Citation Nr: 21043122 Decision Date: 07/14/21 Archive Date: 07/14/21 DOCKET NO. 17-65 113 DATE: July 14, 2021 ORDER Entitlement to service connection for a cervical disorder, claimed as a "chronic neck condition the atlas is out of place," as secondary to service-connected posttraumatic stress disorder (PTSD), is granted. Entitlement to service connection for a back disorder, claimed as a "back condition with chronic pain," as secondary to service-connected PTSD, is granted. Entitlement to service connection for a right hip disorder, claimed as a "right hip condition with chronic pain," as secondary to service-connected PTSD, is granted. FINDINGS OF FACT 1. The Veteran's PTSD caused his cervical disorder. 2. The Veteran's PTSD caused his back disorder. 3. The Veteran's PTSD caused his right hip disorder. CONCLUSIONS OF LAW 1. The criteria for secondary service connection for a cervical disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for secondary service connection for a back disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for secondary service connection for a right hip disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 2002 to February 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned in April 2020. Secondary Service Connection Service connection on a secondary basis is merited if there is (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Issue 1: Entitlement to service connection for a cervical disorder, claimed as a "chronic neck condition the atlas is out of place," as secondary to service-connected PTSD In November 2020, a VA examiner diagnosed the Veteran with a cervical strain. This satisfies the first prong of a secondary service connection claim. VA has service connected the Veteran's PTSD. It has rated it as 50 percent disabling since December 13, 2012. As relevant here, the Board highlights the Veteran's March 2014 PTSD VA compensation examination. In her report, the examiner noted: Young veteran who is notably upset when discussing index trauma. He reports that he has had a sense of emotional detachment in relationships, ongoing sleep disturbance (sleep onset insomnia, limited sleep duration), nightmares and reactivity to triggering stimuli (fire, red meat). In addition to service-related stressors, he indicates situational stress in his life; both his mother & his sister are stated to have terminal illnesses. This satisfies the second prong of a secondary service connection claim. The appeal turns on the third prong of a secondary service connection claim medical nexus. Two nexus opinions are in the record a private opinion from the Veteran's chiropractor and a VA examination opinion. In March 2018, the Veteran submitted a February 2018 nexus statement from Dr. B.B., D.C. Dr. B.B. opined that the Veteran's "spine, left shoulder, and pelvis condition" was secondary to his PTSD. Specifically, x-rays show "abnormal/reverse curvature in the cervical spine, which is consistent with whiplash." Dr. B.B. concluded that the Veteran's PTSD caused this "whiplash" due to the "forces and compression loads on the spine associated with a diagnosis of" PTSD. In November 2020, the VA examiner opined: I have reviewed the VA e-folder and Remand Order and there is nothing in the medical literature to find a neck condition associated with the nasal mucosa irritated by allergens or a nexus between PTSD and joint injuries including a psychiatric conversion disorder. I reviewed the opinion of Dr. B.B. a chiropractor, who is not a neurosurgeon, orthopedist, or psychiatrist and cannot opine on a joint nexus with PTSD. The VA examiner erred, and the probative value of his opinion is diminished, because he dismissed Dr. B.B.'s opinion based solely on his credentials. That said, while the Veteran submitted 400-500 pages of treatment records from Dr. B.B. in February 2021 establishing a longstanding pattern of treatment, the records and opinion do not fully explain the Veteran's theory of entitlement. To fill this gap, the Board observes three things. First, the Veteran's VA treatment records contain multiple entries that the Veteran has chronic sleep impairment, as noted at the March 2014 PTSD VA compensation examination. Second, the American Psychiatric Association observes, in a "Q&A" section on its website, that: Q: Are there physical problems that are commonly associated with PTSD? A: In addition to the thoughts and feelings identified in the What is PTSD? section, people with PTSD may also experience physical symptoms, such as increased blood pressure and heart rate, fatigue, muscle tension, nausea, joint pain, headaches, back pain or other types of pain. The person in pain may not realize the connection between their pain and a traumatic event. For people with chronic pain, the pain may actually serve as a reminder of the traumatic event, which in turn may intensify PTSD symptoms. Some people who develop PTSD and chronic pain also experience depression and alcohol and prescription medication misuse. Chronic PTSD has been shown to increase the risk of having a variety of health issues and decreased life expectancy. During the COVID-19 pandemic, the perception of the lethal threat of the virus has been associated with stress and trauma-related somatic symptoms. Third, an August 5, 2013 VA treatment record states "patient reports erratic sleep. Wakes up sore as if exercising." These three sources contextualize the Veteran's experience and explain Dr. B.B.'s opinion. Specifically, the Veteran experiences severe sleep disturbance. He has recurring, sudden bodily movements in response to re-experiencing the trauma occasioned by the PTSD when he sleeps. These movements, over time, have caused the diagnosed cervical strain. Given the totality of the evidence, the Board finds this satisfies the third prong of a secondary service connection claim. The Veteran has satisfied all three prongs of a secondary service connection claim. Accordingly, the Board will grant the appeal. Issue 2: Entitlement to service connection for a back disorder, claimed as a "back condition with chronic pain," as secondary to service-connected PTSD In November 2020, a VA examiner diagnosed the Veteran with a lumbosacral strain. This satisfies the first prong of a secondary service connection claim. VA has service connected the Veteran's PTSD. It has rated it as 50 percent disabling since December 13, 2012. As relevant here, the Board highlights the Veteran's March 2014 PTSD VA compensation examination. In her report, the examiner noted: Young veteran who is notably upset when discussing index trauma. He reports that he has had a sense of emotional detachment in relationships, ongoing sleep disturbance (sleep onset insomnia, limited sleep duration), nightmares and reactivity to triggering stimuli (fire, red meat). In addition to service-related stressors, he indicates situational stress in his life; both his mother & his sister are stated to have terminal illnesses. This satisfies the second prong of a secondary service connection claim. The appeal turns on the third prong of a secondary service connection claim medical nexus. Two nexus opinions are in the record a private opinion from the Veteran's chiropractor and a VA examination opinion. In March 2018, the Veteran submitted a February 2018 nexus statement from Dr. B.B., D.C. Dr. B.B. opined that the Veteran's "spine, left shoulder, and pelvis condition" was secondary to his PTSD. Specifically, x-rays show "abnormal/reverse curvature in the cervical spine, which is consistent with whiplash." Dr. B.B. concluded that the Veteran's PTSD caused this "whiplash" due to the "forces and compression loads on the spine associated with a diagnosis of" PTSD. In November 2020, the VA examiner opined: I have reviewed the VA e-folder and the Remand order and reviewed the medical literature and there is no nexus between PTSD including Conversion disorders and any joint disease connected to PTSD. Dr. B.B.'s February 2018 private was reviewed, however, [I] disagree with the nexus opinion as the opinion is given by a chiropractor not a medical doctor, so it cannot be considered. The VA examiner erred, and the probative value of his opinion is diminished, because he dismissed Dr. B.B.'s opinion based solely on his credentials. That said, while the Veteran submitted 400-500 pages of treatment records from Dr. B.B. in February 2021 establishing a longstanding pattern of treatment, the records and opinion do not fully explain the Veteran's theory of entitlement. To fill this gap, the Board observes three things. First, the Veteran's VA treatment records contain multiple entries that the Veteran has chronic sleep impairment, as noted at the March 2014 PTSD VA compensation examination. Second, the American Psychiatric Association observes, in a "Q&A" section on its website, that: Q: Are there physical problems that are commonly associated with PTSD? A: In addition to the thoughts and feelings identified in the What is PTSD? section, people with PTSD may also experience physical symptoms, such as increased blood pressure and heart rate, fatigue, muscle tension, nausea, joint pain, headaches, back pain or other types of pain. The person in pain may not realize the connection between their pain and a traumatic event. For people with chronic pain, the pain may actually serve as a reminder of the traumatic event, which in turn may intensify PTSD symptoms. Some people who develop PTSD and chronic pain also experience depression and alcohol and prescription medication misuse. Chronic PTSD has been shown to increase the risk of having a variety of health issues and decreased life expectancy. During the COVID-19 pandemic, the perception of the lethal threat of the virus has been associated with stress and trauma-related somatic symptoms. Third, an August 5, 2013 VA treatment record states "patient reports erratic sleep. Wakes up sore as if exercising." These three sources contextualize the Veteran's experience and explain Dr. B.B.'s opinion. Specifically, the Veteran experiences severe sleep disturbance. He has recurring, sudden bodily movements in response to re-experiencing the trauma occasioned by the PTSD when he sleeps. These movements, over time, have caused the diagnosed lumbosacral strain. Given the totality of the evidence, the Board finds this satisfies the third prong of a secondary service connection claim. The Veteran has satisfied all three prongs of a secondary service connection claim. Accordingly, the Board will grant the appeal. Issue 3: Entitlement to service connection for a right hip disorder, claimed as a "right hip condition with chronic pain," as secondary to service-connected PTSD In November 2020, a VA examiner examined the Veteran for this claim. In contrast to the previous two issues, the examiner reported that "the Veteran does not have a current diagnosis associated with any claimed condition," i.e., a "right hip condition." However, the Veteran's chiropractor has diagnosed him with "nonallopathic lesions" of the pelvis and "subluxations / restricted joint motion with taut / tender muscle fibers, loss of mobility, and tenderness through the end point" requiring palpation in multiple regions including the "right pelvis." Given this, the Board is satisfied that the Veteran has met the first prong of a secondary service connection claim. VA has service connected the Veteran's PTSD. It has rated it as 50 percent disabling since December 13, 2012. As relevant here, the Board highlights the Veteran's March 2014 PTSD VA compensation examination. In her report, the examiner noted: Young veteran who is notably upset when discussing index trauma. He reports that he has had a sense of emotional detachment in relationships, ongoing sleep disturbance (sleep onset insomnia, limited sleep duration), nightmares and reactivity to triggering stimuli (fire, red meat). In addition to service-related stressors, he indicates situational stress in his life; both his mother & his sister are stated to have terminal illnesses. This satisfies the second prong of a secondary service connection claim. The appeal turns on the third prong of a secondary service connection claim medical nexus. One nexus opinion is in the record a private opinion from the Veteran's chiropractor. In March 2018, the Veteran submitted a February 2018 nexus statement from Dr. B.B., D.C. Dr. B.B. opined that the Veteran's "spine, left shoulder, and pelvis condition" was secondary to his PTSD. Specifically, x-rays show "abnormal/reverse curvature in the cervical spine, which is consistent with whiplash." Dr. B.B. concluded that the Veteran's PTSD caused this "whiplash" due to the "forces and compression loads on the spine associated with a diagnosis of" PTSD. In contrast, the November 2020 VA examiner did not opine on nexus because he did not identify a hip disability. The Veteran submitted 400-500 pages of treatment records from Dr. B.B. in February 2021, establishing a longstanding pattern of treatment. That said, the records and opinion do not fully explain the Veteran's theory of entitlement. To fill this gap, the Board observes three things. First, the Veteran's VA treatment records contain multiple entries that the Veteran has chronic sleep impairment, as noted at the March 2014 PTSD VA compensation examination. Second, the American Psychiatric Association observes, in a "Q&A" section on its website, that: Q: Are there physical problems that are commonly associated with PTSD? A: In addition to the thoughts and feelings identified in the What is PTSD? section, people with PTSD may also experience physical symptoms, such as increased blood pressure and heart rate, fatigue, muscle tension, nausea, joint pain, headaches, back pain or other types of pain. The person in pain may not realize the connection between their pain and a traumatic event. For people with chronic pain, the pain may actually serve as a reminder of the traumatic event, which in turn may intensify PTSD symptoms. Some people who develop PTSD and chronic pain also experience depression and alcohol and prescription medication misuse. Chronic PTSD has been shown to increase the risk of having a variety of health issues and decreased life expectancy. During the COVID-19 pandemic, the perception of the lethal threat of the virus has been associated with stress and trauma-related somatic symptoms. Third, an August 5, 2013 VA treatment record states "patient reports erratic sleep. Wakes up sore as if exercising." These three sources contextualize the Veteran's experience and explain Dr. B.B.'s opinion. Specifically, the Veteran experiences severe sleep disturbance. He has recurring, sudden bodily movements in response to re-experiencing the trauma occasioned by the PTSD when he sleeps. These movements, over time, have caused the diagnosed right hip disorder. Given the totality of the evidence, the Board finds this satisfies the third prong of a secondary service connection claim. The Veteran has satisfied all three prongs of a secondary service connection claim. Accordingly, the Board will grant the appeal. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Sopko, 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.