Citation Nr: 21072830 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 14-24 896A DATE: December 6, 2021 ORDER Entitlement to service connection for a lumbar spine disability, to include mechanical back pain and a recurrent back cyst, is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a right hand disability, to include cervical spine radiculopathy, is denied. FINDINGS OF FACT 1. A lumbar spine disability was not manifested during the Veteran's active-duty service; lumbar spine arthritis was not manifested within a year following his discharge from active-duty service; and his lumbar spine disability was not shown to be etiologically related to his active-duty service or to have been caused or aggravated by his service-connected right shoulder disability. 2. A cervical spine disability was not manifested during the Veteran's active-duty service; cervical spine arthritis was not manifested within a year following his discharge from active-duty service; and his cervical spine disability was not shown to be etiologically related to his active-duty service or to have been caused or aggravated by his service-connected right shoulder disability. 3. A right hand disability was not manifested during the Veteran's active-duty service; right hand arthritis was not manifested within a year following his discharge from active-duty service; and his right hand disability was not shown to be etiologically related to his active-duty service or to have been caused or aggravated by his service-connected right shoulder disability. CONCLUSIONS OF LAW 1. Service connection for a lumbar spine disability is not warranted. 38 U.S.C. §§ 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.309, 3.310. 2. Service connection for a cervical spine disability is not warranted. 38 U.S.C. §§ 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.309, 3.310. 3. Service connection for a right hand disability is not warranted. 38 U.S.C. §§ 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active-duty service from January 1976 to January 1980. In May 2018, the agency of original jurisdiction (AOJ) recognized the appellant as a valid substitute claimant in place of the Veteran for the issues on appeal. Accordingly, the appellant has been substituted as the claimant for the purposes of all claims that were pending on the date of his death. This case is before the Board of Veterans' Appeals (Board) on appeal from a January 2013 Department of Veterans Affairs (VA) rating decision that denied service connection for a lumbar spine disability, a cervical spine disability, and a right hand disability. In November 2018, July 2020, and June 2021, the Board remanded these matters for additional development. In January 2016, the appellant also claimed entitlement to accrued and Dependency and Indemnity Compensation (DIC) benefits. As the Board noted in its last remand, the issue was not adjudicated. At present, the matters remain unadjudicated. Hence, the Board continues to lack jurisdiction over the issues. Service Connection Service connection is warranted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Secondary service connection may be established for a disability which is proximately due to, or the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310. To substantiate a claim of secondary service connection, the record must show (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) that the already service-connected disability caused or aggravated the disability for which service connection is sought. Wallin v. West, 11 Vet. App. 509 (1998). Analysis The record does not show (and the Veteran or appellant did not allege) that the Veteran sustained a back, neck, or right hand injury in service, that a lumbar spine disability, cervical spine disability, or right hand disability was manifested in service, or that lumbar spine, cervical spine, or right hand arthritis was manifested in his first post-service year. The Veteran's primary asserted contention was essentially one of secondary service connection; he asserted that his service-connected right shoulder disability caused a lumbar spine disability, a cervical spine disability, and a right hand disability. He reported that he was losing strength in his right hand and dropping things. He also reported that his right shoulder caused back pain. It is not in dispute that he was diagnosed with a recurrent back cyst and reported back pain, that he was diagnosed with cervical spine arthritis and radiculopathy resulting in right hand pain, or that he had a service-connected right shoulder disability. The Veteran's post-service medical records show that in May 2011, he reported occasional low back pain. In June 2011, he reported that he dropped things with his right hand. In February 2012, he complained of back pain for several years due to a back cyst. In May 2012, he reported that his right shoulder pain radiated into his right hand. An August 2012 cervical spine x-ray showed degenerative changes and he was diagnosed with cervical spondylosis with cervical spine radiculopathy. The critical question in dispute is whether these conditions were secondary to the service-connected right shoulder disability. On this question, at a November 2012 VA examination, the Veteran reported that his right shoulder disability caused pain, stiffness, and numbness that radiated into his right hand. He reported that his cervical spine and right hand symptoms began several years ago as he overcompensated for his right shoulder disability. X-rays of the Veteran's lumbar spine and right hand were normal. The examiner reported that the Veteran did not have a diagnosis of a lumbar spine disability, cervical spine disability, or right hand disability. The VA examiner commented that the Veteran's STRs noted a "possible" right hand fungal infection during his active-duty service, but opined that it was less likely than not that any right hand disability was due to his active-duty service as the Veteran did not have a current right hand disability. In a July 2019 opinion based on a review of the record, a VA examiner opined that the Veteran's lumbar spine disability, cervical spine disability, and right hand disability were less likely than not due to the Veteran's service-connected right shoulder disability; however, the examiner provided no rationale for his opinion. In an April 2020 opinion based on review of the record, a VA examiner opined that the Veteran's lumbar spine disability, to include mechanical low back pain and a recurrent back cyst, was less likely than not due to his active-duty service. The examiner reported that the Veteran's lumbar spine disability was due to his employment at the United States Postal Service (USPS) for 30 years and a recurrent back cyst. The examiner noted that the Veteran did not report back pain until May 2011. The examiner reported that the Veteran's STRs were silent for any back issues, and he specifically denied having any back or skin issues at his separation physical. The examiner reported that back pain was a very common condition that could occur at any time, especially when it involved employment that required repetitive lifting and carrying heavy loads like the Veteran's employment. The examiner opined that the Veteran's cervical spine disability was less likely than not due Veteran's active-duty service. The examiner reported that the Veteran's cervical spine spondylosis with radiculopathy was caused by the normal aging process. The examiner reported that the Veteran was not diagnosed with cervical spine arthritis until August 2012, over three decades after his separation from active-duty service. The examiner reported that the Veteran's STRs were silent for any neck issues. The examiner opined that the Veteran's right hand disability was less likely than not due to his active-duty service. The examiner reported that the Veteran's right hand pain and numbness were due to his cervical spine radiculopathy diagnosed in August 2012. The examiner reported that the Veteran's hand numbness was not due to his right shoulder disability as he did not report these symptoms until he was diagnosed with cervical spine radiculopathy in August 2012. In an August 2021 opinion based on review of the record, a VA examiner opined that any lumbar spine disability or cervical spine disability with radiculopathy was less likely than not proximately due to, the result of, or aggravated by the Veteran's service-connected right shoulder disability, to include any overcompensation for his right shoulder disability. The examiner reported that the Veteran's mechanical back pain could occur secondary to repetitive microtrauma, spinal strains, poor body mechanics, obesity, and disk degeneration over the years. The examiner reported that the Veteran was diagnosed with age-related wear and tear of the cervical spine that could result in tingling, numbness, and weakness in the hands. The examiner reported that the Veteran's 30-year work history at the USPS involved repetitive neck motions, awkward positioning, and overhead work that put extra stress on the back and neck. The examiner reported that the Veteran was nearly 60 years old when diagnosed with cervical spine spondylosis, which was a normal part of aging. The examiner reported that an opposite joints (left shoulder) issue might be expected to occur in situations of overcompensating for the affected joint (right shoulder). The examiner reported that the evidence of record did not document a diagnosis of a right hand disability. The examiner reported that the Veteran's complaints of right hand numbness, tingling, and weakness were manifestations of the Veteran's cervical spine radiculopathy. Ultimately, the August 2021 VA examiner's opinions are the most probative regarding secondary service connection. The August 2021 opinions are based on a thorough review of the medical history of the Veteran's lumbar spine disability, cervical spine disability, right hand disability, (service-connected) right shoulder disability. The opinions included rationale that cited to supporting clinical data and medical principles (with citation to supporting medical treatises), and identifies an alternate (considered to be more likely) etiology for the lumbar spine disability (work and age related), cervical spine disability (work and age related), and right hand disability (due to cervical spine radiculopathy). There is no (neither the Veteran nor the appellant submitted any) competent (medical) evidence in the record to the contrary. Whether a service-connected disability (here the right shoulder) caused or aggravated a lumbar spine disability, a cervical spine disability, or a right hand disability is a complex medical question that requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran's own assertion that his lumbar spine disability, cervical spine disability, and right hand disability were secondary to (were caused by) his service-connected right shoulder disability was not competent evidence in the matter. He was a layperson, and lacked the medical training and expertise to provide a competent medical opinion in the matters; he did not cite to supporting clinical data in the record (e.g., evidence of overcompensating for his right shoulder disability that might have impacted the lumbar spine, cervical spine, or right hand) or supporting medical opinion or treatise. Therefore, the Board finds the August 2021 medical opinions persuasive regarding secondary service connection. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claims, and the appeal in the matters must be denied. Corey Bosely Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berryman, 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.