Citation Nr: 22016930 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 17-55 808 DATE: March 23, 2022 ORDER Entitlement to a service connection for a cervical spine disability, to include as secondary to a service-connected right or left shoulder disability, is denied. FINDING OF FACT The Veteran's cervical spine disability is not secondary to service-connected bilateral shoulder disabilities and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for cervical spine disability due to service or bilateral shoulder disabilities are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1975 to August 1997. This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case has been before the Board three times before. In December 2019 this issue was remanded to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board sought an opinion on secondary service-connection and aggravation. It was then sent back to the Board in April 2020 and was again remanded this time for an addendum VA medical opinion. The case was returned to the Board in September 2020 and was again remanded in order to obtain a Supplemental Statement of the Case (SSOC). However, the SSOC had been issued the day before the Board remand. A VA memo from September 2020 as well as a VA From 8 from October 2020 confirmed that the remand directives of the September 2020 Board remand had already been undertaken and the case could be returned to the Board for further appellate action. Service Connection Cervical Spine Disability The Veteran contends that his cervical spine disabilities are related to his service-connected bilateral shoulder disabilities. For the reasons explained below, the Board finds that the entitlement to service connection is not warranted. Service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. 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. Allen v. Brown,7 Vet. App. 439, 448 (1995) (en banc). Here, the Veteran has been diagnosed with various cervical spine disabilities so part one is satisfied. Numerous VA examinations have been undertaken to determine part two. In a January 2020 VA examination that the Veteran hurt his back/neck while lifting a heavy object in 1977. The Veteran's service treatment records (STRs) contain complaints of cervical/neck pain. In September 1996 the Veteran was diagnosed with a cervical strain. The pain was not constant. The STRs also contain other complaints of neck pain. In October 2000, the Veteran complained of right shoulder pain as well as a tingling, numbness, and pain in the neck. Following a series of additional complaints related to both the Veteran's shoulders and his cervical spine an MRI was ordered. A cervical spine MRI was completed in February 2015. This found multilevel cervical spondylosis with canal and neural foraminal stenoses as well as mild developing narrowing of the spinal canal which contributed to central stenosis. Following this MRI, the Veteran underwent a VA examination in February 2015. The Veteran was examined and diagnosed with degenerative disc disease and degenerative arthritis of the neck. Intervertebral disc syndrome was also noted. However, no incapacitating episodes were found. The Veteran's range of motion (ROM) was measured and ultimately the examiner found all to be normal for the Veteran's age. The examiner concluded that the Veteran's degenerative disc disease was likely age related. In March 2015 the Veteran was diagnosed with cervical radiculopathy. A June 2015 assessment of the Veteran's cervical spine resulted in a finding of cervical stenosis and cervical spondylosis. In March 2017 the Veteran underwent decompression and fusion surgery of the cervical spine. No complications were indicated. A second VA examination was completed in November 2020. The examiner found that the Veteran's medical records did not document any chronic and ongoing cervical spine issues that could serve as a nexus. The 1996 in-service cervical strain was acute and unrelated to the Veteran's current cervical spine symptoms. The examiner could find no medical basis for connecting the Veteran's bilateral shoulder disabilities to his cervical strain. Nor could any medical basis be found to justify a finding of aggravation of the cervical spine based upon the bilateral shoulder disabilities. While the examiner noted that there was no medical basis the examiner did not provide a more extensive rationale. The examiner also noted a negative direct service-connection opinion. This lack of explanation was the basis for the April 2020 Board remand. Following the Board remand, a new VA examination was completed in August 2020. The examiner went into greater detail regarding the Veteran's cervical spine conditions. The examiner found that the spondylitic and degenerative changes were chronic conditions and were not caused by one specific event such as any of the Veteran's service-connected disabilities, to include the bilateral shoulders. While the cause of spondylosis has not been well defined, the examiner states that aging is an important factor. All of the Veteran's cervical spine conditions are multifactorial in nature and due to a complex interplay between mechanical, cellular, and biomechanical factors which lead to the current pathology. The examiner further explains his finding by noting that there is no peer-reviewed medical literature or authority that supports a causative relationship between the Veteran's cervical disabilities and his bilateral shoulder disabilities, or any other service-connected disabilities. Additionally, no evidence of aggravation was found. While it was true that the Veteran's neck and shoulders were often treated at the same time the examiner explained that this can often be due to the anatomical location of the complaints. The shoulder disabilities could lead to possible exacerbation of the cervical spine but that this exacerbation would not result in a permanent aggravation beyond the normal progression of any of the cervical spine disabilities. The most recent Board remand required that the AOJ review all evidence and that an SSOC be issued. The SSOC was issued one day prior to the most recent Board remand as noted above. Therefore, the Board considers the remand directives of the September 2020 Board remand to be fulfilled and the issue is ripe to be decided. The Board finds that the August 2020 medical opinion is adequate. In this regard, the examiner thoroughly reviewed and discussed the relevant evidence, considered the contentions of the appellant, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As there is no medical opinion of record to the contrary, the August 2020 VA medical opinion is the most probative evidence of record. The August 2020 examiner opined against an etiological relationship between the Veteran's claimed disability and a service-connected disability. Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the weight of the evidence is against the claim, and entitlement to service connection for a cervical disability is not warranted. 38 U.S.C. § 5107 (b) (2018 Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). L. Baskerville Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.