Citation Nr: 21011038 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 18-01 803 DATE: February 26, 2021 ORDER Entitlement to service connection for a back disability is granted. Entitlement to service connection for a neck disability is granted. Entitlement to service connection for a right leg disability as secondary to the back disability is granted. Entitlement to service connection for left thumb and index finger numbness as secondary to the neck disability is granted. FINDINGS OF FACT 1. It is just as likely as not the Veteran’s back and neck disabilities are causally related to an event, injury, or disease during his service. 2. His right leg disability is caused by his back disability. 3. His left thumb and index finger numbness is caused by his neck disability. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, the criteria are met for entitlement to service connection for back and neck disabilities and for secondary right leg disability and thumb and index finger numbness. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from December 1978 to December 1990. He testified in support of these claims during a virtual hearing in August 2020 before the undersigned Veterans Law Judge. A transcript of the proceeding is of record. Service Connection Establishing service connection requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or an injury; and (3) evidence of a correlation (“nexus”) between the disease or injury in service and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). See also 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).   Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d).   Establishing service connection on a secondary basis requires evidence showing a service-connected disability caused or is aggravating the condition being additionally claimed. 38 C.F.R. § 3.310(a) and (b); see also Allen v. Brown, 7 Vet. App. 439 (1995).   There is no disputing the Veteran has diagnosed back, neck, and right leg disabilities, and left thumb and index finger numbness. What therefore must be resolved, instead, is whether these disabilities are attributable to his military service, either in terms of direct attribution of his back and neck disabilities to his service and insofar as whether his additionally claimed right leg and left thumb and index finger conditions are secondary to — meaning caused or aggravated by — his claimed back and neck disabilities. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) (“A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.”). The Board is mindful the Veteran has not been afforded a VA examination to determine the etiology of these claimed conditions. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Ordinarily, in this circumstance, the Board might first remand these claims to have this done; however, in May 2017, he submitted a medical nexus opinion from Dr. A.F., his neurosurgeon, supporting the claims for service connection for the disabilities at issue. Dr. A.F. also submitted an addendum medical nexus opinion more recently in April 2018 reiterating his findings and providing all required supplemental information that was not provided in his initial opinion. Regarding the Veteran’s back disability, this commenting doctor explained that there is minimal evidence of pre-service lumbar symptoms and no evidence of such symptoms at the Veteran’s entrance into service. Therefore, his current back symptoms stem from an initial in-service back injury in January 1979, which eventually triggered disc herniations and worsened to the point of requiring surgical intervention in 2002. Following his surgery, he experienced severe problems with his right leg, including persistent leg pain that has been difficult to resolve despite numerous attempts. Dr. A.F. opined that, to a reasonable degree of medical probability, the existing peristent radiculopathy in the Veteran’s right leg is clearly linked to the 2002 operation.   Dr. A.F. also opined that it is clear from review of the claims file that the Veteran’s neck injury occurred in 1985 following a head impact from tank movement. For at least two years following that incident, there continued to be symptoms in service, indicating that it was a chronic neck injury. Dr. A.F. concluded that, to a reasonable degree of medical certainty, the subsequent further deterioration of the C5/C6 disc, which required surgery in 2007, was a late-stage progression of the neck injury suffered in December 1985. The Veteran’s current left thumb and index finger numbness resulted from his neck disability. This private medical opinion is the only opinion in the record addressing the determinative issue of causation and does so favorably concerning all the claims. Certainly, then, it is as likely as not, if not even more likely than not, this posited correlation is true since there is no equally probative opinion to the contrary. Consequently, resolving all reasonable doubt in the Veteran’s favor, the Board finds that this private physician’s opinion is sufficient reason for accepting the posited correlation between the Veteran’s claimed disabilities and his service, on both of the theories alleged – direct and secondary service connection. Thus, service connection for back, neck, and right leg disabilities, and left thumb and index finger numbness is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Mukherjee 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.