Citation Nr: 18155520 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 16-54 191 DATE: December 4, 2018 ORDER Entitlement to service connection for a cervical spine disability claimed as a neck condition is denied. FINDING OF FACT The Veteran’s cervical spine disability did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1999 to June 2005. 1. Entitlement to service connection for a cervical spine disability claimed as a neck condition Service connection is established on a direct basis when there is 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. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). Service connection for chronic diseases listed in 38 U.S.C. sections 1101 (3) and 38 C.F.R. § 3.309 (a) may be established on a presumptive basis if the chronic disease was shown as chronic in service; manifested to a compensable degree within a presumptive period, usually one year, after separation from service; or was noted in service with continuity of symptomatology since service. 38 U.S.C. §§ 1112, 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a). The Veteran asserts that his neck disability was caused by the general wear and tear of service. He additionally reports that in-service treatment for right arm pain was a symptom of the diagnosed degenerative disc disease of the cervical spine. The question for the Board is whether arthritis of the cervical spine was shown as chronic in service, whether it manifested to a compensable degree within the applicable presumptive period, or whether continuity of symptomatology has existed since service. If the answer to one of those questions is yes, service connection will be granted. The Board concludes that, while the Veteran currently has arthritis of the cervical spine which is considered a chronic disease under 38 U.S.C. § 1101 (3) and 38 C.F.R. § 3.309 (a), the conditions did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101 (3), 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a). VA and private treatment records show the Veteran was not diagnosed with degenerative disc disease of the cervical spine until May 2013, which is approximately eight years after his separation from service and outside of the applicable one-year presumptive period for service connection for arthritis. While the Veteran is competent to report experiencing symptoms of pain and limited cervical spine since service and during the presumptive period and consistently since, the Board finds the evidence weights against his assertion. A review of the post-separation medical records show that the Veteran reported experiencing neck pain in 2013, and in a July 2013 VA treatment record he asserted that the pain onset three years prior which would be in approximately 2010. The Board finds that his reports in contemporaneous treatment records in 2013 are more probative and outweigh his assertions of continuity of symptomology which show that he did not complain about any of the above arthritic conditions during service or until many years after separation from service, which is outside of the presumptive period. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Service connection for arthritis of the cervical spine may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s conditions and an in-service injury, event or disease. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). A review of the Veteran’s service treatment records shows that while the Veteran reported and was treated for musculoskeletal conditions affecting the lower back, knee, ankle, and forearm, there were no complaints or treatment for a cervical spine condition or for neck problems generally. Additionally, a June 2001 service treatment record shows that he reported right forearm pain that onset four days prior after the use of a jackhammer. On the Veteran’s June 2005 separation report, he did not report a history of neck pain but did note knee and GERD issues. A June 2015 letter from the Veteran’s VA primary care provider remarked that the Veteran’s current right arm pain was not due to tendonitis as previously diagnosed but due to cervical disc diseases with root compression noting the May 2013 MRI. The physician reported that it was more likely than not that this is related to service. A September 2016 VA examination report focusing on the cervical spine noted that deep tendon reflexes were normal for the right arm. Sensory examination was also noted normal for the right arm. No radicular pain of the right arm was noted. The examiner reviewed the Veteran’s service treatment records did not document objective findings consistent with a high energy injury to the soft tissue or osseous structures of the cervical spine, such as fracture, herniated disc, or dislocation. The examiner reported that in the absence of such findings a post traumatic or chronic inflammatory process was less likely than not to have occurred. The examiner noted that the Veteran had active duty for less than 10 years with no reports of repetitive injury, thus, opined that any microtrauma the Veteran sustained during active duty, even in aggregate, would be insufficient to initiate and sustains a posttraumatic or chronic inflammatory process, since the literature suggest a 10-year exposure as the threshold value. Finally, the examiner noted that there exists a substantial treatment gap from onset of symptoms to contemporary evaluation which was evidence against a causative relationship between his current pathology and active duty. After a review of the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for a cervical spine disability. The Board has received nexus opinions from two medical professionals, one VA primary care and one VA examiner. Because these medical professionals are both presumed to have appropriate medical training and experience, the Board accepts both opinions as competent and credible. Nevertheless, the Board must determine what evidence is the most probative. Upon review of the medical evidence of record, the Board places more probative weight on the September 2016 opinion of the VA examiner, than on the June 2015 opinion of the VA primary care physician. The opinion of the September 2016 VA examiner is supported by a rationale that thoroughly considers the medical evidence of record, including the Veteran’s service treatment records and post-service treatment records. The examiner specifically explained why the objective evidence of record was against the Veteran’s theory of entitlement. The Board finds this opinion credible and affords it great weight, because the probative value of a medical opinion comes from its reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board accordingly affords great probative weight to this opinion. Conversely, with respect to the June 2015 opinion of VA primary care physician, the physician concluded that the Veteran’s right forearm pain was a neurological symptom for a cervical spine disability and that this condition was related to service. The physician did not note if a review of the service treatment records and post-service treatment records was undertaken as there were no references to the in-service use of a jackhammer that caused right forearm pain. Nor did the physician remark on the gap of time from the Veteran first being diagnosed with degenerative disc disease of the cervical spine and separation from service. The Board, therefore, places less probative weight on the June 2015 opinion, as there was no reference to the pertinent evidence of record or a review of the claims file took place. While the Veteran believes his arthritis of the cervical spine is related to an in-service injury, event, or disease, including because of general impacts of active service, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education/knowledge of the interaction between the musculoskeletal system and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence of record contained to the service treatment records, post-service treatment records, and VA examination report. (Continued on the next page)   The Board concludes that Veteran’s cervical spine disability is not otherwise related to an in-service injury, event or disease and the claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Dworkin, Associate Counsel