Citation Nr: 1329636 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 10-16 947 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for a right shoulder disorder. REPRESENTATION Appellant represented by: Illinois Department of Veterans Affairs ATTORNEY FOR THE BOARD Mary E. Rude, Associate Counsel INTRODUCTION The Veteran served on active duty from April 1953 to July 1961. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. The Board remanded the issue in August 2012 and March 2013 for further development. In May 2013, the Veteran's claim was referred for a medical opinion by an expert from the Veterans Health Administration (VHA). 38 U.S.C.A. § 7109 (West 2002); 38 C.F.R. § 20.901 (2012). In June 2013, an opinion letter was received and referred to the Veteran and his representative for review and the submission of any additional evidence or argument. 38 C.F.R. §§ 20.903, 20.1304(c) (2012). A copy of the VHA opinion letter has been associated with the claims file. The case is now once again before the Board for adjudication. A review of the Virtual VA paperless claims processing system reveals pertinent VA treatment records dated from April 2001 to March 2012. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran's current right shoulder disorder is causally related to his military service. CONCLUSION OF LAW The criteria for establishing service connection for a right shoulder disability have been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION In light of the fully favorable determination in this case, no further discussion of compliance with VA's duty to notify and assist is necessary. The Veteran asserts that he has a current right shoulder disability as a result of shoulder injury and strain caused by 6 years of serving on a Division Rifle Team in service, which required him to frequently fire rifles. The Veteran has stated that he began having shoulder pain in the service which became continually worse over the years. He has stated that he began receiving injections to alleviate pain in his right shoulder in the late 1960s or early 1970s, and has had an injection every 4 to 6 months since that time. Generally, in order to establish direct service connection, three elements must be established. There must be medical evidence of a current disability; medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2012); see also Hickson v. West, 12 Vet. App. 247, 253 (1999). Medical records establish that the Veteran has a current right shoulder disability. A December 2008 private magnetic resonance imaging (MRI) study from the Monroe Clinic revealed a massive right rotator cuff tear. January 2009 private treatment notes from the Monroe Clinic documented the Veteran's complaints of right shoulder pain and discomfort for "years." At the Veteran's November 2012 VA examination, he was diagnosed with chronic right rotator cuff tear status post surgical repair and osteoarthritis of the right shoulder. There is also evidence suggesting in-service incurrence of a right shoulder injury and activities indicative of frequent rifle usage. The Veteran's service treatment records show that he was treated for soreness in both shoulders in March 1959. The Veteran's DD Form 214 reflects that he served as a Light Weapons Infantryman. His decorations, medals, and badges include Rifle and Carbine bars and an Excellence in Competition badge for rifle. Additional service personnel records, submitted by the Veteran in June 2009, show that the Veteran also received the Distinguished Rifleman Badge. The Board notes that the Veteran is competent to report that he experienced right shoulder symptoms since service and that he has been receiving injections in his right shoulder on a regular basis for approximately the past 40 years. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board finds the Veteran's statements regarding his in- service shoulder strain and his treatment and ongoing shoulder pain since service to be credible and uncontradicted by any evidence of record. Finally, there is persuasive medical evidence that the Veteran's current right shoulder disability is related to injury from firing rifles in service. In May 2009, the Veteran's private physician opined that the type of repetitive trauma sustained as a rifle shooter for six years "could explain with a reasonable degree of medical certainty [the Veteran's] subsequent shoulder difficulties." In June 2013, VA received a VHA response from a physician which stated that if his injury in service resulted in repetitive injections, the "injections over multiple years certainly could weaken the rotator cuff and lead to a rotator cuff tear. If this is the case, then this would be a fairly direct correlation between his military service and his current rotator cuff injury." The VHA opinion is afforded high probative value as it was made after a review of the relevant evidence, including past examinations of the Veteran, and contained a thorough rationale for the conclusion reached. Taking into consideration the Veteran's competent and credible statements regarding his shoulder injections over many years, this opinion provides competent and credible evidence of a link between the Veteran's service and his current right shoulder disorder. Although the November 2012 VA examiner came to a differing opinion regarding the likely etiology of the Veteran's current right shoulder disability, the Board finds that the most competent and probative evidence regarding the link between his current right shoulder disorder and in-service injury is at least in equipoise. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. As such, entitlement to service connection is warranted. See 38 U.S.C.A. § 5107(b). ORDER Entitlement to service connection for a right shoulder disorder is granted. ____________________________________________ CHERYL L. MASON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs