Citation Nr: 21005417 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 13-00 334 DATE: February 1, 2021 ORDER Entitlement to service connection for a cervical spine disability, claimed as a neck condition, to include as secondary to service-connected right shoulder status post partial AC separation with minimal degenerative changes at the AC joint, is denied. REMANDED Entitlement to service connection for left carpal tunnel syndrome, claimed as left arm numbness, to include as secondary to service-connected right shoulder status post partial AC separation with minimal degenerative changes at the AC joint is remanded. FINDING OF FACT The Veteran’s cervical spine conditions did not onset in service, are not etiologically related to service, and are not caused or aggravated by service-connected right shoulder status post partial AC separation with minimal degenerative changes at the AC joint. CONCLUSION OF LAW The criteria for service connection for a cervical spine disability, to include as secondary to service-connected right shoulder status post partial AC separation with minimal degenerative changes at the AC joint are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 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. These matters come before the Board of Veterans’ Appeals (Board) from an August 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Board remanded the issues on appeal for further development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Spondylosis, as a form of arthritis, is an enumerated condition under 38 C.F.R. § 3.309(a). Degenerative disc disease, on the other hand, is not. 1. Entitlement to service connection for a cervical spine disability, claimed as neck condition, to include as secondary to service-connected right shoulder status post partial AC separation with minimal degenerative changes at the AC joint, is denied. The Veteran contends that he has a cervical spine disability due to service, or in the alternative, due to his service-connected right shoulder disability. In a statement received in September 2012, the Veteran claimed that the disc disease he suffers from is due to an injury in his neck caused by the weakness in his service-connected right shoulder. In an October 2014 Statement in Support of Claim the Veteran asserted that due to his service-connected right shoulder disability, he overcompensated with his neck and left arm, which caused him to develop neck problems and left arm numbness. Service treatment records do not show any complaints related to the Veteran’s neck or spine. The July 1973 separation examination noted normal neck and spine. Post-service medical records show the Veteran had no neck complaints or clinical findings until many years after service. For example, March 2004 and March 2007 physical examination reports from Correctional Managed Care noted that his head, neck, and spine were normal. A March 2010 record from Correctional Managed Care noted the Veteran’s joints as normal, and his neck showed full range of motion. In an August 2010 VA medical note, the Veteran reported neck pain; however, physical examination showed his neck was supple without lymphadenopathy. In July 2011, the Veteran complained that pain in his neck was exacerbated. Physical exam revealed mild tender left trapezius and cervical strain was noted. Cervical strain with radiculopathy was noted in January 2012. A September 2012 VA medical record noted cervical stenosis C5-6 with radiculopathy, without myelopathy. The Veteran underwent a VA examination in August 2012. The Veteran reported that he injured his right shoulder in 1980, and that his neck also popped and progressed until 2008 when he noticed numbness in the left arm. He reported he has occasional pain in his neck with right rotation. He was diagnosed with cervical spine degenerative disc disease and cervical spondylosis. The examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected right shoulder disability. The examiner explained that the Veteran’s cervical pathology is degenerative disc disease and spondylosis, which are normal result of aging, and is not caused by specific injuries in the past. The examiner concluded that the claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected right shoulder disability. The Board remanded the appeal in October 2018 because the August 2012 VA examiner did not address whether the cervical spine conditions were aggravated by the service-connected right shoulder disability. The Veteran underwent a VA examination in October 2019 pursuant to the Board’s remand. The Veteran stated he injured his neck around 1983-1984 while pushing a box. He was diagnosed with cervical strain, degenerative arthritis of the spine, and bilateral upper extremity radiculopathy. The examiner opined that these conditions are less likely than not incurred in or caused by service. The examiner explained that the separation exam did not indicate any neck condition at the time of discharge in 1973, and that a November 2008 record from Correctional Managed Care years later did not indicate neck pain. The examiner noted the Veteran was only diagnosed with degenerative disc disease and spondylosis during in August 2012, and with cervical strain and bilateral upper extremity radiculopathy in October 2019. The examiner also noted that the Veteran is retired, and previously did house remodeling for 7 years. The examiner concluded that the cervical strain, degenerative disc disease, and bilateral upper extremity radiculopathy are less likely than not caused by his service. The examiner also opined that these conditions are less likely than not proximately due to or the result of Veteran’s service-connected right shoulder disability. The examiner noted the Veteran has degenerative arthritis of the cervical spine and the right shoulder. The examiner noted that degenerative arthritis of one joint does not cause degenerative arthritis of another joint nor aggravate it beyond its natural progression, as degenerative arthritis is a wear and tear disease of the joints or discs that progresses over time. The examiner indicated that medical literature does not support such as well. After careful review of the evidence, the Board concludes that, while the Veteran has currently diagnosed cervical spine conditions, the preponderance of the evidence weighs against finding that they began during service or are otherwise related to an in-service injury, event, or disease. The Board has first considered whether service connection for the cervical spine spondylosis (arthritis) is warranted via the chronic disease presumption, or through a demonstration of continuity of symptomatology. See 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a). Cervical spine spondylosis was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Medical records show the Veteran was not diagnosed with spondylosis until decades after his separation from service and decades outside of the applicable presumptive period. While the Veteran would competent to report having experienced symptoms of cervical spine pain since service, he is not competent to determine those symptoms were manifestations of the spondylosis as such a determination is issue is medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). For these reasons, cervical spine arthritis is not presumed to be service-connected. Service connection for the current cervical spine conditions may still be granted on a direct basis; however, the preponderance of the competent medical evidence is against causal nexus. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The August 2012 and October 2019 VA examiners’ opinions establish that the Veteran’s cervical spine conditions are not at least as likely as not related to an in-service injury, event, or disease. The examiners provided supporting rationale for these opinions as noted above. Their opinions are probative because they are based on an accurate medical history and provide explanation that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no medical opinion to the contrary. Lastly, the preponderance of the evidence is against finding that the Veteran’s cervical spine conditions are proximately due to or the result of, or aggravated beyond its natural progression by his service-connected right shoulder disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The October 2019 VA examiner opined that the Veteran’s cervical spine conditions are not caused or aggravated by the service-connected right shoulder disability, and provided supporting rationale for his opinion, as noted above. The opinion and rationale are probative because it was based on an accurate medical history and contained clear conclusions and supporting data. There is no medical opinion to the contrary. The Veteran believes his cervical spine conditions are related to service or is caused or aggravated beyond its natural progression by his service-connected right shoulder disability, but he is not competent to provide a nexus opinion regarding these questions. The record does not show that he has the medical skills, education, or training to make such a determination. Jandreau, 492 F.3d at 1377; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the competent medical opinions, which are unfavorable on causal nexus. As such, the preponderance of the evidence is against the claim and the benefit of the doubt rule is inapplicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for a cervical spine disability is not warranted.   REASONS FOR REMAND Entitlement to service connection for left carpal tunnel syndrome, claimed as left arm numbness, to include as secondary to service-connected right shoulder status post partial AC separation with minimal degenerative changes at the AC joint is remanded. The Veteran has asserted that due to his service-connected right shoulder disability, he overcompensated with his neck and left arm, which caused him to develop neck problems and left arm numbness. The Board remanded the appeal in October 2018 for an addendum opinion regarding whether left carpal tunnel syndrome was aggravated by the service-connected right shoulder disability. The October 2019 VA opinion that was provided is not adequate for adjudication purposes. The examiner indicated that the Veteran did not have a current diagnosis of left carpal tunnel syndrome at the examination. Rather, he determined that the Veteran’s current diagnosis is left upper extremity radiculopathy related to his cervical spine conditions. The examiner did not, however, adequately reconcile these findings with the August 2012 VA examiner’s diagnosis of carpal tunnel syndrome. The Board also notes that a diagnosis of left carpal tunnel syndrome is apparent throughout the VA medical records as well. As the Veteran had a diagnosis of left carpal tunnel syndrome during the appeal period, even if the disability has since resolved, he is still considered to have that current disability. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Further to the extent that the examiner indicated the current diagnosis is left upper extremity radiculopathy from cervical spine pathology, the stated rationale does not clearly explain why this condition is not aggravated by the service-connected right shoulder disability. For these reasons, another addendum opinion is required. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s left upper extremity disability, claimed as numbness. After reviewing the file, and the Board’s remand, the examiner is to address the following: a) With respect to any chronic left upper extremity condition manifested as numbness, state whether it is at least as likely as not that such condition onset in service or is otherwise etiologically related to service. A rationale for this opinion must be provided. In providing the above opinion, if left upper extremity carpal tunnel syndrome is not found on examination, the examiner is asked to attempt to reconcile the absence of that diagnosis with the prior findings of such, including at the August 2012 VA examination. b) Is at least as likely as not related to any current left upper extremity condition manifested as numbness is proximately due to the service-connected right shoulder disability OR aggravated beyond its natural progression by such service-connected disability. (Continued on the next page)   (Two opinions are required: one for proximate causation and one for aggravation.) A rationale must be provided and should reflect consideration of the Veteran’s contention that, due to his service-connected right shoulder disability, he overcompensated with his left arm and as a result developed left arm numbness. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jake Choi, 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.