Citation Nr: 1406384 Decision Date: 02/12/14 Archive Date: 02/24/14 DOCKET NO. 11-19 876 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to an evaluation in excess of 20 percent for lumbar spine strain. 2. Entitlement to service connection for a cervical spine disability. ATTORNEY FOR THE BOARD L. Reeder, Associate Counsel INTRODUCTION The Veteran served on active duty from July 2001 to December 2001, and from December 2003 to March 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board also notes that, in addition to the paper claims file, a paperless, electronic claims file is associated with the Veteran's claim, and has been reviewed. FINDINGS OF FACT 1. For the period prior to March 31, 2009, the Veteran's lumbar spine strain was manifested by forward flexion greater than 30 degrees but not greater than 60 degrees, with no additional limitation of motion due to pain. 2. For the period from March 31, 2009 through October 3, 2010, the Veteran's lumbar spine strain was manifested by limitation of forward flexion to 30 degrees upon repetitive motion. 3. For the period from October 4, 2010, the Veteran's lumbar spine strain was manifested by forward flexion greater than 30 degrees but not greater than 60 degrees, with no additional limitation of motion due to pain. 4. The most probative evidence is against a finding that the Veteran suffers from a cervical spine disability. CONCLUSIONS OF LAW 1. For the period prior to March 31, 2009, the criteria for an evaluation in excess of 20 percent for lumbar spine strain have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2013); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2013). 2. For the period from March 31, 2009 through October 3, 2010, the criteria for an evaluation of 40 percent, but no greater, for lumbar spine strain have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2013); 38 C.F.R. §§ 4.3, 4.71a, Diagnostic Code 5237 (2013). 3. For the period from October 4, 2010, the criteria for an evaluation in excess of 20 percent for lumbar spine strain have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2013); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2013). 4. The requirements for establishing service connection for a cervical spine disability have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002 & Supp. 2013); 38 C.F.R. § 3.303 (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 Under the Veterans Claims Assistance Act of 2000 (VCAA), when VA receives a complete or substantially complete application for benefits, it must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2013); 38 C.F.R. § 3.159 (2013). Compliant VCAA notice was provided in a July 2009 letter. The VA has also fulfilled its duty to assist the Veteran in making reasonable efforts to identify and obtain relevant records in support of the Veteran's claims and to provide a VA examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c)(4)(i) (2013). In this case, the VA obtained service treatment records (STRs) for the Veteran's second period of active duty service, post-service VA treatment records, and VA examination reports. The Board notes that in November 2008 VA issued a Formal Finding Memorandum as to the unavailability of records for both of the Veteran's periods of service. The STRs for his second period of service, from December 2003 to March 2005, were subsequently obtained, associated with the claims file, and reviewed by the RO. When STRs are lost or missing, the Court has held that VA has a heightened duty "to consider the applicability of the benefit of the doubt rule, to assist the claimant in developing the claim, and to explain its decision." Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) (citing Russo v. Brown, 9 Vet. App. 46, 51 (1996)); see also Cuevas v. Principi, 3 Vet. App. 542, 548 (1992) and O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, the Board notes that the Veteran specifically indicated in his initial claim that the disabilities at issue arose during his second period of active duty service-the period for which the STRs have been obtained. The Board also notes that the Veteran was not afforded a VA examination regarding his claim for service connection for a cervical spine disability, and no medical opinion has otherwise been obtained. However, there is no competent evidence of a current diagnosis of a cervical spine disability, and x-ray images taken in April 2011 indicated a normal cervical spine. Thus, the Board finds that obtaining a VA examination or opinion on this issue is not required. See 38 C.F.R. § 3.159(c)(4) (2013); see also McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). As discussed above, the Veteran was notified and aware of the evidence needed to substantiate the claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between the Veteran and VA in obtaining such evidence. The Veteran was provided with a meaningful opportunity to participate in the claims process, and has done so by providing evidence and argument. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to cause injury to the Veteran. See Pelegrini, 18 Vet. App. at 121. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Dingess, 19 Vet. App. 473. II. Analysis The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Increased Rating The Veteran is seeking an increased rating for his lumbar spine strain, currently evaluated as 20 percent disabling. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the appellant has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability, separate, or "staged," ratings can be assigned for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40 (2013); see also 38 C.F.R. §§ 4.45, 4.59 (2013). Recently, the United States Court of Appeals for Veterans Claims (Court) clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Veteran's lumbar spine strain is rated under Diagnostic Code 5237 which utilizes the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Under the General Rating Formula provides a 20 percent disability rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. The General Rating Formula provides further guidance in rating diseases or injuries of the spine. In pertinent part, Note (1) provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note (2) provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. See also Plate V, 38 C.F.R. § 4.71a. The Veteran was afforded a VA examination in December 2008. At that time he reported he currently had pain on a daily basis. He denied radiation, stiffness, or weakness. The Veteran indicated experiencing flare-ups three to four times per week, but denied additional limitation of motion or functional impairment during those flare-ups, which he stated he treated by changing positions and taking Tylenol. He denied any neurological symptoms and stated he used no assistive devices. The Veteran also denied any effect on his ability to perform job duties, and indicated he had not missed work in the past year as a result of his disability. Upon physical examination, the examiner reported erect posture with a slight curvature noted in the mid-thoracic area. He noted no other spinal deformity, no limp when the Veteran walked, and no muscle spasm. The examiner reported range of motion (ROM) as follows: forward flexion to 60 degrees, extension to 30 degrees, left lateral flexion to 20 degrees, right lateral flexion to 20 degrees, left lateral rotation to 25 degrees, and right lateral rotation to 25 degrees. Pain was noted at each end point. During repetitive motion testing of extension and forward flexion, the Veteran indicated an increase in pain, but the examiner noted that the pain did not change ROM or cause joint fatigability. The examiner also noted no instability or balance problems. X-rays of the lumbosacral spine were normal." The examiner diagnosed the Veteran with lumbar spine strain, noting the negative x-rays. The Veteran underwent another VA examination in March 2009. At that time he described steady, aching pain of a severity of 7 or 8 on a 1 to 10 scale. He indicated it began in the middle of his back and extended into his low back. The Veteran stated he had flare-ups that occurred every night and affected his ability to sleep. He stated he treated the pain with ice and Tylenol, and that he could not take anything else due to his blood pressure medication. He described no incidents requiring bed rest, and stated that the main limitation caused by his flare-ups was sleep disturbance. The Veteran reported no weakness or unsteadiness, and no real limit to his walking or driving ability. He reported an occasional numbness in his upper extremities, which resolved when he shook them. He reported no other neurological complaints. The Veteran stated he was currently employed as a machine operator, and that he did not have any problems with his work and did not have to miss work due to his back. He reported some discomfort when picking up his three-year-old son or carrying laundry. Upon physical examination, the examiner noted no apparent scoliosis, and no asymmetry or atrophy on either side of the Veteran's body. The examiner instructed the Veteran to perform repetitive flexion and extension motions, and recorded results as follows: forward flexion to 70 degrees, then 50 degrees, then 30 degrees; extension to 30 degrees, then 15 degrees, then 10 degrees; right lateral flexion to 20 degrees without change upon repetition; right lateral rotation to 20 degrees without change upon repetition; left lateral rotation to 20 degrees without change upon repetition. Left lateral flexion was not reported. The examiner indicated that the Veteran described pain throughout these movements, but that he noted no objective evidence of painful motion such as spasms, weakness, or tenderness. He detected no evidence of guarding or localized tenderness, and no abnormal gait. Regarding functional limitation, the examiner stated that the Veteran complained of pain throughout the ROM testing, but that he did not believe that fatigue, weakness, or lack of endurance were significant problems. He diagnosed the Veteran with chronic lumbosacral strain. The Veteran was afforded a third VA examination on October 4, 2010. At that time the Veteran reported constant pain localized in the lumbar region of his spine and radiating into the thoracic region. He rated his pain as severe, but indicated that he had no episodes of total incapacitation in the past year. He denied neurological symptoms. The Veteran indicated he took Tylenol two to three times per day for pain. He indicated that he received transcutaneous electrical nerve stimulation (TENS) and chiropractic treatments through VA, but that the treatments provided no relief from the pain. The Veteran indicated he experienced flare-ups two to three times per week that lasted approximately half a day, and that he could not lift any objects or bend forward during that time. He stated that he was currently employed full time at a local factory as a machine operator, which required him to stand all day. He stated he had difficulty performing heavy lifting tasks, and that he took several breaks each day to sit and rest his back, but denied other occupational limitations. The Veteran reported difficulty with household chores that required bending and lifting, or long periods of standing. He also indicated that he could no longer play sports or lift weights due to his back condition. Upon physical examination, the examiner noted erect posture and a normal gait. The examiner noted that the Veteran exhibited no difficulty rising from his chair, moving on and off of the examination table, or walking into the examination room. The examiner reported ROM as follows: forward flexion to 45 degrees, extension to 15 degrees, left lateral flexion to 20 degrees, right lateral flexion to 15 degrees, left rotation to 20 degrees, and right rotation to 20 degrees, with pain throughout each ROM. She reported that the Veteran complained of increased pain upon repetition with right rotation, only, and that no changes in ROM were noted. The examiner stated that there was no fatigability, weakness, or incoordination, and that the Veteran demonstrated no objective evidence of pain during the examination, only verbal complaints. X-ray imaging of the lumbosacral spine revealed no changes from the previous study, and the examiner diagnosed the Veteran with chronic lumbar strain with no evidence of radiculopathy or neurological residuals. In addition to his VA examinations, the Veteran has received ongoing VA treatment for his back condition, to include the previously noted TENS therapy and chiropractic treatments. In January 2009, the Veteran presented to a VA emergency department complaining of back pain that had lasted several days. He was given an injection of Toradol and diagnosed with acute lumbar myofascial strain. At a follow-up appointment in February 2009 the Veteran described pain that interfered with his ability to sleep. The examiner noted trunk ROM within normal limits. The Veteran indicated he had no numbness, pain, or tingling in his lower or upper extremities, and no bladder or bowel problems. The examiner diagnosed the Veteran with mid to upper back pain, and instructed him in proper posture and stretching exercises. As a result of that appointment the Veteran began the TENS treatments, and in March 2009 the examiner noted improvement in the Veteran's symptoms, including a report of better sleep. The Board has also reviewed and considered the Veteran's lay assertions in support of his claim, as well as the lay assertions of the Veteran's girlfriend and his work supervisor, which describe the pain the Veteran experiences and the effect his disability has on his work and home life. However, the Board finds that the clinical evidence of record is of greater probative value as to the level of impairment. Turning first to the time periods prior to March 31, 2009 and from October 4, 2010, the Board finds that a rating in excess of 20 percent for the Veteran's lumbar spine strain is not warranted. The clinical evidence of record shows the Veteran had forward flexion to 60 degrees during his December 2008 examination, and forward flexion to 45 degrees during his October 2010 examination, without change after repetitive motion in either instance. The Veteran noted pain on forward flexion during both examinations, but, "although pain may cause functional loss, pain itself does not constitute functional loss" that is compensable for VA benefit purposes. Mitchell, 25 Vet. App. at 37. The only other ROM testing conducted during either of those time periods noted trunk ROM that was within normal limits. In short, the objective findings do not show the Veteran's forward flexion was limited to 30 degrees or less, even after consideration of pain, weakness and other symptoms described in DeLuca, nor do they show favorable ankylosis of the entire thoracolumbar spine. As a result, a rating of 40 percent is not appropriate for those time periods. Moreover, the findings do not show unfavorable ankylosis of the entire thoracolumbar spine, as required by the 50 percent ratings. Thus, the preponderance of the competent and probative evidence of record is against a finding of an initial rating in excess of 20 percent for the Veteran's lumbar spine strain for the period prior to March 31, 2009, and is also against a finding of a rating in excess of 20 percent for the period from October 4, 2010. Turning next to the period from March 31, 2009 through October 3, 2010, after resolving all doubt in favor of the Veteran, the Board finds that the Veteran's lumbar spine strain more nearly approximated a 40 percent rating during that time. During the March 31, 2009 VA examination, the Veteran performed repetitive ROM tests, and the examiner noted forward flexion of the thoracolumbar spine that decreased to 30 degrees after three repetitions. The examiner noted that there was no objective evidence of painful motion such as spasms, weakness, or tenderness. He indicated he saw no evidence of guarding, and that the Veteran had a normal gait. However, in accordance with DeLuca, and with resolution of reasonable doubt in the Veteran's favor, the Board will assign a 40 percent evaluation to contemplate limitation on repetitive motion due to pain, as noted in the March 31, 2009 VA examination. However, there is no objective evidence supporting an evaluation of 50 percent, as ankylosis has not been shown at any time during the course of the claim. Accordingly, the preponderance of the evidence supports a rating of 40 percent, but no higher, for the period from March 31, 2009 through October 3, 2010. The Board has also considered whether a referral for an extraschedular evaluation is warranted with regard to the Veteran's increased rating claim. See 38 C.F.R. § 3.321(b)(1) (2013); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Here, the rating criteria reasonably describe the Veteran's disability level and symptomatology, and provide for a higher rating for more severe symptomatology (including unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine) than is shown by the evidence. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. For all musculoskeletal disabilities, the rating schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell, 25 Vet. App. at 37. For disabilities of the joints in particular, the rating schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, supra. In summary, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss. Given the variety of ways in which the rating schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran's disability picture. Thus, his disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extraschedular consideration is not warranted. As a final matter, the Board notes that various lay statements have been submitted, both by the Veteran and by third parties, indicating that the Veteran's low back disability causes him to miss work. However, as previously noted, the Veteran denied any effect on his ability to perform his job duties during his 2008 VA examination, and indicated that he had not missed work due to his back in the past year. During his 2009 examination, the Veteran indicated he had no problems at work and that he had not missed work due to his back. During his 2010 VA examination, the Veteran denied occupational limitations other than having to take breaks during the day and having difficulty lifting heavy objects. Moreover, after various lay statements were submitted in June 2009, the RO sent the Veteran a letter, in July 2009, asking him to confirm whether he intended to claim individual unemployability. Although the Veteran submitted an additional statement in August 2009, which he indicated was submitted to explain why he believed he deserved a higher disability rating, he did not state that he intended to file a claim for individual unemployability. Based on the above, no action pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009) is required at this time. Service Connection The Veteran also seeks entitlement to service connection for a cervical spine disability, which he claims manifested during his second period of active duty service. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303 (2013). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Although the Veteran has been diagnosed with and service-connected for a lumbar spine strain, the evidence of record does not indicate that he has been diagnosed with a cervical spine disability. Additionally, x-ray images of the Veteran's cervical spine were taken in April 2011, and the radiologist indicated that his cervical spine was normal. As a lay person, the Veteran is competent to testify with respect to facts and symptoms that are capable of lay observation. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). However, there is no indication that he has specialized training in diagnosing spinal conditions, a matter that requires medical testing and expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Thus, the Veteran's contention that he suffers from a cervical spine disability is not a competent medical opinion. The Board accords significantly greater probative value to the medical evidence of record than to the Veteran's lay assertion that he suffers from a cervical spine disability. The Board acknowledges that the Veteran has ongoing back pain. However, upon review of the record in its entirety, the Board finds that the competent and probative evidence indicates that the Veteran has not been diagnosed with a cervical spine disability. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C.A. § 1110. In the absence of proof of a current diagnosis of a cervical spine disability, service connection for that disability cannot be established. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the Board finds that the preponderance of the evidence is against the claim, and service connection for a cervical spine disability is denied. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine, and applied it to award a staged rating for the Veteran's low back disability. However, as the preponderance of the evidence is otherwise against the Veteran's claims, the doctrine is applicable in that instance, only. See 38 U.S.C.A. § 5107(b) (West 2002 & Supp. 2013); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). (CONTINUED ON NEXT PAGE) ORDER An initial evaluation in excess of 20 percent for lumbar spine strain for the period prior to March 31, 2009 is denied. From March 31, 2009 through October 3, 2010, an evaluation of 40 percent, but no higher, for lumbar spine strain is granted, subject to the rules and regulations governing the payment of VA monetary benefits. For the period from October 4, 2010, an evaluation in excess of 20 percent for lumbar spine strain is denied. Service connection for a cervical spine disability is denied. ____________________________________________ K. A. BANFIELD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs