Citation Nr: 21021526 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-12 097 DATE: April 13, 2021 ORDER Entitlement to service connection for a neck disability characterized as degenerative disc disease and psoriatic arthritis of the cervical spine is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, he has had chronic and continuous neck pain since service related to his neck disability characterized as degenerative disc disease and psoriatic arthritis of the cervical spine. 2. Resolving all reasonable doubt in favor of the Veteran, his psoriatic arthritis is due to his service-connected psoriasis. CONCLUSION OF LAW 1. The criteria for entitlement to service connection for degenerative disc disease and psoriatic arthritis of the cervical spine are met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303(a)-(c), 3.307, 3.309(a); 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served in the United States Army National Guard on active duty from January 1985 to April 1985, April 1989 to May 2006, May 2006 to July 2007, and July 2007 to December 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision dated in January 2015. The Board remanded the matter to the AOJ in September 2018, January 2019, and July 2020. The Board notes that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. VA treatment records reflect diagnoses of degenerative disc disease and psoriatic arthritis of the cervical spine. See March 2015 VA treatment record. As such, the Board has characterized the issue of entitlement to service connection for a neck disability to include as secondary to a right foot disability as entitlement to service connection for a neck disability, to include degenerative disc disease and psoriatic arthritis of the cervical spine. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). 1. Entitlement to service connection for a neck disability The Veteran seeks service connection for a neck disability, which he asserts is related to service Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Board has carefully reviewed the evidence of record and finds that the Veteran’s symptoms of neck pain have been chronic and continuous since discharge. Thus, resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for degenerative disc disease of the cervical spine have been met. See 38 C.F.R. § 3.303(b). (Service connection may be granted based on chronicity or continuity of symptomatology for a disability which is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a), including arthritis.) In addition, the Board finds that the Veteran’s service connected psoriasis caused the Veteran’s psoriatic arthritis of the cervical spine. Thus, resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for psoriatic arthritis of the cervical spine as secondary to the Veteran’s service-connected psoriasis have been met. See 38 C.F.R. § 3.310 (Service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury). At the outset the Board notes that in May 2009, service connection for psoriasis was established. A current diagnosis of degenerative disc disease of the cervical spine has been established. See March 2009 VA treatment record, December 2014 VA examination, March 2015 VA treatment record, and July 2020 VA examination. There is no contrary medical opinion of record. In addition, a current diagnosis of psoriatic arthritis of the cervical spine has been established. A December 2013 VA skin diseases examination reflects a diagnosis of psoriatic arthritis, based upon symptoms of pain in his ankles, feet, knees and elbows, and x-ray documentation of arthritis. The examiner further noted that there were no specific disability benefits questionnaire (DBQ) appropriate for a psoriatic arthritis diagnosis because it is a sero-negative condition, that is, routine tests performed for rheumatoid type disorders were negative. The examiner noted that epidemiologic evidence of psoriatic arthritis was based on a finding of significant higher prevalence of arthritis in psoriatic populations compared with controls. The examiner also noted that studies showed that up to 30 percent of people with psoriasis develop psoriatic arthritis and that the majority do so between 30 and 50 years of age. In March 2015, a VA medical doctor noted that a recent MRI of the Veteran’s neck revealed extensive degenerative disc disease and arthritis; and opined that the Veteran’s psoriatic arthritis also affected his neck. But see December 2014, July 2019, December 2019, and July 2020 VA examinations and opinions. The Board notes that the December 2014, July 2019, and December 2019 reports were written by the same VA examiner. In December 2014, a VA examiner noted that the Veteran had a history of psoriatic arthritis, and a history of symptoms of neck pain which had gotten worse in the last 2 years. The examiner opined that the current medical literature did not support the Veteran’s claim that his degenerative disc disease of the cervical spine was due to or the result of his psoriatic arthritis. In July 2020, a VA examiner also noted that medical research reports indicate that psoriatic arthritis is generally in the hands and feet, and the disease did not often damage the vertebrae in the neck. The December 2014 VA examiner did not discuss whether the Veteran’s neck pain could also be a symptom of psoriatic arthritis of the cervical spine. See Clemons, supra. In addition, the addendum opinion in December 2019 and the July 2020 VA opinions that psoriatic arthritis was not degenerative joint disease and typically affected ankles, fingers, knees, lower back and toes, did not provide convincing rationale that the Veteran did not have a current diagnosis of psoriatic arthritis of the cervical spine. Notably, the examiners did not discuss the Veteran’s neck pain as a symptom of psoriatic arthritis, and the examiners did not discuss the December 2013 notation that psoriatic arthritis is a sero-negative condition. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Thus, resolving all reasonable doubt in favor of the Veteran, the Board finds that the March 2015 VA treatment record coupled with the December 2013 VA examination establishes that the Veteran has a current diagnosis of psoriatic arthritis of the cervical spine. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). Therefore, the December 2014, July 2019, December 2019, and July 2020 VA opinions cannot be afforded greater probative value. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). The Board finds that the Veteran is presumed to have been in sound physical condition as to his cervical spine prior to service. 38 U.S.C. §§ 1111, 1132; 38 C.F.R. § 3.304(b); see also Quirin v. Shinseki, 22 Vet. App. 390, 396-397 (2009). See November 1984 and April 1989 Medical examination and history reports. The Board finds that the evidence of record establishes that the Veteran’s neck pain has been chronic and continuous since service. At the outset, the Board notes that the Veteran has competently and credibly reported that he felt pain in his neck since January 2007 in service. See September 2019 correspondence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006); Layno v. Brown, 6 Vet. App. 465, 469 (1994). An October 2007 medical history report for separation, and an undated medical history report for retirement reflects that the Veteran reported that he had minor back aches. An August 2008 VA treatment record reflects an assessment of neck pain. The treatment provider noted that the Veteran was about to retire from active guard reserve (AGR). The Veteran reported episodes of intermittent neck tightness, especially after waking up. A November 2008 private treatment record reflects an assessment of neck pain. Physical examination revealed minimal tenderness of C5-6 of the cervical spine. Post service treatment records reflect an impression of degenerative neck changes with popping and cracking in March 2009. A July 2014 MRI confirmed degenerative disc disease of C5-6 and C6-7 of the cervical spine. See December 2014 VA examination. Thus, the Board finds that the statements of the Veteran coupled with service treatment records and post service treatment records, support a finding that the Veteran had neck pain in service, and that his symptoms continued when the Veteran returned home from service. See Jandreau, supra; Buchanan, supra; Layno, supra. In March 2015, a VA medical doctor noted that a recent MRI of the Veteran’s neck revealed extensive degenerative disc disease and arthritis. The treatment provider opined that the Veteran’s degenerative disc disease and facet arthritis was secondary to trauma in service as well as the Veteran’s psoriatic arthritis, which affected his neck, knees, and ankles. The treatment provider noted that the Veteran performed sit-ups during physical training (PT) for 24 years, which the treatment provider opined caused flexion trauma to the neck. Although a July 2020 VA examiner opined that it was less likely as not (less than 50 percent probability) that the Veteran’s cervical degenerative disc disease was incurred in or caused by the claimed in-service injury, event, or illness. The Board finds that the examiner’s opinion supports a finding that the Veteran’s degenerative disc disease of the cervical spine is related to service. The July 2020 VA examiner noted that over time, normal wear and tear can lead to degenerative disc “disease” (breakdown of the spinal discs), with the development of small cracks and tears and/or loss of fluid in the discs, which could lead to changes in the neighboring spinal vertebrae, including the formation of bone spurs. The examiner noted that according to medical literature, once the degeneration begins (typically in the second or third decade), cervical joint degeneration slowly worsens over the lifetime; and the relative roles of daily wear and tear, trauma, and genetics on the rate of degeneration remain unclear, although radiographic spondylosis is generally age related and no known treatments can reverse the process. In this case, the Veteran retired from active duty after more than 20 years of service in December 2008, when he was approximately 45 years old. Based on the July 2020 VA examiner’s opinion, it is at least as likely as not that normal wear and tear led to the Veteran’s neck pain and degenerative disc disease of the cervical spine during the Veteran’s active duty service. Further, the Board finds that a December 2013 VA examination for skin diseases also supports a finding that the Veteran has psoriatic arthritis of the cervical spine which is due to his service-connected psoriasis. As previously discussed, the examiner noted that the Veteran had been diagnosed with psoriatic arthritis, based upon symptoms of pain in his ankles, feet, knees and elbows, and x-ray documentation of arthritis. Thus, the Board finds that the May 2015 VA treatment record coupled with the July 2020 VA examination and the other medical evidence of record including service treatment records, VA treatment records, private treatment records, and lay evidence, supports a conclusion that service connection for degenerative disc disease of the cervical spine is warranted. In addition, the Board finds that the May 2015 VA treatment record coupled with the December 2013 VA examination and the other medical evidence of record including service treatment records, VA treatment records, private treatment records, and lay evidence, supports a conclusion that service connection for psoriatic arthritis of the cervical spine is warranted. Resolving all reasonable doubt in favor of the Veteran and based on the medical and lay evidence of record, the Board finds that the evidence of record supports a finding that service connection for a neck disability characterized as degenerative disc disease and psoriatic arthritis of the cervical spine is warranted. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). SONJA S. AN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Johnson 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.