Citation Nr: 21028677 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-25 413 DATE: May 11, 2021 ORDER Entitlement to service connection for a cervical spine condition is denied. FINDING OF FACT The probative evidence of record does not show a nexus between the Veteran's current cervical spine condition and his military service. CONCLUSION OF LAW The criteria for service connection for a cervical spine condition have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1974 to March 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In September 2019 the Board issued a remand order for further development to be conducted. The Board finds that there has been substantial compliance with its remand directives. See Stegall v. West,11 Vet. App. 268, 271(1998). Service Connection Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. See Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weight its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge, such as experiencing a physical symptom such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau, 492 F.3d 1372 (holding that a layperson is competent to identify a simple condition such as a broken leg). Nevertheless, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); see also 38 C.F.R. § 3.159 (a)(2). Entitlement to service connection for a cervical spine condition The Veteran contends that he suffers from a cervical spine condition due to his military service. A review of the Veteran's service treatment records (STRs) shows that, in December 1981, he was in an automobile accident and experienced muscle spasms of the neck. See September 2014 STR-Medical, pp. 3, 13, 17. The Veteran's January 1983 Report of Medical Examination did not document any cervical spine disability at the time of separation from service. Id at 3. Post-service, the first indication of a cervical spine disability was in March 1992. The Veteran reported that he was "lifting overhead with boxes" and continued working, despite the gradually increasing discomfort." See October 2014 Medical Treatment Record Non Government Facility, p. 16. In July 1992, the Veteran was diagnosed with anterior cervical discectomy and fusion. In May 1993, a private physician stated that the Veteran's "physical impairment due to his neck problem would be 15%" without explanation on how impairment was measured. In August of 1993 the Veteran's symptoms were described as being "a few episodes of neck pain and numbness but not many." See January 1997 Medical Treatment Record Non Government Facility, pp. 12, 8. The Veteran's treatment for neck pain continued, with numbness reported as of August 2011 and spinal surgery in April 2013. See September 2014 Medical Treatment Record Non Government Facility, pp. 8, 11, 25. A careful review of the Veteran's medical treatment record does not show any nexus opinions as towards the etiology of the Veteran's cervical spine condition. In June 2014, the Veteran submitted a claim of service connection for a cervical spine condition. See June 2014 VA 21-526EZ. The Veteran's claim was denied in November 2014 and he submitted a timely notice of disagreement (NOD). In doing so, the Veteran stated that he suffered "impact and stress injuries to the neck and back" as a paratrooper and that he had undergone 5 surgeries of his cervical spine. See August 2015 NOD. The Veteran was scheduled for a VA examination in March 2016. He failed to appear and he was provided a statement of the case (SOC) in March 2016 explaining his denial. In April 2016, the Veteran wrote to VA and explained that he had missed his VA examination due to losing the examination letter. See April 2016 Report of General Information. In May 2016, the Veteran perfected his appeal via VA Form 9. In doing so, the Veteran reiterated his contention that his service as a paratrooper caused "a great amount of impact stress placed on one's physical framework." See May 2016 Form 9. In September 2018, the Board found that the Veteran had shown good cause for missing his previously scheduled VA examination and ordered a new exemption to be provided. See September 2018 Remand BVA. As per Board remand directives, a VA examination was provided in May 2019. There, the Veteran reported that his neck problems began in 1977 and had worsened since. See May 2019 C&P Exam, pp. 1-2. The VA examiner opined that the Veteran's cervical spine disability was less likely than not due to his military service. In this, the VA examiner provided a detailed timeline of the Veteran's treatment in service and treatment post-service. He concluded that the Veteran was found to have no neck problems upon separation and that the Veteran's current disability was more likely due to a civilian work-related injury in 1992 and an automobile injury in 1996. Id at 13. A supplemental statement of the case (SSOC) was provided in August 2020 and the claim is now properly before the Board. The Board finds that the Veteran's claim must be denied on the grounds that the criteria for the third element of service connection, a nexus between his current disability and his military service, have not been met. In reaching this conclusion the Board acknowledges the Veteran's sincere belief that his current cervical spine condition was caused by his military service. However, the question of whether a diagnosis or nexus exists is a medical determination that requires perquisite medical training, skills and expertise, as the determination of the etiology of the Veteran's disability is a complex medical condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The only probative nexus opinion of record is that of the May 2019 VA examiner. Given that the VA examiner reviewed the Veteran's medical records, considered his lay statements, and provided a detailed rationale based upon the evidence of record, the Board finds the May 2019 medical opinion to be of significant probative value. As there is no competing positive nexus opinion of record, the Board finds the Veteran's claim must be denied as there is no nexus between the Veteran's cervical spine condition and his military service. The benefit-of-the doubt doctrine is not for application, and the claim for service connection for a cervical spine disability must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Abels, 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.