How the Board ruled on neck (cervical spine) claims, 2021–2025

Neck (cervical spine) (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

44.7% granted of 3,686 decided cases (margin of error 43.1–46.3%). 1,646 granted, 2,040 denied, 5,088 sent back to VA (remanded, not decided), 607 dismissed.

What convinced the Board in granted cases

• The Board granted when service records showed neck complaints or an in-service injury, such as a vehicle accident, fall or heavy lifting, and the veteran credibly reported neck pain continuing since service. (14 of 22 decisions read; e.g. 21037301, 24007840, A24013672)
• Negative VA opinions were given little or no weight when they ignored the veteran's reports of continuous symptoms, relied only on a lack of records, were vague, or rested on wrong facts, such as missing an in-service neck complaint. (9 of 22 decisions read; e.g. A23021919, 21060872, 21055772)
• Private physician opinions were favored or put the evidence in balance when they reviewed the records (one went back to 1981), relied on an accurate history and the veteran's consistent reports, explained how the in-service injury led to the current condition, or came from a relevant specialist. (8 of 22 decisions read; e.g. A21006946, A24001567, 23041646)

Common reasons in denied cases

• The Board found no current diagnosed neck disability, or no neck pain causing functional impairment, during the appeal period. (7 of 18 decisions read; e.g. A24015774, 21042970, 23005605)
• A VA opinion found persuasive pointed to the first neck complaint coming many years after service, a post-service accident, years of strenuous civilian work, or normal aging. (6 of 18 decisions read; e.g. A21012729, 21067235, 21040463)
• The Board found no credible in-service neck injury, or no competent medical opinion linking the neck to service. A private opinion that mixed up the conditions it addressed was given no weight. (6 of 18 decisions read; e.g. 23010795, 21070974, 21062903)

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Neck (cervical spine) (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

16.7% granted of 36 decided cases (margin of error 7.9–31.9%). 6 granted, 30 denied, 71 sent back to VA (remanded, not decided), 1 dismissed.

Common reasons in denied cases

• The Board denied when thorough VA opinions found no link to service or exposure and went unrebutted; a private opinion lost weight because its author did not review the service records. (5 of 13 decisions read; e.g. 21035980, 23019747, 22011396)
• Most denials noted no neck injury or complaints in service and neck problems first documented years or decades later, with no continuity of symptoms. (7 of 13 decisions read; e.g. 21035980, 23001107, 21072809)
• Exposure was not shown or the cited literature did not support a link, and the veteran's own belief was not competent to diagnose or link the condition. (3 of 13 decisions read; e.g. 21053347, A21004054, 21000812)

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Neck (cervical spine) secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

36.4% granted of 379 decided cases (margin of error 31.7–41.4%). 138 granted, 241 denied, 894 sent back to VA (remanded, not decided), 24 dismissed.

What convinced the Board in granted cases

• The Board credited opinions explaining how the service-connected condition led to neck problems, such as posture changes, connected spinal structures, altered gait, or a fall, often citing literature. (6 of 12 decisions read; e.g. A24048345, 23004132, A25005921)
• Negative VA opinions lost weight when vague, not specific to the veteran, reliant on a lack of records, or silent on the actual theory raised. (4 of 12 decisions read; e.g. A24042349, A24021543, 21044706)
• Credible statements from the veteran and family about neck pain continuing since service supported grants. (3 of 12 decisions read; e.g. 22060970, 22041875, 21069907)

Common reasons in denied cases

• Reasoned VA opinions found the neck condition was not caused or worsened by the service-connected condition or service, and no competent contrary opinion existed. (9 of 10 decisions read; e.g. 21014701, 22051093, 21014346)
• The Board found another cause more likely, such as aging and wear and tear, or separate neck injuries. (4 of 10 decisions read; e.g. 21014701, 22051093, 21014346)
• The veteran's own belief that one spine condition caused another was not competent medical evidence. (4 of 10 decisions read; e.g. 21014701, 21028619, 21026035)

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Neck (cervical spine) secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

36% granted of 125 decided cases (margin of error 28.1–44.7%). 45 granted, 80 denied, 302 sent back to VA (remanded, not decided), 8 dismissed.

What convinced the Board in granted cases

• The Board credited opinions that explained how the low back problem led to neck damage, such as altered gait or movement, poor posture and alignment, extra load on the rest of the spine, or falls caused by the back condition. (10 of 19 decisions read; e.g. 24017883, A24017902, 21057721)
• Negative VA opinions lost weight when they addressed only direct causation and not aggravation or the effects of the back condition (gait, falls), or when they conflicted with imaging or other records. (7 of 19 decisions read; e.g. 21059148, 21057721, A24017902)
• Favorable opinions, often private, were given more weight when they reviewed the record and backed the conclusion with medical literature applied to the veteran's own facts. (6 of 19 decisions read; e.g. 21059148, A24045391, 22055175)

Common reasons in denied cases

• A detailed VA opinion found the neck condition came from aging, wear and tear, or the neck itself as a separate part of the spine, and nothing of equal weight rebutted it. (9 of 15 decisions read; e.g. 21035027, 23000070, 21029481)
• The only support was the veteran's own belief, general articles not applied to the veteran's case, or a private opinion that said the back 'may well' have contributed. (6 of 15 decisions read; e.g. 21029481, A24005628, A24014376)
• On aggravation, the examiner found the neck had not worsened beyond its natural progress, for example because imaging was similar over time. (4 of 15 decisions read; e.g. 23000070, 21014346, 21028619)

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Neck (cervical spine) secondary to shoulder

Secondary (caused or worsened by a service-connected condition)

34% granted of 47 decided cases (margin of error 22.2–48.3%). 16 granted, 31 denied, 94 sent back to VA (remanded, not decided), 4 dismissed.

What convinced the Board in granted cases

• Private opinions won when they explained how the shoulder condition strains the neck, such as altered biomechanics or compensating muscle spasm, and were based on the records, exam findings, or medical literature. (6 of 11 decisions read; e.g. A21008774, 21047479, 22021602)
• Negative VA opinions lost weight when they addressed only direct service connection, mixed up direct and secondary reasoning, answered the reverse question, or ignored the veteran's account of in-service neck pain. (5 of 11 decisions read; e.g. 22021602, A24030573, 23054183)
• In some grants, no probative medical opinion contradicted the favorable evidence linking the neck to the shoulder. (2 of 11 decisions read, few decisions; e.g. A23001486, A24070539)

Common reasons in denied cases

• Reasoned VA opinions went unrebutted when they explained the shoulder is anatomically separate from the neck, or that neck changes came from aging or separate neck injuries. (6 of 12 decisions read; e.g. 21015425, 23036433, 22015121)
• The veteran's own belief that the neck was linked to service or the shoulder was not competent medical evidence, and in one case his account was found not credible. (3 of 12 decisions read; e.g. 21000390, 22015121, 21054876)

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Neck (cervical spine) secondary to knee

Secondary (caused or worsened by a service-connected condition)

16.7% granted of 30 decided cases (margin of error 7.3–33.6%). 5 granted, 25 denied, 72 sent back to VA (remanded, not decided), 0 dismissed.

What convinced the Board in granted cases

• The Board granted when a fall caused by the service-connected knee injured the neck, and a medical opinion (a private doctor or nurse practitioner) supported that link. (2 of 3 decisions read, few decisions; e.g. 21069612, 21066958)

Common reasons in denied cases

• The Board most often denied when thorough VA opinions found no medical link between the knee and the neck, such as that arthritis does not spread joint to joint, and no opinion rebutted them. (6 of 13 decisions read; e.g. 21040892, 21003905, 23047575)
• The Board denied when the only support was the veteran's own belief, or a reported doctor's comment that was conclusory, gave no rationale, and did not appear in the records. (4 of 13 decisions read; e.g. A24040820, A22005364, 21027470)
• The Board denied when the evidence pointed to other causes, such as post-service accidents, heavy lifting at work, or ordinary wear on the neck. (3 of 13 decisions read; e.g. 21054924, 21056656, 23025237)

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Neck (cervical spine) secondary to foot (flat feet / plantar fasciitis)

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 2 granted, 8 denied, 23 sent back to VA (remanded, not decided), 0 dismissed.

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