Citation Nr: 1306802 Decision Date: 02/27/13 Archive Date: 03/01/13 DOCKET NO. 09-04 974 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to service connection for a right shoulder disability. 2. Entitlement to service connection for a left shoulder disability. REPRESENTATION Appellant represented by: National Association for Black Veterans, Inc. WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Andrew Mack, Counsel INTRODUCTION The Veteran served on active duty from October 1976 to October 1996. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. In March 2012, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge at the RO. A transcript of that hearing is included in the claims file. These matters were remanded by the Board in June 2012, and have been returned for further appellate action. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to ensure a total review of the evidence. FINDING OF FACT The Veteran's bilateral adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and acromioclavicular joints are the result of service. CONCLUSIONS OF LAW 1. The criteria for service connection for right adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and acromioclavicular joints have been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309(a) (2012). 2. The criteria for service connection for left adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and acromioclavicular joints have been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309(a) (2012). REASONS AND BASES FOR FINDING AND CONCLUSIONS As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). In this case, the Board is granting in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (2012). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). In addition, for certain chronic diseases, such as arthritis, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within a prescribed period following discharge from service; the presumptive period for arthritis is one year. 38 C.F.R. §§ 3.307, 3.309(a) (2012). In this case, the Veteran's DD Form 214 (Certificate of Release or Discharge from Active Duty) reflects that the Veteran's primary specialty during his last 11 years and three months was as an ammunition specialist. Service treatment records reflect that in October 1986 the Veteran complained of left-sided chest pain going into his arm first thing in the morning and was assessed as having strain of the shoulder and neck muscles. At the time of his June 1996 examination for separation from service, the Veteran reported a history of bilateral shoulder pain in the morning without relief from Motrin. In March 2003, the Veteran reported left anterior shoulder pain and tingling since February 2003, which had started about one week after participating in self-defense classes. He denied injuring the arm, and stated that the only time he had pain or tingling was when raising his arm above his head, so that he was not able to play racket ball. He stated that the tingling went from his shoulder to elbow, and he reported no history of left shoulder injury or surgery and no problems with the right shoulder. The assessment was left shoulder pain, with possible mild rotator cuff pain. VA treatment records further reflect that in April 2003, the Veteran complained of left-sided chest pain, left arm tingling, and left anterior shoulder pain and tingling. He reported that he now had pain, numbness, and tingling that were constant and worse when using his left arm and lying on his left side. He was noted to have had some tenderness to the deltoid with some trigger points to the upper shoulder. The diagnosis was brachial plexus injury and upper extremity injury. On follow-up treatment in April 2003, the Veteran reported constant pain of the left shoulder with paresthesia in the left arm and hand. Electromyography (EMG) and nerve conduction study (NCS) both revealed normal studies, with no evidence of left cervical radiculopathy, brachial plexopathy, or neuropathy. April 2003 X-rays of the left shoulder revealed no articular, osseous, or soft tissue abnormalities demonstrated. A February 2007 statement from the Veteran's wife reflects her assertion that during the last 11 and a half years on active duty in the munitions logistical supply field, having manual and physical control of various munitions, the Veteran would come home many days in severe pain, and that although she told the Veteran to go to sick call he would not. She further asserted that the pain had gotten more severe as the years went on, that the pain extended from his shoulders to his elbows, and that he tried to deal with this by using pain relievers. An August 2008 statement from the Veteran's co-worker, P.R., indicates that the Veteran missed at least three days each month from work, in part due to severe pain in both shoulders when lifting and pushing objects. VA treatment records reflect that in August 2008, the Veteran reported a history of left shoulder pain since the 1980s when he was in the military. Examination of the left shoulder revealed decreased passive and active range of motion with forward flexion and abduction and possible impingement. The assessment was left-sided neck and shoulder pain of unclear etiology. X-rays of the shoulder were noted to be normal. In September 2008, the Veteran complained of chronic bilateral shoulder pain, which he reported had had a gradual onset during service in the 1980s, when he did a lot of heavy lifting. He reported bilateral shoulder pain, left greater than right, and some weakness of his left upper extremity, and denied any paresthesias or numbness. He was noted to have decreased range of motion of the shoulders bilaterally. October to December 2008 VA treatment records reflect continuing complaints of bilateral shoulder pain. Private treatment records dated from September 2009 to May 2012 reflect treatment, including physical therapy, for bilateral shoulder pain, with diagnoses of adhesive capsulitis of the bilateral shoulders, and impingement of the left shoulder. During his March 2012 Board hearing, the Veteran testified that although he had shoulder pain in service, he rarely sought medical treatment for it, but that he reported it at the time of his separation examination. He testified that his job was in ammunition supply, which required a significant amount of lifting, and that following his separation from service he did not seek medical treatment for his shoulders until the early 2000s, when he began receiving VA treatment. The Veteran was afforded a VA examination of the shoulders in August 2012. The VA examining orthopedic surgeon noted that he reviewed the claims file prior to his interview and evaluation of the Veteran, and noted the October 1986 service treatment records regarding shoulder strain and the June 1996 separation examination report of pain in both shoulders. At the time of the examination, the Veteran reported that during his period of service he was a munitions sergeant, working with and loading and unloading ammunition and munitions. He reported repeated daily lifting with loading and unloading heavy objects, and that he did not seek treatment for his shoulder conditions because he saw too many other service personnel coming in frequently to sick call with complaints, and rather took medications himself at home. He also reported that his shoulder pain began because of repeated heavy lifting of munitions. The Veteran further reported that after military service he had an injury to his left shoulder at work in a defensive tactics class, which did not involve a Labor and Industry claim. On examination, impingement test was mildly positive, and restricted range of motion was noted, in both shoulders. X-rays of both shoulders revealed mild joint space narrowing and osteophytosis of the glenohumeral joint consistent with osteoarthritis and probably early osteoarthritis of the right acromioclavicular (AC) joints of both shoulders. It was noted by the examiner that left shoulder X-rays in April 2003 and August 2008 were interpreted as normal. The VA examiner diagnosed adhesive capsulitis, mild rotator cuff impingement and degenerative joint disease of the shoulder and AC joints of each shoulder. The examiner further opined that it was as likely as not that the Veteran's right and left shoulder conditions were caused by his work with repeated lifting of munitions during military service. The examiner noted that the Veteran gave a history of treating himself symptomatically at home and not coming in for evaluation of his shoulder conditions in service, but that review of service treatment records indicated that he did complain of bilateral shoulder pain several times during active service. The examiner further noted that the Veteran gave a history of an injury to his left shoulder while working several years before, but that there had been no Labor and Industry claim. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the Veteran's service connection claims must be granted. The record reflects current, diagnosed shoulder disabilities of adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and AC joints. It also reflects that the Veteran was an ammunition specialist for the last 11 years and three months of his service, and that he was seen in service for shoulder muscle strain and reported a history of bilateral shoulder pain at the time of his separation examination in June 1996. Moreover, the only competent and probative opinion on the question of whether any right or left shoulder disability is related to the Veteran's period of service is that of the August 2012 VA examiner, who opined that that it was as likely as not that the Veteran's right and left shoulder conditions were caused by his work with repeated lifting of munitions during military service. The Board acknowledges that, while the Veteran reported shoulder pain at the time of his separation examination in June 1996, he did not seek treatment for any shoulder problems until March 2003, at which time he reported that such problems had begun one month earlier, and at which time he reported no history of left shoulder injury or surgery and no problems with the right shoulder. The Board further acknowledges that the Veteran did not seek treatment for his shoulders after April 2003 until August 2008, and that in both April 2003 and August 2008 X-rays of the left shoulder were normal. However, the Board finds the opinion of the August 2012 VA examiner in this case to be highly probative. The examiner expressed expertise as an orthopedic surgeon, fully examined the Veteran, including with X-rays, and reviewed the claims file prior to examining the Veteran and providing an opinion. Also, in opining that the Veteran's right and left shoulder conditions were as likely as not caused by his work with repeated lifting of munitions during service, the examiner acknowledged the Veteran's left shoulder injury in 2003, and also noted that April 2003 and August 2008 X-rays of the left shoulder had been interpreted as normal. Furthermore, the basis of the examiner's opinion is plausible and consistent with the record given the Veteran's job as an ammunition specialist for the last 11 years and three months of his service, the Veteran's testimony and his wife's statement regarding his consistent shoulder pain in service, and the Veteran's in-service treatment for shoulder muscle strain and report of bilateral shoulder pain at the time of his June 1996 separation examination. Moreover, there is no medical opinion or other such competent evidence contradicting the opinion of the August 2012 VA examiner. Given the above, the Board finds that the evidence as to whether the Veteran's current left and right shoulder disabilities were the result of service to be at least in relative equipoise. Therefore, resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's bilateral adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulders and AC joints are the result of service. Accordingly, the claims for service connection for adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and AC joints of the right and left shoulder must be granted. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 53-56. ORDER Service connection for right adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and acromioclavicular joints is granted. Service connection for left adhesive capsulitis, mild rotator cuff impingement, and degenerative joint disease of the shoulder and acromioclavicular joints is granted. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs