Citation Nr: 21030442 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 15-18 911A DATE: May 18, 2021 ORDER Entitlement to service connection for cervical radiculopathy of the right upper extremity, as secondary to service-connected cervical spine degenerative arthritis, is granted. Entitlement to service connection for cervical radiculopathy of the left upper extremity, as secondary to service-connected cervical spine degenerative arthritis, is granted. FINDINGS OF FACT 1. Right upper extremity cervical radiculopathy is related to service-connected cervical spine degenerative arthritis. 2. Left t upper extremity cervical radiculopathy is related to service-connected cervical spine degenerative arthritis. CONCLUSIONS OF LAW 1. The criteria for service connection for right upper extremity cervical radiculopathy have been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2020). 2. The criteria for service connection for left upper extremity cervical radiculopathy have been met. 38 U.S.C. §§ 1101, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from May 1984 to May 1990. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In June 2018, in pertinent part, the Board denied the Veteran's claims for service connection, on appeal. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court). In May 2019, the parties filed a Joint Motion for Partial Remand (Joint Motion or JMPR) which requested that the Board's decision be vacated and remanded. A May 2019 Court Order granted the motion, and remanded the claims for readjudication consistent with the terms of the Joint Motion. In November 2019 and November 2020, the Board remanded the case to the AOJ in an effort to comply with the directions laid out in the Joint Motion. A supplemental statement of the case was most recently issued in March 2021. The case has since been returned to the Board for appellate review. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § §§ 1110, 1131; 38 C.F.R. § 3.303(a) (2020). To establish a right to compensation for a present disability, a Veteran must show: (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 servicethe so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 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). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. For chronic diseases, if chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § § 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for a neurological disorder of the right upper extremity, to include as secondary to service-connected disabilities. 2. Entitlement to service connection for a neurological disorder of the left upper extremity, to include as secondary to service-connected disabilities. The Board finds that the evidence of record demonstrates service connection for cervical radiculopathy of the right upper extremity and cervical radiculopathy of the left upper extremity is warranted. The Veteran does not assert that his cervical radiculopathy of the right and left upper extremities is directly related to service; instead, he asserts that his cervical radiculopathy of the right and left upper extremities are the result of his service-connected disabilities, namely his service-connected cervical spine degenerative arthritis. The Board finds that the available medical evidence of record supports the Veteran's contentions. Initially, the Board notes that the Veteran has been diagnosed with cubital tunnel syndrome, carpal tunnel syndrome, and neuropathy of the upper extremities, and is currently service connected for cervical spine degenerative arthritis. Nevertheless, the Board observes that, despite the absence of a formal diagnosis of radiculopathy at his November 2013 and February 2021 VA examinations, the Veteran was found to have signs and symptoms of cervical radiculopathy; at the November 2013 VA examination, the Veteran's cervical radiculopathy symptomatology included mild intermittent pain and paresthesias and/or dysesthesias, and mild to moderate numbness of the upper extremities. Likewise, at the February 2021 VA examination, the Veteran was found to have moderate paresthesias and/or dysesthesias and numbness of the upper extremities, positive Phalen's and Tinel's signs, and mild incomplete paralysis of the right and left median and ulnar nerves. As such, the Board finds that the evidence demonstrates that the Veteran has cervical radiculopathy of the right and left upper extremities. As to a nexus, the Board acknowledges that the January 2020 and February 2021 VA examiners have found that it is less likely than not that the Veteran's right and left cubital tunnel syndrome and carpal tunnel syndrome are related to his service, including his service-connected cervical spine degenerative arthritis; likewise, the January 2020 VA examiner found that the Veteran did not meet the diagnostic criteria for peripheral neuropathy. However, the Veteran's private treatment records from Dr. K of Alabama Neurology Associates reflect a diagnosis of polyneuropathy of the bilateral upper and lower extremities. Moreover, treatment records from Dr. K indicate that the Veteran's right and left upper extremity polyneuropathy is clinically correlated to disc protrusions at C4-5 and C5-6, without cord compression, as shown on MRI in October 2019. Moreover, the Board observes that the Veteran has consistently complained of numbness and tingling radiating from the neck and shoulders since at least his April 1992 VA examination. In light of the fact that he Veteran's treating provider, Dr. K, indicates that the Veteran's neurological symptoms of the right and left upper extremities, to include complaints of numbness and tingling, are clinically correlated to the Veteran's cervical disc protrusions, which are, in turn, due to the Veteran's service-connected cervical spine degenerative arthritis, the Board finds that the Veteran's cervical radiculopathy of the right and left upper extremities is secondary to the Veteran's service-connected cervical spine degenerative arthritis. See 38 C.F.R. § 3.310. See also Madden v. Gober, 125 F.3d 1477, 1481 (1997) (in evaluating the evidence and rendering a decision on the merits, the Board is required to assess the credibility and probative value of proffered evidence in the context of the record as a whole). Hence, on this record, the evidence is found to be at least evenly balanced in showing that the Veteran's cervical radiculopathy of the right and left upper extremities are at least as likely as not related to his service-connected cervical spine degenerative arthritis. In resolving all reasonable doubt in the Veteran's favor, service connection for cervical radiculopathy of the right and left upper extremities is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Hallie E. Brokowsky, 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.