Citation Nr: 21004217 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-10 643A DATE: January 26, 2021 ORDER Service connection for right upper extremity neuropathy is denied. Service connection for left upper extremity neuropathy is denied.   FINDING OF FACT The Veteran’s bilateral upper extremity disorders did not have their onset during service and are not otherwise related. The bilateral upper extremity disorders were not caused or aggravated by his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for right upper extremity neuropathy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. 2. The criteria for service connection for left upper extremity neuropathy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from July 1980 to July 2000. The case is on appeal from a May 2011 rating decision. In March 2017, the Veteran testified at a Board hearing. The claims most recently came before the Board in September 2019 and were remanded for further development. In December 2020, the Veteran requested that his case be expedited due to “financial hardships caused by the COVID-19 National Emergency.” The Board notes a case may be advanced on the docket (AOD) if the appellant is seriously ill or is under severe financial hardship, or if other sufficient cause is shown. The Veteran has submitted no further evidence related to his request for AOD. In the absence of supporting evidence showing that the Veteran is facing severe financial hardship, or other sufficient cause, the Veteran’s AOD request is denied. 38 C.F.R. § 20.800(c); 38 U.S.C. § 7107(b)(3). In accordance with this ruling, the appeal will remain in its current docket number order. In any case, the appeal is presently being addressed. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Service connection for right upper extremity neuropathy. 2. Service connection for left upper extremity neuropathy. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Analysis The Veteran contends that his bilateral upper extremity disorders are related to service. Alternatively, he asserts that the conditions were caused or aggravated by his service-connected disabilities, to include his back and bilateral shoulder disabilities. The Veteran’s service treatment records (STRs) include entries of bilateral upper extremity numbness. In September 1980, the Veteran reported a numbing sensation to the lateral aspect of the left elbow for five days. In April 1999, he indicated he was experiencing numbness in the upper extremities, reporting shoulder pain and both arms going numb while running. The Veteran further reported both shoulders going numb in November 1999. Following his August 2010 claims, a July 2014 MRI of the neck and back was obtained. The July 2014 record indicated multilevel degenerative disease of the cervical spine with findings most pronounced at C5-C6 and C6–C7 disc levels, where moderate to severe foraminal narrowing is demonstrated on the right side. The Veteran was afforded a March 2017 Board hearing in which he testified that his upper extremity disorders had their onset during service. He indicated when he would run in service, his arms and hands would go numb. The Veteran also stated his upper extremity conditions may be related to his service-connected back or shoulder disabilities. The claims were remanded by the Board in December 2017 for further development, including a VA examination. The Veteran was afforded a June 2018 VA examination in which he was diagnosed with bilateral upper extremity radiculopathy. The examiner indicated the disorders are secondary to the Veteran’s cervical spine degenerative joint disease (DJD) and degenerative disc disease (DDD). He reported the upper extremity conditions are not due to or the result of the Veteran’s service-connected conditions. The examiner stated such upper extremity conditions are no longer considered to be abnormal but are an age-related involutional change. He opined the Veteran’s upper extremity nerve complaint is a direct consequence of his nonservice-connected, age-related cervical spine DJD/DDD and not his mild bilateral A/C joint DJD or right supraspinatus tendonitis. The examiner also stated that the STRs were silent for an upper extremity nerve root disorder and right arm pain found in service was related to a right shoulder impingement condition. The Veteran’s representative submitted an August 2019 appellate brief which indicated the Veteran’s bilateral upper extremity numbness found in his STRs was not adequately addressed by VA prior to adjudication. As noted, in September 2019, the claims were remanded by the Board for further development, including a VA opinion as to the etiology of the disorders. Pursuant to the Board’s remand, the Veteran was afforded a December 2019 VA examination in which he was diagnosed with bilateral upper extremity radiculopathy. The examiner indicated the Veteran’s bilateral upper extremity neuropathy conditions are unrelated to his low back and shoulder disabilities. She stated degenerative changes in the low back would not result in neuropathy in the upper extremities. She noted radiculopathy and neuropathy are different conditions. Moreover, peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome, that involves trapped nerves in the wrist. However, radiculopathy is the pinching of the nerve at the root (eg; where they originate in the spinal cord), which can also produce pain, weakness, and numbness in the wrist and hand. The examiner indicated the Veteran’s radiculopathy in the upper extremities is from his DJD and DDD of the cervical spine, not neuropathy from the arthritis of the left and right shoulder joints, or the back disability. With regard to direct service connection, the December 2019 examiner took note of the reports and treatment for upper extremity numbness found in the Veteran’s STRs. She opined the upper extremity disorders are less likely than not incurred in or caused by service. She stated the right arm pain in service was related to the right shoulder impingement disorder and was acute during service. As noted, she found the Veteran’s nonservice-connected arthritis and DDD of the cervical spine is the current source of the upper extremity radiculopathy and is caused due to compression. After careful review of the evidence, the Board determines that service connection for bilateral upper extremity disorders is not warranted. The most persuasive medical evidence of record supports that the Veteran’s upper extremity radiculopathy did not have its onset during service and is not otherwise related. Additionally, the evidence shows the upper extremity disorders are not causally related to the Veteran’s service-connected back and bilateral shoulder disabilities. The Board finds the December 2019 VA examination report to be the most persuasive evidence of record and thus, it is accorded the greatest probative weight. The examiner’s opinion is consistent with the evidence of record, including the Veteran’s STRs and all post-service medical evidence. Moreover, the opinion contains clear conclusions and well-reasoned explanations in support. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board notes there are no medical opinions of record supporting that the Veteran’s bilateral upper extremity radiculopathy is causally related to service or a service-connected disability. The Board acknowledges the Veteran’s lay contentions, as well as his more than 20 years of service. However, the present claim involves a complex medical issue requiring medical training. While the Veteran as a lay person is competent to report experiencing upper extremity symptoms, he lacks the requisite expertise to render a medical opinion as to the etiology of his upper extremity radiculopathy. This is a complex medical question which falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Therefore, the Veteran’s opinion as to the etiology of his bilateral upper extremity disorders is afforded less probative weight than the December 2019 examination report. In sum, the Board finds after review of all the evidence of record, that the preponderance of the evidence is against the service connection claim. Thus, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for bilateral upper extremity disorders is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.