Citation Nr: 18153133 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 13-06 680 DATE: November 27, 2018 ORDER Service connection for a neck/cervical spine disorder is denied. Service connection for a neurological disorder of the left upper extremity is denied. Service connection for a neurological disorder of the right upper extremity is denied. FINDINGS OF FACT 1. The weight of the competent and probative evidence is against finding that the current neck disorder had its onset in or is otherwise related to the Veteran’s active service, or that it is proximately due to the service-connected bilateral shoulder disabilities. 2. The weight of the competent and probative evidence is against finding that a neurological disorder of the left upper extremity had its onset in or is otherwise related to the Veteran’s active service, or that it is proximately due to the service-connected bilateral shoulder disabilities. 3. The weight of the competent and probative evidence is against finding that a neurological disorder of the right upper extremity had its onset in or is otherwise related to the Veteran’s active service, or that it is proximately due to the service-connected bilateral shoulder disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a neck/cervical spine disorder have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for a neurological disorder of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to service connection for a neurological disorder of the right upper extremity have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1969 to October 1972. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in March 2015 and April 2017, on which occasions it was remanded for further development. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). As a general matter, establishing service connection requires competent evidence of (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Alternatively, service connection may be granted on a secondary basis for a disability that is proximately due to or the result of (caused) or worsened beyond its natural progression (aggravated) by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc); 38 C.F.R. § 3.310. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). In relevant part, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). 1. Entitlement to service connection for a neck/cervical spine disorder. After review of the record, the Board finds that the criteria for service connection for a neck/cervical spine disorder have not been met. The record contains competent diagnoses of arthritis, degenerative disc disease, intervertebral disc syndrome (IVDS), spondylosis, stenosis, and disc bulge of the cervical spine. 06/14/2012, VA Examination; 07/12/2011, Medical-Non-Government. The Board, accordingly, finds competent evidence of a current disorder. The Veteran contends that his current neck disorder is proximately due to his service-connected bilateral shoulder disabilities. The Veteran is service-connected for residuals of arthroplasties of the bilateral shoulders. The left shoulder was previously rated as left shoulder impingement syndrome. The Board notes that the evidence does not demonstrate, and the Veteran does not claim, in-service treatment for, complaints of, or diagnoses related to the neck. 03/26/2015, STR-Medical. Nor does the evidence demonstrate, and the Veteran does not claim, that his neck disorder is related to service, other than on a secondary basis. The Veteran was first diagnosed with a neck disorder in February 2011, more than 38 years after service. The Board, accordingly, finds that the weight of the competent and probative evidence is against finding that a neck disorder had its onset during or manifested within one year of service, or that it was noted in service with evidence of symptoms on a continuous basis since. See 38 C.F.R. §§ 3.303, 3.307, 3.309. In May 2018, a VA board-certified orthopedic surgeon opined that the Veteran’s current neck disorder was not caused nor has aggravated by his bilateral shoulder disabilities. The surgeon noted that the Veteran’s cervical spine disorders are quite common as one ages, and even more common for those, like the Veteran, who work in manual labor jobs such as construction. The orthopedic surgeon explained that motion of the shoulder joint is independent of the cervical spine. Limitations in shoulder motion and function do not directly impact motion, function, or stress of the cervical spine. The shoulder joint involves the humerus and scapula, which move independently of the cervical spine. The orthopedic surgeon concluded that the Veteran’s cervical spine disorder would have developed even if he did not have any problems with his shoulders. 08/08/2018, Other; see also 06/14/2012, VA Examination (reflecting Veteran’s report that he worked as a laborer in construction for many years after service). The Board finds the orthopedic surgeon’s opinion to be competent, credible, and highly probative, as it is supported by review of the relevant medical records, lay evidence of post-service occupational work, medical expertise, and an adequate rationale. The Board, accordingly, finds that the weight of the competent and probative evidence is against finding that a current neck disorder was caused or has been aggravated by the Veteran’s service-connected bilateral shoulder disabilities. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. 2. Entitlement to service connection for a neurological disorder of the left upper extremity. 3. Entitlement to service connection for a neurological disorder of the right upper extremity. After review of the record, the Board finds that the criteria for service connection for a neurological disorder of the bilateral upper extremities has not been met. The record contains competent diagnoses of cubital tunnel syndrome, ulnar nerve entrapment at the elbow, and cervical radiculopathy of the bilateral upper extremities. 06/14/2012, VA Examination; 07/12/2011, Medical-Non-Government. The Board, accordingly, finds competent evidence of a current disorder. The Veteran contends that the neurological disorder of the arms is proximately due to his service-connected bilateral shoulder disabilities. The Board notes that the evidence does not demonstrate, and the Veteran does not claim, in-service treatment for, complaints of, or diagnoses related to a neurological disorder of the arms. 03/26/2015, STR-Medical. Nor does the evidence demonstrate, and the Veteran does not claim, that a neurological disorder of the arms is related to service, other than on a secondary basis. The Veteran was first diagnosed with a neurological disorder of the bilateral upper extremities in February 2011, more than 38 years after service. The Board, accordingly, finds that the weight of the competent and probative evidence is against finding that a neurological disorder of the bilateral upper extremities had its onset during or is otherwise related to the Veteran’s period of service. See 38 C.F.R. § 3.303. In May 2018, a VA board-certified orthopedic surgeon opined that a neurological disorder of the arms was not caused nor has aggravated by his bilateral shoulder disabilities. The surgeon explained that one of the most common causes of cubital tunnel syndrome is manual labor. The mechanism is local inflammation of the muscles around the elbow that control grip strength as well as repetitive flexion/extension of the elbow. Other contributing factors can be the use of heavy machinery that causes vibrations to the elbow, and the Veteran worked doing manual labor in construction for many years after service. The anatomy and biomechanics of the shoulder and ulnar nerve are independent of each other. The ulnar nerve is not impacted by shoulder conditions such as recurrent shoulder instability, rotator cuff tendinitis, impingement, rotator cuff tear, or arthritis. Limits in motion, function, and strength of the shoulder would not impact the ulnar nerve at the cubital tunnel. The orthopedic surgeon concluded that the Veteran’s cubital tunnel syndrome would have developed even if he did not have any problems with his shoulders. 08/08/2018, Other. The Board finds the orthopedic surgeon’s opinion to be competent, credible, and highly probative, as it is supported by review of the relevant medical records, proper consideration of lay evidence, medical expertise, and an adequate rationale. The Board, accordingly, finds that the weight of the competent and probative evidence is against finding that a neurological disorder of the bilateral upper extremities was caused or has been aggravated by the Veteran’s service-connected bilateral shoulder disabilities. In arriving at the decision to deny the claims, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Gelber, Associate Counsel