Citation Nr: 21013890 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 12-14 338 DATE: March 10, 2021 ORDER Service connection for a cervical spine condition, thoracolumbar spine condition, and a bilateral shoulder condition is denied.   FINDINGS OF FACT 1. The Veteran does not have a bilateral shoulder condition. 2. The Veteran’s cervical and thoracolumbar spine conditions did not have their onset in service or within one year of service, and are not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral shoulder condition have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for cervical and thoracolumbar spine conditions have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1989 to September 1993. The case is on appeal from a September 2009 rating decision. The Board remanded the claim for additional development in November 2014, May 2017, February 2018, and May 2019. In a December 2018 decision, the Board denied service connection for sleep apnea. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for a cervical spine condition, thoracolumbar spine condition, and a bilateral shoulder condition. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases, including arthritis, 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; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In addition, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis The Veteran is seeking service connection for a disability manifesting in pain of the upper back, shoulders, and neck. He asserts that the condition is related to an in-service weightlifting injury. The Veteran also asserts that he experienced additional injuries in 1997 and 2007 while weightlifting and moving to a new home due to this injury. Initially, other than for the shoulders, the current disability requirement is established. An August 2019 VA examination reflects diagnoses including degenerative arthritis of the cervical spine and thoracolumbar spine, intervertebral disc syndrome (IVDS) of the cervical spine, and bilateral upper extremity radiculopathy. However, concerning the Veteran’s claim as it pertains to a bilateral shoulder condition, the Board concludes the Veteran does not have a current diagnosis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this regard, the Veteran underwent VA examinations in April 2012, August 2017, and August 2019. The examiner who provided the April 2012 examination did not diagnose a muscle injury of shoulders. In addition, the examiners who provided examinations pertaining to the Veteran’s shoulders and arms in August 2017 and August 2019 did diagnose a shoulder or arm condition. The Board also considered whether the Veteran has a shoulder condition characterized by pain alone, without an accompanying diagnosis of a present disease, that can qualify as a disability” because it “reaches the level of a functional impairment of earning capacity.” Saunders, 886 F.3d at 1367-69. However, pain that reaches a level of functional impairment with regard to the Veteran’s shoulders is absent from the record. In this regard, the examiner who provided the April 2012 VA examination determined the Veteran did not experience any cardinal signs and symptoms of a muscle disability and the Veteran’s shoulder muscle strength was normal. In addition, the examiner who provided the August 2017 VA examination determined that the Veteran’s right and left shoulder range of motion was almost normal, there was no pain noted on examination, and muscle strength testing was normal. Similarly, the examiner who provided the August 2019 VA examination found that the Veteran’s shoulder range of motion was normal. In addition, the Veteran denied experiencing pain near the shoulders or trapezius muscles. While the Veteran believes he has a current diagnosis of a shoulder condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, which shows that the Veteran does not have current disability concerning his shoulders be it by diagnosis or functional impairment The evidence of record shows the occurrence of an in-service injury. In this regard, the Veteran’s service treatment records (STRs) reflect that in December 1992, the Veteran reported that he strained his neck while lifting weights. At that time, he described hearing something pop and experiencing pain down the left side of his back. The Veteran was assessed as having a left trapezius strain. The Veteran’s STRs also reflect that he continued to experience neck pain until through February 1993, at which time the Veteran reported that his neck pain was “slowly resolving” and requested pain medication. Thus, the occurrence of an in-service injury is established. Thus, the question becomes whether there is a nexus between the Veteran’s currently diagnosed arthritis of the cervical spine and thoracolumbar spine, IVDS, and bilateral upper extremity radiculopathy and his in-service injury. The evidence of record includes VA opinions concerning this question that were obtained in August 2019 and October 2020, which were obtained pursuant to the Board’s May 2019 remand. The Board notes that other VA opinions of record including opinions dated in April 2012, August 2017, October 2018 address the Veteran’s contention that he has a shoulder condition. As such, they are not pertinent to the question of whether there is a nexus between the Veteran’s currently diagnosed arthritis of the cervical spine and thoracolumbar spine, IVDS, and bilateral upper extremity radiculopathy and his in-service injury, and will not be discussed. Concerning the August 2019 VA opinion, the examiner concluded that it is less likely than not that the claimed condition was caused by the in-service injury. She explained that the in-service injury to the Veteran’s neck/shoulder/trapezius was acute, as there is no chronicity of care. In this regard, she noted that there is a 19-year gap in treatment for neck/shoulder complaints from February 1993 to February 2012. She also noted that although the Veteran asserted that he was treated for a neck/shoulder condition in 2009, he was actually treated for headaches at that time. The examiner commented further that even if the Veteran was treated for a neck/shoulder condition in 2009, that is still a 16-year gap in treatment. An addendum opinion was obtained in October 2020 to specifically address the Veteran’s diagnoses including degenerative arthritis of the cervical spine and thoracolumbar spine, IVDS, and bilateral upper extremity radiculopathy. The examiner who provided the October 2020 addendum opinion concluded that it is less likely than not that the Veteran’s current disabilities were incurred in or caused by the in-service injury. By way of background, the examiner noted that the Veteran reported a weight room injury in December 1992, was later examined on January 15, 1993, January 22, 1993, and February 8, 1993. He also noted that the Veteran reported that his symptoms were resolving. The examiner commented that the initial diagnosis was left cervical muscle strain, but later examinations reflect a left trapezius strain. He determined that there is no evidence of degenerative spine disease or a chronic condition arising from these events. The examiner explained that although a separation examination is missing, the first noted complaints of a possible neck/shoulder condition took place in February 2012, which is 19 years after service. He explained further, that neither muscle strain nor neck strain cause degenerative spine disease, including the thoracic and cervical spine. The examiner provided the more likely etiology by explaining that degenerative spine disease is considered a natural aging process due to normal wear and tear and natural desiccation of the discs, when involved, which is established by medical knowledge and practice, and supported by medical literature. He also noted that degenerative spine disease risk rises significantly by age 50, and increases substantially every decade after. The examiner concluded by commenting that he concurred with the August 2019 VA opinion. The Board acknowledges the Veteran’s contention that his degenerative arthritis of the cervical spine and thoracolumbar spine, IVDS, and bilateral upper extremity radiculopathy are due to the in-service weightlifting injury and that he suffered additional incidents of muscle strain in 1997 and 2007 due to this incident. However, the Veteran’s statements may not be used to establish a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. See Jandreau, 492 F.3d at 1377; see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). As the Veteran has no known or reported medical expertise, he is not legally competent to opine on a relationship between his degenerative arthritis of the cervical spine and thoracolumbar spine, IVDS, and bilateral upper extremity radiculopathy and the in-service weightlifting injury. As such, his opinion lacks probative value, and an opinion by a qualified medical expert is required to decide the claim. Consequently, the Board gives more probative weight to the VA opinions described above. The Board finds the opinions, cumulatively, to be persuasive, as they rely on expert knowledge and the Veteran’s medical history. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Even if the earlier opinion was not entirely sufficient, when taken together, the opinions support that the Veteran’s weightlifting injury was acute and resolved. In this regard, both opinions are consistent in reaching this conclusion. In addition, this conclusion is bolstered by a July 1993 notation in the Veteran’s STRs reflecting that at that time, as he was nearing separation from service, he reported experiencing symptoms related to an unrelated condition and denied experiencing any other medical problems, indicating further that the condition had resolved. Moreover, there is no similar medical opinion of record weighing in favor of service connection. Additionally, because the Veteran has diagnoses of arthritis, which is one of the listed chronic diseases, the Board has carefully considered whether service connection is warranted under 38 C.F.R. § 3.303(b) or on a presumptive basis. As explained by the Federal Circuit in Walker, there are two ways to establish service connection for a chronic disease. In this case, the evidence does not show that Veteran was diagnosed with arthritis during service or that it manifested during that time period even if diagnosed later. As such, it cannot be said that the chronic disease (arthritis) was established and not subject to legitimate question during service. Similarly, the evidence does not reflect that arthritis manifested to a compensable degree within one year of the Veteran’s separation from service. Rather, the earliest diagnosis of arthritis was in February 2012, when the Veteran was diagnosed mild degenerative changes of the cervical spine, decades after the Veteran separated from service. Accordingly, in order to establish service connection, the Veteran must demonstrate a continuity of symptomatology. The Veteran indicated that he experienced additional instances of muscle strain in 1997 due to weightlifting and in 2007 due to too much activity when moving to a new home. The Veteran is competent to report the presence of symptoms and frequency of treatment. Jandreau, 492 F.3d at 1377. However, the Board does not find that two instances of neck and shoulder pain separated by a decade are sufficient to demonstrate a continuity of symptomatology. Moreover, other evidence of record does not support a continuity of symptomology as related to arthritis of the cervical spine and thoracolumbar spine. Specifically, as noted above, notations in the Veteran’s STRs indicate the condition was resolving and that he denied experiencing any other medical problems in July 1993 besides an unrelated medical condition. In reaching the conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is not warranted for a thoracolumbar spine condition, cervical spine condition or bilateral shoulder condition. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Gray, 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.