DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

M. HYLAND · 2026 · Case ID: A26026702

MIXED

Summary

The Veteran, who served from October 1981 to November 1984 and again from December 2003 to November 2004, appeals the October 2020 rating decision. The Veteran sought service connection for a neck disability and left upper extremity radiculopathy, claiming they were secondary to his service-connected lumbar spine disability. He also sought an increased rating for his right knee disability. The Board reviewed evidence of record up to the October 2020 decision, plus evidence submitted at the October 2021 hearing. For the neck and left upper extremity radiculopathy claims, the Board found the private medical opinion from Dr. C. R. more persuasive than the VA examiner's opinion. Dr. C. R. provided a detailed rationale linking the neck and radiculopathy conditions to the lumbar spine disability, citing mechanical connections and symptom migration. Resolving reasonable doubt in the Veteran's favor, the Board granted service connection for both the neck disability and the left upper extremity radiculopathy. The claim for an increased rating for the right knee disability was remanded. The Board found the October 2020 VA examination inadequate because it failed to accurately describe the Veteran's medical history, specifically his use of pain medications and joint injections for the right knee, and did not account for the ameliorative effects of medication. The case was remanded for a new VA examination to determine the current severity of the right knee disability, including the impact of medications and flare-ups.

Rationale

Private physician opinion found persuasive; Opinion provided detailed rationale linking conditions; Resolving reasonable doubt in Veteran's favor

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210310-145779

Full Decision Text

Citation Nr: A26026702
Decision Date: 03/25/26 Archive Date: 03/25/26

DOCKET NO. 210310-145779
DATE: March 25, 2026

ORDER

Entitlement to service connection for a neck disability, as secondary to a lumbar spine disability, is granted.

Entitlement to service connection for left upper extremity radiculopathy, as secondary to a lumbar spine disability, is granted.

REMANDED

Entitlement to an initial increased rating for a right knee disability, currently rated as 10 percent disabling, is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not that his neck disability was caused by his service-connected lumbar spine disorder.

2. Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not that his left upper extremity radiculopathy disability was caused by his service-connected lumbar spine disorder.

CONCLUSIONS OF LAW

1. The criteria for service connection for a neck disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for left upper extremity radiculopathy disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1981 to November 1984 and from December 2003 to November 2004.

The rating decision on appeal was issued in October 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 6, 2021.

Therefore, the Board may only consider the evidence of record at the time of the October 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran 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 decision on appeal 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 that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, 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 the claim of entitlement to an increased initial rating for the right knee disability, 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. Entitlement to service connection for a neck disability

2. Entitlement to service connection for left upper extremity radiculopathy

Service connection may be granted when a claimed disability is found to be proximately due to or the result of a service-connected disability, or when any increase in severity (aggravation) of a nonservice-connected disease or injury is found to be proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310.

The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. Wood v. Derwinski, 1 Vet. App. 190 (1991); Washington v. Nicholson, 19 Vet. App. 362 (2005).

When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4
imately due to or the result of a service-connected disability. 38 C.F.R. § 3.310.

When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (holding evidence is not in approximate balance, or nearly equal, when the evidence "persuasively favors one side or the other").

In September 2020, the Veteran submitted a claim seeking service connection for a neck disability. He asserted the neck disability was caused by his service-connected lumbar spine disability.

In October 2020, a VA neck conditions examination was provided. The examiner diagnosed degenerative disc disease of the neck and left upper extremity radiculopathy. The examiner opined the neck disability was less likely than not proximately due to the Veteran's lumbar spine disability because there was no "common medical knowledge or medical evidence to support a causal relationship" between the conditions. He did not discuss the specific limitations associated with the Veteran's back disability or any mechanical, structural, or kinetic connections between the lower spine and the neck. As a medical professional the examiner is competent to provide an etiology opinion. This opinion is supported by a very limited rationale. It is entitled to some weight. The examiner did not provide any opinion as to the left upper extremity radiculopathy disability.

On the date of the Board hearing, the Veteran submitted a February 2021 etiology opinion from Dr. C. R., a private physician. Dr. C. R. examined the Veteran and reviewed his medical records. She identified a current neck disability with left upper extremity radiculopathy. She opined these disabilities were at least as likely as not caused by the service connected lumbar spine disability. In support, she stated over time pain from the Veteran's back migrated up to his neck. She explained the lower region of the spine is mechanically connected to the neck through ligaments, tendons, intervertebral discs, and facet joints. When a breakdown occurs in one region, the connections will impact and cause discomfort in other areas. Spinal stenosis of the lower back causes misalignment and overuse of the tendons, muscles and ligaments. This caused deterioration in the neck over time. The lower back disability resulted pain, stiffness, decreased range of motion, tingling, numbness, and muscle weakness in the neck and these symptoms migrated into the upper left extremity. As a medical professional, Dr. C. R. is competent to provide an etiology opinion. Her opinion is supported by a complete rationale which explains the connection between the Veteran's lower back disability and his neck and upper left extremity radiculopathy disabilities. It is entitled to great weight.

Here, the medical evidence confirms current neck and left upper extremity radiculopathy disabilities. Resolving reasonable doubt in favor of the Veteran, the weight of the evidence supports a finding that these disabilities were at least as likely as not caused by his service connected lumbar spine disability. Entitlement to service connection for a neck disability and for left upper extremity radiculopathy is granted. 38 C.F.R. § 3.310; see Lynch, supra.

REASONS FOR REMAND

1. Entitlement to an initial increased rating for a right knee disability, currently rated as 10 percent disabling, is remanded.

Under the provisions of the AMA, the Board must remand any appeal that cannot be granted in full for correction of a pre-decisional duty-to-assist error. 38 C.F.R. § 20.802(a). The Board may also remand to ensure compliance with a regulatory or statutory duty if such compliance would have a reasonable possibility of aiding in substantiating the claim. Id.

VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 2 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)).

In assigning a disability rating, the Board may not consider the ameliorative effects of medications where such effects are
al duty-to-assist error. 38 C.F.R. § 20.802(a). The Board may also remand to ensure compliance with a regulatory or statutory duty if such compliance would have a reasonable possibility of aiding in substantiating the claim. Id.

In assigning a disability rating, the Board may not consider the ameliorative effects of medications where such effects are not explicitly contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). More recently, in Ingram v. Collins, 38 Vet. App. 130 (2025), the Court of Appeals for Veterans Claims determined that because the applicable diagnostic codes and special regulations pertaining to musculoskeletal disabilities do not explicitly contemplate medication use, the Board must discount the beneficial effects of medication when assigning an evaluation of a musculoskeletal disability.

In October 2020, a VA knee conditions examination was provided. As medical history, the examiner stated the Veteran had not undergone treatment, used medications, or had surgery on his right knee. However VA treatment records show, in the months prior to the September 2020 claim and October 2020 examination, the Veteran used gel medications and acetaminophen for pain, including knee pain. These records also document an October 2019 right knee therapeutic joint injection. On the date of the Board hearing, the Veteran submitted a February 2021 VA knee conditions disability benefits completed by Dr. C. R. Dr. C. R. confirmed the Veteran's use of pain medications to treat his right knee disability. Here, the October 2020 VA knee conditions examination has not accurately described the Veteran's right knee medical history. The evidence confirms his use of pain medications. The October 2020 examination does not account for the ameliorative effects of medication. It is inadequate to evaluate the claim. The failure to obtain an adequate examination is a pre-decisional duty to assist error.

The matters are REMANDED for the following action:

Schedule the Veteran for examinations by an appropriate clinician to determine the current severity of his right knee disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the right knee disability under the rating criteria.

In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

In addressing the severity of the Veteran's right knee, disability (as to all evaluations directed above), the examiner is instructed to consider and specifically address: (1) whether any medications the Veteran uses or has used during the appeal period affect or affected the severity of his right knee symptomatology, and if so, to identify each medication and clearly explain how such medication affects the right knee symptomatology, and (2) if any such medication is productive of ameliorative effects, clearly identify such effects and opine as to the severity of the condition absent such medication.

M. HYLAND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Celtnieks, Jeanne

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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