Citation Nr: 22018733 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 17-34 062 DATE: March 30, 2022 ORDER The claim for entitlement to service connection for left upper extremity radiculopathy, including as secondary to the service-connected cervical spine disorder is granted. The claim for entitlement to service connection for right upper extremity radiculopathy, including as secondary to the service-connected cervical spine disorder is granted. FINDINGS OF FACT 1. According the Veteran all benefit of the doubt, left upper extremity radiculopathy is the etiological result of the service-connected cervical spine disorder. 2. According the Veteran all benefit of the doubt, right upper extremity radiculopathy is the etiological result of the service-connected cervical spine disorder. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left upper extremity radiculopathy secondary to service-connected cervical spine strain have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for right upper extremity radiculopathy secondary to the service-connected cervical spine strain have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from June 2000 to June 2014. Service records further show that she served in the southwest Asia theater of operations. The issues of service connection for left and right upper extremity radiculopathy come to the Board of Veteran Appeals (Board) from a January 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran indicated she wished to testify before the Board in her May 2018 substantive appeal, and selected the option of testifying before a Veterans Law Judge by video teleconference from her local RO. In April 2021, the Veteran testified before the undersigned Veterans Law Judge. However, the issues of service connection for bilateral upper extremity radiculopathy were determined not to be within the Board's jurisdiction at that time, and thus no testimony concerning these issues was taken. Subsequently, the Veteran was given another opportunity to testify before a Veterans Law Judge. In January 2022, the Veteran's attorney declined the opportunity to testify and withdrew her request to have another hearing before the Board. The Board finds it may proceed with the issues of service connection for left and right upper extremity radiculopathy. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition, a disability that is the etiological result of a service-connected disability shall also be service connected. 38 C.F.R. § 3.310. In the case of secondary service connection, the second element of Shedden is the service-connected disability; and medical evidence of a nexus, or causal link, between the service-connected disability and the claimed disability is required. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). The Veteran contends that she is diagnosed with left and right upper extremity radiculopathy that is the result of her service-connected cervical spine disorder. The medical evidence supports her contentions. VA and private treatment records reflect the Veteran was found to exhibit signs and symptoms consistent with cervical radiculopathy from 2018, and private treatment records show cervical radiculopathy was diagnosis in 2019, 2020, and 2021. See CAPRI treatment records (rec'd 4/3/2018), pp 2-4; Medical Treatment Record Non-Government (rec'd 2/16/2022 and 2/17/2022); Appellate Brief (rec'd 2/16/2022). In addition, service connection for cervical strain secondary to the service-connected bilateral shoulder disorders was granted in a December 2016 rating decision effective in September 2016. This meets the first and second elements for service connection under Holton. In 2018 the VA examiner opined the claimed left and right upper extremity radiculopathy was less likely than not the result of the service-connected cervical spine disorder. As rationale, the examiner explained that nerve conduction studies and electromyography conducted during active service in 2013 resulted in normal findings. Moreover, the examiner explained that no signs or symptoms of radiculopathy were observed during the 2018 VA Examination. However, the 2018 VA examination was conducted in January 2018. In April 2018, VA treatment records were received including an entry dated in February 2018 which document findings of signs and symptoms of cervical radiculopathy. In February 2022, the Veteran's attorney submitted private treatment records showing continued symptoms and diagnoses of cervical radiculopathy in 2019, 2020, and 2021. As these records were not present in the claims file at the time of the 2018 VA examination, the 2018 VA examination cannot provide an adequate basis upon which to decide this claim. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Service treatment records show no reports, defects, abnormalities, or other findings concerning the Veteran's upper extremities on report of medical history and examination prior to entry to active service in 2000. Service treatment records do show treatment for pain, tingling and numbness in the upper extremities in 2010 and 2013 during active service. In 2013, she was prescribed Neurotonin for her symptoms. Cervical radiculopathy was considered in 2013 but, as noted above, clinical findings did not confirm the diagnosis. In fact, cervical radiculopathy is not shown as a diagnosis again until 2019. VA treatment records show she had been prescribed Gabapentin by a private treating physician in 2014, and that she continues to be prescribed Gabapentin by VA health care providers. In sum, the medical evidence documents the Veteran reported and was treated for bilateral upper extremity pain, tingling, and numbness during active service, these symptoms persisted during service and after her discharge in 2014 to the post service diagnosis of cervical radiculopathy in 2019, 2020, and 2021. VA and private health care providers have associated her signs and symptoms of bilateral upper extremity radiculopathy with her service-connected cervical spine disorder; and beginning in 2019, she has been diagnosed with cervical radiculopathy with observed left and right upper extremity symptoms including biceps tendon spasms. The Veteran has provided her statements that her left and right upper extremity pain, tingling and numbness had their onset during active service and have persisted to the present. The Veteran is competent to attest to those symptoms that are observable to the lay witness. See Layno v. Brown, 6 Vet. App. 465 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In addition, the medical evidence provides observations of and documented treatment for these symptoms beginning in 2013 and continuing to the present. The observations of symptoms of pain, tingling, and numbness in the left and right upper extremities associated with cervical radiculopathy in 2019, 2020, and 2021 corroborate the Veteran's assertions. Given the diagnosis of cervical radiculopathy tends to establish the diagnosed left and right upper extremity radiculopathy is causally linked to the service-connected cervical spine disorder, the Board finds the evidence concerning service-connection for left and right upper extremity radiculopathy to be, at the least, in equipoise. According the Veteran all benefit of the doubt, the third element under Holton is met. The claim for entitlement to service connection for left and right upper extremity radiculopathy as the result of service-connected cervical strain is granted. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bakke, Lila J. 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.