Citation Nr: 22014834 Decision Date: 03/15/22 Archive Date: 03/15/22 DOCKET NO. 16-38 399 DATE: March 15, 2022 REMANDED Service connection for a cervical spine disability is remanded. Service connection for a left upper extremity radiculopathy, as secondary to a cervical spine disability, is remanded. REASONS FOR REMAND The Veteran served on active military service from November 1988 to May 1991, to include service in Southwest Asia. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The appeal was remanded in June 2019 for additional development. It has since been returned to the Board for further appellate consideration. In an October 2020 rating decision, the RO granted service connection for ischemic optic neuropathy, right eye, effective May 22, 2014. Accordingly, this issue is no longer for Board consideration. 1. Service connection for a cervical spine disability is remanded. The Board regrets the delay, however additional development is required prior to adjudicating the claim for a cervical spine disability. Remand is required to obtain an adequate VA examination and opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran received an August 2020 VA examination. The examiner opined the Veteran's neck disability is not etiologically related to service, to include as due to exposure to environmental hazards in southwest Asia. In doing so the examiner again failed to address the Veteran's lay statements and/or contentions regarding onset and continuity of his symptoms, as well as the service treatment records (STRs) which document complaint and treatment for back pain during active service. In his August 2016 substantive appeal (VA Form 9) the Veteran asserted his neck and arm nerve damage were caused by the countless ditches he hit at high speeds while driving the Bradley. Further supporting the Veteran's contention is an April 1990 STR that documents the Veteran was treated for back pain after hitting a hard barrier while driving a "Bradley." The treatment provider noted the Veteran had a history of trauma and following the accident the areas of concern were the T1-T3 vertebrate. Through his representative the Veteran argues, "the T1 and T2 (top two thoracic nerves) feed into nerves that go into the top of the chest as well as into the arm and hand. T3, T4, and T5 feed into the chest wall and aid in breathing." See June 2019 Appellate Brief. Accordingly, remand is required. 2. Service connection for a left upper extremity radiculopathy, as secondary to a cervical spine disability is remanded. Remand is required as this issue is intertwined with other issue being remanded. A June 2014 private treatment letter from Dr. M. indicates that the Veteran was treated for left shoulder pain that ended up being related to his cervical spine disability. Thus, the left upper extremity disability claim must be remanded as it is inextricably intertwined with the cervical spine issue being remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). Moreover, the August 2020 VA examiner determined there was no diagnosis of a left arm disability. However, a February 2012 private treatment record documents a diagnosis of radicular syndrome of the upper left limb. Also, the June 2015 VA examination documents radiculopathy into the left arm. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disability on appeal. 2. Following the receipt of any outstanding records, schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and likely cause of any cervical spine disability. The Veteran's entire claims file, to include a copy of this remand, should be provided to the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. Following a complete review of the record, the examiner is asked to provide the following opinion: Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed cervical spine disability had onset in, or is otherwise related to active military service, to include his exposure to environmental hazards in Southwest Asia or his reported trauma while driving the Bradley. See August 2016 VA Form 9. 3. If the examiner finds that the Veteran has a cervical spine disability related to service, the examiner must determine and identify any diagnosis of left upper extremity radiculopathy. If there is no diagnosis of a left upper extremity radiculopathy, the examiner must address the diagnosis of recorda February 2012 private treatment record documents a diagnosis of radicular syndrome of the upper left limb, and the June 2015 VA examination documents radiculopathy into the left arm.. See December 2005 to June 2014 private treatment records and June 2015 VA examination report. The Veteran's entire claims file, to include a copy of this remand, should be provided to the examiner. Following a complete review of the record, the examiner is asked to provide the following opinion: Whether it is at least as likely as not (50 percent or greater) that any diagnosed left upper extremity radiculopathy is caused or aggravated by the cervical spine disability. 4. In addressing the above, the examiner must consider and discuss all pertinent medical and lay evidence of record, to include competent, lay assertions as to the nature, onset, and continuity of symptoms. If lay assertions in any regard are discounted, the examiner should clearly state, and explain why. All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, Associate 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.