Citation Nr: 18150977 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-33 643 DATE: November 16, 2018 ORDER Service connection for a right shoulder condition is denied. Service connection for hernia, secondary to Meniere’s disease is granted. FINDINGS OF FACTS 1. The weight of the evidence is against finding that the Veteran’s right shoulder condition manifested during service or is otherwise related to service. 2. The probative medical evidence shows that the Veteran’s hernia is related to the Veteran’s service connected Meniere’s Disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a hernia have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1981 to December 1989. This matter is on appeal from a November 2015 rating decision. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). In general, service connection requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310 (b). 1. Right Shoulder The Veteran contends that he sustained a right shoulder injury during service in May 1985, at the same time he suffered a broken bone in his right hand from a fall. He also reported to having reinjured his right shoulder in May 1987 when he hurt his right ankle. Service treatment records confirmed a report of a sprained ankle in May 1987. Treatment records after that also extensively document pain, range of motion and recovery of the ankle, including physical therapy. There was no complaints, treatment, or diagnosis of a right shoulder condition. The only mention of the Veteran’s shoulder was a mildly irritated spot on the right axilla, which was diagnosed as a skin tag in November 1986. It was also noted that the condition resolved. Treatment records dating on and around May 1985 also confirmed injury to his hand/finger. There was no mention of a shoulder injury. Post-service private treatment records showed that the Veteran injured his right shoulder around Christmas in 1995, a number of years after service. It was noted that the Veteran reported experiencing shoulder pain for a couple weeks in January 1996. He later underwent shoulder surgery for right shoulder pain and impingement syndrome in June 2015. His postoperative diagnosis was both impingement syndrome and full-thickness rotator cuff tear. However, there is no suggestion in the medical evidence of record that the Veteran’s shoulder disability resulted from any in service shoulder injury. After reviewing the medical evidence of record, the Board finds that service connection for a right shoulder disability is not warranted. The record does not contain evidence of a diagnosis of an ongoing condition that manifested during service or has been related to service, as the first evidence of a shoulder condition does not appear until at least 6 years after service, and following a shoulder injury. The passage of time between the Veteran’s discharge and an initial diagnosis of the claimed disorder, while not dispositive, is one factor that weighs against the Veteran’s claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board notes that although the Veteran indicated that he injured his shoulder in service, extensive documentation of in service injuries showed no reference to a shoulder condition. Other than his own statement, the Veteran has not submitted any objective medical evidence that links his current condition to his service. Consideration has been given to the Veteran’s allegation that he had problems with his shoulder since his military service. He is clearly competent to report symptoms of pain as well as injury. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, while the Veteran may describe pain, he lacks the medical training or qualification to diagnose a shoulder disability. Id. His opinion therefore cannot provide the requisite nexus and does not refute the medical opinion of record. Accordingly, service connection for a shoulder disability is not warranted. 2. Service connection for hernia secondary to service connected Meniere’s disease. The Veteran has asserts that his hernia is secondary to his service connected Meniere’s disease due to severe bouts of vomiting. He was afforded a VA examination in April 2016. There, the Veteran stated that he had severe Meniere’s disease that caused severe vomiting spells that resulted in abdominal pain and development of hernia in 2006. He remembered a “pull” sensation in his stomach after a bout of vomiting. A hernia was subsequently discovered upon medical attention. The Veteran underwent an operation in November 2006 with a mesh. Then, in 2014, the Veteran experienced another severe bout of Meniere’s with vomiting, with the same “pull sensation.” After an MRI in 2014, he noticed a bulge in the abdomen. He then underwent a repair in July 2015. The Veteran currently reports persistent intermittent pain, with post-operative discomfort. He reports pain with coughing, and bending over. The VA examiner explained that increased intra-abdominal pressure can predispose to ventral hernia formation. However, while severe vomiting can lead to this, it may also be caused by other factors predisposed to the formation of ventral hernias. Obesity is a primary risk factor because adipose tissue separate muscle bundles and layers weakening those layers leading to hernia formation. After reviewing the medical evidence of record, the Board finds that service connection for a hernia secondary to Meniere’s disease is warranted. The probative medical evidence on file, which is the April 2016 VA examination report indicated that while obesity is a predisposed factor, the Veteran’s weakened muscle tissue, coupled with vomiting can cause a hernia. The examiner specifically found that the Veteran’s severe vomiting was the secondary reason for the hernia formation. In rendering his opinion, the report was based on the Veteran’s physical examination, medical records, and the Veteran’s statements. The opinion is sufficient to satisfy the statutory requirements of producing an adequate statement of reasons and bases where the expert has fairly considered material evidence and appears to support the Veteran’s position. Wray v. Brown, 7 Vet. App. 488, at 492 (1995). Given the positive medical opinion, service connection for hernia, secondary to Meniere’s disease is warranted and the claim is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.Yeh, Associate Counsel