CERVICAL SPINE LIMITATION OF MOTION

Summary

The veteran, who served from January 2002 to March 2011 with deployments to Afghanistan, appeals the denial of service connection for a cervical spine disability. The Board reviewed the case based on evidence available up to an October 2024 rating decision, as the veteran elected Direct Review. The primary issue was whether the veteran's current cervical spine strain is etiologically related to in-service complaints. Service treatment records from August 2010 noted neck complaints following a motor vehicle accident, but the veteran reported no significant injury or worsening of prior pain. A February 2011 post-deployment assessment noted no ongoing neck complaints. A 2017 VA examination found no neck abnormality. A February 2025 VA addendum opinion, considered more probative, concluded the cervical strain was less likely than not related to service, citing medical literature suggesting soft tissue injuries typically heal within weeks and noting the absence of post-service neck complaints in medical records. The Board afforded the veteran's lay contentions little probative value for establishing nexus due to medical complexity. As the weight of the evidence favored denial and was not in equipoise, the benefit of the doubt did not apply. Service connection for the cervical spine disability was denied.

Rationale

Weight of probative evidence does not establish nexus to service.; October 2024 VA addendum opinion afforded great probative weight.; April 2024 VA opinion afforded no probative weight due to inaccurate premise.; Veteran's lay contentions afforded little probative value for nexus.; No competent medical evidence of chronic cervical spine arthritis or other presumptive conditions.

Full Decision Text

Citation Nr: A26038864
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 260114-624346
DATE: April 27, 2026

ORDER

Entitlement to service connection for a cervical spine disability is denied.

FINDING OF FACT

The weight of the most probative evidence does not show that the Veteran's current cervical spine disability is etiologically related to active service. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. § 3.303.

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REASONS AND BASES FOR FINDING AND CONCLUSION

Preliminary Matters

The Veteran served on active duty from January to May 2002, February 2003 to June 2004, and February 2010 to March 2011.  He also had additional inactive service.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a U.S. Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ). 

By way of background, in an October 2024 rating decision, the AOJ denied entitlement to service connection for a cervical spine disability (in pertinent part).  Later that month, the Veteran timely sought Higher-Level Review (HLR) of this issue adjudicated in the October 2024 rating decision.  In a February 2025 HLR rating decision, the AOJ again denied the claim. 

In January 2026, the Veteran timely appealed to the Board via a VA Form 10182 (Notice of Disagreement) and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the October 2024 rating decision (which was later subject to HLR). 38 C.F.R. § 20.301. 

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 C.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. 

The Board has thoroughly reviewed all evidence in the claims file.  Consistent with the law, the analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims, and the Board's reasons for rejecting evidence favorable to the appellant.  See Timberlake v. Gober, 14 Vet. App. 122 (2000).  The appellant must not assume the Board has overlooked evidence not explicitly discussed in this decision.

Entitlement to service connection for a cervical spine disability is denied.

The Veteran claims entitlement to service connection for a cervical spine disability.  He contends that his current cervical spine disability is related to neck symptoms he experienced during active service.

Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303 (a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Initially, in the October 2024 and February 2025 rating decisions, the AOJ found that the Veteran has a current cervical spine disability (strain).  The AOJ also found that August 2010 service treatment records (STRs) showed in-service neck complaints.  The Board is bound by these prior favorable findings (which were not clearly and unmistakably erroneous).  See 38 C.F.R. § 3.104(c).

Accordingly, this appeal primarily hinges on whether the Veteran's current cervical spine disability is etiologically related to active service, to include the contemporaneously documented, in-service neck complaints.

As noted above, an August 2010 STR note reflected that the Veteran was involved in a motor vehicle accident (MVA) earlier that morning.  The Veteran complained of a sore and stiff neck "but is in no pain at this time."  The Veteran reported some prior neck pain before the accident, which he reported was no worse
 (STRs) showed in-service neck complaints.  The Board is bound by these prior favorable findings (which were not clearly and unmistakably erroneous).  See 38 C.F.R. § 3.104(c).

Accordingly, this appeal primarily hinges on whether the Veteran's current cervical spine disability is etiologically related to active service, to include the contemporaneously documented, in-service neck complaints.

As noted above, an August 2010 STR note reflected that the Veteran was involved in a motor vehicle accident (MVA) earlier that morning.  The Veteran complained of a sore and stiff neck "but is in no pain at this time."  The Veteran reported some prior neck pain before the accident, which he reported was no worse.  The clinician issued the Veteran Ibuprofen for the prior neck spasm and potential soreness and noted, "No significant injuries seen."   

In a February 2011 Post Deployment Health Assessment (following the Veteran's 2010 to January 2011 Afghanistan deployment), he reported that during this deployment, he experienced a blast or explosion as well as a vehicular accident / crash.  He did not report neck complaints.  He self-rated his overall health during the past month as very good.  He generally endorsed medical or dental problems that developed during the deployment, but answered "No" regarding whether such problems were still bothering him now.  No medical referral was made.  

In December 2016, the Veteran filed service connection claims for multiple disabilities, including a back disability.  (He did not file a claim for a neck disability at this time.)  An October 2017 VA Gulf War examination (obtained to develop the 2016 claims) reflected that the Veteran's neck was supple with full range of motion.  No neck complaint, abnormality, or diagnosis is noted in this VA examination report.  

VA clinical records reflect post-active service complaints of and treatment for various medical issues, including musculoskeletal issues, such as knee pain and chronic low back pain.  However, such VA treatment records do not show complaints of or treatment for neck issues. March 2018, May 2020, and August 2020 VA treatment notes show that neck examinations were conducted and the clinicians did not note any neck abnormalities. 

In April 2024, the Veteran was afforded a VA cervical spine examination.  The examiner diagnosed cervical spine strain.  The Veteran reported the onset of neck pain in 2013.  He reported that he developed neck pain while driving, when he "hit a bump" and hit his head on the roof of the vehicle while wearing his helmet.  He described the course of this condition since onset as progressed / worsened.  

The April 2024 VA examiner opined that the Veteran's cervical strain was less likely than not related to his military service. The examiner incorrectly reasoned that there were no STRs identified in the record addressing neck pain or injuries. 

In an October 2024 VA addendum medical opinion, the examiner opined that the Veteran's cervical spine condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.  The examiner acknowledged the August 2010 STR showing that the Veteran complained of neck pain after a car accident.  However, based on cited medical literature, the examiner found that a single neck strain injury does not generally lead to chronic neck strain. Rather, the body is able to heal a soft tissue injury over time, within a few days to weeks. Thus, the Veteran's one-time injury was unlikely to result in chronic cervical strain. The examiner also reasoned that post-separation medical records did not show complaints or treatment for any neck issue. 

After a full review of the evidence of record summarized above, the Board must deny the claim.  The weight of the most probative evidence does not establish a nexus between the Veteran's current cervical spine strain and active service, to include the August 2010 in-service neck complaints soon after a MVA.

The Board affords great probative weight to the competent, credible, and persuasive October 2024 VA addendum medical opinion because it was based on an accurate review of the Veteran's pertinent medical history and a sound medical rationale, including consideration of relevant medical literature.  In contrast, the Board affords no probative weight to the April 2024 negative VA medical opinion because it was based in part on an inaccurate factual premise.  

The Board considered the Veteran's lay contention that his current neck disability is etiologically related to neck complaints he experienced during active service.  As a lay person, he is competent to report observable symptoms he experiences, such as neck pain, and the onset, duration, and course of such symptoms.  However, he is not competent to opine on the etiology of his current neck disability due to the medical complexity of the matter involved.  Therefore,
 an accurate review of the Veteran's pertinent medical history and a sound medical rationale, including consideration of relevant medical literature.  In contrast, the Board affords no probative weight to the April 2024 negative VA medical opinion because it was based in part on an inaccurate factual premise.  

The Board considered the Veteran's lay contention that his current neck disability is etiologically related to neck complaints he experienced during active service.  As a lay person, he is competent to report observable symptoms he experiences, such as neck pain, and the onset, duration, and course of such symptoms.  However, he is not competent to opine on the etiology of his current neck disability due to the medical complexity of the matter involved.  Therefore, the Board affords such lay contentions little probative value to establish a nexus between the Veteran's current cervical spine strain and active service.

Finally, there is no competent medical evidence suggesting that the Veteran has a current diagnosis of cervical spine arthritis (or any other relevant condition listed under 38 C.F.R. § 3.309(a)).  Therefore, the chronic disease presumptive provisions do not apply here.  See 38 C.F.R. §§ 3.303(b), 3.307(a), 3.309(a); see also Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

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In conclusion, the weight of the most probative evidence is against the claim for service connection for a cervical spine disability.  Since the evidence is not at least in approximate balance, the benefit of the doubt rule does not apply.  Therefore, the appeal is denied.

 

 

R. JANOFSKY

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Stratton, C.

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.