Citation Nr: 22017937 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 16-10 580 DATE: March 27, 2022 REMANDED Entitlement to service connection for radiculopathy of the bilateral upper extremities, to include on a secondary basis, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1977 to February 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO), which, among other things, denied service connection for radiculopathy of the upper extremities. In June 2015 the Veteran filed a notice of disagreement (NOD) and in December 2015 the RO issued a statement of the case (SOC). In January 2016 the Veteran timely filed a substantive appeal to the Board (via VA Form 9). In July 2018 the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In August 2021 the Board remanded the Veteran's claim to determine the etiology of his bilateral upper extremity radiculopathy. Unfortunately, another remand is warranted for an additional medical opinion. The Board regrets the additional delay. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310(a),(b). Entitlement to service connection for radiculopathy of the bilateral upper extremities, to include on a secondary basis, is remanded. In November 2021 a VA examiner evaluated the Veteran's radiculopathy and determined that she did not have a current disability. However, the VA examination was conducted utilizing a thoracolumbar spine (back) disability benefits questionnaire (DBQ). On the February 2022 informal hearing presentation (IHP), the Veteran's representative argued that she should be provided another VA examination which specifically evaluates her cervical spine. The Board agrees that another VA examination is warranted. Further, the November 2021 VA examiner did not address a January 2015 VA treatment note which indicated that the Veteran experiences chronic neck pain with radicular symptoms. In this regard, a diagnosis is not required to meet the current disability requirement and pain can constitute disability if it causes impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). Therefore, the November 2021 VA examination is inadequate, and another remand is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: Request an opinion from an appropriate clinician to determine the etiology of the Veteran's bilateral upper extremity radiculopathy. If a VA examination is deemed necessary, one should be conducted, to include via telehealth if appropriate. The clinician should first indicate whether there is a diagnosis of radiculopathy of the upper extremities. If there is no diagnosis, the clinician should indicate whether there are symptoms of the upper extremities causing impairment in earning capacity. Then, the clinician should indicate whether it is approximately at least as likely as not (approximately 50 percent or greater) that any disability, either a diagnosis or symptoms causing impairment in earning capacity, of the upper extremities had its onset in service or is otherwise related to an in-service injury, disease, or event. The clinician should also opine whether any disability, either a diagnosis of symptoms causing impairment in earning capacity of the upper extremities is either (i) caused or (ii) aggravated by her service-connected cervical spine disability or any other service-connected disability. If aggravation is found, the baseline of the Veteran's radiculopathy of the upper extremities prior to aggravation should be identified, if possible. The clinician should acknowledge the January 2015 VA treatment note which indicated that the Veteran experienced chronic neck pain with radicular symptoms. The clinician should review the claims file prior to rendering the opinion and a complete rationale should accompany each opinion provided. The clinician is advised that the Veteran is competent to report symptoms and treatment, and that her reports must be taken into account in formulating the requested opinion. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Miller, 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.