals (Board) via a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)). The Veteran requested the direct review docket.

As an appeal in which the appellant requested, on the Notice of Disagreement, direct review by the Board without submission of additional evidence and without a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the respective decisions on the issues on appeal. 38 C.F.R. § 20.301.

Evidence has been submitted during a window of time when the Board may not consider it in reaching this decision. This evidence includes, but is not limited to, additional medical records. If the Veteran wishes for this evidence to be considered, she may do so by filing a supplemental claim. Instructions for filing a supplemental claim are included with this decision.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a).

To establish a right to compensation for a present disability, a Veteran must show: "(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." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Under 38 C.F.R. § 3.310(a), service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury. Such permits a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation to a nonservice-connected disability by a service-connected disability. Id. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b).

In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify
ervice-connected disability by a service-connected disability. Id. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b).

Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b).

Entitlement to service connection for cervical strain with degenerative disc disease.

As noted above, the August 2024, RO decision included a favorable finding that the Veteran had been diagnosed with a cervical strain. That finding will not be disturbed and so the first element of service connection has been met.

For the second element of service connection, the Veteran has not raised specific contentions about suffering an injury during her time in service. However, at her May 2024 disability benefits questionnaire (DBQ) examination the Veteran reported that her pain began during enlisted service and that she would receive waivers for PT tests due to neck pain. The Board will interrupt this as the injury was caused by the physical demands of training while in active service. The Board will give the benefit of the doubt to the Veteran and find this satisfies the second element of service connection. 38 U.S.C. § 5107(b). Accordingly, the only issue before the Board is a causal relationship between the Veteran's cervical strain and the physical demands of her time in service.

A review of the Veteran's STRs fails to show any evidence of treatment or complaints for a cervical strain or any other neck pain. However, the essence of a service connection claim is symptoms, not treatment, and so the lack of STRs alone is not fatal to the Veteran's claim. Hensley v. Brown, 5 Vet. App. 155, 160 (1993).

Post-service medical records show the Veteran has consistently been treated by a chiropractor for pain in the cervical region. The available records show treatment from July 2018 to February 2020. The last available treatment record from February 2020 indicates that the Veteran saw overall improvement between 81-99 percent and that conservative chiropractic management should be continued.

In April 2024, the Veteran submitted a private medical opinion from a Doctor of Chiropractic medicine. This letter linked the Veteran's cervical strain to her time in service. The letter specifically noted that it was the examiner's opinion that the Veteran's years in the military had caused much of the Veteran's pain. It was specifically noted that the physical fitness examinations and running had caused instability in the Veteran's neck and shoulders.

In April 2024, there was an annual medical certification completed by the Veteran. In it she noted that she was suffering from neck problems. She also stated that she was being treated for neck problems.

In May 2024, a cervical DBQ was completed. The examiner diagnosed the Veteran with a cervical strain with degenerative disc disease. The Veteran reported that her neck pain started several years ago during her enlisted service. The Veteran reported receiving waivers for PT tests due to her neck pain. She reported she is currently treating with Tylenol for pain while continuing to see a chiropractor once a week for her neck pain. The Veteran reported suffering daily flare-ups of neck pain which she described as moderate but last all day. These flare-ups were precipitated by hyperextending her neck or carrying more than 10 pounds and alleviated by visiting the chiropractor. The examiner found no evidence of guarding or muscle spasms, no muscle atrophy, no radiculopathy, no ankylosis, and no IVDS.

The examiner provided a negative direct service connection opinion. The examiner noted that the Veteran has occipital neuralgia which is a condition causing headaches
reported receiving waivers for PT tests due to her neck pain. She reported she is currently treating with Tylenol for pain while continuing to see a chiropractor once a week for her neck pain. The Veteran reported suffering daily flare-ups of neck pain which she described as moderate but last all day. These flare-ups were precipitated by hyperextending her neck or carrying more than 10 pounds and alleviated by visiting the chiropractor. The examiner found no evidence of guarding or muscle spasms, no muscle atrophy, no radiculopathy, no ankylosis, and no IVDS.

The examiner provided a negative direct service connection opinion. The examiner noted that the Veteran has occipital neuralgia which is a condition causing headaches which can feel like pinching or shock wave like pain in the upper neck. The examiner noted there were no STRs showing the Veteran complaining of any neck issues while in service. The Board notes that this examiner's opinion failed to discuss the diagnosed cervical strain with degenerative disc disease and if it was related to service. Instead, the examiner focused on the occipital neuralgia that may also result in neck pain while ignoring the diagnosed neck condition.

In January 2025, an additional cervical DBQ medical opinion was provided. The examiner provided a negative direct service connection opinion. The opinion stated that there was no evidence of neck pain or injury in the Veteran's STRs. The examiner acknowledged the Veteran's diagnosis but indicated there was no relation to her time in service. This examiner failed to discuss the possibility of general wear and tear from physical training causing the neck pain and the Veteran's lay statement that her neck pain began during the physical training.

The Board finds that both the May 2024 and January 2025 DBQ medical opinions failed to provide a full discussion of the Veteran's lay statements regarding the history of physical training in service. While the Veteran's lay statements are not enough to provide a positive etiology opinion, they need to be addressed by the examiner in order to provide a complete picture of the Veteran's disability. Therefore, the Board finds that these two DBQ opinions cannot be the basis for a denial of the Veteran's claim for service connection.

Looking at the April 2024 private opinion, the Board finds that while the rationale is not as fulsome, it considers the Veteran's lay statements and is an area in which a chiropractor would be able to opine. While the Board does not have a complete history of the Veteran's chiropractic appointments, it seems logical that this letter was drafted by a chiropractor with knowledge of the Veteran's treatment. Additional medical evidence of the Veteran's continued chiropractic care would shed light on this, but the Board will not further delay these proceedings for additional evidence. Instead, the Board finds that the evidence for and against the Veteran's claim is in approximate balance. Accordingly, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for a cervical strain with degenerative disc disease is warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Entitlement to service connection for right shoulder tendinopathy.

As noted above, the August 2024, RO decision included a favorable finding that the Veteran had been diagnosed with a right shoulder disability. That finding will not be disturbed and so the first element of service connection has been met.

For the second element of service connection, the Veteran has not raised specific contentions about suffering an injury during her time in service. However, at her January 2025 DBQ examination the Veteran reported that while she was not sure of the exact date of onset, she noted pain in the shoulder during her physical training with the military. The Board will interrupt this as the injury being caused by the physical demands of training while in active service. The Board will give the benefit of the doubt to the Veteran and find this satisfies the second element of service connection. 38 U.S.C. § 5107(b). Accordingly, the only issue before the Board is a causal relationship between the Veteran's right shoulder disability and the physical demands of her time in service.

A review of the Veteran's STRs fails to show any evidence of treatment or complaints for a right shoulder disability. However, the essence of a service connection claim is symptoms, not treatment, and so the lack of STRs alone is not fatal to the Veteran's claim. Hensley v. Brown, 5 Vet. App. 155, 160 (1993).

Post-service medical records show the Veteran has consistently been treated by a chiropractor for pain in the right shoulder. The available records show treatment from July 2018 to February 2020. The last available treatment record from February 2020 indicates that the Veteran saw overall improvement between 81
's right shoulder disability and the physical demands of her time in service.

Post-service medical records show the Veteran has consistently been treated by a chiropractor for pain in the right shoulder. The available records show treatment from July 2018 to February 2020. The last available treatment record from February 2020 indicates that the Veteran saw overall improvement between 81-99 percent and that conservative chiropractic management should be continued.

In April 2024, the Veteran submitted a private medical opinion from a Doctor of Chiropractic medicine. This letter linked the Veteran's right shoulder pain to her time in service. The letter specifically noted that it was the examiner's opinion that the Veteran's years in the military had caused much of the Veteran's pain. It was specifically noted that the physical fitness examinations and running had caused instability in the Veteran's neck and shoulders.

In April 2024, there was an annual medical certification completed by the Veteran. In it she noted that she was suffering from shoulder problems and that she was continuing treatment for this issue.

In May 2024, a shoulder DBQ was completed. The examiner diagnosed the Veteran with right shoulder retinopathy and did not provide a diagnosis for a left shoulder disability. The Veteran was noted as right-handed. The Veteran stated that she had right shoulder pain for several years and that she was seeing a chiropractor for her shoulder pain. She also reported that she had tried acupuncture in the past. The Veteran reported suffering right shoulder flare-ups about once per month. The Veteran described these as moderate in nature and that they last about two days. These flare-ups were precipitated by lifting objects more than 10 pounds and were alleviated by rest, ice, and heat, the chiropractor, and the use of Tylenol. The Veteran's range of motion (ROM) was noted as abnormal in both shoulders. For the right shoulder the examiner provided a negative opinion. The rationale stated only that there were no records suggesting the Veteran suffered right shoulder pain or an injury during service.

In January 2025 a shoulder DBQ opinion stated that the Veteran's right shoulder disability was not related to her TERA.

Also in January 2025, an additional shoulder DBQ was completed. The examiner diagnosed the Veteran with right shoulder tendinopathy and no left shoulder diagnosis. The Veteran stated she did not know how her condition began but said that she noted it during physical training with the military. She complained of a dull aching pain with intermittent pain shooting down her right arm. There were flare-ups that last an entire day prompted by simple arm movements and alleviated by rest. The Veteran's ROM was abnormal. This examiner did not provide a direct service connection opinion.

The Board finds the May 2024 medical opinion failed to provide a full discussion of the Veteran's lay statements regarding the history of physical training in service. While the Veteran's lay statements are not enough to provide a positive etiology opinion, they need to be addressed by the examiner in order to provide a complete picture of the Veteran's disability. The entire basis for the denial of a positive service connection opinion was the lack of medical records in service. This alone cannot be the basis for a negative opinion. Therefore, the Board finds that these two DBQ opinions cannot be the basis for a denial of the Veteran's claim for service connection.

Looking at the April 2024 private opinion, the Board finds that while the rationale is not as fulsome, it considers the Veteran's lay statements and is an area in which a chiropractor would be able to opine. While the Board does not have a complete history of the Veteran's chiropractic appointments, it seems logical that this letter was drafted by a chiropractor with knowledge of the Veteran's treatment. Additional medical evidence of the Veteran's chiropractic care would shed light on this, but the Board will not further delay these proceedings for additional evidence. Instead, the Board finds that the evidence for and against the Veteran's claim is in approximate balance. Accordingly, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for right shoulder tendinopathy is warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Entitlement to service connection for a left shoulder condition.

The Veteran has not raised specific contentions for her left shoulder condition and how it relates to service.

In July 2018, the Veteran was
care would shed light on this, but the Board will not further delay these proceedings for additional evidence. Instead, the Board finds that the evidence for and against the Veteran's claim is in approximate balance. Accordingly, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for right shoulder tendinopathy is warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Entitlement to service connection for a left shoulder condition.

The Veteran has not raised specific contentions for her left shoulder condition and how it relates to service.

In July 2018, the Veteran was receiving chiropractic treatment for her left shoulder. The medical records show that the Veteran had subluxation of the left shoulder. This satisfies the first element of service connection.

For the second element of service connection, the Veteran has not raised specific contentions about suffering an injury during her time in service. However, at her January 2025 disability benefits questionnaire (DBQ) examination the Veteran reported that while she was not sure of the exact date of onset, she noted pain in the shoulder during her physical training with the military. The Board will interrupt this as the injury was caused by the physical demands of training while in active service. The Board will give the benefit of the doubt to the Veteran and find this satisfies the second element of service connection. 38 U.S.C. § 5107(b). Accordingly, the only issue before the Board is a causal relationship between the Veteran's left shoulder disability and the physical demands of her time in service.

A review of the Veteran's STRs fails to show any evidence of treatment or complaints for a left shoulder disability. However, the essence of a service connection claim is symptoms, not treatment, and so the lack of STRs alone is not fatal to the Veteran's claim. Hensley v. Brown, 5 Vet. App. 155, 160 (1993).

Post-service medical records show the Veteran has consistently been treated by a chiropractor for pain in the left shoulder. The available records show treatment from July 2018 to February 2020. The last available treatment record from February 2020 indicates that the Veteran saw overall improvement between 81-99 percent and that conservative chiropractic management should be continued. It was these records that contain a finding of left shoulder subluxation.

In April 2024, the Veteran submitted a private medical opinion from a Doctor of Chiropractic medicine. This letter linked the Veteran's left shoulder pain to her time in service. The letter specifically noted that it was the examiner's opinion that the Veteran's years in the military had caused much of the Veteran's pain. It was specifically noted that the physical fitness examinations and running had caused instability in the Veteran's neck and shoulders.

In April 2024, there was an annual medical certification completed by the Veteran. In it she noted that she was suffering from shoulder problems and that she was continuing treatment for this issue.

In May 2024, a shoulder DBQ was completed. This examiner did not provide a diagnosis of the left shoulder. The examiner did note abnormal ROM of the left shoulder. The examiner provided a negative direct service connection opinion and noted that the Veteran was diagnosed with left shoulder neuralgia. The examiner said there was no evidence of STRs containing left shoulder complaints. The examiner also noted that the Veteran did not complain of left shoulder pain at the time of the examination. The Board notes that despite the opinion noting the Veteran suffered from left shoulder neuralgia which is characterized by pain, numbness, and tingling the examiner did not provide this diagnosis in the diagnosis section of the examination. The examiner also failed to discuss the Veteran's left shoulder subluxation diagnosis and continued chiropractic treatment.

In January 2025 a shoulder DBQ opinion stated that the Veteran's left shoulder disability was not related to her TERA.

Also in January 2025, an additional shoulder DBQ was completed. The examiner found no left shoulder diagnosis. The Veteran stated she did not know how her condition began but said that she noted it during physical training with the military. She complained of a dull aching pain with intermittent pain shooting down her right arm. There were flare-ups that last an entire day prompted by simple arm movements and alleviated by rest. The Veteran's ROM was abnormal. This examiner did not provide a direct service connection opinion.

The Board finds the May 2024 medical opinion failed to provide a full discussion of the Veteran's lay statements regarding the history of physical training in service. While the Veteran's lay statements are not enough to provide a positive etiology opinion, they need to be addressed by the examiner in order to provide a complete picture of the Veteran's disability. The entire basis for the denial of a positive
her condition began but said that she noted it during physical training with the military. She complained of a dull aching pain with intermittent pain shooting down her right arm. There were flare-ups that last an entire day prompted by simple arm movements and alleviated by rest. The Veteran's ROM was abnormal. This examiner did not provide a direct service connection opinion.

The Board finds the May 2024 medical opinion failed to provide a full discussion of the Veteran's lay statements regarding the history of physical training in service. While the Veteran's lay statements are not enough to provide a positive etiology opinion, they need to be addressed by the examiner in order to provide a complete picture of the Veteran's disability. The entire basis for the denial of a positive service connection opinion was the lack of medical records in service. The examiner also failed to discuss the chiropractic records including a diagnosis of left shoulder subluxation. The lack of STRs alone cannot be the basis for a negative opinion. Therefore, the Board finds that these two DBQ opinions cannot be the basis for a denial of the Veteran's claim for service connection.

Looking at the April 2024 private opinion, the Board finds that while the rationale is not as fulsome, it considers the Veteran's lay statements and is an area in which a chiropractor would be able to opine. While the Board does not have a complete history of the Veteran's chiropractic appointments, it seems logical that this letter was drafted by a chiropractor with knowledge of the Veteran's treatment. Additional medical evidence of the Veteran's chiropractic care would shed light on this, but the Board will not further delay these proceedings for additional evidence. Instead, the Board finds that the evidence for an against the Veteran's claim is in approximate balance. Accordingly, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for a left shoulder disability is warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Entitlement to service connection for right upper extremity radiculopathy.

The Veteran has not raised specific contentions for her right upper extremity radiculopathy and how it relates to service. Though not specifically filed as secondary to the Veteran's cervical strain the Board will treat it as such based on the findings of a May 2024 DBQ.

In January 2025, a peripheral nerve DBQ was completed. This examination found the Veteran suffering from right upper extremity mild incomplete paralysis. This satisfies the first element of service connection.

For the second element of secondary service connection, the Board finds that earlier in this decision service connection for a cervical strain was granted. This satisfies the second element of secondary service connection. Accordingly, the only issue before the Board is a finding of evidence establishing a connection between the Veteran's cervical strain and the right upper extremity radiculopathy.

A review of the Veteran's STRs fails to show any evidence of treatment or complaints for right upper extremity radiculopathy. However, the essence of a service connection claim is symptoms, not treatment, and so the lack of STRs alone is not fatal to the Veteran's claim. Hensley v. Brown, 5 Vet. App. 155, 160 (1993).

Post-service medical records show the Veteran has consistently been treated by a chiropractor for pain in cervical spine. The available records show treatment from July 2018 to February 2020. Despite this treatment there is no indication of right upper extremity radiculopathy during these visits.

In April 2024, the Veteran submitted a private medical opinion from a Doctor of Chiropractic medicine. This letter linked the Veteran's right upper extremity radiculopathy to her time in service and specifically the neck and shoulder pain. The letter specifically noted that it was the examiner's opinion that the Veteran's years in the military had caused much of the Veteran's pain. It was specifically noted that the physical fitness examinations and running had caused instability in the Veteran's neck and shoulders which led to nerve tension down her arms.

In May 2024, a cervical DBQ was completed. The examiner did not provide a radiculopathy diagnosis. However, the examiner was asked to provide a radiculopathy opinion. This examiner provided a positive opinion noting that there is a possible nexus to the risk of development of cervical radiculopathy and the performance of rigorous physical endurance training during enlistment. The examiner notes that this often begins with a pinched or irritated nerve in the neck causing pain that radiates. This same opinion also stated that the Veteran had been diagnosed with radiculopathy of the right upper extremity. While there is some confusion in the wording of this opinion, the Board will take it at face value as a positive service
her arms.

In August 2024, an additional DBQ radiculopathy opinion was provided. The examiner provided a negative opinion and stated that there was no radiculopathy noted on the May 2024 DBQ.

In January 2025, a peripheral nerve DBQ was completed. The examiner diagnosed the Veteran with right upper extremity radiculopathy. The Veteran stated that it began in 2015. She described her symptoms as a dull aching pain shooting down her right arm and into her hand. She suffered from moderate intermittent pain, mild paresthesias and/or dysesthesia, and mild numbness.

The Board finds the May 2024 medical opinion to be both contradictory and informative. While the examiner did not diagnosis the Veteran with right upper extremity radiculopathy in the examination, the opinion provided this diagnosis. Additionally, a second opinion from August 2024 denied the Veteran had radiculopathy and provided a negative opinion. Contrast this with the January 2025 examination which diagnosed the Veteran with right upper extremity radiculopathy. There is also the private opinion of the chiropractor that related the nerve tension down the Veteran's arms to the neck issues.

There are two opinions which find the Veteran's right upper extremity radiculopathy to be connected to his time in service via the neck pain and others which find no diagnosis of radiculopathy. Overall, the Board finds that the evidence for and against the Veteran's claim is in approximate balance. Accordingly, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for right upper extremity radiculopathy, to include as secondary to a cervical strain, is warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Entitlement to service connection for left upper extremity radiculopathy.

The first element of any service connection claim is the evidence of a current disability. Here, the Board finds that the Veteran does not currently have left upper extremity radiculopathy.

A review of the Veteran's STRs is silent for any complaints of or treatment for left upper extremity radiculopathy. At the Veteran's chiropractic treatments following service there is no indication she was suffering from left upper extremity radiculopathy. The April 2024 private chiropractic opinion only notes that the Veteran suffered from nerve tension down her arms with no specific diagnosis. At her April 2024 annual medical certification, the Veteran did not mention complaints of or treatment for left upper extremity radiculopathy.

At the May 2024 cervical DBQ there was no finding of left upper extremity radiculopathy or any other radicular signs or symptoms. In January 2025, a peripheral nerve DBQ was completed. This DBQ fails to show any complaints of left upper extremity radiculopathy and does not provide a diagnosis of the same. There was no finding of any pain, numbness, or other radicular symptoms of the left upper extremity. A medical opinion was provided which noted that there was no pathology to warrant a diagnosis of left upper extremity radiculopathy and therefore no opinion was provided.

The Board acknowledges that pain alone can be a disability. Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018). However, there has been no diagnosis, no consistent complaints of pain, weakness, or other evidence of a current disability, the Board finds that the first element of service connection has not been met, and the claim is denied.

In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran does not have a current disability of left upper extremity radiculopathy. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

Entitlement to service connection for gastroesophageal reflux disease.

In the Veteran's April 2024 initial claim, she indicated her belief that her GERD was caused by exposures in service. She specifically pointed to service in Saudi Arabia. As noted earlier, an April 2024 TERA memorandum confirmed the Veteran participated in TERA.

In May 2024, an esophageal condition DBQ was completed which diagnosed the Veteran with GERD. Therefore, the first element of service connection has been met. Given the Veteran's confirmed TERA participation, the second element of service connection has also been met. Accordingly, the only issue before the Board is a causal relationship between the Veteran's GERD and her time in service to include TERA.

A review of the Veteran's STRs fails to show any complaints of or treatment for GERD.

In December 2021, the Veteran was treated for GERD. She noted that her symptoms were quiet with the use of Famotidine.

At her April 2024 annual medical certification, the Veteran noted a current problem of acid reflux and stated she was taking Omeprazole.

At the May 2024 DBQ, the Veteran was diagnosed with GERD. She indicated she was taking Pepcid AC daily and occasionally twice a day as needed. The only symptom noted for her GERD was reflux. There was no evidence of an esophageal stricture or tumors or neoplasms. No medical opinion was provided.

In August 2024 a TERA opinion for the Veteran's GERD was provided. The Veteran reported that she did not know when the GERD symptoms began. She also denied currently suffering any GERD symptoms. The examiner noted that the Veteran's GERD was less likely than noted related to the Veteran's TERA. The examiner explained that the medical literature does not sufficiently demonstrate that GERD is caused by the Veteran's indicated toxic exposure. It continued by stating that medical studies are lacking to show that these exposures would cause GERD.

In January 2025, a Gulf War DBQ was completed. The examiner concluded that the Veteran's GERD was not caused by toxic exposure. The examiner explained that GERD is caused by the lower esophageal sphincter relaxing which allows stomach acid to flow back into the esophageus.

An additional GERD DBQ was completed in January 2025 where the Veteran noted her GERD began in 2000 when she developed epigastric pain with regurgitation.

In April 2025, an additional TERA opinion was provided. This opinion was also negative and stated that no positive association exists between the Veteran's TERA exposure and GERD.

A review of the totality of evidence finds negative service connection opinions in August 2024, January 2025, and April 2025. There is no positive nexus opinion available of record and the Board has no reason to doubt the probative nature of any of the examinations or opinions of record. Therefore, the Board finds that the third element of service connection has not been met, and the claim is denied.

In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran's GERD is not related to her TERA in service. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ledman, Andrew

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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