Citation Nr: 23017644 Decision Date: 03/21/23 Archive Date: 03/21/23 DOCKET NO. 18-55 504 DATE: March 21, 2023 ORDER Entitlement to service connection for nerve damage affecting the right side of the face is denied. Entitlement to service connection for a neurological disorder of the right upper extremity, including radiculopathy, is denied. FINDINGS OF FACT 1. The Veteran does not have a nerve damage affecting the right side of the face. 2. The Veteran does not have a neurological disorder of the right upper extremity, including radiculopathy. CONCLUSIONS OF LAW 1. The criteria for service connection for nerve damage affecting the right side of the face have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for a neurological disorder of the right upper extremity, including radiculopathy, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1994 to August 2014. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a notice of disagreement in October 2016 and a statement of the case was issued in October 2018. The Veteran submitted a VA Form 9 in December 2018 and requested a video conference hearing before the Board. In April 2021, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. This matter was previously before the Board in April 2022, at which time the Board remanded the claims for further development. A review of the claims file shows that there has been substantial compliance with the Board's prior remand directives and thus, no further action in this regard is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). The RO issued a supplemental statement of the case in September 2022, and the case has returned to the Board for further appellate action. 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). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence showing that (1) a current disability exists and (2) the current disability was either (a) caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). 1. Entitlement to service connection for nerve damage affecting the right side of the face is denied. 2. Entitlement to service connection for a neurological disorder of the right upper extremity, including radiculopathy, is denied. The Veteran contends that he has a current disorder manifested by nerve damage on the right side of the face, and a current neurological disorder of the right upper extremity, which are both related to symptoms of numbness of the right side of the face and numbness and tingling of the right arm he experienced during active duty. He has reported that the nerve damage to the face is manifested by decreased sensation of the skin "located on the lower right mandible approximately from the mental to the ramus, extending upward to, and including, the right ear and the occipital portion of the right side on [his] head." See November 2015 Statement in Support of Claim. He also alleges that treatment for low back pain during active duty, which included the use of anti-inflammatories, masked the symptoms in his face and right upper extremity, which is why he was not properly diagnosed during service. See October 2016 Statement in Support of Claim, April 2021 Hearing Transcript. He also contends that lifting of heavy equipment and gear during active duty contributed to a current right upper extremity disorder. See April 2021 Hearing Transcript. Turning to the evidence of record, on a January 2008 post-deployment health assessment, the Veteran answered "yes" to experiencing numbness or tingling in the hands or feet during his deployment from July 2007 to January 2008. However, a December 2009 service treatment record (STR) clarified that the Veteran had an episode of left leg numbness which was attributed to wearing body armor during his deployment in 2007 to 2008. A January 2013 emergency room (ER) record noted that the Veteran presented to the ER complaining of numbness on the right side of his face while he was shaving approximately 2 hours ago. He also complained of tingling on the fingers of the right hand. Multiple tests were completed, including a complete blood count (CBC), a chemistry profile, a CT of the head, and an EKG. All were unremarkable. At the ER, the Veteran was feeling fine, and there was no weakness, incoordination, or speech difficulty. The Veteran was discharged and instructed to follow up with his physician in 24 hours and a neurologist in 1 week. The final diagnosis was "numbness on the right side of the face and tingling in the fingers of the right hand, likely secondary to transient ischemic attack." A January 8, 2013 STR noted that the Veteran reported that the previous day he went to the ER for right body numbness. The Veteran stated he received a CT scan without contrast and an EKG. He reported that both were normal. A neurology consultation was requested, and the Veteran was suspended pending results from the consultation. A January 2013 memorandum indicated that the Veteran was recommended for a medical suspension due to right sided face and arm numbness. A January 31, 2013 STR noted that the Veteran requested to be fit and cleared for numbness issues but reported that he was still experiencing intermittent numbness. A February 2013 STR noted that the Veteran endorsed a complaint of a less than 2-hour episode of transient numbness involving the right face noted when he was shaving. It further noted that the Veteran presented to the ER in January 2013, where he underwent a head CT without contrast, that was interpreted as normal. The note also indicated that the whole time the Veteran was in the ER, he was asymptomatic. The Veteran denied any prior history of TIAs (transient ischemic attack) or strokes. He denied any history of hypertension, diabetes, excessive alcohol or tobacco use that would imply risk factors for ischemic stroke. Segmental strength testing was 5/5 in the upper extremities. The STR further noted that as to the Veteran's concerns about the transient right facial numbness that occurred in January, they would proceed with an MRI of the brain without contrast and a carotid ultrasound. It noted that the Veteran's symptoms were not related to his chronic lumbar pain or paresthesias involving his right lower extremity. Rather, it was a single isolated episode with no further recurrence with no significant stroke risk factors. An April 2013 STR noted that the Veteran reported feeling fine. He reported that his facial and arm numbness had completely resolved and that an MRI of his neck and brain and ultrasound of his neck were all normal per neurology. An April 2013 memorandum noted that the Veteran reported he was no longer experiencing right sided face and arm numbness. He also reported he was evaluated and cleared by a neurologist and that he was ready to return to duties. The Veteran was medically recommended for fit and clear due to resolved numbness symptoms. An August 2013 pain clinic note indicated that a motor examination of the Veteran's upper extremities was normal. His upper extremity range of motion and upper extremity sensation were both normal. There was no swelling in the upper extremities. Tender points were present in the upper extremities. An October 2013 PRP medical records audit noted that in January 2013 the Veteran was on medical suspension due to face and arm numbness, and in April 2013, he was fit and clear and his numbness resolved. On a November 2013 retirement report of medical assessment, the Veteran reported that since his last medical examination, he had been treated for loss of feeling in the face. The examiner noted that in January 2013, the Veteran complained of right-side face numbness and right hand/finger tingling and was evaluated in the emergency room for a suspected transient ischemic attack. The examiner noted the Veteran did not have a stroke and his CT scan was negative. In February 2013, the Veteran was cleared by the neurology clinic. The examiner further noted that in April 2013, the Veteran reported he was no longer experiencing symptoms of right face or upper extremity numbness. At a December 2013 periodic military services physical, the Veteran reported that at the beginning of the year he went to the hospital for numbness in his face. He indicated that the tests at the hospital were unremarkable. A March 2014 STR noted that the Veteran's review of systems findings revealed no neurological symptoms. A March 2015 General Medical Disability Benefits Questionnaire (DBQ) reported no neurological conditions. In February 2016, the Veteran was afforded a VA examination. The Veteran reported that he continued to have symptoms of right sided facial numbness and tingling intermittently but that he had not pursued further evaluation or workup since his discharge. The Veteran also reported no functional limitations of his facial numbness and tingling. The VA examiner found that at that time, there was no objective diagnosis to attribute to the Veteran's subjective complaints of facial numbness. The examiner noted that a new brain MRI had been ordered to compare to the 2013 brain MRI and a cervical spine x-ray had also been ordered. The examiner indicated they would provide an addendum after the test results were available. The February 2016 cervical spine x-ray showed that there was degenerative disc disease at C5-C6 with anterior osteophytes and that there were degenerative changes in the facet joints of the cervical spine. There was no evidence of a fracture, and the cervical soft tissue planes were normal. Following the receipt of the cervical spine x-ray results, the February 2016 VA examiner provided an addendum opinion noting that the Veteran was still pending an MRI, but that as previously stated, there has not been a diagnosis determined for his claimed facial numbness. The examiner indicated that they would provide another addendum opinion after the brain MRI. In March 2016, the Veteran underwent a brain MRI. The results were essentially normal. The impression was a normal non-contrast MRI brain and no significant focal intracranial abnormality to account for the Veteran's symptoms. An April 2016 private treatment record indicated that the Veteran underwent an EMG and nerve conduction study for right upper extremity numbness and weakness. The impression was a mild abnormal EMG and nerve conduction study. The study showed the Veteran had possible cervical radiculopathy due to the increased insertion activity at cervical paraspinal muscle. It noted that the Veteran may need a cervical spine MRI for further evaluation. In June 2016, the February 2016 VA examiner provided an addendum opinion. The examiner indicated that there had been no clinical evidence to explain the complaints of facial numbness, and that the radiologist stated there was nothing seen on the MRI to explain the reported symptoms. The examiner also noted that right upper extremity radiculopathy would not be able to cause facial numbness or equivalent because it was not anatomically possible. The examiner reported that facial sensory and motor innervation come from the cranial nerves, not the spine. In September 2016, the Veteran submitted a copy of results from an August 2016 cervical spine MRI. The impression was unremarkable cervical cord with and without contrast, central bulging annulus at C5-6, and prominent cisterna magna versus posterior fossa arachnoid cyst. In December 2018, the Veteran submitted a letter written by his private physician, Dr. H. L. Dr. H. L. stated that the Veteran suffered from nerve damage of the dermis of the right side of his face, specifically the posterior mandible on the right side, the right ear, and the area approximately 2 to 3 inches away from the connecting point of the ear toward the back of the head. Dr. H. L. also reported the Veteran had sporadic right upper extremity radiculopathy. Dr. H. L. noted that an exam conducted while the Veteran was stationed at Minot Air Force Base showed some loss of sensation of the face, and by March 2014, it was noted that this issue had resolved. Dr. H. L. stated that during this time, the Veteran was suffering from a bulged disc in the L4-L5 area of the lower spine causing back pain and numbness in the right leg, and he was self-medicating with over-the-counter Naproxen to reduce pain and swelling of the disc to minimize numbness in his leg. Dr. H. L. further stated "it is very possible that the anti-inflammatory he was taking to reduce the swelling in his lower spine also reduced the swelling in his upper to the point of not noticing at the time of resolution" in March 2014. Dr. H. L. also indicated that a periodic exam was conducted in November 2013 for the Veteran's right upper extremity radiculopathy and attributed to a possible ischemic event, but a TIA was never fully determined, and the right upper radiculopathy was never properly diagnosed by health care providers at that time. Dr. H. L. noted that the report of radiculopathy was reported resolved in November 2013 and March 2014. Dr. H. L. stated that in April 2016, the Veteran was diagnosed by EMG with cervical radiculopathy and still suffers from the condition 2-3 times a month. Dr. H. L. indicated that the Veteran reports his symptoms are still present and presents about 2-3 times a month and that he also still reports numbness on the right side of the head. Dr. H. L. also noted that the Veteran still reports lower back pain related to bulging discs in the lumbar spine. Dr. H. L. opined that given that his lower right extremity radiculopathy and numbness of the right side of his head presented, he believes it is 50% more likely than not that these conditions were caused during military service, were not properly diagnosed due to issues seeming to resolve themselves and continue to affect the Veteran to this day with varying degrees of intensity multiple times a month. In January 2019, the Veteran was afforded another cranial nerve VA examination. At the VA examination, the Veteran reported numbness not on the face but behind the ear and jawline to the back of the right side of his head. He indicated that this was first noted in 2013 and that he was seen in the ER with a diagnosis of numbness of the right side of the face and tingling in the fingers of the right hand, likely secondary to transient ischemic attack. The Veteran reported a resolution of symptoms but that they reoccurred a few months later and had been intermittent since. He also described numbness in the area of C2 dermatome map. The examiner reported that the Veteran did not have a cranial nerve condition. Muscle strength and sensory testing were normal. A cranial nerve evaluation revealed that none of his cranial nerves were affected. The VA examiner concluded that there was no documentary, historical, or clinical evidence of a primary cranial nerve condition for the Veteran, and, therefore, an opinion regarding service connection was not warranted. In addition, in January 2019, the Veteran was afforded a cervical spine VA examination. The VA examiner noted that the Veteran had been diagnosed with less than 1mm central, bulging of the annulus on an August 2016 MRI. The VA examiner concluded that the EMG did not support a diagnosis of neuropathy and reported "possible cervical radiculopathy" with recommendation of cervical spine MRI if clinically indicated. The VA examiner noted that the cervical MRI did not show nerve root impingement or support radiculopathy. The examiner stated that Dr. H. L. indicated that the Veteran "suffers from nerve damage of the right side of his face, specifically the posterior mandible on the right side, the right ear, and area approximately 2 to 3 inches away from the connecting point of the ear toward the back of the head." However, the examiner noted that Dr. H. L. did not provide a specific diagnosis. The examiner stated that the Veteran did not have a diagnosis of right upper extremity radiculopathy or neuropathy and that the objective medical evidence did not support a diagnosis of right upper extremity radiculopathy or neuropathy. Thus, the examiner found that an opinion regarding service connection was not warranted. At his April 2021 video conference hearing before the Board, the Veteran reported that during his active service, he thought he had a stroke due to numbness on the right side of his head and tingling in his right arm. He indicated he went to the emergency room, and they did a CT scan, x-ray, MRI, and diagnostic testing and they were unable to find anything, so they ruled it off as a transient ischemic attack. The Veteran reported he did not have any problems shortly thereafter; however, he stated that occasionally, he would get shooting pains down his right arm that he attributed to muscle spasms or muscle pain and that the numbness would come and go. After he retired, he noticed it was getting a little worse and he sought treatment from his family doctor, who referred him to a neurologist. He reported that his neurologist said he had some slight bulging in the C4-C5 area of his cervical spine. The Veteran stated that he did not injure his neck specifically during service, but that he also had a lower spinal compression. He indicated that his family doctor said these could possibly be related. The Veteran reported he was receiving treatment in the form of anti-inflammatories and his physical therapist showed him techniques to help push the discs back in. The Veteran further reported that his numbness and tingling were constant. He stated that he had noticed his right ear did not have as much sensation as the left ear. He also stated that some nights he would wake up with his arm having "shooting pains." He reported that on some days, he lost the ability to grip his fingers on his right hand. He also stated that he was a registered nurse, and his right sided head numbness keeps him from turning his head all the way. He further reported that he had to be very cognizant if he was working with a patient and started feeling signs that his arm was about to go numb. In July 2022, the Veteran was afforded an in-person cranial nerve VA examination. The Veteran reported noticing a difference in the feeling to the right side of his face and head while on active duty, which persists to date, and was more noticeable at some times than others. He denied having a complete loss of sensation to the right side of his head/face but described it as a numbness when compared to the other side. The Veteran suspected that a pinched nerve in his neck may be the underlier. The VA examiner reported that the Veteran did not have a diagnosis of a cranial nerve disorder. Muscle strength and sensory testing were normal, and the examiner noted that none of the cranial nerves were affected. The VA examiner concluded that based on the evidence, the Veteran did not have a diagnosed neurological disorder, disease, or condition of the right side of the face upon which to base the current claim. The VA examiner cited to an UpToDate article about the trigeminal nerve and further stated as follows: This Veteran's symptoms have a strictly sensory presentation which is consistent with trigeminal neuropathy; however, the reported distribution of the subjective sensory reduction does not follow the characteristic distributions of the trigeminal nerve. Rather, as stated in the previous cranial nerve exam from 2019, a more diffuse "C2 dermatomal distribution" is noted which, in light of previously negative imaging studies and normal sensory exam findings, is non-specific for any underlying pathology. As stated above, the symptoms of neuropathy do NOT establish a diagnosis of neuropathy or other peripheral nerve conditions. That said, this Veteran's subjective symptoms are transient and non-limiting in nature, producing no functional impairment, and cannot be attributed to any known medical condition or diagnosis. The vaguely noted "nerve damage of the dermis of the right side of the face" stated by Dr. H. L. apparently attempts to describe the Veteran's subjectively reported symptoms but does not substantiate the presence of a diagnosed medical condition. In July 2022, the Veteran was also afforded an in-person peripheral nerve VA examination. The Veteran reported having numbness and tingling to the right arm between the shoulder and elbow with occasional involvement of the 4th and 5th fingers of the right hand. He reported the symptoms were intermittent, occur a few times a week to a few times a month, last a couple of hours a day, and were associated with neck stiffness and discomfort. He indicated he had imaging and EMG testing completed in or around 2016 and was told that he had some protruding discs in the neck for which he had physical therapy without significant improvement of progression. The VA examiner reported that the Veteran does not have a peripheral nerve condition or peripheral neuropathy. The examiner noted that the Veteran had symptoms of mild paresthesias and/or dysesthesias and mild numbness in the right upper extremity. Muscle strength and reflex testing was normal. A sensory examination revealed decreased sensation in the inner/outer forearm of the right arm, normal sensation in the right shoulder area, and normal sensation in the right hand/fingers. Special tests were indicated and performed for median nerve evaluation. Phalen's sign and Tinel's sign tests were positive for the right upper extremity. The radial nerve, median nerve, ulnar nerve, musculocutaneous nerve, circumflex nerve, long thoracic nerve, upper radicular group (5th and 6th cervical), middle radicular group, and lower radicular group were all noted as normal. The VA examiner indicated there was no functional impact of the Veteran's claimed condition. The VA examiner concluded that based on the evidence, the Veteran did not have a right upper extremity neuropathy or radiculopathy upon which to base the current claim. The VA examiner further stated as follows: [The Veteran] reports sensory symptoms of numbness and paresthesias to the upper arm/shoulder with occasional involvement of the 4th and 5th fingers (ulnar nerve distribution), while exam findings suggest a possible median nerve distribution. Previous MRI imaging of the cervical spine from 2016 noted a minimal disc bulge at C5-6, which does not correspond to the ulnar distribution of symptoms. Furthermore, current EMG testing was negative for evidence of radiculopathy or peripheral neuropathy of the median or ulnar nerves. There is, therefore, no objective evidence of a right upper extremity neurological condition to support or confirm a diagnosis for the conflicting right upper extremity symptoms/findings. The report by Dr. H. L. from 2018 which documents a sporadic right upper extremity radiculopathy falls within the spectrum of possibility given the diagnostic studies (such as EMG and MRI imaging) are not 100% sensitive in diagnosing mild disease. However, definitive confirmation of a cervical radiculopathy cannot be made at this time based on the currently available evidence. In August 2022, the Veteran underwent a VA physical medicine rehab consultation for evaluation of his right upper extremity symptoms. He described intermittent pain in the right lateral shoulder, which could be sharp, sometimes shooting, and some intermittent paresthesias right lateral arm and sometimes into the right ring and pinky digits. Muscle testing was 5/5 for the upper extremities. His reflexes were 1+ and symmetric. Hoffman's testing was negative bilaterally, and his tone was normal. His sensation was intact to light touch but diminished on the right shoulder and forearm. Nerve conduction studies were performed, and the Veteran's results were normal. A needle examination of selected right upper extremity muscles was performed, and the results were normal. The clinical assessment was normal right median and ulnar studies as noted, and no active or acute right C5-T1 radiculopathy by EMG. Correlation with imaging of the cervical spine was advised. Approximately one week later, in August 2022, the Veteran was afforded another peripheral nerves VA examination. The VA examiner noted a diagnosis of right upper extremity radiculopathy with a date of diagnosis of 2016. The examiner noted the Veteran had moderate intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the right upper extremity. Muscle strength testing and reflex testing for the right upper extremity were normal. The Veteran had decreased sensation in his right hand/fingers. Special tests were indicated and performed for median nerve evaluation. Phalen's sign and Tinel's sign testing were both negative in the right upper extremity. The VA examiner indicated there was mild incomplete paralysis of the right upper radicular group (5th and 6th cervical). The VA examiner also reported the Veteran's right upper extremity radiculopathy may limit tasks such as heavy lifting or grip and grasps of objects. The VA examiner noted that the Veteran's right upper extremity radiculopathy was a separate and unrelated condition to the Veteran's diagnosis of right lower extremity radiculopathy, because they were medically unrelated and were separate medical conditions. The VA examiner opined that the Veteran's right upper extremity radiculopathy less likely than not (50 percent or lesser probability) originated while the Veteran was servicing on active duty or is otherwise related to a disease or injury in service. After reviewing the opinions of record, including Dr. H. L.'s letter, the VA examiner indicated they were unable to determine that the acute episode of numbness and tingling in the right upper extremity in 2013 was related to the cervical radiculopathy in 2016 because the documentation shows that the right upper extremity numbness and tingling was acute and resolved. The examiner noted that the diagnosis in 2013 was noted to likely be related to TIA per the emergency department records, and the symptoms were noted to be resolved. The examiner further noted that the Veteran was not diagnosed with cervical radiculopathy until 2016 by Dr. H. L. and that the Veteran is not service connected for a cervical condition. The examiner indicated that a transient ischemic attack was transient and acute and resolves. The examiner noted that TIAs are clinically diagnosed based on symptomatology and that the imaging studies will often be negative for findings. The VA examiner cited to medical literature regarding the diagnosis and management of transient ischemic attacks as support. The examiner also stated that there were no known injuries found in the service records that may be related to the cervical radiculopathy. Finally, the examiner reported that the Veteran's service-connected bulging disc at L4 and L5 with degenerative disc and joint disease of the lumbar spine was a separate and unrelated condition to the cervical or right upper extremity radiculopathy. The examiner stated that the right lower extremity radiculopathy was a separate condition and is related to the back and not the neck. After reviewing the evidence of record, the Board finds that the evidence persuasively weighs against a finding that the Veteran has a disorder manifested by nerve damage of the right side of his face or a neurological disorder of the right upper extremity, including radiculopathy. The existence of a current disability is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Specifically, service connection requires a showing of a current disability. Here, the most probative evidence does not support a finding of nerve damage affecting the right side of the face or a neurological disorder of the right upper extremity at any point during the course of this appeal. As such, service connection on a direct basis for either claim cannot be established. In addition, service connection for the claimed right upper extremity radiculopathy as secondary to service-connected right lower extremity radiculopathy cannot be established without a finding of a current disability. As to the Veteran's service connection claim for nerve damage affecting the right side of the face, the Board assigns significant probative weight to the collective findings of the February 2016, June 2016, January 2019, and July 2022 VA examiners' findings that the Veteran does not have a nerve disorder. The Board finds the July 2022 VA examination particularly probative. The July 2022 VA examiner considered the medical evidence of record and the Veteran's lay statements, and the opinion is supported by well-reasoned rationale. Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-49 (2000). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board affords no probative weight to Dr. H. L.'s August 2018 opinion. Dr. H. L. stated that the Veteran suffers from nerve damage affecting the right side of his face, specifically the posterior mandible on the right side, the right ear, and the area approximately 2 to 3 inches away from the connecting point of the ear toward the back of the head. Although he described the Veteran's symptoms, he did not provide a diagnosis for the Veteran's symptoms. In addition, Dr. H. L. opined that the Veteran's numbness of the right side of his head was more than 50 percent likely than not incurred during his active service. However, his opinion is speculative, and he failed to provide adequate rationale. The Board notes that the Veteran is competent to report the symptoms he has experienced, including numbness of the face, and when he began experiencing such symptoms, and the Board finds his statements are credible. See Layno v. Brown, 6 Vet. App. 465 (1994). However, the Board finds that the medical evidence of record does not support a finding of a disorder manifested by numbness of the face, and, on his October 2016 Notice of Disagreement, the Veteran himself denied having a diagnosed disorder. As to the Veteran's claim for service connection for a neurological disorder of the right upper extremity, to include radiculopathy, the Board affords significant probative weight to the January 2019 and July 2022 VA examiners' findings that the Veteran does not have right upper extremity radiculopathy. The July 2022 VA examination is particularly probative, as the VA examiner's opinion is based upon a thorough review of the record and is supported by adequate rationale. The Board affords no probative weight to the August 2022 VA examiner's finding that the Veteran has right upper extremity radiculopathy. The VA examiner indicated that the date of diagnosis was 2016; however, the EMG results in April 2016 only found that the Veteran had "possible cervical radiculopathy." Notably, the Veteran underwent a VA physical medicine rehabilitation consultation one week prior to his August 2022 VA examination, and the EMG conducted did not find active or acute right C5-T1 radiculopathy. However, the Board affords probative weight to the August 2022 VA examiner's opinion that the Veteran's January 2013 in-service transient ischemic attack was acute and resolved. The examiner's findings are consistent with the service treatment records, which found that the Veteran's in-service numbness and tingling resolved by April 2013. Overall, the medical evidence of record supports that the Veteran's in-service TIA was acute and that he does not have a neurological disorder of the right upper extremity, to include radiculopathy. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board affords no probative weight to Dr. H. L.'s August 2018 opinion. Dr. H. L. stated that the Veteran was diagnosed by EMG with cervical radiculopathy in April 2016. However, this assertion is not supported by the medical evidence, as the April 2016 EMG results simply stated that the Veteran had "possible cervical radiculopathy." In addition, Dr. H. L. failed to provide adequate rationale for his opinion that the Veteran's claimed right upper extremity radiculopathy incurred during his military service. The Board notes that the Veteran is competent to report the symptoms he has experienced, including numbness and tingling of his right upper extremity, and when he began experiencing such symptoms, and the Board finds his statements are credible. See Layno v. Brown, 6 Vet. App. 465 (1994). However, the Board finds that the most probative evidence of record does not support a finding of a neurological disorder of the right upper extremity, including radiculopathy. Based on the foregoing reasons, the Board finds that service connection is not warranted. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence of record persuasively weighs against the claims and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021). Accordingly, the claims are denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Bruce, 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.