Citation Nr: 22017019 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 17-16 263 DATE: March 23, 2022 ORDER Entitlement to service connection for degenerative arthritis of the cervical spine is granted. FINDING OF FACT The Veteran's degenerative arthritis of the cervical spine began during active service. CONCLUSION OF LAW The criteria for entitlement to service connection for degenerative arthritis of the cervical spine have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from May 1984 to May 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in February 2019 and December 2021 when it was remanded for additional development. The matter is once again before the Board. Entitlement to service connection for a cervical spine disability The Veteran seeks service connection for a cervical spine disability that he contends had its onset during or otherwise was caused by service. In the alternative, he contends that the cervical spine disability was caused or aggravated by his service-connected lumbar spine disability. The Veteran's service treatment records show that in March 1990 the Veteran injured his neck in a motor vehicle accident and experienced neck pain. There was pain, but no sensory or motor issues. The provisional diagnosis is whiplash injury and ultimately diagnosed as cervical strain. In April 1990, the Veteran was seen for follow-up for cervical sprain that was resolving well. The Veteran continued to experience tightness of the mid-thoracic spine with lateral stretching. The impression was resolving sprain. In May 1992, the Veteran complained of sudden neck pain while shooting during a basketball game. He was noted to possibly have facet joint pain which may be muscular. The discomfort resolved in three days. Physical examination reports in 1988, 1991, and 1993 are silent for any back or neck symptoms or abnormalities. In March 1995, the Veteran reported discomfort to his upper back for two days after falling asleep in a chair. On examination, there was decreased range of motion of the neck with some discomfort noted. He was diagnosed with a strain. In a February 2000 Report of Medical History, the Veteran denied a history of recurrent back pain. A February 2000 Report of Medical Examination included a normal spine examination. In December 2000, he reported back pain for four days and was diagnosed with a muscle strain. In 2001, the Veteran again sought treatment for upper back problems. An October 2003 Report of Medical Assessment included the Veteran's report of back problems in 2000 and 2001 and that he had suffered intermittent back pain during service for which he had not sought treatment. On a November 2003 Report of Medical History, the Veteran reported a history of recurrent back pain which he specified was in the lower back. The Veteran described back problems for 3 years, for which he had received 2 weeks of physical therapy. A contemporaneous Report of Medical Examination, however, included a normal spine examination. After service, in July 2012, the Veteran reported right-sided neck tightness and pain with radiation down the right arm. He was in an accident "many years ago" affecting the neck. He denied recent trauma, numbness, tingling, changes in vision, or muscle weakness. He had not tried medication for pain. In May 2014, the Veteran reported neck pain and years of cervical strain status post 3 rounds of physical therapy. In June 2014, the Veteran reported neck pain with right upper extremity radiation that began in 2002, with worsening the past 2 years. He attributed the pain to heavy lifting and bending. Another June 2014 private treatment record included the Veteran's report of neck pain radiating into the shoulder for the past 15 years. The Veteran was provided with a VA neck examination in December 2014 where he reported that his neck pain began in the spring of 2000. The VA examiner noted diagnoses for a cervical strain in 1990 and mild degenerative arthritis. The examiner found that the Veteran's neck disability was less likely than not related to his service. The examiner reasoned that the Veteran's service injuries were muscular in nature and muscular irritations did not result in arthritis 20 years after the strain. Prior Board remands, however, have found this examination report inadequate. As such, further consideration is not warranted. A May 2016 letter from a private physician stated in its entirety, "After review of [the Veteran's] military medical records I have concluded that it is more likely than not that his current neck/back condition is related to conditions he was also given treatment for while serving on active military duty. His medical record does not contain Xray or MRI results for comparison." The Veteran's November 2016 notice of disagreement included his contention that the neck problems began in service while onboard ship working as an Information Technician. Work duties included running cables through overheads and other small tight spaces that required his back to torque in different angles. When the Veteran sought treatment during service, he was prescribed Motrin 3 times a day. However, he was not given a full examination until 2000 when a flight surgeon determined that the symptoms were due to the constant sitting at the server terminal working. Based on the foregoing, the Veteran concluded that his current neck problems were caused by his in-service difficulties. In his March 2017 substantive appeal, the Veteran stated, "While I was never diagnosed with a chronic condition, the evidence I presented shows numerous instances of cervical strain/mobility issues without a long term solution provided. Medicines were prescribed but never a long term a solution to my issues. The medical examiner without the presence or new information that was submitted would have made a correlation between my chronic back issues and the continuing issues after service. Section 3.309 lists arthritis as a Chronic disease and shall be granted service connection." The Veteran was provided with another VA neck conditions examination in December 2019 where he reported that his neck pain began in 1993. The VA examiner noted diagnoses for cervical strain and degenerative arthritis of the spine. The VA examiner found the Veteran's neck disability was less likely than not related to service. The examiner stated that the records did not reflect a continuity of care between the Veteran's service and his current diagnosis of arthritis as there was a "gap in complaints from 1991 to 2002." The prior Board remand also found this examination report inadequate. As such, further consideration is not warranted. An April 2021 MRI showed stable post cervical spondylosis with bilateral foraminal stenosis at C5-C6 and C6-C7. A December 2021 MRI showed degenerative changes of the cervical spine. The Veteran underwent a VA neck examination in January 2022. The examiner noted diagnoses of degenerative arthritis and right upper extremity cervical radiculopathy. The Veteran reported onset of symptoms in 1990 after injuring his back with subsequent onset of neck pain aggravated with sitting. He reported being treated with physical therapy and chiropractic manipulation. During active service he was seen at a hospital. The Veteran had difficulty turning his head to drive and had flare-ups of neck pain that made working difficult. Following examination, the examiner concluded that it was less likely than not that the claimed neck disability was proximately due to or the result of the Veteran's service-connected low back disability. The rationale indicated that medical literature noted that osteoarthritis traditionally was thought to be a disorder directly linked to "wear and tear," but now was believed to be the result of multiple factors. Factors included genetic predisposition, epigenetics, dietary changes, sex, ethnicity differences, muscle strength, physical activity, and work-related habits. Another study indicated, "As claimants age, the functional integrity of their spines deteriorates and predisposes claimants to degenerative changes as a result of the alterations in load-bearing forces." The examiner concluded that the medical literature demonstrated that degenerative arthritis of the cervical spine was caused by a number of factors, but that a lumbar spine disability was not a medically accepted pathophysiological pathway leading to the development of the cervical spine disability. As to aggravation, the examiner stated, "The sited medical literature shows that independent injury and the natural aging process / inflammation and physical activity or lack thereof would cause worsening of the veteran[']s cervical spine condition however a lumbar spine disability / lumbar strain would not cause further deterioration of the cervical spine strain or cervical arthritis which naturally continues to deteriorate due to the nature of the condition with aging." However, in another section of the report, the examiner did address the history of treatment in service with a supportive opinion as follows. It is at least as likely as not that any currently diagnosed cervical spine disability to include cervical degenerative arthritis is related to service. The complaints of neck pain and possible diagnosis of facet joint pain in May 1992 reported discomfort to the veterans upper back and diagnosis of a sprain in March 1995 and diagnosis of muscle strain in December 2000 and the November 2003 report of medical history with the veteran reported recurrent back pain has been reviewed. The veteran did suffer complaints of neck pain while in service and was seen for this condition multiple times while active duty and chronic inflammation from his cervical strain has caused limited range of motion leading to the development of cervical spine arthritis. The Board concludes that the Veteran has a current disability that began during active service or otherwise was caused by service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The evidence against the claim includes the VA examinations in December 2014 and December 2019 that have been found inadequate by previous Board determinations. As noted above, the January 2022 VA examination report provided a medical theory for many factors in the development of arthritis but also provided a supportive opinion as to whether the cervical spine disability had its onset in service or otherwise was caused by service. The opinion explained how the Veteran's multiple in-service treatment visits for neck problems manifestations of the degenerative arthritis were ultimately documented by diagnostic testing after service. The evidence in favor of the claim also includes the May 2016 private physician's opinion. That opinion was based on a review of the Veteran's in-service treatment records and concluded that his current neck problems were continuation of the manifestations of disability for which he was treated during service. The Board acknowledges that the opinion includes a limited rationale, but significantly did note the absence of in-service x-rays or MRIs for comparison. In addition, the Veteran has consistently reported a continuity of neck symptoms from service to the time of initial diagnosis. There is nothing in the record to contradict the Veteran's assertions. The Board finds the foregoing evidence the most probative evidence of record. (continued next page) The Board finds the weight of competent and credible evidence in favor of finding that the Veteran's current degenerative arthritis of the cervical spine had its onset during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for degenerative arthritis of the cervical spine is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 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.