Citation Nr: 1321901 Decision Date: 07/09/13 Archive Date: 07/18/13 DOCKET NO. 07-26 354 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected bilateral wrist disabilities. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD H. Bunker, Associate Counsel INTRODUCTION The Veteran served on active duty from June 1973 to May 1976 and from August 1981 to August 1984. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. Jurisdiction of the case has since been transferred to the New Orleans, Louisiana RO. This case was previously brought before the Board in April 2011 and September 2012 at which time the claim was remanded to the Agency of Original Jurisdiction (AOJ) to further assist the Veteran with the development of his appeal. The case is once again before the Board. FINDING OF FACT The Veteran's cervical spine disorder is shown to have been caused by a service-connected disability. CONCLUSION OF LAW A cervical spine disorder was caused by a service-connected disability. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Veterans Claims Assistance Act of 2000 (VCAA) Since the Board is granting entitlement to service connection for a cervical spine disorder the entire benefit sought on appeal has been granted. Thus, no purpose would be served by undertaking an analysis of whether there has been compliance with the notice and duty to assist requirements set out in the VCAA. See, e.g., Bernard v. Brown, 4 Vet. App. 384 (1993); VAOPGCPREC 16-92, 57 Fed. Reg. 49,747 (1992). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder on a direct basis, generally there must be probative evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). For secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or the result of service-connected disease or injury or that service-connected disease or injury has chronically worsened the disability for which service connection is sought. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends that his cervical spine disorder is the result of his service-connected bilateral wrist disabilities. For the reasons discussed below, the Board finds that service connection is warranted. In a May 1997 VA examination report the Veteran was noted to have cervical spondylosis, which the examiner linked to the numbness in the Veteran's hands. The examiner stated this was not related to the Veteran's tendinous synovitis of the wrists. There is no rationale given for this opinion. At an August 2000 examination the Veteran was again diagnosed with cervical spondylosis with radiculopathy. In an April 2004 VA treatment record x-rays showed the Veteran had mild neural foraminal narrowing and disc bulges in his cervical spine. The Veteran also had cervical acute and chronic radiculopathy. April 2005 x-rays also showed left C5-T1 radiculopathy with ongoing denervation and chronic left C5-6 radiculopathy. March 1998 EMG studies showed left C6 radiculopathy predominantly with milder involvement of the C7 root also. January 2005 EMG summaries showed denervation in the C5-T1 area. The Veteran was afforded a VA examination in December 2005. He reported neck pain with radiation to his thumbs. He was noted to have had bilateral decompression of tendons in 1984 and had 2 releases on his right wrist and 1 on his left. X-rays showed degenerative disc disease, mild chronic compression, and narrowing of the interfacetal joints suggestive of degenerative joint disease. The examiner opined the cervical spine disorders were at least as likely as not aggravated by his service-connected bilateral wrist disabilities. His rationale was that the Veteran's wrist disabilities history was closely related to his cervical disc disease with radiculitis and that the Veteran's symptoms continued even after wrist surgeries. He opined this could be also a double crush nerve irritation at both the wrist and cervical spine. The Veteran again had bilateral release surgeries for his carpal tunnel syndrome. See e.g., November 2010 and March 2011 private treatment records. The Veteran was afforded a VA examination in May 2011. X-rays showed moderate degenerative changes in the mid to lower cervical spine. The examiner opined the Veteran's mild service cervical spine problems in-service were trivial and that he worked for 23 years after service with a neck stressing job. He also did not retire due to neck problems. He did not relate the wrist and thumb problems to the neck problems as the thumb surgery was related to the tendons and the most recent EMG did not show radiculopathy. The examiner did not offer an opinion as to aggravation of the Veteran's cervical spine by his service-connected wrist disabilities. In a January 2013 addendum opinion the examiner again stated that the in-service neck problems were very trivial and that he worked at a neck stressing job for 23 years following service. He opined that the wrist and thumb problems were not related to his neck problems based on the fact that the thumb tendon, not nerve, surgery was done and was not related to the nerves in the neck. The most recent EMG also did not show radiculopathy. The examiner also opined that the wrist problem likely did not aggravate neck problems because the nervous system works from the neck to the wrists and not in the opposite direction. The examiner did not discuss the December 2005 opinion or acknowledge that the Veteran has also had wrist surgeries, in addition to his thumb surgeries. The examiner also did not discuss previous EMG findings showing radiculopathy. The Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. See Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In this case the December 2005 examiner offered a rationale for why he believed the Veteran's service-connected wrist disabilities were related to the Veteran's cervical spine disorder to include the possibility of a double crush nerve irritation. He indicated he had reviewed the claims file and performed an examination of the Veteran. The May 1997 VA examiner did not offer a rationale for his opinion and did not discuss whether the Veteran's cervical spine was aggravated by his wrist disabilities. The May 2011 and January 2013 opinions were offered by the same examiner who did not discuss the December 2005 nexus opinion or the Veteran's wrist surgeries, instead only referring to a thumb surgery. The examiner also cited to the fact that recent EMG findings did not show radiculopathy, but did not discuss previous findings of radiculopathy. Accordingly, the Board assigns little probative value to the May 1997, May 2011, and January 2013 VA medical opinions. The Board assigns the December 2005 VA examination report the most probative value. At the very least, the Board finds the evidence is in relative equipoise. While two VA physicians stated the Veteran's wrist disabilities did not cause his cervical spine disorder, another VA physician linked the conditions and provided a rationale for his opinion. The Board will resolve all reasonable doubt in favor of the Veteran and the claim of entitlement to service connection for a cervical spine disorder is granted. 38 U.S.C.A. § 5107 (West 2002). ORDER Entitlement to service connection for a cervical spine disorder is granted. ____________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs