CERVICAL SPINE LIMITATION OF MOTION

MICHAEL LANE · 2026 · Case ID: A26019958

MIXED

Summary

The Veteran served in the Marine Corps from July 1999 to September 2003, including service in Kuwait during the Gulf War Era. The Veteran appeals the denial of service connection for a cervical spine disability, a lumbosacral spine disability, and hypertrophic gastritis, and seeks remand for obstructive sleep apnea, traumatic brain injury (TBI), and chronic fatigue syndrome (CFS). The Board granted service connection for the cervical spine disability, finding it related to service based on the Veteran's lay statements and a VA examiner's opinion attributing it to physical activities during service. The Board also granted service connection for the lumbosacral spine disability, noting the Veteran's in-service complaints and a private physician's opinion linking the condition to service, despite a VA examiner finding the records silent. Service connection for hypertrophic gastritis was granted, with the Board finding the Veteran's GI symptoms related to service, supported by a private physician's opinion and the Veteran's post-deployment health assessment, despite a VA examiner's opinion suggesting otherwise. The Board remanded the claims for obstructive sleep apnea, TBI, and CFS due to inadequate VA medical opinions. For sleep apnea, the VA examiner failed to address lay evidence and the gap between service and diagnosis. For TBI, the AOJ failed to clarify a current diagnosis despite a prior VA opinion suggesting a possible TBI in service. For CFS, the VA examiner did not adequately explain the lack of diagnosis or address the Veteran's reported symptoms and potential toxic exposures.

Rationale

Current diagnosis of degenerative arthritis of the cervical spine; Lay reports of neck pain and symptoms since service; VA examiner opined condition related to physical activities in service; Evidence in approximate balance, doubt resolved in Veteran's favor

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200514-92050

Full Decision Text

Citation Nr: A26019958
Decision Date: 03/05/26 Archive Date: 03/05/26

DOCKET NO. 200514-92050
DATE: March 5, 2026

ORDER

Entitlement to service connection for a cervical spine disability (characterized as a neck condition) is granted.

Entitlement to service connection for a lumbosacral spine disability (characterized as degenerative arthritis of the spine claimed as lower back condition) is granted.

Entitlement to service connection for hypertrophic gastritis is granted.

REMANDED

Entitlement to service connection for obstructive sleep apnea is remanded.

Entitlement to service connection for a traumatic brain injury (TBI) is remanded.

Entitlement to service connection for chronic fatigue syndrome is remanded.

FINDINGS OF FACT

1. The Veteran's cervical spine disability is related to service.

2. The Veteran's lumbosacral spine disability is related to service.

3. The Veteran's hypertrophic gastritis is related to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for a cervical spine disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a lumbosacral spine disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for hypertrophic gastritis have been 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 from July 1999 to September 20033, including in Kuwait during the Gulf War Era.

A rating decision was issued under the legacy system in September 2017 and the Veteran submitted a timely notice of disagreement. In March 2020, the agency of original jurisdiction (AOJ) issued a statement of the case (SOC). The Veteran opted the claims into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a May 2020 VA Form 10182, Decision Review Request: Board Appeal, identifying the March 2020 SOC. Therefore, the March 2020 SOC is the decision on appeal.

In the May 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in October 2024 and a transcript of the hearing has been included in the record. Therefore, the Board may only consider the evidence of record at the time of the March 2020 SOC, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the March 2020 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted and 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding several of these claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Cervical Strain (neck condition)

The Veteran contends that he is entitled to service connection for a disability of the cervical spine/neck.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between
adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Cervical Strain (neck condition)

The Veteran contends that he is entitled to service connection for a disability of the cervical spine/neck.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The Veteran was provided with a VA examination for his reported neck disability in September 2017. The VA examiner diagnosed the Veteran with degenerative arthritis of the cervical spine. Based on this diagnosis, the first element of service connection requiring a current diagnosis has been met.

During the VA examination, the examiner reported that the Veteran "states that he believes the pain in the back of the neck started in late 2002, but remembers having more severe and frequent pain when he came back from Iraq in 2003. The Veteran states that initially the pain recurred intermittently, often triggered by wearing his helmet. He states that over the years the posterior cervical pain has progressed, and now occurs daily, more severe to the left of the midline than to the right of the midline. He states that he also has numbness and tingling that extends at times from the neck to the left shoulder and even as far as the elbow. The Veteran states that he takes Motrin and Tylenol for pain relief." Given these credible lay reports regarding neck pain and other symptoms since service, the second element of service connection requiring an in-service event has been met.

Thus, the question becomes whether the current disability is related to service. The VA examiner opined that "Degenerative arthritis of the cervical spine is most likely activity related, likely due to many of the physical activities that the veteran was involved with in the service." Given that the VA examiner opined that the Veteran's cervical spine disability is related to physical activities during service, the Board concludes that the Veteran has a current disability that is related to his military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Upon review of the record, the Board finds the evidence to at least be in approximate balance as to whether the Veteran's current cervical spine disability is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a cervical spine disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Lumbosacral disability (degenerative arthritis of lower back)

The Veteran contends that he is entitled to service connection for a disability of the lumbosacral spine/lower back.

The Veteran was provided with a VA examination in September 2017. The VA examiner diagnosed the Veteran with degenerative arthritis of the spine and lumbosacral degenerative disc disease.

During the VA examination, the Veteran reported "that he was cramped in the bus and was carrying heavy gear in one position for a prolonged period. The Veteran states that he did not complain of the back pain since he wanted to get through boot camp. He states that afterward he had intermittent low back pain, usually caused by running through the mountains during which time he carried his rucksack and heavy items. He states that the back pain became worse in Kuwait as result of having to dig and put sand bags into place and from loading and unloading heavy trucks. The Veteran states that after he completed active duty in the back pain persisted."

The Veteran's service treatment records (STRs) document back pain during active-duty service. In a May 2003 post-deployment health assessment, the Veteran reported experiencing back pain during his deployment. Hence, the second element of service connection has been met.

The September 2017 VA examiner opined that "The veteran does have a low back condition, i.e. mild degenerative arthritis of the lumbosacral spine. However, the veteran's STRs except for his post deployment questionnaire are silent for a low back condition. Subsequent medical records until recently have also been silent for a low back condition."

and from loading and unloading heavy trucks. The Veteran states that after he completed active duty in the back pain persisted."

This medical opinion is inadequate because it is based solely on a lack of treatment records during service. The absence of documented treatment in service or thereafter is not fatal to a service connection claim, and the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Further, it did not address or explain the May 2003 notation regarding back pain while deployed.

Prior to the March 2020 SOC, in February 2019, the Veteran submitted a letter from a private physician at a chiropractic office opining that the Veteran had been treated there since May 2018 for neck and back pain. The physician opined that "that several of his injuries began during active duty in the Marine Corp. He states that the pain began during repetitive motions during his duty and as well as minor traumas throughout. Per my expertise I do believe that some of these complaints are stemming from active duty in Iraq and other service related traumas." The Board assigns this opinion probative weight because the private chiropractor is qualified to opine regarding the etiology of back pain. This opinion is also consistent with the STRs which contained a report of back pain while deployed.

Upon review of the record, the Board finds the evidence to at least be in approximate balance as to whether the Veteran's current lumbosacral spine disability is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a lumbosacral spine disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Hypertrophic gastritis (GI symptoms)

The Veteran contends that he is entitled to service connection for a gastrointestinal disorder.

The Veteran was provided with a VA examination for stomach disorders in September 2017. The VA examiner diagnosed the Veteran with gastritis. Accordingly, the first element of service connection has been met.

In a July 2024 VA Memorandum, VA conceded that the Veteran had toxic exposure risk activities (TERA) while deployed to Kuwait from Kuwait from January 28, 2003, through June 7, 2003. In a May 2003 post-deployment health assessment, the Veteran reported that he experienced vomiting and diarrhea while deployed. Accordingly, the second element of service connection has been met.

The September 2017 VA examiner opined that "Gastritis is a disease with a specific and clear etiology and less likely due to a specific exposure event during service in Southwest Asia." No further rationale or explanation was provided. The examiner did not explain what the specific and clear etiology of the Veteran's gastritis was or provide an explanation of why it was unrelated to his service in Southwest Asia.

In September 2018, the Veteran submitted a letter from a private physician who had treated him for his gastrointestinal symptoms. The physician opined that the Veteran "has been under my care for the past two years with regards to his gastrointestinal symptoms. He has been suffering from intermittent abdominal pains and alternating bowel habits with constipation and diarrhea. Multiple diagnostic studies have been performed to evaluate his condition. These issues have limited his ability to work and impacted his quality of life. These symptoms commenced after a 2 week illness he experienced while stationed in Iraq and I believe are likely a sequela of his acute illness while stationed abroad." Medical records reflect ongoing treatment for the Veteran for GI symptoms, including colonoscopy imaging and ongoing treatment of pantoprazole to alleviate symptoms.

Based on a review of the record, the medical evidence reflects that the Veteran's current gastritis disability that had its onset in service or is otherwise related to service. The Board finds the opinion submitted by the private physician to be probative, as they are treating the Veteran for his ongoing gastrointestinal symptoms and opined that it was related to service, which is consistent with the Veteran's STRs documenting diarrhea and vomiting while deployed to Southwest Asia in 2003.

Upon review of the record, the Board finds the evidence to
I believe are likely a sequela of his acute illness while stationed abroad." Medical records reflect ongoing treatment for the Veteran for GI symptoms, including colonoscopy imaging and ongoing treatment of pantoprazole to alleviate symptoms.

Upon review of the record, the Board finds the evidence to at least be in approximate balance as to whether the Veteran's current gastritis disability is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for gastritis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Service connection for obstructive sleep apnea is denied. is remanded.

The Veteran contends that he is entitled to service connection for obstructive sleep apnea.

In October 2017, the Veteran was provided with a VA examination. He described persistent daytime hypersomnolence and symptoms like snoring. The VA examiner opined that "There is no objective evidence of symptoms or complaints of sleep apnea during service. The veteran was first referred to sleep clinic in 2011 due to chronic insomnia and restlessness while sleeping. He was working as an RN during night shift. Impression was: PTSD with circadian rhythm dysfunction, ETOH abuse. He continued with ETOH abuse over the past years. He was lost to follow up after 2013, he came back to Miami VA in 2016 with complaints of snoring. He underwent sleep study with findings of mild OSA. His mild OSA was diagnosed 13 years after active military service and cannot be directly link to service."

This opinion is inadequate because it failed to address buddy statements describing the Veteran having loud snoring, breathing issues and other potential sleep apnea symptoms during service. Buddy statements by A.V., a former servicemember who served with the Veteran, and his mother, both were submitted to VA and included in the evidentiary record on August 1, 2017, nearly 3 months prior to the October 2017 VA examiner's negative opinion. See Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) (holding that an examiner must address the lay evidence to provide the Board with an adequate medical opinion). Further, the examiner did not address the significance, if any, of the duration of time between diagnosis of sleep apnea and separation from service.

VA's pre-decisional duty to assist includes providing the Veteran with an adequate VA examination once it has undertaken the effort to do so. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Due to the inadequate opinion regarding the etiology of the Veteran's diagnosed sleep apnea, a remand is required to obtain an addendum opinion.

2. TBI

The Veteran contends that he is entitled to service connection for a TBI. During his October 2024 Board hearing, the Veteran described hitting his head on equipment and being exposed to a missile that exploded 200 feet from his tent while deployed to Kuwait.

Prior to the March 2020 SOC, in a March 2017 VA examination for posttraumatic stress disorder, the VA examiner reported that "During a TBI Second Level evaluation dated 3/2/2017, it was determined that Veteran may have experienced a TBI in service." However, in the September 2017 rating decision, the AOJ concluded that the "evidence does not show an event, disease or injury in service. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition." This conclusion was also repeated in the March 2020 SOC.

The AOJ did not consider this evidence that the Veteran may have experienced a TBI during service. Although the record does not show a current diagnosis for residuals of a TBI, the Veteran's assertion that he has exposed to a missile explosion are plausible, based on his deployment to Kuwait and being in a designated combat zone.

The Board finds that the Veteran should be afforded a VA examination, with a neurologist, neurosurgeon or similarly qualified medical professional, to ascertain whether there is a current diagnosis for residuals of a TBI. McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The Board finds that the AOJ's failure to clarify whether the Veteran has a current diagnosis for a TBI and instead to deny based on a lack of an in-service event to be a pre-decisional duty to assist error, such that remand is warranted. 38 C.F.R. § 20.802(a).

3. Chronic fatigue syndrome (CFS)

The Veteran contends that he is entitled to service connection for CFS related to his 2003 Southwest Asia deployment.

In a May 2003 post-deployment health assessment contained in the Veteran's STRs, he described experiencing a chronic cough, runny nose, weakness, headaches, dizziness, still feeling tired after sleeping and difficulty remembering. He also reported often being exposed to smoke from burning trash and smoke from oil fire, as well as exhaust fumes and JP8 and other fuels. He testified in the October 2024 Board hearing that he was being treated for chronic fatigue related to burn pit exposure.

The Veteran was provided with a CFS VA examination in September 2017. The examiner did not diagnose the Veteran with CFS and opined that he "does

not meet criteria for chronic fatigue syndrome, records did not show dx for chronic fatigue syndrome. Current complain of fatigue is more likely a symptom of his psychological problem (PTSD/anxiety) and obstructive sleep apnea, and not due to a specific exposure event experienced by the veteran during his service in Southwest Asia."

Though the examiner indicated that there were no diagnosed CFS the examiner did not adequately explain why the Veteran did not meet the diagnostic criteria for CFS or address his reports of fatigue and other symptoms, including symptoms like weakness he reported in May 2003 during his STRs. In addition, the examiner did not address whether the Veteran had an undiagnosed illness or medically unexplained multi-symptom illness (MUCMI) considering the Veteran's reported symptoms. Moreover, as the Veteran participated in a TERA, the VA medical opinion must address the total potential toxic exposure through all military deployments, and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. See 38 U.S.C. § 1168. Accordingly, a new VA examination is warranted to determine whether the Veteran has a diagnosis of CFS.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from a clinician for the Veteran's diagnosis of obstructive sleep apnea.

Prior to obtaining an addendum opinion from an appropriate clinician, the claims folder and a copy of this remand must be made available to the examiner for review of the case, including the buddy statements regarding the Veteran's snoring and other sleeping issues during service.

Based on the review of the claims folder, the examiner is asked to provide an opinion on the following:

Whether it is at least as likely as not that the Veteran's obstructive sleep apnea manifested in service or is otherwise causally or etiologically related to the Veteran's military service, to include the Veteran's deployment to Southwest Asia in 2003. The examiner should specifically address whether any reported symptoms in service may have been indicative of sleep apnea if the disorder was not diagnosed until years later. If the examiner finds the gap of time in between the Veteran's military service and subsequent diagnosis to be significant, he or she should explain the significance of the fact.

A detailed rationale for the medical opinion must be provided. If the requested opinion cannot be provided without resorting to speculation, the examiner should explain why.

2. Schedule the Veteran for a VA examination with a neurologist, neurosurgeon or similarly qualified clinician. The examiner should document all current residuals of TBI, and for any diagnosed residual, opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's TBI is related to his active military service.

The examiner should consider and discuss the Veteran's assertion that he was exposed to a missile that exploded 200 feet from his tent while deployed in Kuwait as well as hitting his head during service.

3. Schedule the Veteran for a VA examination to determine the current nature and etiology of the Veteran's claimed C
examiner should explain why.

3. Schedule the Veteran for a VA examination to determine the current nature and etiology of the Veteran's claimed CFS. The examiner is asked to respond to the following:

(a.) Does the Veteran have CFS, an undiagnosed illness, or a MUCMI related to his symptoms including fatigue and sleep disturbances?

(b.) Whether any diagnosed disability is at least as likely as not related to or otherwise caused by the Veteran's service? The Veteran's May 2003 STRs reflecting experiencing chronic cough, runny nose, weakness, headaches, dizziness, still feeling tired after sleeping and difficulty remembering while deployed to Kuwait should be reviewed and addressed.

In determining whether there is a current disability, the examiner must address any reports of functional impairment and loss and whether the Veteran's impairment rises to the level to affect his earning capacity.

In providing this opinion, the examiner is requested to determine and consider the total potential exposure through all applicable military deployments and service, as well as the synergistic and combined effect of all conceded TERA, including the Veteran's reporting in his STRs of constant exposure to smoke from burning trash and oil fire.

If an opinion cannot be given without resorting to speculation, the examiner should explain. A complete rationale is required for all conclusions.

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board N. Keogh, 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.

Analyze in VA Law Explorer