CERVICAL SPINE LIMITATION OF MOTION

Summary

The veteran, who served in the United States Marine Corps from September 2011 to September 2015, appeals the denial of service connection for a cervical spine disorder. The veteran claimed the condition was a progression of an in-service neck injury, supported by his own statements and a December 2024 medical opinion from his treating chiropractor, J.J.K. The chiropractor opined that the Veteran's current cervical spine pathology was related to his active service, basing this conclusion on clinical expertise, observations of the condition's progression, and the Veteran's medical history. The Board found this opinion highly probative due to its detail, reasoning, and clinical basis. While VA medical opinions in May 2024 and March 2025 were negative, they were based solely on the absence of contemporaneous service treatment records and failed to address the Veteran's consistent reports of in-service injury and post-service symptoms. The Board found these VA opinions inadequate. Applying the benefit of the doubt doctrine, the Board found the evidence in approximate balance, resolving the doubt in the Veteran's favor. Consequently, service connection for a cervical spine disorder was granted.

Rationale

Current cervical spine pathology established; In-service injury (fall) confirmed by STRs; Treating chiropractor's opinion found probative and linked condition to service; VA opinions found inadequate for failing to address lay testimony and in-service injury; Benefit of the doubt applied due to approximate balance of evidence

Full Decision Text

Citation Nr: A26040540
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250612-554314
DATE: April 30, 2026

ORDER

Entitlement to service connection for a cervical spine disorder is granted.

FINDING OF FACT

The evidence is in at least a state of approximate balance as to whether the Veteran's cervical spine disorder was incurred in service.

CONCLUSION OF LAW

The criteria for service connection for a cervical spine disorder are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

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REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Marine Corps from September 2011 to September 2015.  

This matter comes before the Board of Appeals (Board) on appeal from a March 2025 decision of a Department of Veterans Affairs (VA) regional office (RO), which confirmed and continued the previous denial of service connection for neck pain.  See December 2022 Veteran's Application for Disability Compensation (VA Form 21-526EZ) (initially claiming service connection for "neck pain"); March 2023 Rating Decision (denying service connection for a neck disorder); May 2024 Decision Review Request: Supplemental Claim (VA Form 20-0995) (requesting review of the March 2023 rating decision denying service connection for a neck condition); August 2024 Rating Decision (confirming and continuing the previous denial of service connection for a neck condition); December 2024 Decision Review Request: Supplemental Claim (VA Form 20-0995) (requesting review of the August 2024 rating decision denying service connection for a neck condition); March 2025 Rating Decision (finding that new and relevant evidence had been received to readjudicate the claim for service connection for a neck condition but denying the claim on the merits).  

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  See 38 C.F.R. § 19.2(d).  Under direct review, no development may be undertaken; the Board considers the same record as the RO in rendering a decision, and there is no evidence submission or a hearing request.  Accordingly, the evidentiary record is limited to the evidence of record at the time of the March 2025 rating decision.  38 C.F.R. § 20.301.  If evidence was submitted during the period after the AOJ issued the March 2025 decision, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.301, 20.801.  

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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.  

SERVICE CONNECTION

Service connection means that a veteran has a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge when the evidence shows that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Entitlement to service connection is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or "medical nexus" between the current disability and the disease or injury incurred or aggravated during service.  Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see 38 C.F.R. § 3.303(a).

1. Entitlement to service connection for a cervical spine disorder is granted.

The Veteran has asserted entitlement to service connection for a cervical spine disorder, maintaining that this condition represents the progression of an in-service neck injury.  See, e.g., December 202
 causal relationship or "medical nexus" between the current disability and the disease or injury incurred or aggravated during service.  Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see 38 C.F.R. § 3.303(a).

1. Entitlement to service connection for a cervical spine disorder is granted.

The Veteran has asserted entitlement to service connection for a cervical spine disorder, maintaining that this condition represents the progression of an in-service neck injury.  See, e.g., December 2022 Statement in Support of Claim (VA Form 21-4138); May 2024 and March 2025 VA Neck Conditions Disability Benefits Questionnaires (DBQs) (documenting the Veteran's reports regarding the nature of his in-service injuries and the post-service continuity of his symptoms); December 2024 Medical Opinion from J.J.K., D.C. (describing the onset and progression of the Veteran's cervical spine conditions).  

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As an initial matter, the Board notes that the AOJ recognized that the Veteran has a currently diagnosed cervical spine pathology and further conceded the occurrence of "a qualifying event, injury, or disease" during the Veteran's active service, confirmed by service treatment records confirming that the Veteran suffered a fall with resulting facial injuries.  See March 2025 Rating Decision (finding that the Veteran has "been diagnosed with a disability" and noting the medical evidence reflecting a diagnosis of "cervical Strain"); March 2023 Rating Decision (finding that the "evidence shows that a qualifying event, injury, or disease had its onset during [the Veteran's] service").  Accordingly, the first and second elements of service connection, namely that of a current disability and incurrence of an in-service injury, are established.  See 38 C.F.R. § 3.104(c) (reflecting that favorable findings made by VA adjudicators are binding on all subsequent VA adjudicators, absent clear and unmistakable error).  Therefore, the question remains whether there is evidence of a nexus between the diagnosed cervical disorder and the Veteran's active service.  See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.").

In this regard, as noted, the Veteran has asserted in statements adduced throughout the pendency of his claim that he has experienced persistent neck symptoms since his in-service injury.  And the Board observes that the Veteran is competent to report the onset of neck symptoms during his active service.  See Washington v. Nicholson, 19 Vet. App. 362 (2005) (holding that a Veteran is competent to report what occurred during service because he is competent to testify as to factual matters of which he has first-hand knowledge); Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007) (holding that lay testimony is competent to establish the presence of observable symptomatology).  Moreover, lay evidence can be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).  Accordingly, the Veteran is also competent to report experiencing continued neck and back symptoms during and since his active service, as the onset, frequency, and duration of such symptoms as pain are certainly capable of lay observation.  See id.  See also Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge).

The Board additionally finds his competent statements of continuing neck and back symptomatology during and since his active service to be credible.  See Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001).  In this regard, the Veteran's assertions as to the in-service onset and post-service continuity of neck symptoms are bolstered by the December 2024 medical opinion from J.J.K., the Veteran's treating chiropractor, who opined that the Veteran's current cervical spine pathology was related to his active service.  See December 2024 Medical Opinion from J.J.K., D.C.  J.J.K. based this determination upon
 report on that of which he or she has personal knowledge).

The Board additionally finds his competent statements of continuing neck and back symptomatology during and since his active service to be credible.  See Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001).  In this regard, the Veteran's assertions as to the in-service onset and post-service continuity of neck symptoms are bolstered by the December 2024 medical opinion from J.J.K., the Veteran's treating chiropractor, who opined that the Veteran's current cervical spine pathology was related to his active service.  See December 2024 Medical Opinion from J.J.K., D.C.  J.J.K. based this determination upon his treatment of and familiarity with the Veteran; his clinical expertise and knowledge of medical principles and scholarship; his clinical observations regarding the nature and progression of the Veteran's cervical spine condition; and his consideration of the Veteran's competent reports regarding his medical history.  See id.  

The Board finds this evidence to be especially probative as the opinion represents the informed conclusions of a medical professional with relevant expertise; is based on clinical evaluation of the Veteran and consideration of the Veteran's medical history; and is supported by a clear, well-reasoned explanation with reference to relevant medical principles.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that the probative value of a medical opinion the probative value of a medical opinion depends upon whether it is factually accurate, fully articulated, and contains sound reasoning for the conclusion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.").  The December 2024 opinion thus carries significant probative weight in the Board's determination and constitutes highly probative evidence of a nexus between the Veteran's cervical spine pathology and his active service.  See Prejean v. West, 13 Vet. App. 444, 448 (2000) (indicating that the Board may determine the probative value of medical opinions based on their detail, the persuasiveness of their opinions, and the physicians' access to a Veteran's medical records); Caluza v. Brown, 7 Vet. App. 498, 506 (1995).  

The Board acknowledges the negative etiological opinion evidence of record in the form of the May 2024 and March 2025 VA medical opinions disassociating the Veteran's neck condition from his active service.  See May 2024 and March 2025 VA Medical Opinion Disability Benefits Questionnaires (DBQs).  In this regard, the examining VA clinicians based their negative determinations solely upon the absence of evidence of complaints of or treatment for neck problems during the Veteran's active service or in the years immediately following his discharge.  See id. (emphasizing that the negative opinions were based upon the absence of medical records "establish[ing] chronicity or continuity" of neck symptoms during and since service).  However, the examiners provided no additional explanation or support for this conclusory rationale and failed to consider or address in any way the Veteran's competent statements regarding the in-service injury and post-service progression of his neck symptoms.  See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006) (holding that the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible); Cf. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that a VA opinion was inadequate where the examiner did not comment on the Veteran's report of in-service injury and relied on lack of evidence in service medical records to provide a negative opinion).  See also Nieves-Rodriguez, 22 Vet. App. at 302-04 (indicating "[i]t is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion").  As such, the VA medical opinions do not form a sufficient foundation upon which to base a denial of entitlement to service connection, and the Board thus declines to accept them.  See Stefl, 21 Vet. App. at 124; see also Wilson v. Derwinski, 2 Vet. App. 614 (1992) (reflecting that the Board is free to assess medical evidence and is not obligated to accept a physician's opinion).

Accordingly, viewing the evidence in the light most favorable to the Veteran, considering the probative medical opinion evidence linking the Veteran's diagnosed cervical spine
 sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion").  As such, the VA medical opinions do not form a sufficient foundation upon which to base a denial of entitlement to service connection, and the Board thus declines to accept them.  See Stefl, 21 Vet. App. at 124; see also Wilson v. Derwinski, 2 Vet. App. 614 (1992) (reflecting that the Board is free to assess medical evidence and is not obligated to accept a physician's opinion).

Accordingly, viewing the evidence in the light most favorable to the Veteran, considering the probative medical opinion evidence linking the Veteran's diagnosed cervical spine condition to his active service, and in the absence of any probative medical evidence to the contrary, the Board finds that, at the least, reasonable doubt exists as to the question of the origin of the Veteran's neck disorder.  When resolving reasonable doubt in favor of the Veteran, the Board finds that there is at least an approximate balance of positive and negative evidence with respect to the question of whether the Veteran's cervical spine condition is attributable to his active military service.  Under VA law, in such a circumstance, the claimant must prevail.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).  As such, service connection for a cervical spine disorder is granted.

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. McCabe, 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.