Citation Nr: A25035884 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 241011-483794 DATE: April 18, 2025 REMANDED Entitlement to service connection left upper extremity radiculopathy is remanded. Entitlement to service connection right upper extremity radiculopathy is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1999 to March 2019. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2023 rating decision issued by a Department of Veterans Affairs (VA) regional office, which is the Agency of Original Jurisdiction (AOJ) in this case. Although the Veteran initially requested Higher-Level Review when submitting the October 2022 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the November 2023 AOJ Supplemental Claim decision on appeal. 38?C.F.R. § 20.301. If evidence was submitted after the AOJ issued the Supplemental Claim decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. However, because the Board is remanding the service connection claims for right and left upper extremity radiculopathy, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). Service Connection - Right Upper Extremity Radiculopathy Service Connection - Left Upper Extremity Radiculopathy The Veteran asserts that service connection is warranted for right and left upper extremity radiculopathy. Specifically, he asserts that both conditions are a manifestation of or otherwise secondary to the service-connected lumbar spine disability. Of particular note, the record shows that service connection is in effect for both lumbar and cervical spine disabilities. The Veteran was afforded a VA Peripheral Nerves Conditions examination in March 2023. After an in-person examination and a review of the Veteran's claims file, the examiner twice noted a diagnosis for left upper extremity neuropathy. However, the examiner noted that the Veteran had radiculopathy symptoms attributable to a peripheral nerve condition in both upper extremities, and also reported that the Veteran had incomplete paralysis of the radial nerve in both upper extremities. As such, the Board finds that the VA examiner's report that the Veteran only had a diagnosis for left upper extremity radiculopathy was in error, and that a current diagnosis of radiculopathy is noted during the period on appeal for both upper extremities. Regarding etiology, the March 2023 VA examiner did not find a nexus between the Veteran's upper extremity radiculopathy and his lumbar spine condition, and explained that there is no medical literature that shows that arthritis in the lower back would cause upper extremity radiculopathy. An additional opinion regarding whether the upper extremity radiculopathy was secondary to the service-connected cervical spine disability was provided in July 2023, at which time the VA examiner explained that cervical radiculopathy was often caused by wear and tear changes that occur in the spine as one ages, such as arthritis. In younger people, it is most often caused by a sudden injury that results in a herniated disc, and in some cases, there is no traumatic episode that is associated with an onset of symptoms. However, other than checking the box to say it was "less likely than not" related to the cervical spine disability, the examiner did not provide a rationale as to why this particular Veteran's upper extremity radiculopathy was or was not related to his cervical spine disability. The Veteran was also afforded a VA examination for the cervical spine in March 2023. The examiner reported that the Veteran had a diagnosis for a cervical strain. However, in the "Diagnostic Testing" section, the examiner reported that an imaging study was not performed in conjunction with the examination. Instead, the examiner relied on a nearly 20 year old (December 2003) radiographic study that showed the Veteran had a normal cervical spine. The Board finds that the opinion regarding whether the upper extremity radiculopathy was secondary to the service-connected cervical spine condition is inadequate for adjudication purposes. In this regard, the examiner did not provide any rationale indicating why the Veteran's cervical spine disability did not or could not cause his upper extremity radiculopathy. The probative value of a nexus opinion comes from its reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, the VA examiner appears to have diagnosed the Veteran with a cervical strain, based on a nearly twenty-year-old X-ray report that showed a normal cervical spine. The examiner acknowledged that cervical radiculopathy could be caused by wear and tear changes, such as arthritis. However, there was no indication that the Veteran had been provided with radiographic imaging that could definitively ascertain whether the Veteran had arthritic changes in the cervical spine at the time of the examination. For this reason, the Board finds that the AOJ's reliance on the inadequate medical opinions to be a pre-decisional duty to assist error, such that remand is warranted. 38 C.F.R. § 20.802(a). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination, to include any relevant testing, in order to clarify whether the Veteran has a diagnosis for degenerative arthritis of the cervical spine. 2. Obtain an addendum medical opinion regarding the etiology of the Veteran's right and left upper extremity radiculopathy. The examiner should provide the following opinion: a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right and left upper extremity radiculopathy was caused by the service-connected cervical spine disability? Why or why not? b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right and left upper extremity radiculopathy was aggravated (made worse) by the service-connected cervical spine disability? Why or why not? (Continued on the next page) ? If aggravation is found, the examiner should identify the baseline level of severity of the right and left upper extremity radiculopathy by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the right and left upper extremity radiculopathy. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fu, 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.