Citation Nr: A21017644 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 201005-114087 DATE: November 1, 2021 ORDER Service connection for neck pain as secondary to service-connected bilateral knee disabilities is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran's neck pain was caused by altered biomechanics caused by her service-connected bilateral knee disabilities. CONCLUSION OF LAW The criteria for service connection for a neck disability (manifested by neck pain and muscle spasms) is secondary to service-connected bilateral knee disabilities have been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service in the United States Air Force from April 1998 to November 2000. This matter comes before the Board of Veterans Appeals (VA) on appeal from a September 2020 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Veteran opted into the Appeals Modernization Act (AMA) review system by submitting a timely VA Form 10182. She selected the AMA Hearing lane. Thus, the evidence of record allowed for consideration in the appeal is limited to that of record at the time of the September 2020 rating acton, the May 2021 hearing testimony, and evidence received into the record within 90 days of the hearing. The Veteran submitted additional evidence in support of her appeal within the 90-day window, and it has been associated with the record. The Board has considered this evidence in its adjudication of the appeal. In May 2021, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the record is associated with the claims file. The Board notes that the Veteran also testified before the undersigned for her Legacy appeal. A hearing was not partitioned into AMA and Legacy; thus, the hearing transcript contains testimony as to both appeals. The Veteran seeks service connection for a neck disability. She maintains that her current neck disability is secondary to overcompensation and altering of body biomechanics from her longstanding bilateral knee conditions. Transcript (T.) at page (pg.7)). The Board concludes that the evidence is in equipoise as to whether the Veteran's current neck disability is proximately due to or the result of her service-connected bilateral knee disabilities. 38 U.S.C. § 1110; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310 (a). There are VA and private opinions that are against and supportive of the secondary service connection theory of the claim, respectively. Evidence against the claim includes a September 2020 VA opinion. The VA examiner opined that the Veteran was service-connected for several bilateral knee disabilities, and that she had sustained career ending knee injuries while serving in Korea, that she reports having injured her neck in that injury, but that it was never documented. The examiner noted that the literature did not support knee pathology as a cause for neck pathology. Thus, according to the examiner, the claimed neck condition was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service connected condition. The Board finds the VA examiner's opinion to be of reduced probative value in evaluating the claim, notably he did not discuss an April 1998 service treatment record, reflecting that the Veteran complained of upper "side" back pain concurrently with bilateral knee pain. Evidence in support of the claims includes a December 2020 statement, authored by a VA physical therapist after evaluating the Veteran's lower spine. The VA PT opined that it was her opinion that the Veteran's degenerative disc disease and osteoarthritis of the back, neck and shoulders was likely caused by the overcompensation from her bilateral knee injuries and disabilities leading her to favor one side when walking for the last few decades altering her biomechanics and ultimately leading to her back, neck and shoulder problems. The Board finds the December 2020 opinion to be of reduced probative value in evaluating the claim because despite the diagnosis of degenerative disc disease and osteoarthritis of the neck, the Veteran's cervical spine was not evaluated at that time, to include x-rays of the cervical spine such as to confirm a diagnosis of degenerative disc disease and/or osteoarthritis. Evidence in support of the claim includes a March 2021 report, authored by S.C., PT. S.C. indicated that he had worked with the Veteran in treating, in part, her neck and knee pain since 2018. It was his opinion that the years of military service undoubtedly played in a role in her pain experienced. A precipitating event, in his opinion, was the diagnosis and management of her bilateral knee injuries during her active duty career. S.C., PT concluded that years of biomechanical adjustment and compensation may (italics added for emphasis) have played a role in pain experience of her spine and ultimately lead to symptoms in those areas. The Board finds S. C., PT's opinion to be of reduced probative value in evaluating the claim because it is equivocal in nature. The Board acknowledges that the VA and private clinicians did not provide a specific diagnosis for the Veteran's neck condition, aside from the December 2020 VA PT's degenerative disc disease and osteoarthritis that was not confirmed on x-ray, however, the Board notes that pain alone, even without an underlying pathology or diagnosis, can constitute a disability, where such pain results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Here, the Board finds that service connection for bilateral neck pain is warranted. The Veteran credibly testified that she experienced some symptoms of neck pain concurrently, when she injured her knees in service, but that the symptoms increased after discharge around the calendar year 2018. T. at pg. 10. She maintains that her pain causes functional impairment, notably muscle spasms that shift and cause so much pain throughout her back that she is unable do anything when it radiates outward. T. at pg. 12. Her post-service treatment records corroborate her testimony, as her treatment records show complaints of neck pain. While these treatment reports also disclose that the Veteran was involved in a June 2015 motor vehicle accident, she did not complain of any injury to her neck, and there were also no clinical findings referable to the neck, at that time. Thus, the Board finds that the Veteran has shown that her neck pain constitutes a disability because she credibly testified that her pain results in functional impairment. Here, the Veteran is competent to describe a continuity of neck symptoms, to include both pain and muscle spasms and she has credibly testified before the undersigned VLJ about a continuity of such symptoms. The Board is satisfied that the evidence has established that the onset of the Veteran's neck pain symptoms started when she injured her knees in service and that it has continued to increase, after her separation from service, and that her neck pain has resulted in functional impairment, which constitutes a disability. (Continued on the next page) Accordingly, service connection for neck pain as secondary to altered biomechanics caused by service-connected bilateral knee disabilities is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Carole Kammel, 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.