Citation Nr: 21031686 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 15-38 377 DATE: May 24, 2021 ORDER Entitlement to service connection for a cervical spine disability is denied. FINDING OF FACT The Veteran's cervical spine condition, diagnosed as degenerative joint disease of the cervical spine status post fusion with Intervertebral Disc Syndrome (IVDS), is not secondary to any service-connected disability or disabilities, and is not otherwise related to an in-service injury or disease. 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; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1992 to August 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran attended a Board Hearing in February 2019. The transcript of that hearing has been associated with the Veteran's claims file. Entitlement to service connection for a cervical spine disability The Veteran contends that his cervical spine condition, diagnosed as degenerative joint disease of the cervical spine status post fusion with Intervertebral Disc Syndrome (IVDS), began during service or was caused by an in-service injury, event, or disease. He specifically claims it may be related to his noted in-service complaints of neck pain or to a September 2002 motor vehicle accident. Alternatively, he contends that his service-connected disabilities of the bilateral feet, bilateral ankles, and lumbar spine, caused or aggravated his cervical spine condition. 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The Veteran's x-rays and MRIs from August 2011 onward showed degenerative changes at C3-4 and C4-5, and in April 2014 the Veteran underwent an anterior cervical diskectomy and fusion/venture plate instrumentation at C3-4, C4-5. This is sufficient to show the presence of a current disability. The Veteran's service treatment records (STRs) show that from at least August 1998 through October 1998 the Veteran reported cervical spine symptoms, and in September 2002 the Veteran was involved in a motor vehicle accident. These in-service concerns are sufficient to show an in-service injury, event, or disease. The Veteran currently has service-connected disabilities of the bilateral feet, bilateral ankles, bilateral lower extremities, right knee, right shoulder, and thoracolumbar spine. He has explicitly claimed that his disabilities of the feet, ankles, right knee, lower extremities, and/or thoracolumbar spine may have caused or aggravated his cervical spine condition. There are two remaining questions for the Board. First, whether the Veteran's current cervical condition either began during service or is at least as likely as not related to an in-service injury, event, or disease. Second, whether the Veteran's current cervical spine condition is proximately due to, or aggravated by, one or more service-connected disabilities. Evidence The Veteran's April 1992 enlistment examination noted nothing about the Veteran's cervical spine. STRs from August 1998 through October 1998 note movement restrictions in the cervical spine, generally improving. A December 1998 noted cervical radiculopathy by history, resolved, with no further neurological workup needed at the time. STRs show that the Veteran was involved in a September 2002 motor vehicle accident. Contemporaneous x-rays of his cervical spine showed "some density anterior adjacent to C3/4, likely chondral calcification" and "a slight prominence to the soft tissues anterior adjacent to C6/7, but the intervertebral disc space is preserved and there is no evident fracture." The doctor interpreting these results noted in the impression section that the was no fracture of the cervical spine and "[t]he focal subtle prominence of the soft tissues at-C6/7 is subtle - questionable on todays' film." Contemporaneous medical records show the Veteran complaining about recurrent back pain but do not mention complaints about neck pain. In March 2003 and April 2003, the Veteran was subject to a Medical Board Physical Evaluation Board and related physical examination. This examination noted several medical complaints, including chronic low back pain and degenerative changes in the Veteran's lumbar spine, but did not mention neck pain or other cervical spine complaints or diagnoses. In November 2003, VA provided an examination of the Veteran's joints to determine the nature and etiology of any joint related conditions. The Veteran made detailed complaints relating to his bilateral ankles, bilateral knees, and low back. He made no mention of his neck. The earliest post-service medical record showing complaint of a cervical spine condition is from July 2011. The Veteran complained of cervical radicular pain. Contemporaneous x-rays of the cervical spine were normal, but an August 2011 MRI of the cervical spine showed right paramedian herniation of the nucleus pulposus (HNP) at C3-4 and right posterior annular bulge approaching an HNP at C4-5. A treating doctor reviewing the same MRI in December 2012 diagnosed multilevel cervical spondylosis with small disc herniations at C3-4 sand C4-5, centric to the right, causing foraminal stenosis. In November 2011 a physical therapist noted the Veteran's complains of low back and neck pain for many years. The physical therapist noted limited flexion and extension of the cervical spine without providing measurements. In June 2012, a VA examiner opined that the Veteran had nerve impingement, cervical spine with pain to arms and neck, less likely than not secondary to his service-connected low back disability. However, the examiner failed to provide any rationale in support of this opinion. In December 2012, a VA examiner opined that the Veteran had nerve impingement caused by degenerative disc disease (DDD) of the cervical spine and that the cervical spine DDD was less likely than not related to service. The examiner acknowledged the Veteran's in-service complaints of neck pain but stated that they appeared to be cervical sprain which improved during service and there was no evidence of cervical DDD or nerve impingement after that condition resolved. The examiner further opined that cervical sprain had no noted ill effects and was not the type of injury that would cause development of cervical DDD, IVDS, or radiculopathy. Furthermore, the examiner noted that the Veteran had been in a motor vehicle accident in 2006, after his active service, and the examiner opined that this was more likely than not the cause of his cervical DDD and related nerve symptoms. However, the December 2012 VA examiner's opinion did not consider evidence of the Veteran's documented September 2002 motor vehicle accident or consider whether his service-connected disabilities caused or aggravated his cervical spine condition. In December 2013, the Veteran stated that he had neck pain radiating to his right shoulder when he left service, and that he applied for service connection for this as "nerve impingement, right shoulder" when he left service because that is what he had been told the condition was. He stated that he now believes this was misdiagnosed and was actually his claimed neck condition. He further argued that his complaint before his 2006 motor vehicle accident shows that the 2006 accident could not be the cause of his current cervical spine DDD. In September 2019, VA provided an examination to determine the nature and etiology of any cervical spine disability. The examiner diagnosed degenerative joint disease (DJD) of the cervical spine with IVDS and noted that the Veteran had undergone cervical fusion to treat this condition. The Veteran stated that this condition began in 1995 with pain in his neck and had continued since then. The examiner also diagnosed cervical radiculopathy of the right upper radicular group. The September 2009 VA examiner opined that the Veteran's cervical spine DJD with IVDS was less likely than not caused by any in-service injury event or disease. The rationale was that there was no in-service diagnosis or treatment of cervical DJD with IVDS and the Veteran's in-service diagnosis of cervical sprain was documented as resolving during service. Furthermore, cervical sprain is not the type of injury that would progress to cervical DJD with IVDS. The examiner acknowledged the September 2002 motor vehicle accident but noted that the x-ray taken after that accident showed no significant abnormalities and the Veteran did no longitudinal cervical complaints for the rest of the Veteran's active service, indicating that the accident did not cause any chronic cervical spine residuals. The examiner also opined that none of the Veteran's service-connected conditions, including plantar fasciitis, pes planus, thoracolumbar DDD with IVDS, posterior tibial tendinitis, lower extremity radiculopathy, right knee meniscal tear, left chronic medial collateral ligament sprain, left carpal tunnel syndrome, left foot scar, and left lower extremity numbness of the internal saphenous nerve (service-connected conditions) either caused the Veteran's cervical spine DJD with IVDS or aggravated it beyond its natural progression. The rational was that the service-connected conditions were not known to have any pathophysiologic relationship with the cervical spine that could have caused or aggravated cervical spine DJD with IVDS. Analysis The Board concludes that, while the Veteran has a current diagnosis of cervical spine DJD, and evidence shows that he had in-service cervical sprain in August 1998 and was involved in a motor vehicle accident in September 2002, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of cervical spine DJD with IVDS began during service or is otherwise related to an in-service injury, event, or disease. Treatment records show the Veteran was not diagnosed with any cervical spine disability until August 2011, approximately eight years after his separation from service. While the Veteran is competent to report having experienced symptoms of neck pain and shoulder pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of cervical spine DJD with IVDS. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, while only the September 2019 VA examiner discussed all of the relevant medical evidence and supported their opinion with a sufficient rationale, the Board notes that neither the July 2012 examiner, December 2012 examiner, nor any other medical provider of record has opined that the Veteran's cervical DJD is related to his active service. The Board finds the September 2019 examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his cervical spine DJD is related to his in-service cervical sprain or his September 2002 motor vehicle accident. However, the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, supra; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the September 2019 VA examiner's opinion that to the Veteran's opinion. The Board concludes that the preponderance of the evidence is against finding that the Veteran's cervical spine DJD with IVDS is proximately due to or the result of, or aggravated beyond its natural progression by one or more service-connected disabilities. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The September 2019 VA examiner opined that the Veteran's cervical spine DJD with IVDS is less likely than not caused by or aggravated beyond it's natural progression by any of the Veteran's service-connected conditions because there was no known pathophysiologic relationship with the cervical spine that could have either caused or aggravated the claimed condition. The Veteran believes his combined service-connected disabilities caused or aggravated his cervical spine DJD with IVDS. The Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, pathology, and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau supra; see also Kahana, supra. Consequently, the Board gives more probative weight to the September 2019 VA examiner's opinion that to the Veteran's opinion. For the above reasons the Board finds that the preponderance of the evidence is against finding either that the Veteran has a cervical spine disability that began in or was caused by his active service, or that he has a cervical spine disability that is proximately due to or the result of, or aggravated beyond its natural progression by one or more service-connected disabilities. Service connection for a cervical spine disability is therefore not warranted on either a direct or secondary basis. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.