Citation Nr: 21004723 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-27 857A DATE: January 28, 2021 ORDER Entitlement to service connection for a cervical spine disorder, to include degenerative disc disorder and/or diffuse idiopathic skeletal hyperostosis, is denied. FINDING OF FACT The Veteran’s cervical spine disorder, to include degenerative disc disorder and/or diffuse idiopathic skeletal hyperostosis, was not shown in service or for many years thereafter and is not otherwise etiologically related to active duty service. CONCLUSION OF LAW The criteria for cervical spine disorder, to include degenerative disc disorder and/or diffuse idiopathic skeletal hyperostosis, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1970 to August 1973. The Board remanded the matter in August 2020 to obtain an addendum medical opinion. The Board is now satisfied that there was substantial compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-147 (1999). Service Connection In general, under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Entitlement to service connection for a cervical spine disorder, to include degenerative disc disorder and/or diffuse idiopathic skeletal hyperostosis The Veteran alleges that his cervical spine disorder is related to his active duty service. Specifically, he contends that landings from parachute jumps while wearing heavy equipment during service caused his cervical spine disorder, and that he has been experiencing symptoms since service. After a review of the evidence, the Board concludes that while the Veteran has current diagnoses of degenerative disc disease of the cervical spine and cervical radiculopathy with advanced diffuse idiopathic skeletal hyperostosis (DISH), the preponderance of the evidence weighs against finding that these disorders began during service or are otherwise etiologically related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363. 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304. 3.310. First, the Veteran’s service treatment records do not contain any evidence of treatment for or diagnoses of cervical spine disorders during or within one year of service. In April 1972, the Veteran sought treatment for soreness on the left side of his neck, but he was diagnosed with and treated for adenopathy rather than a musculoskeletal disorder of the cervical spine. At the time, he specifically denied any trauma. Of particular note, the Veteran’s separation examination in August 1973 noted a normal examination of the spine and that the Veteran was in good health. Indeed, the medical records indicate that the Veteran did not seek treatment for neck pain until January 2011, when he was diagnosed with degenerative disc disease of the cervical spine, cervical radiculopathy, and DISH disease. The Board notes that this first indication of cervical spine symptoms is approximately 38 years after he left service. Therefore, continuous symptoms have not been shown on a clinical basis. The Board has considered the Veteran’s statements that he has experienced neck pain since service. However, the Board is unable to grant service connection purely on his statements alone. While the Veteran reported to his physician in October 2018 that he has experienced symptoms since service but that they began worsening in 2011, the Veteran’s symptoms were not reported until 38 years after service in 2011. Additionally, he reported to the 2019 VA examiner that he had neck symptoms for approximately the past 10 years. As such, the medical evidence of record weighs against his testimony of continuous symptoms. 38 C.F.R. § 3.303. Next, despite lack of continuous symptoms, service connection may still be warranted even if the evidence otherwise indicates a relationship between the Veteran’s current disorder and his active duty service. However, the competent evidence fails to establish a nexus between active duty service and the Veteran’s current cervical spine disorders. As discussed, the medical treatment records indicate the Veteran was diagnosed with degenerative disc disease of the cervical spine, cervical radiculopathy, and DISH disease beginning in January 2011, and he continues to be treated for these conditions. VA examinations were scheduled to determine whether there is a nexus between the Veteran’s current disorders and an event or injury that occurred in service. In December 2011, the Veteran reported to a VA examiner that he has suffered insidious onset of right neck pain and sharp shoulder pain that radiates down his arm, dorsal forearm, and into the index finger. The examiner noted that they were unable to review the C-file, and, therefore, were unable to provide a nexus opinion, but noted that the Veteran was diagnosed with DISH disease in 2011. In April 2012, a VA examiner opined that it is unlikely the Veteran’s DISH disease was caused by, a result of, or aggravated by parachute jumping during the Veteran’s military service. They noted that DISH is an idiopathic disorder with an unknown cause, but that “risk factors include… long-term use of retinoids and elevated insulin levels.” They further stated that the Veteran’s service treatment records do not contain a diagnosis of a cervical condition and there was a significant period between service and when he was diagnosed. Furthermore, in November 2019, the Veteran reported to a VA examiner that he developed neck pain “about 10 years ago,” and the pain continues. The Veteran also reported that he had 16 jumps altogether, with “some bad jumps,” but that his neck did not hurt during that time. The examiner opined that it is less likely than not that the Veteran’s current cervical spine disorders are caused or aggravated “to any degree” by his military service, including parachute jumps. The examiner noted that the service treatment records are silent for chronic cervical spine symptoms or diagnoses, and that 16 jumps is not normally expected to produce chronic, repetitive decelerative joint and spine injury. The examiner added that there were no reported neck injuries or symptoms documented from any of his jumps, and that there are no wedge compressions from axial loading or chip fractures from trauma on imaging to suggest decelerative trauma as the source of the Veteran’s current cervical spine disorders. Because the November 2019 examiner did not consider the reported neck pain in the Veteran’s service treatment records in April 1973, nor did they discuss the Veteran’s allegations that he has suffered neck pain since service, an addendum opinion was obtained. Lastly, in October 2020, a VA examiner opined that it is less likely than not that the Veteran’s cervical spine disorder is related to or caused by service. They noted that the Veteran’s service treatment records are silent for any neck condition that could be related to a musculoskeletal condition, as “the only neck complaint documented [in April 1973] was associated with swollen lymph nodes,” which is a medical condition that is unrelated to any musculoskeletal condition and is “mostly secondary to an infection’s inflammatory response.” The examiner further noted that the Veteran’s separation examination in 1973 demonstrated a normal neck exam, making it less likely that he had a recurrent or chronic disabling neck condition in service. The October 2020 examiner also noted that there were no objective findings of DISH disease in service, and that such a disease is more common in obese persons or persons with early obesity or diabetes mellitus, conditions in which increased levels of insulin are present. Elevated levels of insulin, insulin-like growth factor-1, and growth hormone have been reported in some studies of DISH patients, and the examiner noted that the Veteran has been diabetic since 2002. Because the April 2012 VA examiner reviewed the evidence of record, examined the Veteran, and considered his contentions in forming their opinion, and the October 2020 VA examiner reviewed the evidence of record and considered the Veteran’s contentions, the Board finds these opinions to be of great probative value. In arriving at these conclusions, the Board has considered the statements made by the Veteran asserting a causal connection between his cervical spine disorder and active duty service. Specifically, the Board notes the Veteran’s contention that his cervical spine disorder was caused by parachute landings while wearing heavy military equipment. While lay statements may be competent on a variety of matters concerning the nature and cause of disability, etiology of dysfunctions and disorders is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of his cervical spine disorder, especially given that the evidence fails to demonstrate symptoms in service, or any other in-service incident, illness, or injury to which such a condition may be presently linked. The Board concludes that the weight of the evidence is against the claim for service connection and there is no other doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Veltri, Associate Counsel