Citation Nr: 1038540 Decision Date: 10/14/10 Archive Date: 10/22/10 DOCKET NO. 07-18 841 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to an extension of the period of temporary total rating for convalescent purposes pursuant to 38 C.F.R. § 4.30, currently provided from February 2, 2004, to April 1, 2004. 2. Entitlement to a rating in excess of 10 percent for tendonitis of the left shoulder, status post rotator cuff repair from April 1, 2004. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M.H. Stubbs, Associate Counsel INTRODUCTION The Veteran served on active duty from November 1972 to June 2000. His DD Form 214 also indicates 3 years and 28 days of prior active service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, which awarded a temporary evaluation of 100 percent assigned effective February 2, 2004, based on surgical or other treatment necessitating convalescence, and an evaluation of 10 percent was assigned from April 1, 2004. Additionally, entitlement to special monthly compensation based on housebound criteria was granted from February 2, 2004, to April 1, 2004, an evaluation of 30 percent for coronary artery atherosclerosis with left ventricular hypertrophy was continued, and a noncompensable evaluation of scars of the left and right shoulders and upper back was continued. In November 2006, the Veteran submitted a notice of disagreement (NOD) with the September 2006 rating decision. In an attached October 2006 statement the Veteran stated he did not agree with the determination that his recurrence of Melanoma should not increase his disability award, and further stated that the scars were "real but relatively minor by-products of his two cancer events." He explained that it was service connection for cancer that was the core of his claim. He also attached a copy of a July 2005 statement where he noted he underwent corrective surgery for his shoulder that should be considered in his rating. The Veteran's representative, in an April 2007 letter, clarified the November 2006 NOD by stating that the Veteran was disagreeing with the decision in regards to his melanoma and his left shoulder disorder. In April 2007, the RO issued a statement of the case (SOC) addressing the Veteran's claims for entitlement to an extension of the temporary 100 percent evaluation assigned effective February 25, 2004, to April 1, 2004, and the evaluation of tendinitis, left shoulder, status post rotator cuff repair, currently evaluated at 10 percent disabling. Based on the foregoing, the Board concludes that the Veteran's appeal does not encompass the evaluation of the scars. Indeed, he references a claim for melanoma itself, which has not yet been adjudicated by the RO. In an April 2007 rating decision the RO provided an evaluation of 100 percent assigned effective March 29, 2006, with the evaluation reduced to 10 percent effective October 1, 2006, for right shoulder and neck scars, status post malignant melanoma removal. Entitlement to special monthly compensation based on housebound criteria being met was granted from March 29, 2006, to October 1, 2006. Again, while the Veteran has been provided service connection for residual scars from the removal of melanoma, it appears from the record that he was claiming entitlement to service connection for melanoma. As such, the issue of entitlement to service connection for melanoma has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. By April 2004, the evidence of record demonstrates that the Veteran's left shoulder was returning toward a healthy state; his flexion was only 10 degrees shy of normal at this time. 2. Throughout the rating period on appeal, tendonitis of the left shoulder, status post rotator cuff repair has been manifested by subjective symptoms of constant pain and weakness when lifting overhead; objectively, he had flexion to at least 160 degrees, with no evidence of ankylosis or impairment of the humerus, and with degenerative joint disease diagnosed by x-ray. CONCLUSIONS OF LAW 1. The criteria for extension of temporary total rating for convalescent purposes pursuant to 38 C.F.R. § 4.30 have not been met. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. §§ 3.159, 4.30 (2010). 2. The criteria for a rating in excess of 10 percent from April 1, 2004, for tendonitis of the left shoulder, status post rotator cuff repair, have not been met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2009); 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5024 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), and as interpreted by the United States Court of Appeals for Veterans Claims (the Court) have been fulfilled. In this case, the Veteran filed his increased rating claims in April 2006. Thereafter, he was notified of the provisions of the VCAA by the RO in correspondence dated in June 2006. The letters notified the Veteran of VA's responsibilities in obtaining information to assist the Veteran in completing his claim, identified the Veteran's duties in obtaining information and evidence to substantiate his claim, and provided other pertinent information regarding VCAA. Thereafter, the claim was reviewed and a supplemental statement of the case (SSOC) was issued in August 2008. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other grounds, 444 F.3d 1328 (Fed. Cir. 2006); Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006); Kent v. Nicholson, 20 Vet. App. 1 (2006), Mayfield v. Nicholson (Mayfield III), 07-7130 (Fed. Cir. September 17, 2007). During the pendency of this appeal, the Court in Dingess v. Nicholson, 19 Vet. App. 473 (2006) found that the VCAA notice requirements applied to all elements of a claim. Additional notice as to these matters was provided in the June 2006 letter. The notice requirements pertinent to the issues on appeal have been met and all identified and authorized records relevant to these matters have been requested or obtained With respect to the other issue on appeal, the Veteran has not been provided VCAA notice regarding the information and evidence necessary to substantiate a claim for a temporary total rating, pursuant to 38 C.F.R. § 4.30. However, review of the record reflects that he is clearly aware of the evidence and information required to substantiate this claim. See Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007) (actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what is necessary to substantiate a claim); see also Sanders v. Nicholson, 487 F.3d 881, 889 (Fed. Cir. 2007), rev'd on other grounds sub nom. Shinseki v. Sanders/Simmons, 129 S. Ct. 1696 (2009) (VA can demonstrate that a notice defect is not prejudicial if it can be demonstrated ... that any defect in notice was cured by actual knowledge on the part of the appellant). In this regard, in his July 2005 statement he indicated that he had undergone two surgeries, and wanted to ensure that the VA was considering the more recent surgery when evaluating his claim. The April 2007 SOC provided a copy of 38 C.F.R. § 4.30 convalescence ratings. The Veteran initially filed a claim for an increased rating for his left shoulder tendonitis. In the August 2010 informal hearing presentation, the Veteran's representative argued that the Veteran's convalescence period should have been extended. Significantly, the Veteran has been represented by a Veterans Service Organization during the pendency of this appeal. He also provided statements regarding how his left shoulder tendonitis affects him, and treatment records from his recovery period. Based on the foregoing, the Board finds that any VCAA notice deficiency has not prejudiced the adjudication of the claim herein decided. See, e.g., Dunlap v. Nicholson, 21 Vet. App. 112 (2007) (holding that notice deficiencies are not prejudicial if they did not render the claimant without a meaningful opportunity to participate effectively in the processing of his or her claim). The Veteran has been made aware of the information and evidence necessary to substantiate his claims and has been provided opportunities to submit such evidence. A review of the claim file also shows that VA has conducted reasonable efforts to assist him in obtaining evidence necessary to substantiate his claim during the course of this appeal. The Veteran's service treatment records and VA treatment records were obtained and associated with his claims file. He was also afforded VA medical examinations in July 2006 and July 2008 to assess the current nature of his claimed disability. Furthermore, the Veteran has not identified any additional relevant evidence that has not otherwise been requested or obtained. The Veteran has been notified of the evidence and information necessary to substantiate his claim, and he has been notified of VA's efforts to assist him. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). As a result of the development that has been undertaken, there is no reasonable possibility that further assistance will aid in substantiating his claim. Laws and Regulations A total disability rating will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge or outpatient release that entitlement is warranted, effective the date of hospital admission or outpatient treatment and continuing for a period of one, two, or three months from the first day of the month following such hospital discharge or outpatient release. Such total rating will be followed by appropriate schedular evaluations. Total ratings will be assigned under this section if treatment of a service-connected disability resulted in surgery necessitating at least one month of convalescence, surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight- bearing prohibited), or immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30. Convalescence has been defined as "the stage of recovery following an attack of disease, a surgical operation, or an injury." Felden v. West, 11 Vet. App. 427, 430 (1998) (citing Dorland's Illustrated Medical Dictionary 374 (28th ed. 1994)). In Felden, the Court also defined recovery as "the act of regaining or returning toward a normal or healthy state." Id. (citing Webster's Medical Desk Dictionary 606 (1986)). Furthermore, the Court has noted that the term "convalescence" does not necessarily entail in-home recovery. Felden, supra. at 430 (rejecting VA Secretary's argument that the term "convalescence" requires housebound medical status). The severity of a service-connected disability is ascertained, for VA rating purposes, by the application of rating criteria set forth in VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (2010) (Schedule). To evaluate the severity of a particular disability, it is essential to consider its history. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2 (2010). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination upon which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40 (2010). Raters must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, taking into account any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions regarding pyramiding do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flare-ups. 38 C.F.R. § 4.14 (2010). The guidance provided by the Court in DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. However, the Board notes that the provisions of 38 C.F.R. § 4.40 (2010) and 38 C.F.R. § 4.45 (2010) should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59 (2010). Where there is a reasonable doubt as to the degree of disability, such doubt will be resolved in favor of the claimant. See 38 C.F.R. §§ 3.102, 4.3 (2010). In addition, where there is a question as to which of two disability evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7 (2010). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board further acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The Veteran is currently rated for his left shoulder, status post rotator cuff surgery under Diagnostic Code (DC) 5024. 5024 Tenosynovitis. The diseases under diagnostic codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002. 520 1 Arm, limitation of motion of: Majo r Mino r To 25° from side 40 30 Midway between side and shoulder level 30 20 At shoulder level 20 20 520 2 Humerus, other impairment of: Majo r Mino r Loss of head of (flail shoulder) 80 70 Nonunion of (false flail joint) 60 50 Fibrous union of 50 40 Recurrent dislocation of at scapulohumeral joint. With frequent episodes and guarding of all arm movements 30 20 With infrequent episodes, and guarding of movement only at shoulder level 20 20 Malunion of: Marked deformity 30 20 Moderate deformity 20 20 500 3 Arthritis, degenerative (hypertrophic or osteoarthritis): Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations 20 With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups 10 Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note (2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic code 5013 to 5024, inclusive. Factual Background The Veteran filed a claim for an increased rating for tendinitis of the left shoulder, status post rotator cuff repair in April 2006. Separate treatment records note that in February 2004 the Veteran underwent a right shoulder rotator cuff repair and a left rotator cuff repair. The notes which indicate that it was the left shoulder (which start February 9, 2004) state that the Veteran had a massive retracted tear of the left shoulder and that he underwent arthroscopic surgery. However, a March 2004 record, noted to be two weeks out from the surgery, referred to his right shoulder. It also noted that he could wall walk from zero to 90 degrees, and the impression was "stable." An April 12, 2004, record notes a rotator cuff repair, but mistakenly refers first to the right shoulder, and then the left shoulder in the same treatment record. Movement was noted to be from zero to 170 degrees with the ability to do wall walks. The shoulder was stable and he was provided physical therapy. A May 2004 record again notes that it was the right shoulder that recently underwent rotator cuff repair. However, the radiologist report and the operation report both refer to the left shoulder, and so the Board will assume that this 2004 surgery was for the left shoulder. The operation took place on February 25, 2004, to repair a failed massive rotator duff rear of the left shoulder. In July 2006, the Veteran was afforded a fee-basis VA examination. He reported symptoms of constant pain at a level 7 on a scale of 1 to 10 (with 10 being the highest amount of pain), stiffness, weakness, lack of endurance, fatigability, and giving way. He noted that he could function without medication at the time of pain, and that his condition did not cause incapacitation. He noted he had three surgeries: a 1995 rotator cuff repair, a 1999 right shoulder rotator cuff repair, and a 2003 rotator cuff repair. He had no prosthetic implants of the joint, and he was then undergoing physical therapy. He was noted to be right hand dominant. His left shoulder range of motion was noted to be as follows: Movement Normal ROM ROM in degrees Degree pain occurs Flexion 180 175 160 Abduction 180 175 160 Ext Rotation 90 80 70 Int. Rotation 90 90 70 On the left, the joint function was noted to be additionally limited by pain, fatigue, and lack of endurance after repetitive use. However, the examiner found that the additional limitation of the joint function was by zero degrees. X-ray reports confirmed a prior rotator cuff repair. In July 2008, the Veteran was afforded an additional fee-basis VA examination. He reported symptoms of weakness, stiffness, lack of endurance and fatigability. He stated he did not have problems with swelling, heat, redness, giving way, locking, or dislocation. He reported constant pain at a level of 2 on a scale from 1 to 10 (with 10 being the highest level of pain). He reported he could function with medication when in pain, and that his current treatment for the left shoulder included taking Tylenol for pain. He did report that he avoided exertional overhead activity. On physical examination his left shoulder was tender, but there were no signs of edema, effusion, weakness, redness, heat, guarding of movement, or subluxation. Range of motion testing revealed the following results for the left shoulder: Movement Normal ROM ROM in degrees Degree pain occurs Flexion 180 180 Abduction 180 180 Ext Rotation 90 80 60 Int. Rotation 90 90 The examiner noted that joint function of the left shoulder was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. X-ray reports, taken in conjunction with the examination, revealed status post operation of the left shoulder with mild degenerative joint disease of the left glenohumeral and acromioclavicular (AC) joints. Analysis Initially, the Board notes that the Veteran underwent left rotator cuff surgery on February 25, 2004. In the September 2006 rating decision, the RO mistakenly noted the surgery occurred on February 2, 2004, and so the Veteran received some additional time under the convalescence rating due to error. In the April 2007 SOC the RO noted the effective date was February 25, 2004; however, a subsequent rating decision contained a list of disabilities subject to compensation which continued to list February 2, 2004, as the beginning of the temporary 100 percent rating for the left shoulder rotator cuff repair. Regarding the Veteran's claim for an extension of the temporary 100 percent convalescence rating he received from February 2, 2004, to March 31, 2004, the Board finds that the evidence does not show that an extension is warranted. Total disability based on surgery (convalescence) is effective the date of hospital admission or outpatient treatment and continuing for a period of one, two, or three months from the first day of the month following such hospital discharge or outpatient release. In this case, the Veteran received one month of total rating/convalescence starting the first day of the month after his surgery (March 1, 2004). Treatment records show that by March 8, 2004, he could wall walk his shoulder from zero to 90 degrees (shoulder height), and that by April 12, 2004, he could wall walk his arm from zero to 170 degrees (10 degrees short of full flexion). As the Veteran had nearly full flexion in early April, the evidence shows that he had recovered from his surgery by early April (as above, recovery is defined as "the act of regaining or returning toward a normal or healthy state). Therefore, the evidence does not show that an extension in covalence time is warranted, as by March the Veteran had flexion at shoulder level and by April he had ten degrees less than full flexion. Regarding the Veteran's claim for a rating in excess of 10 percent for tendonitis of the left shoulder, status post rotator cuff repair from April 1, 2004, the Board finds that an increased rating is not warranted. The evidence of record shows at worst that the Veteran has flexion to 160 degrees (taken as from the degree pain started during the July 2006 VA examination). DC 5200 and 5202 do not apply here as there is no evidence of ankylosis, flail shoulder, false flail joint, recurrent subluxation, or malunion of the humerus. DC 5201 provides for a 20 percent rating for limitation of motion of the non-dominant arm at shoulder level, or at roughly 90 degrees. See 38 C.F.R. § 4.71a, Plate I. While DC 5201 does not provide a 10 percent rating for limitation of movement of the arm better than 90 degrees, DC 5003 provides a 10 percent rating for degenerative arthritis of a major joint (established by x-ray) that results in limitation of motion. DC 5003 only provides a 20 percent rating for two or more major or minor joints, with incapacitating episodes. The Veteran indicated that he does not have incapacitating episodes. The Board also finds that there is no basis for the assignment of any higher rating during either time period based on consideration of the factors addressed in 38 C.F.R. §§ 4.40, 4.45 and Deluca, 8 Vet. App. at 204-07. Competent medical evidence reflects that the currently assigned 10 percent rating already compensates the Veteran for the extent of functional loss resulting from any such symptoms. In this regard, the Board notes that the Veteran described his pain as constant, and that both the July 2006 and the July 2008 fee-basis VA examination findings detailed that the Veteran performed Deluca testing, and found no objective clinical findings that function was additionally limited by degrees by pain, fatigue, weakness, incoordination, or lack of endurance. The July 2006 examiner noted the Veteran was additionally limited by pain, fatigue, and lack of endurance after repetitive use. However, he noted the Veteran was additionally limited by zero degrees. Thus, no true additional functional impairment has been objectively demonstrated such as to enable a finding that the disability picture most nearly approximates the next-higher 20 percent evaluation. Additionally, the Board finds that the Veteran is competent to describe pain and observable symptoms related to his left shoulder disability. See 38 C.F.R. § 3.159(a)(2) (2009) (defining "competent lay evidence"). The Board also finds that his statements and complaints regarding pain are credible because they are generally consistent throughout the record. However, although objective medical findings have documented pain, fatigue and lack of endurance, the pain has not been shown to limit his range of motion to 90 degrees (required for a 20 percent rating), including on repetition. Thus, his statements alone cannot here serve as a basis for an increased rating. Consideration has also been given regarding whether the schedular evaluation is inadequate, thus requiring that the RO refer a claim to the Chief Benefits Director or the Director, Compensation and Pension Service, for consideration of "an extra- schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities." 38 C.F.R. § 3.321(b)(1) (2010); Barringer v. Peake, 22 Vet. App. 242, 243-44 (2008) (noting that the issue of an extraschedular rating is a component of a claim for an increased rating and referral for consideration must be addressed either when raised by the Veteran or reasonably raised by the record) An extra-schedular evaluation is for consideration where a service-connected disability presents an exceptional or unusual disability picture with marked interference with employment or frequent periods of hospitalization that render impractical the application of the regular schedular standards. Floyd v. Brown, 9 Vet. App. 88, 94 (1996). An exceptional or unusual disability picture occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of the Veteran's service-connected disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, then the Board must consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Id. at 115-116. When those two elements are met, the appeal must be referred for consideration of the assignment of an extraschedular rating. Otherwise, the schedular evaluation is adequate, and referral is not required. 38 C.F.R. § 3.321(b)(1); Thun, 22 Vet. App. at 116. In this case, the schedular evaluation in this case is not inadequate. An evaluation in excess of that assigned is provided for certain manifestations of the service-connected disability at issue, but the medical evidence reflects that those manifestations are not present in this case. Additionally, the diagnostic criteria adequately describes the severity and symptomatology of the Veteran's disorder. Accordingly, referral for extraschedular evaluation is not in order here. In reaching the conclusion above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F. 3d. 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55- 57 (1990). ORDER Entitlement to an extension of the period of temporary total rating for convalescent purposes pursuant to 38 C.F.R. § 4.30, currently provided from February 2, 2004 to April 1, 2004, is denied. Entitlement to a rating in excess of 10 percent for tendonitis of the left shoulder, status post rotator cuff repair from April 1, 2004 is denied. ____________________________________________ ERIC S. LEBOFF Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs