Citation Nr: 0811119 Decision Date: 04/03/08 Archive Date: 04/14/08 DOCKET NO. 03-10 144 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUE Entitlement to service connection for a bilateral shoulder disorder, claimed as secondary to service-connected disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert E. P. Jones, Counsel INTRODUCTION The veteran served on active duty from November 1944 to November 1945. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office in Winston-Salem, North Carolina. A September 2005 Board decision granted the veteran's claims for service connection for degenerative changes of the left knee and lumbar spine. This decision also remanded the veteran's claim for service connection for a bilateral shoulder disability. The veteran's bilateral shoulder claim was again remanded by the Board in October 2007. This case has been advanced on the Board's docket under 38 U.S.C.A. § 7107 (West 2002) and 38 C.F.R. § 20.900(c) (2007). FINDING OF FACT The veteran has a bilateral shoulder disability that is secondary to his service-connected knee and back disabilities. CONCLUSION OF LAW A bilateral shoulder disability is proximately due to service-connected disability. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran claims that he should be granted service connection for a bilateral shoulder disorder as secondary to his service-connected knee and back disabilities. At a July 2003 hearing before a hearing officer, and at September 2005 and March 2008 hearings before Veterans Law Judges, the veteran reported that he has a hard time getting up from a seated position due to his service-connected back and knee disabilities. The veteran asserted that he has to use his shoulders to help pull himself up from a seated position. The veteran maintains that he now has bilateral shoulder disability due to the strain of having to pull himself up from a seated position so often. He testified that several doctors have told him that this is the cause of his bilateral shoulder disorder. The veteran's service medical records do not show that the veteran had any complaints or treatment relating to either shoulder. Post service medical records reveal complaints related to the shoulders beginning in July 2002, at which time the veteran complained to a private chiropractor of left shoulder pain. In a July 2002 letter, the chiropractor stated that the veteran's most recent complaint was bilateral shoulder pain. The chiropractor stated that the problem appeared to be from overuse, i.e. lifting himself up from a seated position. On VA orthopedic examination in October 2002, the veteran reported that he had symptoms of sore shoulders that he believed were due to the strain placed upon him by his service-connected right knee. The veteran was noted to have bilateral shoulder pain and the examiner stated that it was likely that the veteran has some bursitis and/or arthritic changes in the shoulders. The examiner expressed the opinion that the development of arthritis in the left knee with soreness in the back and shoulders was not due to the service-connected right knee disability. The examiner noted that the veteran had been able for many years without excess effort to lift himself without undue strain on the shoulders. A February 2003 letter from a private physician, B.V., M.D., notes that the veteran had degenerative changes of the lumbar spine and degenerative arthritis of both knees. Dr. B.V. went on to say that patients with degenerative arthritis of the knees often do compensate with their upper extremities, which frequently leads to degenerative changes. On VA examination in March 2007, the veteran was noted to have bilateral shoulder pain and stated that the veteran's bilateral shoulder disability significantly interfered with the veteran's ability to perform daily activities. The examiner expressed the opinion that it was at least as likely as not that the veteran's limitation of shoulder function was due to his service-connected knee and back disabilities. The examiner noted that while the limitation of function of the shoulders might occur in the process of normal aging, in the veteran's case, the veteran had been as active as his disabilities would permit and only reached the present limitation by virtue of the well-documented sequence of events applicable to the spine and knee disabilities. In general, applicable laws and regulations state that service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may be granted for disability which is proximately due to or the result of a service- connected disease or injury. 38 C.F.R. § 3.310(a). Moreover, where a service-connected disability causes an increase in, but is not the proximate cause of, a nonservice- connected disability, the veteran is entitled to service connection for that incremental increase in severity attributable to the service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). The veteran has previously established service connection for status post total right knee replacement, rated as 40 percent disabling, and for degenerative arthritis of the left knee, status post total knee replacement, rated as 40 percent disabling. The veteran also has service connection in effect for degenerative changes of the lumbar spine, rated as 10 percent disabling. In this case private medical personnel and a VA examiner have indicated that the veteran has bilateral shoulder disability as a result of the veteran's service-connected back and knee disabilities. The Board gives more weight to this evidence than to the contrary opinion contained in the report of the October 2002 VA examination. The Board finds that the veteran has bilateral shoulder disability resulting from his service-connected disabilities, and that service connection for a bilateral shoulder disability on a secondary basis is warranted. 38 C.F.R. § 3.310(a). In light of the favorable determination contained herein, further development with regard to VA's duties to notify and assist would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540 (1991). ORDER Service connection for a bilateral shoulder disability is granted. ____________________________________________ MARY GALLAGHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs