RADICULOPATHY

KRISTY L. ZADORA · 2026 · Case ID: A26027586

MIXED

Summary

The veteran served on active duty from April 1989 to March 1997. The veteran appeals the denial of service connection for right upper extremity radiculopathy, claimed as secondary to a nonservice-connected cervical spine disorder and service-connected lumbosacral spine strain with degenerative joint disease. The Board denied this claim, finding no current diagnosis of right upper extremity radiculopathy during the appeal period, which is a prerequisite for service connection. While the veteran reported shoulder issues and sought private treatment for her neck, service treatment records were negative for radiculopathy complaints, and post-service records also did not indicate such a condition. A private examination in January 2018 and a VA examination in February 2018 both failed to diagnose right upper extremity radiculopathy. The Board noted that while pain alone can constitute a disability, the veteran did not allege functional impairment from this specific condition. The Board also clarified that lay statements are not probative for diagnosing complex conditions like radiculopathy. The Board remanded claims for entitlement to a higher rating for left shoulder chronic strain, service connection for cervical spine disorder secondary to lumbosacral spine strain, and service connection for left upper extremity radiculopathy secondary to cervical spine disorder and lumbosacral spine strain, due to inadequacies in the VA examinations provided.

Rationale

No current diagnosis of right upper extremity radiculopathy during appeal period; Service treatment records negative for radiculopathy complaints; Private and VA examinations did not diagnose right upper extremity radiculopathy

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200305-76936

Full Decision Text

Citation Nr: A26027586
Decision Date: 03/26/26 Archive Date: 03/26/26

DOCKET NO. 200305-76936
: March 26, 2026

ORDER

Entitlement to service connection for right upper extremity radiculopathy, to include as secondary to a nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease, is denied.

REMANDED

Entitlement to a rating in excess of 20 percent for a left shoulder chronic strain is remanded.

Entitlement to service connection for a cervical spine disorder, to include as secondary service connected lumbosacral spine strain with degenerative joint disease, is remanded.

Entitlement to service connection for left upper extremity radiculopathy, to include as secondary to a nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease, is remanded.

FINDING OF FACT

At no time during the pendency of the claim does the Veteran have a current diagnosis of right upper extremity radiculopathy and the record does not contain a recent diagnosis of the disability prior to the Veteran's filing of the claim.

CONCLUSION OF LAW

The criteria for entitlement to service connection for right upper extremity radiculopathy, to include as secondary to a nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1989 to March 1997.

The matters come before the Board of Veterans' Appeals (Board) from a January 2020 Statement of the Case (SOC).

A rating decision was issued under the legacy system in March 2018 and the Veteran submitted a timely notice of disagreement. In January 2020, the agency of original jurisdiction (AOJ) issued a SOC. The Veteran opted the claim(s) into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a March 2020 VA Form 10182, Decision Review Request: Board Appeal, identifying the January 2020 SOC. Therefore, the January 2020 SOC is the decision on appeal.

In the March 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in April 2024 before the undersigned Veterans Law Judge; a hearing transcript has been associated with the claims file. Therefore, the Board may only consider the evidence of record at the time of the January 2020 SOC as well as any evidence submitted by the Veteran and her 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 January 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 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. However, because the Board is remanding the claims of service connection for a cervical spine disorder and the left upper extremity radiculopathy as well as the increased rating claim for the left shoulder chronic strain, 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).

Service Connection Criteria

Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v
the left shoulder chronic strain, 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).

Service Connection Criteria

Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310.

Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. See Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (stating that the term "disability" as used in 38 U.S.C. § 1110" refers to the functional impairment of earning capacity, not the underlying cause of said disability," and holding that "pain alone can serve as a functional impairment and therefore qualify as a disability").

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he or she files his or her claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

The veteran is competent to report symptoms and experiences observable by his or her senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a).

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim.

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to service connection for right upper extremity radiculopathy, to include as secondary to a nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease, is denied.

The Veteran contends that she has a right upper extremity radiculopathy due to service. In the alternative, she assert that it is secondary to a nonservice connected cervical spine disorder and/or service
VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Veteran contends that she has a right upper extremity radiculopathy due to service. In the alternative, she assert that it is secondary to a nonservice connected cervical spine disorder and/or service connected lumbosacral spine strain with degenerative joint disease. See May 2017 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ).

Service treatment records are negative for complaints, treatments or diagnoses related to right upper extremity radiculopathy. During the February 1997 separation Report of Medical Examination, the clinical evaluation of the Veteran's upper extremities were normal. In a corresponding Report of Medical History, the Veteran specifically denied that he had or ever had neuritis or paralysis. She did report having painful or "trick" shoulder or elbow. The Veteran also completed a Report of Medical Assessment in January 1997 noting shoulder problems but did not specify any concerns with numbness or tingling of her upper extremities.

Post-service treatment records are negative for complaints, treatments or diagnoses related to right upper extremity. The Veteran submitted private chiropractor reports in July 2009; she was not found to have right upper extremity conditions and did not receive treatments for her right upper extremity.

The Veteran submitted a private examination for cervical spine condition in January 2018. The examiner noted that the Veteran did not have, nor had ever had, symptoms and/or a diagnosis of a right upper extremity radiculopathy.

The Veteran reported for a VA Peripheral Nerves Conditions examination in February 2018. During this examination, the examiner issued a diagnosis of the left shoulder impingement syndrome but did not issue to any diagnosis of the right upper extremities.

After a review of the evidence of record, the Board finds that service connection is not warranted for right upper extremity radiculopathy as the January 2018 private examination and February 2018 VA examination explicitly found that she did not have a current disability related to the radiculopathy of the right upper extremity. See Romanowsky v. Shinseki, supra; McClain v. Nicholson, supra. As the record does not reflect a current diagnosis related to right upper extremity radiculopathy, the cornerstone element of service connection has not been met, and service connection is not warranted. See Boyer v. West, supra; Brammer v. Derwinski, supra. No further discussion of the remaining elements is necessary.

Finally, the Board is cognizant of the holding in Saunders v. Wilkie which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In sum, pain alone resulting in functional impairment is in fact a disability and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. However, the Veteran does not claim, nor do her medical records establish, that she experiences any functional impairment due to her claimed right upper extremity radiculopathy. As such, the Veteran's claimed right upper extremity radiculopathy does not amount to a functional impairment of earning capacity, and Saunders is not applicable in this case. Moreover, the Veteran has not alleged manifestations of similar severity, frequency and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020).

The Board notes that the Veteran is competent to report her own symptoms or matters within her personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (the Board's categorical statement that 'a valid medical opinion' was required to establish nexus, and that a layperson was 'not competent' to provide testimony as to nexus because she was a layperson, conflicts with Jandreau).

However, the
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (the Board's categorical statement that 'a valid medical opinion' was required to establish nexus, and that a layperson was 'not competent' to provide testimony as to nexus because she was a layperson, conflicts with Jandreau).

However, the matter of a medical diagnosis for a disability not capable of lay observation, such as that of a gynecological disorder is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). In the instant case, there is no suggestion that the Veteran has developed an expertise in the diagnosis and etiology of right upper extremity radiculopathy. Therefore, as she does not have the appropriate medical training and expertise to competently ascertain the nature and etiology of right upper extremity radiculopathy, the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 ("[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110. Thus, where, as here, the probative evidence indicates that the Veteran does not have current diagnosis of right upper extremity radiculopathy for the entire appeal period, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (service connection cannot be granted if the claimed disability does not exist); Brammer v. Derwinski, supra.

Accordingly, the Board finds that service connection for right upper extremity radiculopathy, to include as secondary to a nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

REASONS FOR REMAND

1. Entitlement to a rating in excess of 20 percent for a left shoulder chronic strain is remanded.

The Veteran contends that her left shoulder chronic strain warrants a higher rating than currently assigned. Notably, the Veteran reported worsening of her left shoulder symptoms with four to five times of flare-ups per month, with increasing weakness in the left hand and grip, as well as experiencing some level of tingling of the wrist. See April 2024 Board hearing transcript.

The Veteran was afforded a VA examination in February 2018 to determine the severity of the Veteran's left shoulder strain. The Veteran is left hand dominant and the Veteran reported experiencing flare-ups which manifest as not being able to do what she used to do, including playing sports, overhead reaching, or lifting. It has also affected her intimacy with her partner, with limitation of range of motion, as if she uses her shoulder too much, she would have to use a homemade sling. Range of motion testing was performed and showed painful flexion from 0 to 130 degrees, abduction from 0 to 130 degrees, and internal and external rotation from 0 to 70 degrees. Pain was noted on examination and was found to cause functional loss, with pain noted on flexion and abduction. There was evidence of pain with weight bearing, and objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the anterior shoulder. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and had no additional loss or range of motion after three repetitions. Repeated use over time testing and flare-up testing were not performed, and the examiner noted that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Muscle strength testing showed active movement against some resistance, with no muscle atrophy or ankylosis. Rotator cuff condition was noted for the left shoulder and showed positive results for the Hawkins' Impingement Test, Empty-can Test, External Rotation/Infr
of localized tenderness or pain on palpation of the joint or associated soft tissue of the anterior shoulder. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and had no additional loss or range of motion after three repetitions. Repeated use over time testing and flare-up testing were not performed, and the examiner noted that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Muscle strength testing showed active movement against some resistance, with no muscle atrophy or ankylosis. Rotator cuff condition was noted for the left shoulder and showed positive results for the Hawkins' Impingement Test, Empty-can Test, External Rotation/Infraspinatus Strength Test, and Lift-Off subscapularis Test. The examiner confirmed shoulder instability, dislocation, or labral pathology, with no history of mechanical symptoms or recurrent dislocation of the glenohumeral joint. Clavicle, scapula, acromioclavicular joint and sternoclavicular joint conditions were not suspected. The Veteran did not have any conditions or impairments of the humerus. The Veteran did confirm using a homemade sling for her left shoulder occasionally. The examiner did not endorse any functional impact.

The Board finds that the February 2018 VA examination incomplete to the decide the appeal. The February 2018 VA examination report did not provide passive range of motion measurements and response to testing may not be dose dependent; however, it is not clear what the examiner is referring to with this statement. On remand, a new VA examination to determine the nature and severity of the Veteran's left shoulder chronic strain should be conducted. Ingram v. Collins, 38 Vet. App. 130 (2025); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The failure to obtain an adequate examination is a pre-decisional duty to assist error.

2. Entitlement to service connection for a cervical spine disorder, to include as secondary service connected lumbosacral spine strain with degenerative joint disease, is remanded.

The Veteran contends she has cervical spine disorder due to service. See May 2017 VA Form 21-526EZ. Specifically, during the April 2024 Board hearing, the Veteran testified that she was involved in a motor vehicle accident while reporting for duty at the Naval Air Station in the 1990s, and that she has had back and neck problems since then, to include neck pain. See April 2024 Board Hearing Transcript.

Service treatment records confirm a motor vehicle accident in January 1997. The Veteran was diagnosed with back and shoulder trauma at the time, with primarily lower back complaints. During the February 1997 separation Report of Medical Examination, the clinical evaluation of the Veteran's head, face, neck, and scalp were normal. In a corresponding Report of Medical History, the Veteran specifically denied having had swollen or painful joints, broken bones, bone, joint or other deformity and denied to recurrent back pain. The Board also notes that the Veteran submitted a Report of Medical Assessment in January 1997 where the Veteran confirmed to lower back problems and shoulder problems but did not report any concerns with her neck.

Post service, the Veteran is first found to have a neck condition in September 2017. See January 2018 Private Examination.

In January 2018, the Veteran submitted a private neck conditions Disability Benefits Questionnaire examination report. The physician diagnosed the Veteran with degenerative disc disease of the cervical spine and radiculopathy dating back to September 2017. The physician did not provide any opinion regarding the nature and etiology of the claimed neck condition but did note that the injury to her lumbar spine has an impact on her entire spine. As such, the January 2018 private Disability Benefits Questionnaire report is insufficient to decide the appeal.

The Veteran next reported for a VA Neck Conditions examination in March 2018. During this examination, the examiner confirmed the diagnosis of degenerative arthritis of the cervical spine but denied any radiculopathy symptoms or diagnosis. The examiner opined that the claimed cervical spine condition was at least as likely as not caused by service. However, in providing the rationale, the examiner opined that the claimed cervical spine condition was less likely caused by the complaints of the neck pain from a motor vehicle accident in May and June 1995, noting that there is insufficient information in the medical history, based on objective findings over the long period of time, that establishes a causal-effect relationship between injury that occurred more than 20 years ago to the present day condition. The examiner noted that cervical spine degenerative joint disease and symptoms are relatively common in those in the Veteran's age demographics without regards to prior injuries. With regards to secondary service connection, the examiner concurred to the opinions presented in the January 201
the claimed cervical spine condition was at least as likely as not caused by service. However, in providing the rationale, the examiner opined that the claimed cervical spine condition was less likely caused by the complaints of the neck pain from a motor vehicle accident in May and June 1995, noting that there is insufficient information in the medical history, based on objective findings over the long period of time, that establishes a causal-effect relationship between injury that occurred more than 20 years ago to the present day condition. The examiner noted that cervical spine degenerative joint disease and symptoms are relatively common in those in the Veteran's age demographics without regards to prior injuries. With regards to secondary service connection, the examiner concurred to the opinions presented in the January 2018 private opinion in that the injury of the Veteran's lumbar spine has an impact on her entire spine as lumbosacral spine pathology contributes to the overall symptomatology and pain and suffering in the cervical spine, but neither the medical literature and/or the VA standard guidelines concede that thoracolumbar pathology causes, that is having a direct causal-effect relationship of the cervical spine condition in the clinical scenario similar to the Veteran's case.

The Board finds VA March 2018 VA opinion incomplete to decide the merits of the claim. While the March 2018 VA opinion provides an etiology opinion as to direct service connection and secondary causation, an opinion as to secondary aggravation was not provided. El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Therefore, this opinion is incomplete and insufficient to decide the appeal.

On remand, an addendum VA opinion as to secondary aggravation should be obtained. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. The failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error.

3. Entitlement to service connection for left upper extremity radiculopathy, to include as secondary to nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease, is remanded.

The Veteran contends that she has left upper extremity radiculopathy due to her nonservice connected cervical spine disorder and service connected lumbosacral spine strain with degenerative joint disease. Notably, during the Board hearing, the Veteran testified that she began to experience radiculopathy symptoms gradually over time from the time of the motor vehicle accident. See April 2024 hearing transcript. In the alternative, the Veteran also contends that her left upper extremity radiculopathy is due to her cervical spine condition and lumbosacral spine strain with degenerative joint disease.

In January 2018, the Veteran submitted a private neck conditions Disability Benefits Questionnaire report. The physician diagnosed the Veteran with radiculopathy in the left upper extremity but did not provide an opinion regarding the nature and etiology of the claimed left upper extremity radiculopathy.

During the March 2018 VA neck conditions examination, the Veteran was not found to have a diagnosis or symptoms of radiculopathy and no opinion was provided. The March 2018 VA examiner did not address the January 2018 private opinion finding a diagnosis of right upper extremity radiculopathy.

On remand, an addendum VA opinion should be obtained to discuss the conflicting finding regarding the presence of currently diagnosed left upper extremity radiculopathy and provide an opinion as to direct and secondary service connection. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. The failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error.

The matters are REMANDED for the following action:

1. Forward the claims file, to include a copy of this remand, to an appropriate VA examiner for opinion as to the nature and etiology of the Veteran's claimed cervical spine disorder. The opinion should be rendered by an appropriate medical professional. The examiner should review the record and note such review in the examination report. The examination should include a review of the Veteran's history and current complaints as well as a comprehensive evaluation and any tests deemed necessary. The need for further in-person examination is left to the discretion of the examiner

The examiner must provide an opinion regarding the following questions:

(A) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's
following action:

The examiner must provide an opinion regarding the following questions:

(A) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's cervical spine disorder had its onset in service or is etiologically related to service?

(B) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's cervical spine condition is proximately caused by and/or otherwise aggravated by service connected lumbosacral strain and degenerative joint disease?

All opinions should be supported with a rationale.

If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

2. Forward the claims file, to include a copy of this remand, to an appropriate VA examiner for opinion as to the nature and etiology of the Veteran's left upper extremity radiculopathy. The opinion should be rendered by an appropriate medical professional. The examiner should review the record and note such review in the examination report. The examination should include a review of the Veteran's history and current complaints as well as a comprehensive evaluation and any tests deemed necessary. The need for further in-person examination is left to the discretion of the examiner

The examiner must provide an opinion regarding the following questions:

(A) Explain the discrepancy between the diagnosis rendered between the January 2018 private medical examination and the March 2018 VA medical examination regarding the diagnosis of left upper extremity radiculopathy.

If the examiner determines that the Veteran does not have currently diagnosed left upper extremity radiculopathy, he or she should reconcile such finding with the January 2018 private examination.

(B) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left upper extremity radiculopathy had its onset in service or is etiologically related to service?

(C) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left upper extremity radiculopathy is proximately caused by and/or aggravated by the service connected lumbosacral strain and degenerative joint disease?

All opinions should be supported with a rationale.

3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected left shoulder chronic strain. The entire electronic claims folder, including a copy of this remand, must be provided to and reviewed by the examiner in conjunction with the examination. All indicated tests and studies should be performed, and all findings should be set forth in detail. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

(A) Pursuant to Correia v. McDonald, 28 Vet. App. 158 (2016), the examiner must record the results of range of motion testing for pain on both active and passive motion and in weight-bearing and nonweight-bearing. If a joint cannot be tested on weight-bearing, then the examiner must specifically indicate why that testing cannot be done.

(B) Pursuant to Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017), the examiner must inquire whether the Veteran experiences flare-ups. If the Veteran answers that she does experience flare-ups, the examiner should state their severity, frequency, and duration, identify precipitating and alleviating factors, and estimate, per the veteran, to what extent, if any, flare-ups affect functional impairment.

If it is not possible to provide a specific range of motion measurements based on direct observation during a flare-up or after repeated use over time, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups and repeated use over time based on the other evidence of record
(B) Pursuant to Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017), the examiner must inquire whether the Veteran experiences flare-ups. If the Veteran answers that she does experience flare-ups, the examiner should state their severity, frequency, and duration, identify precipitating and alleviating factors, and estimate, per the veteran, to what extent, if any, flare-ups affect functional impairment.

If it is not possible to provide a specific range of motion measurements based on direct observation during a flare-up or after repeated use over time, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups and repeated use over time 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).

A rationale should be provided for all opinions offered.

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The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record. Medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Audrey Kim, 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.

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