RADICULOPATHY

Summary

The Veteran, an Army prosthodontist Officer with 20 years and 10 months of service from August 1976 to June 1997, appeals the November 2025 rating decision concerning his extremities. The Veteran claims service connection for bilateral lower extremity radiculopathy and bilateral upper extremity neuropathy, excluding carpal tunnel syndrome. The Board found the evidence in relative equipoise for all four conditions. Key evidence included the Veteran's DD 214, medical records detailing surgeries and diagnoses like peripheral neuropathy and radiculopathy, and VA examinations. A March 2025 VA opinion was unfavorable, stating less likely than not due to service but then contradicting itself in the rationale. An addendum clarified the lower extremity radiculopathy was due to low back disability (in remand) and upper extremity disorders due to wear and tear. However, a May 2024 VA opinion found the conditions at least as likely as not due to TERA activities. Crucially, private orthopedic and hand surgeon opinions from January and February 2026 provided favorable nexus opinions, linking the radiculopathy to prolonged static postures and repetitive strain from dental duties, and the upper extremity neuropathies to cumulative occupational overuse and repetitive microtrauma. The Board resolved reasonable doubt in the Veteran's favor, granting service connection for all four claimed conditions.

Rationale

Evidence in relative equipoise; Reasonable doubt resolved in Veteran's favor; Private opinion linked to dental duties

Full Decision Text

Citation Nr: A26031002
Decision Date: 04/06/26	Archive Date: 04/06/26

DOCKET NO. 251217-623822
DATE: April 6, 2026

ORDER

Entitlement to service connection for left lower extremity radiculopathy is granted.

Entitlement to service connection for right lower extremity radiculopathy is granted.

Entitlement to service connection for left upper extremity neuropathy, other than left carpal tunnel syndrome, is granted.

Entitlement to service connection for right upper extremity neuropathy, other than right carpal tunnel syndrome, is granted.

FINDINGS OF FACT

1. The evidence is in relative equipoise as to whether left lower extremity radiculopathy is due to service.  

2. The evidence is in relative equipoise as to whether right lower extremity radiculopathy is due to service.  

3. The evidence is in relative equipoise as to whether left upper extremity neuropathy, other than left carpal tunnel syndrome, is due to service.

4. The evidence is in relative equipoise as to whether right upper extremity neuropathy, other than right carpal tunnel syndrome, is due to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for left lower extremity radiculopathy have been met.  38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.  

2. The criteria for service connection for right lower extremity radiculopathy have been met.  38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.  

3. The criteria for service connection for left upper extremity neuropathy, other than left carpal tunnel syndrome, have been met.  38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.  

4. The criteria for service connection for right upper extremity neuropathy, other than right carpal tunnel syndrome, have been met.  38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.  

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from August 1976 to June 1997.  

The appeal arises from a November 2025 rating decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  A notice of disagreement was received in December 2025 whereby the Veteran selected the Evidence Submission Review Lane.  The Board therefore may consider the evidence of record at the time of the November 2025 rating decision as well as any evidence submitted by the Veteran during an evidentiary window, which in the instant case is within 90 days of the December 2025, notice of disagreement.  If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence.  If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.

The Board notes that in a separate appeal stream in March 2026 the Board remanded the issues of service connection for right carpal tunnel syndrome and left carpal tunnel syndrome, thus the issues pertaining to neuropathy of the upper extremities in the instant appeal are characterized as reflected herein.  

In the November 2025 rating decision, the Agency of Original Jurisdiction (AOJ) included the following favorable findings: the Veteran had toxic exposure risk activities (TERA) during service and there are diagnoses of bilateral lower extremity radiculopathy and right radial nerve release.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104(c).  

Lastly, the Board recognizes that it has not been one year since the November 2025 rating decision was issued, potentially implicating Williams v. McDonough, 37 Vet. App. 305 (2024).  However, in this case the Veteran submitted evidence along with his December 2025 notice of disagreement.  Thus, per 38 C.F.R. § 20.303 Williams is not for application.

Issues 1-4: Entitlement to service connection for left and right lower
A) during service and there are diagnoses of bilateral lower extremity radiculopathy and right radial nerve release.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104(c).  

Lastly, the Board recognizes that it has not been one year since the November 2025 rating decision was issued, potentially implicating Williams v. McDonough, 37 Vet. App. 305 (2024).  However, in this case the Veteran submitted evidence along with his December 2025 notice of disagreement.  Thus, per 38 C.F.R. § 20.303 Williams is not for application.

Issues 1-4: Entitlement to service connection for left and right lower extremity radiculopathy and left and right neuropathy of the upper extremities other than carpal tunnel syndrome.  

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.  This may be accomplished by affirmatively showing inception or aggravation during service.  38 C.F.R. § 3.303(a).  Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service.  38 C.F.R. § 3.303(d).

For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic."  Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned.  38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection including for other organic diseases of the nervous system if the disability is manifest to a compensable degree within one year of discharge from service.  38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

The Veteran contends that neuropathy of the upper and lower extremities is due to service.  See, e.g., July 2024 claim and December 2025 statement.  The Veteran's DD 214 Form shows that his military occupational specialty was prosthodontist Officer for 20 years and 10 months. 

Medical records in August 2018 show the Veteran underwent a right radial tunnel release, Gunyon canal release, and trigger thumb release and lateral release.  The postoperative diagnoses included Gunyon canal entrapment, right trigger thumb, and lateral epicondylitis.  Private medical records in January 2022 show diagnoses to include peripheral neuropathy and polyneuropathy.  

January 2025 private medical records show that based on NCV and EMG findings there was ulnar monopathy of the bilateral elbows, sensory predominant axonal polyneuropathy, and bilateral L5/S1 radiculopathy.  

On VA examination for peripheral nerves in June 2025 in addition to bilateral carpal tunnel release the diagnoses included right radial nerve release.  

There are favorable and unfavorable opinions of record.  As for the unfavorable opinions, in a March 2025 VA opinion, the examiner provided an inconsistent opinion whereby he opined that the claimed neuropathy of the upper and lower extremities was less likely than not due to service while in the rationale he stated that it is at least as likely as not related to toxic exposures during service.  In an addendum opinion in November 2025 the examiner clarified that it was less likely than not that neuropathy of the upper and lower extremities was due to TERA activities in service.  The examiner stated that bilateral upper extremity nerve disorders were due to wear and tear.  He opined that bilateral lower extremity radiculopathy was due to the low back disability leading to nerve root impingement.  At this juncture service connection for a low back disability is part of a separate appeal stream in remand status.  

As for the favorable opinions, in a May 2024 VA opinion, the examiner opined that the Veteran's neuropathy of the upper and lower extremities was at least as likely as not due to TERA activities during service.  

In a January 2026 private opinion received from the Veteran in February 2026, a private examiner
 was due to TERA activities in service.  The examiner stated that bilateral upper extremity nerve disorders were due to wear and tear.  He opined that bilateral lower extremity radiculopathy was due to the low back disability leading to nerve root impingement.  At this juncture service connection for a low back disability is part of a separate appeal stream in remand status.  

As for the favorable opinions, in a May 2024 VA opinion, the examiner opined that the Veteran's neuropathy of the upper and lower extremities was at least as likely as not due to TERA activities during service.  

In a January 2026 private opinion received from the Veteran in February 2026, a private examiner, Dr. R.H., an orthopedic surgeon, noted that the Veteran was a dentist during service and experienced bilateral radiculopathy in the lower extremities that stemmed from prolonged static postures, repetitive movements, and poor ergonomics, compressing spinal nerve roots causing pain, numbness, tingling, and weakness in the legs.  Following retirement, he continued to experience low back pain radiating into the lower extremities.  Diagnostic studies to include MRI and EMG show bilateral sciatica and radiculopathy.  Dr. R.H. opined that it was at least as likely as not that the Veteran's right lower extremity radiculopathy and left lower extremity radiculopathy were related to military duties performed as a dentist based on the rationale that consistent with early manifestations of lumbar nerve irritation, the mechanism of injury and repetitive strain involved during service as a dentist are well recognized in medical literature as risk factors for radiculopathy, and chronological continuity of symptoms.  

In a February 2026 private opinion received from the Veteran in February 2026, Dr. J.H., an orthopedic hand surgeon, noted that the Veteran had been diagnosed with peripheral neuropathy of the upper extremities, with clinical findings including cubital tunnel syndrome, Guyon's canal syndrome, and associated flexor tendon pathology including stenosing tenosynovitis and ruptured tendons on the left and right middle fingers.  Dr. J.H. acknowledged that during service the Veteran was a dentist, which is an occupation that requires prolonged and repetitive fine motor activity, sustained gripping and pinching of instruments, repetitive wrist flexion and extension, and prolonged elbow flexion forearm pronation and supination, and static upper-extremity postures.  He stated that these biomechanical demands are well recognized as significant risk factors for the development of compressive and entrapment neuropathies of the upper extremities.  Cubital tunnel syndrome is commonly associated with prolonged elbow flexion and repetitive upper-limb positioning, while ulnar nerve compression at Guyon's canal is associated with repetitive wrist motion and sustained pressure at the ulnar aspect of the hand.  Repetitive finger flexion and forceful gripping are well-established contributors to trigger finger pathology, which frequently coexists with and exacerbates neuropathic symptoms.  The examiner opined that based on the Veteran's occupational history as a military dentist for 21 years, the chronicity and progression of symptoms, and the absence of a more likely non-service-related etiology, the bilateral upper extremity neuropathy was consistent with cumulative occupational overuse and repetitive microtrauma.  The examiner concluded that it was at least as likely as not that the Veteran's peripheral neuropathy of the upper extremities, to include cubital tunnel syndrome, Guyon's canal syndrome, and trigger fingers, were caused by repetitive and prolonged dental duties performed during his 21 years of military service.  

Based on the above and resolving reasonable doubt in the Veteran's favor, the Board finds that the evidence is at least in relative equipoise, and service connection is warranted for left lower extremity radiculopathy; right lower extremity radiculopathy; left upper extremity neuropathy, other than left carpal tunnel syndrome; and right upper extremity neuropathy, other than right carpal tunnel syndrome.

 

 

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Mac, M.

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.