Citation Nr: 21024382 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 19-29 920 DATE: April 22, 2021 ORDER Entitlement to service connection for a cervical spine condition, to include cervical transverse myelitis, is granted. Entitlement to service connection for muscular degeneration of the left leg as secondary to cervical transverse myelitis is granted. Entitlement to service connection for right upper extremity condition as secondary to cervical transverse myelitis is granted. Entitlement to service connection for right lower extremity condition as secondary to cervical transverse myelitis is granted. Entitlement to service connection for left lower extremity neuropathy, as secondary to cervical transverse myelitis is granted. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran’s cervical transverse myelitis is related to his service. 2. The Veteran’s muscular degeneration of the left leg is a residual of his cervical transverse myelitis. 3. The Veteran’s right upper extremity condition is a residual of his cervical transverse myelitis. 4. The Veteran’s right lower extremity condition is a residual of his cervical transverse myelitis. 5. The Veteran’s left lower extremity condition is a residual of his cervical transverse myelitis. CONCLUSIONS OF LAW 1. The criteria for cervical transverse myelitis have been met. 38 U.S.C. § 1110, 1131 (West 2012); 38 C.F.R. § 3.303. 2. The criteria for muscular degeneration of the left leg have been met. 38 U.S.C. § 1110, 1131 (West 2012); 38 C.F.R. §§ 3.303, 3.310. 3. The criteria for a right upper extremity condition have been met. 38 U.S.C. § 1110, 1131 (West 2012); 38 C.F.R. §§ 3.303, 3.310. 4. The criteria for a right lower extremity condition have been met. 38 U.S.C. § 1110, 1131 (West 2012); 38 C.F.R. §§ 3.303, 3.310. 5. The criteria for a left lower extremity condition have been met. 38 U.S.C. § 1110, 1131 (West 2012); 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1989 to April 2016. In April 2021, the Veteran testified at a video conference Board hearing before the undersigned Veterans Law Judge. The Board notes that based on the evidence of record, the Board has re-characterized the Veteran’s claim of entitlement to service connection for right upper extremity neuropathy, more broadly as a claim of entitlement to service connection for a right upper extremity condition, to include as secondary to the Veteran’s service-connected cervical transverse myelitis. The Board has also-characterized the Veteran’s claim of entitlement to service connection for right lower extremity neuropathy, more broadly as a claim of entitlement to service connection for a right lower extremity condition, to include as secondary to the Veteran’s service-connected cervical transverse myelitis. Lastly, the Board has re-characterized the Veteran’s claim of entitlement to service connection for left lower extremity neuropathy, more broadly as a claim of entitlement to service connection for a left lower extremity condition, to include as secondary to the Veteran’s service-connected cervical transverse myelitis. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection Legal Principles and Regulations Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Additionally, service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists and (2) that the current disability was either (a) proximately due to or the result of; or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310 (b); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Analysis Cervical Transverse Myelitis The Veteran seeks service connection for a cervical spine condition, to include cervical transverse myelitis, which he relates to his service. With respect to the first element of service connection, a current disability, the Veteran’s VA treatment records and private records reflect a diagnosis of transverse myelitis in the cervical spinal cord. Thus, the first element of service connection is satisfied. With respect to the second element of service connection, in-service incurrence, the Veteran’s service treatment records reflect that on March 25, 2005 he was hospitalized and diagnosed with partial left transverse myelitis in the cervical spinal cord. Thus, the second element of service connection is satisfied. Therefore, the dispositive issue in this case is with respect to the third element, a causal relationship, i.e., nexus between the claimed in-service disease or injury and the current disability. The Board finds that the medical evidence of record is in equipoise as to whether the Veteran’s cervical transverse myelitis, resulting from a disease or injury, was incurred in active service. Here, in a February 2020 medical opinion, after reviewing the Veteran’s service treatment records and the Veteran’s medical history, the VA examiner noted that the Veteran had an episode of idiopathic transverse myelitis (an idiopathic inflammatory condition of the cervical spine) in 2005 at the C6 level, primarily involving the left side of his spinal cord. The VA examiner noted this transverse myelitis occurred while the Veteran was on active duty and was not pre-existing. This condition is recognized to be physically limiting to the Veteran, and he was never again able to run or complete any sort of physical combat training. Given such, the VA examiner noted that this condition is directly related to the Veteran’s service. Based on the foregoing, the Board finds that the February 2020 VA examiner’s medical opinion, which links the Veteran’s transverse myelitis to his service, supports a finding that the Veteran’s transverse myelitis is at least as likely as not related to the Veteran’s service. Thus, the third element of service connection is satisfied. The Board acknowledges, when considering all the evidence of record, some of it is favorable and some of it is unfavorable and thus in equipoise. A claim will be denied only if the preponderance of the evidence is against the claim. If the evidence for and against a claim is in equipoise, the claim will be granted. See 38 U.S.C. § 5107. Resolving reasonable doubt in the Veteran’s favor, entitlement to service connection for cervical transverse myelitis is warranted. Residuals of Cervical Transverse Myelitis Here, in a February 2020 VA medical opinion, the VA examiner noted that the Veteran developed residual disabilities as secondary to his cervical transverse myelitis. Muscular Degeneration of the Left Leg With respect to the Veteran’s claim for service connection for muscular degeneration of the left leg, the Board finds that the evidence supports a finding that this condition is secondary to the Veteran’s cervical transverse myelitis. As stated above, the first element of secondary service connection requires evidence of a current disorder. In a February 2020 VA medical opinion, the examiner noted that the Veteran has muscular degeneration of the left leg. Thus, the Veteran has satisfied the first element of secondary service connection. The second element of secondary service connection requires evidence of a service-connected disability. This decision grants service connection for cervical transverse myelitis. Thus, the Veteran has satisfied the second element of secondary service connection. Lastly, the third element of secondary service connection requires medical nexus evidence establishing a connection between the service-connected disability and the current disorder. Here, the February 2020 VA examiner noted that the Veteran’s 2005 attack of transverse myelitis caused a moderate degree of spastic weakness in the left leg, persistent hyperreflexia, and a late finding of disuse atrophy in the left leg. He is easily prone to cramps and has pathologic reflexes, including a positive Babinski sign on the left. Based on the foregoing, the Board finds that the February 2020 VA medical opinion supports a finding that the Veteran’s muscular degeneration of the left leg is at least as likely as not proximately due to or a result of his service-connected cervical transverse myelitis. Thus, the third element of secondary service connection is satisfied. Right Upper Extremity Condition With respect to the Veteran’s claim for service connection for right upper extremity condition, the Board finds that the evidence supports a finding that this condition is secondary to the Veteran’s cervical transverse myelitis. As stated above, the first element of secondary service connection requires evidence of a current disorder. In a February 2020 VA medical opinion, the examiner noted that the Veteran has a right upper extremity condition that mimics a right upper extremity neuropathy. Specifically, the examiner explained that the Veteran has a predisposition to muscle cramps specifically involving his right arm. Thus, the Veteran has satisfied the first element of secondary service connection. The second element of secondary service connection requires evidence of a service-connected disability. This decision grants service connection for cervical transverse myelitis. Thus, the Veteran has satisfied the second element of secondary service connection. Lastly, the third element of secondary service connection requires medical nexus evidence establishing a connection between the service-connected disability and the current disorder. Here, the February 2020 VA examiner noted that the Veteran’s 2005 attack of transverse myelitis caused the symptoms that mimic right upper extremity neuropathy, leaving the Veteran with muscle cramps in the right arm. Based on the foregoing, the Board finds that the February 2020 VA medical opinion supports a finding that the Veteran’s right upper extremity condition is at least as likely as not proximately due to or a result of his service-connected cervical transverse myelitis. Thus, the third element of secondary service connection is satisfied. Right Lower Extremity Condition With respect to the Veteran’s claim for service connection for a right lower extremity condition, the Board finds that the evidence supports a finding that this condition is secondary to the Veteran’s cervical transverse myelitis. As stated above, the first element of secondary service connection requires evidence of a current disorder. In a February 2020 VA medical opinion, the examiner noted that the Veteran has a right lower extremity condition that causes severe numbness in the right lower extremity. Specifically, the VA examiner noted that the Veteran’s right lower extremity condition is manifested by a decreased sensation to pinprick from the right lower cervical regions through the entire right leg caused by loss of the crossed spinothalamic tracts in the left lateral cervical spinal cord. Thus, the Veteran has satisfied the first element of secondary service connection. The second element of secondary service connection requires evidence of a service-connected disability. This decision grants service connection for cervical transverse myelitis. Thus, the Veteran has satisfied the second element of secondary service connection. Lastly, the third element of secondary service connection requires medical nexus evidence establishing a connection between the service-connected disability and the current disorder. Here, the February 2020 VA examiner noted that the Veteran’s 2005 attack of transverse myelitis caused the Veteran’s right lower extremity symptoms. Specifically, the VA examiner noted that the Veteran’s 2005 attack of transverse myelitis condition causes decreased sensation to pinprick from the right lower cervical regions through the entire right leg caused by loss of the crossed spinothalamic tracts in the left lateral cervical spinal cord. Based on the foregoing, the Board finds that February 2020 VA medical opinion supports a finding that the Veteran’s right lower extremity condition is at least as likely as not proximately due to or a result of his service-connected cervical transverse myelitis. Thus, the third element of secondary service connection is satisfied. Left Lower Extremity Condition With respect to the Veteran’s claim for service connection for a left lower extremity condition, the Board finds that the evidence supports a finding that this condition is secondary to the Veteran’s cervical transverse myelitis. As stated above, the first element of secondary service connection requires evidence of a current disorder. In a February 2020 VA medical opinion, the examiner noted that the Veteran has a left lower extremity condition that causes spastic weakness of the entire left lower extremity, which includes increased tone, an upgoing toe, fixed plantar flexion, and inversion of the left foot in a spastic gait on the left. Thus, the Veteran has satisfied the first element of secondary service connection. The second element of secondary service connection requires evidence of a service-connected disability. This decision grants service connection for cervical transverse myelitis. Thus, the Veteran has satisfied the second element of secondary service connection. Lastly, the third element of secondary service connection requires medical nexus evidence establishing a connection between the service-connected disability and the current disorder. Here, the February 2020 VA examiner noted that the Veteran’s 2005 attack of transverse myelitis caused the Veteran’s left lower extremity symptoms. Specifically, the VA examiner noted that the Veteran’s 2005 attack of transverse myelitis condition causes spastic weakness of the entire left lower extremity. Based on the foregoing, the Board finds that February 2020 VA medical opinion supports a finding that the Veteran’s left lower extremity condition is at least as likely as not proximately due to or a result of his service-connected cervical transverse myelitis. Thus, the third element of secondary service connection is satisfied. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Abdelbary, 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.