Citation Nr: A19001567 Decision Date: 09/25/19 Archive Date: 09/25/19 DOCKET NO. 190212-3312 DATE: September 25, 2019 REMANDED Entitlement to service connection for a cervical spine disability, to include as secondary to a service-connected lumbar spine disability, is remanded. Entitlement to service connection for left upper extremity radiculopathy, to include as secondary to a cervical spine disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1981 to July 2002. He submitted an intent to file a claim form in March 2016, and formally filed the claims currently on appeal in February 2017. In March 2017, the Agency of Original Jurisdiction (AOJ) denied the issues of service connection for a cervical spine disability and left upper extremity radiculopathy. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with the Department of Veterans Affairs (VA)’s decision on their claim to seek review. The Veteran chose to participate in VA’s test program RAMP, the Rapid Appeals Modernization Program. This decision has been written consistent with the new AMA framework. The Veteran selected the Supplemental Claim lane when he submitted his RAMP election form on April 30, 2018. In August 2018, the AOJ issued a RAMP decision and the Veteran timely appealed this rating decision to the Board, requesting the Evidence Submission process. In adjudicating the claims of entitlement to service connection for a cervical spine disability and left upper extremity radiculopathy, the Board may consider evidence associated with the record between the March 29, 2016 intent to file and May 30, 2018, 30 days after VA received his supplemental claim form. The record was closed between May 31, 2018 and January 29, 2019, the date VA received his direct appeal to the Board. The evidence record reopened January 29, 2019 when the Veteran filed his appeal requesting the Evidence Submission lane, and remained open for 90 days thereafter. The 90-day time period to submit evidence has elapsed, with no additional evidence received within that time period. Moving to the merits of the appeal, the Veteran contends that he has a current cervical spine disability, with associated left upper extremity radiculopathy, that developed secondary to his service-connected lumbar spine disability. After reviewing the evidence of record, the Board finds that the appeal must be remanded to correct duty to assist errors that occurred prior to the issuance of the RAMP rating decision on appeal. In this regard, the Veteran was afforded a VA cervical spine examination in March 2017. The March 2017 VA examiner opined that the claimed condition was less likely than not related to service. The March 2017 examiner also opined that the claimed condition was less likely than not proximately due to or the result of the Veteran’s service-connected lumbar spine disability. The examiner reasoned that the longitudinal medical evidence provided and reviewed does not support a chronic, disabling cervical spine condition or diagnosis prior to service, during service, or at the time of separation from service. Entry and separation medical examinations were silent for cervical spine and neck complaints. The service treatment records (STRs) were silent for an acute or chronic cervical spine condition. Interim medical records were silent for cervical spine or neck complaints from the time of service separation until medical workup for neck pain with left upper extremity complaints in September 2016. The examiner further reasoned that the Veteran’s cervical spine disability was due to the natural progression of aging. The Veteran was 53 years old at the time of his c-spine imaging. Cervical spine degenerative disc disease, as part of natural aging, typically affects older patients over 40 years old. Those older than 40 years were also found to have the greatest risk of cervical radiculopathy. The opinions provided are inadequate because the examiner did not discuss aggravation. A medical opinion regarding secondary service connection must address both causation and aggravation. See El Amin v. Shinseki, 26 Vet. App. 140 (2013). Additionally, the Veteran’s STRs document complaint and treatment of upper back and neck pain, and numbness in the left shoulder blade area. However, the examiner did not discuss this evidence in rending her opinion. In light of the aforementioned deficiencies in the March 2017 VA cervical spine examination, the Board finds that an addendum opinion should be obtained on remand. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). (stating that, when VA undertakes to provide a veteran with an examination, that examination must be adequate for VA purposes). The matters are REMANDED for the following action: 1. Return the file to the March 2017 VA examiner for an addendum opinion. If that examiner is unavailable, the opinion should be provided by another examiner. If a clinical evaluation is deemed necessary to answer the questions presented, one should be scheduled. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the diagnosed cervical spine disability and/or left upper extremity radiculopathy had their onset during active service, or within one year of the Veteran's separation from active service, or are otherwise related to service? The examiner is asked to specifically discuss the Veteran’s complaint and treatment of upper back and neck pain, and numbness in the left shoulder blade area documented in his STRs in addressing whether the current condition is related to the conditions for which the Veteran sought treatment in service. In this regard, the Board notes that documented evidence of a chronic condition in service is not a requirement for service connection. (b.) Is it at least as likely as not that the Veteran's cervical spine disability was aggravated by the Veteran's service-connected lumbar spine disability? (c.) If the examiner finds that the cervical spine disability has been permanently worsened beyond normal progression (aggravated) by the Veteran's service-connected lumbar spine disability the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to the disability. All findings and conclusions should be supported with a complete rationale which reflects the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, Associate 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.