Citation Nr: 25005133 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 20-09 927 DATE: April 16, 2025 ORDER Service connection for a neck disorder is denied. FINDINGS OF FACT 1. The Veteran did not have symptoms of a neck disorder during service. 2. There is no indication that the Veteran's neck disorder is related to service or was caused or aggravated by service-connected carpal tunnel syndrome (CTS). CONCLUSION OF LAW The criteria for service connection for a neck disorder have not been met. 38?U.S.C. §§ 1131, 5107; 38?C.F.R. §§?3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from July 1979 to July 1983. The case is on appeal from a March 2018 rating decision. In September 2023, the Board denied service connection for a neck disorder. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In May 2024, the Court granted a Joint Motion for Remand (JMR) vacating the Board's September 2023 decision. The case has now returned to the Board. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted on a presumptive basis for diseases listed in 38?C.F.R. §?3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38?C.F.R. §?3.307. Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Service connection for a neck disorder The Veteran maintains that symptoms of the current neck disorder onset during service and continued thereafter. In the alternative, she contends that the current neck disorder was caused or worsened by the service-connected CTS. The Veteran has been diagnosed with chronic neck pain and soft tissue tightness and has a history of cervical strain. Although she is diagnosed with arthritis, it is not shown to be related to the neck/cervical spine; therefore, presumptive service connection based on continuity/chronicity is not applicable to this case. Service treatment records (STRs) do not reveal any in-service complaints, reports, diagnoses, or treatment of neck problems. The Veteran received treatment for right wrist and hand pain and numbness at various times during service but had no accompanying neck symptoms. At the September 1981 service examination, the neck and spine were clinically normal. In September 1982, the Veteran specifically denied having neck (i.e., cervical spine) symptoms while being evaluated for right wrist and hand pain, and cervical spine X-rays were unremarkable. Therefore, the medical evidence does show an in-service neck injury, disease, or symptoms. The Board finds that the Veteran's current neck disorder is less likely than not related to service. The Veteran denied experiencing neck pain while seeking treatment for CTS in January 2002. The earliest report of neck pain in the record occurred in November 2005 when she reported to a VA medical provider that she had experienced neck pain since being involved in a 2004 (i.e., post-service) motor vehicular accident (MVA). The Veteran did not attribute her neck pain to service, nor is there any indication in these treatment records of neck pain dating back to service. Thus, the Veteran's statements of neck pain onsetting and continuing since service are inconsistent with the objective evidence of record and not credible. Rather, the evidence shows a 21-year gap between service and the onset of neck symptoms, which demonstrates that the Veteran's neck symptoms did not onset during service. Moreover, there is no competent medical opinion evidence linking the current neck disorder to service. In this case, no VA medical opinion was obtained addressing whether any incident, event, or symptoms during service caused the current neck disorder. However, no such opinion is needed because it would be based on the inaccurate factual premise of a neck injury or disease or neck symptoms during service, so it would be of no probative value. See Bardwell v. Shinseki, 24?Vet. App.?36 (2010) (holding that, where the Board makes a finding that lay evidence regarding an in-service event or injury is not credible, a VA examination is not required); see also Reonal v. Brown, 5?Vet. App.?458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise is not probative). As to secondary service connection, after review of the record and interview and examination of the Veteran, the January 2009 VA examiner opined that there was no relationship between the neck symptoms and the service-connected CTS. The January 2009 VA examiner reasoned that, by definition, CTS was a compression of the median nerve at the level of the wrist, and the pathophysiology of that process did not recognize any symptoms having to do with cervical spine (i.e., neck) or shoulder pain, weakness, etc. The January 2009 VA examiner had medical expertise and training as a neurologist, had accurate and sufficient facts and data as documented in the record, and provided sound rationale for the medical opinion. As such, the January 2009 VA medical opinion is of probative value. There is no contradictory opinion, and this evidence weighs against the appeal. The January 2009 VA examiner did not specifically address the question of secondary aggravation by the service-connected CTS; however, there is no competent evidence suggesting a link between the neck disorder and the service-connected CTS, so no medical opinion is needed on the question of secondary aggravation. See Waters v. Shinseki, 601 F.3d 1274, 1277-1278 (Fed. Cir. 2010) (concluding that a veteran's lay belief that his schizophrenia and anti-psychotic drugs to treat it had aggravated his diabetes and hypertension was not of sufficient weight to trigger VA's duty to seek a medical opinion on the issue); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). In the May 2024 JMR, the Court asked the Board to address a February 2020 VA treatment record in which the Veteran stated that she was still experiencing soreness and stiffness in the back of her neck and that she had experienced this pain ever since surgery. The Board notes that the entry shows that the Veteran underwent bilateral carpal tunnel release surgery in 2017. It is also acknowledged that the medical provider at that time indicated that the Veteran should return to the surgeon that performed the surgery for any potential post-surgical complications. However, as demonstrated by the record above, the Veteran's neck pain did not begin after her surgery. Rather, she had been having a tightness and tense feeling in her neck dating back to November 2005, at which time she reported having neck pain after a 2004 MVA. Further, the Board cannot discern from the Veteran's statement any indication that her neck pain had worsened. In fact, in the February 2020 entry, the Veteran stated that she had the same symptoms prior to her surgery. As such, the Board finds that the Veteran was reporting symptoms of continuing neck pain. While the Veteran is competent to describe symptoms of neck pain that she experienced, she does not have the requisite medical training to provide an opinion as to the etiology of her neck pain. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Rather, as stated above, the record demonstrates that symptoms of the Veteran's current neck disorder first onset many years after service separation, immediately after a post-service MVA. The competent lay and medical evidence persuasively shows the onset of neck symptoms occurring many years after service following a post-service MVA and shows no nexus relationship between the current neck disorder and the service-connected CTS on either a secondary causation or secondary aggravation basis. For these reasons, the Veteran's lay statements that the current neck disorder is the result of service or was either caused or worsened beyond the normal progression (aggravated) by the service-connected CTS are of no probative value. (Continued on the next page) ? As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. Service connection for a neck disorder is denied. 38 U.S.C. §?5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. George 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.