Citation Nr: 21031579 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 17-02 952 DATE: May 24, 2021 ORDER Entitlement to service connection for a cervical spine disability, to include degenerative joint disease, is denied. FINDING OF FACT A cervical spine disability was not incurred in or otherwise caused by service. CONCLUSION OF LAW The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the United States Air Force from September 1962 to December 1966. Entitlement to service connection for a cervical spine disability, to include degenerative joint disease Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. 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 service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection also is warranted for disability 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) caused by or (b) aggravated by a service-connected disability. Id.; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends that his current cervical spine disabilities were caused by a June 1966 in-service accident. In the alternative, he contends that the neck disabilities were caused or aggravated by one or more of his service-connected disabilities. The Veteran's service treatment records document a June 1966 fall from a firetruck while on active duty. The Veteran had a fractured right distal humerus and lacerations to the right eyelid and chin. On admission to the hospital, the Veteran had noted problems with the foregoing, but there was no notation of neck problems. During an October 1966 Report of Medical History the Veteran indicated that his physical health was good except for his right elbow. A November 1966 Findings of Physical Evaluation Board included only a diagnosis of limitation of motion of the right elbow that was a residual of an open fracture of the humerus. In May 1990, the Veteran reported stiffness and pain in the right neck and right shoulder for the previous 4 to 5 years. During a September 1994 VA examination, the Veteran reported pain moving up his elbow and upper arm to the shoulder when writing for a period of time. In support of his claim, the Veteran submitted a January 2015 private treatment record. The record indicated, "Since the patient has had no other significant injury to his cervical spine other than falling from a moving fire truck while on active duty on June 14, 1966. It is my professional opinion that the patient['s] cervical arthritis is as likely as not directly related to trauma sustained in that injury in June 1966, and in my opinion, the injury to his cervical spine coincided with the injury to his lumbar spine." The Veteran was afforded a VA contract examination in June 2015. The examiner diagnosed degenerative joint disease of the cervical spine. The Veteran reported symptom onset in approximately 2000 and that had worsened since that time. Following examination, the examiner concluded that it was less likely than not that the neck disability was proximately due to or the result of the Veteran's service-connected disability. The rationale noted that there was no increased weight bearing to the cervical spine from the service-connected right shoulder disability. In addition, strength and sensation in the upper extremities was symmetrical bilaterally and without evidence of guarding of the cervical spine. A September 2016 VA medical opinion is of record. Following review of the records, the reviewing physician stated, "I conclude, after a review of medical records, and a review of the medical literature the degenerative joint disease of the cervical spine diagnosed [in the June 2015 VA contract examination], is less than likely permanently aggravated or a result of any event and/or condition that occurred and/or expressed in-service and/or within one year of discharge. The conclusion is supported by a preponderance of evidence that supports the neck as having been normal throughout service and neck symptoms beginning well after military service had ended. The Veteran's separation examination, which was performed through Medical Evaluation Board, clearly indicated a normal neck exam without symptoms. The service treatment records that described the fall off a fire truck included no neck complaints and no documentation of neck symptoms or findings. The [June 2015 VA examination] provides a history from the Veteran in which he states neck/cervical spine symptoms began in 2000, [] well many years after military service had ended. The fact that there is degenerative joint disease i[n] the cervical spine now more likely than not is a finding that is related to normal changes of aging associated with family history. If there had been any event in 1962-1966 during service, if it had been of any significance, the findings on the cervical spine would likely have been much more severe than only the mild findings on x-rays now. The statement by the Eastern OK Orthopedic Center physician that the cervical spine arthritis was related to trauma sustained in the injury in service in June 1966 was not supported by evidence in the service treatment records, which do not appear to have been reviewed prior to issuing this statement and was more likely than not based solely on the undocumented history provided by the Veteran to the physician." During the Veteran's September 2020 Board hearing, he testified about his in-service accident falling off a firetruck and his resulting injuries and hospitalization. The Veteran testified as to his belief that he had traumatic arthritis that started in this right elbow and "it has now climbed all the way up to my shoulders, into my neck, all the way down my spine." He testified that a private doctor had told the Veteran about the traumatic arthritis having "traveled up from my elbow into my spine and other part of my body." The Veteran stated that at least one doctor had told him the current neck problems were related to the accident in service. The Veteran also raised a theory of altered body mechanics as a result of the elbow disability. The Veteran was afforded a VA neck examination in January 2021. The examiner diagnosed degenerative arthritis and degenerative disc disease of the cervical spine. The Veteran reported the onset of problems in 1966 when he fell off a firetruck going 35 miles per hour. At the time of the injury, he reported that he broke his right elbow, injured his neck, and incurred multiple lacerations. The Veteran later developed arthritis in his spine and other skeletal regions of the body. As to whether the neck disabilities were caused or aggravated by his service-connected disabilities, the examiner considered the Veteran's assertions that he had been told by a medical professional that his right elbow arthritis had climbed up to his shoulders, into his neck, and all the way down his spine. The examiner's response to this assertion was, "This is simply medically not correct. This is not the natural progress of nerve conduction. The opposite could certainly occur however." For the same reason, the examiner concluded, altered body mechanics due to the service-connected disabilities did not cause or aggravate the claimed cervical spine disabilities. Thus, the Veteran has current neck disabilities. As such, the crucial inquiry is whether these diagnosed disabilities were incurred in service, are otherwise caused by the Veteran's active service, or were caused or aggravated by a service-connected disability. The Board concludes that the preponderance of the evidence indicates they are not. As to granting the Veteran's claim on a direct basis as having been incurred in service or otherwise related to service, the medical evidence and the contemporaneous lay evidence are against such a finding. The September 2016 VA medical opinion provided an extensive rationale as to why the neck disabilities were not incurred in or otherwise caused by service. The medical professional discussed the absence of any neck complaints while getting treatment after falling off the firetruck and that there was a normal examination of the neck prior to his separation from service. In addition, the medical professional stated that had the Veteran suffered a traumatic neck injury in the accident that his current condition would be expected to be worse than the current mild arthritis shown on x-rays. The medical professional also concluded that the most likely cause of the arthritis was the natural aging process. The Board finds this the most probative evidence of record as to whether the Veteran's neck disabilities were incurred in or otherwise caused by service. By contrast, the Board finds the January 2015 private medical opinion of limited probative value. The sole rationale for the conclusion that the neck disabilities were due to the in-service firetruck accident was that the Veteran had no other significant trauma to the spine. As noted by the September 2016 opinion provider, however, the Veteran did not complain about neck symptoms at the time of the accident and had a normal examination of the neck prior to separation from service. As the January 2015 opinion letter did not reconcile these issues with the opinion provided or explain why the arthritis was not related to the natural aging process, the Board affords greater probative weight to the September 2016 medical opinion's conclusions. To the extent that the Veteran has alleged that the current neck disabilities had their onset in service or otherwise are related to service, given the lack of any complaints regarding the neck at the time of the accident or during subsequent medical examinations between the accident and separation from service, the Board affords far greater weight to the conclusions of the September 2016 medical professional given that individual's greater level of education, training, and experience in the complex medical matter of relating arthritis diagnosed decades after service to the firetruck accident in 1966. Thus, the Board finds the preponderance of the evidence against granting entitlement to service connection for a cervical spine disability as having been incurred in or otherwise related to his active service, to include the June 1966 firetruck accident. As to granting the claim on a secondary basis as having been caused or aggravated by a service-connected disability, the Veteran contends that his service-connected orthopedic disabilities caused or aggravated his cervical spine disabilities. The Board acknowledges that the Veteran is competent to report sensory or observed symptoms, and his testimony in that regard is entitled to some probative weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, linking cervical spine disabilities to his service-connected orthopedic disabilities falls outside the realm of common knowledge of a lay person based on the complexity of determining a relationship between these disabilities. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). There are multiple medical opinions finding against an association between the Veteran's neck disabilities and his service-connected orthopedic disabilities. The June 2015 VA examiner discussed how there was no increased weight bearing to the cervical spine from the service-connected right shoulder disability. In addition, strength and sensation in the upper extremities was symmetrical bilaterally and without evidence of guarding of the cervical spine. The January 2021 medical opinion considered the Veteran's assertions that he had been told by a medical professional that his right elbow arthritis had climbed up to his shoulders, into his neck, and all the way down his spine. The examiner's response to this assertion was, "This is simply medically not correct. This is not the natural progress of nerve conduction." The examiner noted that it was possible for a neck disability to affect the right elbow, but not the other way around. The Board finds these opinions the most probative evidence of record, as they were based on a review of the claims file, consideration of the Veteran's contentions, and their medical training, education, and experience. The Board has considered the April 2021 statement from the Veteran's representative concluding that the January 2021 VA examination report was inadequate because it "does not explain how the arthritis cannot travel or how the veteran's form of arthritis is typically formed after a trauma to the joint. The veteran has supplied medical opinions linking the condition as well as other [VA] examinations have supported his argument." The January 2021 report, however, specifically concluded that the cause of the arthritis was the natural aging process and that the Veteran's contention that the arthritis traveled up from the elbow to the neck was not medically correct as it was not how nerve conduction worked. Given the combination of the conclusion that the cause of the arthritis in the cervical spine was the natural aging process and that it was not how medicine worked that arthritis would spread from the elbow to the neck, the Board finds that the January 2021 medical professional provided an adequate rationale for the opinion. The Board acknowledges the Veteran's contentions during his Board hearing that one or more medical professionals had told him the arthritis had started in the right elbow and traveled up the arm into the neck. To the extent that the Veteran is competent to report such a potentially complex medical conclusion, the Board affords this contention limited probative weight as there is no stated rationale for the opinion, as opposed to the June 2015 and January 2021 medical opinions. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim for entitlement to service connection must be denied. See 38 U.S.C. § 5107(b); see generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.