Citation Nr: 21031262 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 16-41 490 DATE: May 21, 2021 REMANDED Entitlement to service connection for radiculopathy of the left upper extremity (LUE) is remanded. Entitlement to service connection for radiculopathy of the right upper extremity (RUE) is remanded. Entitlement to service connection for a headache disorder, to include as secondary to service-connected posttraumatic stress disorder (PTSD) with unspecified sleep wake disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 2002 to January 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2015 by a Department of Veterans Affairs (VA) Regional Office. In November 2018, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for radiculopathy of the LUE. 2. Entitlement to service connection for radiculopathy of the RUE. 3. Entitlement to service connection for a headache disorder, to include as secondary to service-connected PTSD with unspecified sleep wake disorder. The Veteran claims that his radiculopathy of the bilateral upper extremities and headaches began during his military service and, as will be discussed below, an opinion obtained in October 2019 raises a theory of secondary service connection for the latter disorder. In the November 2018 remand, the Board noted that VA treatment records reflected diagnoses of cervical radiculopathy and migraines. Thus, the Veteran's claims were remanded in order to afford him a VA examination so as to determine the nature and etiology of his claimed disorders. Accordingly, in October 2019, the Veteran underwent VA examinations in which he was diagnosed with radiculopathy of the bilateral upper extremities and migraines, including migraine variants. In regard to his radiculopathy, he reported that he began experiencing burning pain that radiated to his shoulders while participating in activities that included lifting each other as a stretching exercise and obstacle courses in basic training in 2002. In regard to his migraine headaches, he indicated that such began in 2004 when he had piercing pain and sensitivity to light. Noting a review of the record and the Veteran's lay assertions, the October 2019 VA examiner opined that the Veteran's disorders were at least as likely as not related to his military service. In regard to the Veteran's radiculopathy of the bilateral upper extremities, the examiner observed that medical literature indicated that spondylosis and disc degeneration leading to foraminal narrowing and herniated nucleus pulposus are the more common pathologies for non-traumatic mechanical compression. Additionally, local ischemic effects and the inflammatory cascade play a large role in the natural progression of the condition through activation of a pathway triggering pain via sensitization of the nociceptive fibers. He further observed that a 2000-2009 military study identifying all servicemen diagnosed with cervical radiculopathy illustrated higher incidence due to the physically demanding duties required in service. Thus, the examiner found that the Veteran's radiculopathy of the bilateral upper extremities was related to more than one event or injury during service. With respect to the Veteran's headaches, the examiner noted that medical literature indicated that the presence of PTSD is associated with an increased predisposition to the development of migraines, and thus, such disorder was related to multiple stressful events in service. However, as the Veteran's service treatment records are negative for any complaints, treatment, or diagnosis of radiculopathy of the bilateral upper extremities and a chronic headache disorder, and he denied all relevant symptoms during in-service examinations in January 2006, July 2006, September 2007, and January 2008, an addendum opinion from a different VA examiner was obtained in July 2020. Specifically, at such time, the examiner review the record, to include such service treatment records, and opined that the Veteran's radiculopathy of the bilateral upper extremities and his headache disorder were less likely than not related to his military service. In support of such opinion, he noted that there was no documented evidence that such disorders were present in service as multiple examinations were negative for any relevant complaints, findings, or diagnoses. Thus, he found that there was insufficient objective documented evidence to associate such claimed disorders to the Veteran's service. However, as the July 2020 VA examiner did not address the Veteran's report of the onset of his symptoms during service as described at the October 2019 VA examinations, or address whether his radiculopathy of the bilateral lower extremities is related to his physically demanding duties and his headache disorder is related to in-service stressful events and/or caused or aggravated by his PTSD with unspecified sleep wake disorder as raised by the October 2019 VA examiner, the Board finds that a remand is necessary in order to obtain addendum opinions addressing such matters. The matters are REMANDED for the following action: Return the record, to include a copy of this remand, to the July 2020 VA examiner that provided opinions addressing the etiology of the Veteran's radiculopathy of the bilateral upper extremities and headache disorder for an addendum opinion. Following a full review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's diagnosed radiculopathy of the right and left upper extremities and migraines had their onset in, or are otherwise related to, his military service, to include his physically demanding duties and/or stressful events? (B) Did the Veteran's migraines manifest within one year of his separation from service in January 2008, i.e., by January 2009? If so, please describe the manifestations. (C) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's diagnosed migraines are caused or aggravated by his PTSD with unspecified sleep wake disorder? or any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner should consider the following evidence: The Veteran's service treatment records, which are negative for any complaints, treatment, or diagnosis of radiculopathy of the bilateral upper extremities and a chronic headache disorder, and he denied all relevant symptoms during in-service examinations in January 2006, July 2006, September 2007, and January 2008 The Veteran's report at the October 2019 VA examination that he began experiencing burning pain that radiated to his shoulders while participating in activities that included lifting each other as a stretching exercise and obstacle courses in basic training in 2002, and his migraines began in 2004 when he had piercing pain and sensitivity to light The October 2019 VA examiner's citation to medical literature indicating that a 2002-2009 military study identifying all servicemen diagnosed with cervical radiculopathy illustrated higher incidence due to the physically demanding duties required in service The October 2019 VA examiner's citation to medical literature indicating that the presence of PTSD is associated with an increased predisposition to the development of migraines. The examiner is advised that the fact that the Veteran's service treatment records are negative for any indication of radiculopathy of the bilateral upper extremities and a chronic headache disorder cannot form the sole basis of a negative opinion. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Waite 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.