Citation Nr: 18153111 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 14-32 508 DATE: November 27, 2018 ORDER Service connection for right foot disorder is denied. Service connection for left shoulder disorder is denied. Service connection for right shoulder disorder is denied. Service connection for cervical spine disorder is denied. Service connection for low back disorder is denied. Service connection for right knee disorder is denied. Service connection for left knee disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from August 1984 to March 1990. 2. A right foot disorder is not causally or etiologically related to service. 3. A left and right shoulder disorders were not shown in service, not continuous since service, not shown to a comparable degree within one year of separation from service, not shown for many years after service, and are not causally or etiologically related to service. 4. A cervical spine disorder is not causally or etiologically related to service. 5. A low back disorder was not shown in service, not continuous since service, not shown to a comparable degree within one year of separation from service, not shown for many years after service, and is not causally or etiologically related to service. 6. A right knee disorder was not shown in service, not continuous since service, not shown to a comparable degree within one year of separation from service, not shown for many years after service, and is not causally or etiologically related to service. 7. A left knee disorder is not casually or etiologically related to service. CONCLUSIONS OF LAW 1. A right foot disorder was not incurred in or aggravated by service. 38 U.S.C. §§ 1101, 1112, 1131, 1153, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.306 (2017). 2. A left shoulder disorder was not incurred in or aggravated by service and may not be presumed to have incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 3. A right shoulder disorder was not incurred in or aggravated by service and may not be presumed to have incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. A cervical spine disorder was not incurred in or aggravated by service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 5. A low back disorder was not incurred in or aggravated by service and may not be presumed to have incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 6. A right knee disorder was not incurred in or aggravated by service and may not be presumed to have incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 7. A left knee disorder was not incurred in or aggravated by service. 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Right Foot Disorder In addition to the above laws and regulations, a preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b). “[I]f a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder.” See Wagner v. Principi, 370 F.3d 1096 (Fed. Cir. 2004); see also 38 U.S.C. § 1153; 38 C.F.R. § 3.306. In such claims, the claimant has the burden of showing that there was an increase in disability during service to establish the presumption of aggravation. The Veteran filed a claim specifically for right foot metatarsalgia which was denied in November 2012 based on a finding that this disorder was not connected to an in-service event. As he had other foot complaints in service, the claim has been broadened as a claim for a right foot disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). As an initial matter, the Veteran has not asserted that his right foot disorder is caused or aggravated by a service-connected disability; therefore, secondary service connection will not be considered. Further, because a right foot disorder is not a chronic disease under 38 C.F.R. § 3.309(a), presumptive service connection does not apply. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). Therefore, this claim will be evaluated only under direct service connection. As reflected in the record, the Veteran was diagnosed in a September 2012 VA examination with bilateral pes planus and right foot metatarsalgia. Therefore, the first element of a current disorder has been satisfied. Of note, moderate pes planus was noted at entry. Thus, the Veteran is not presumed to have been in sound condition upon entrance into service regarding this disorder. Consequently, to the extent that he seeks compensation for pes planus, the burden is on him to demonstrate an increase in disability during service, which would trigger the presumption of aggravation. Further, a review of the service treatment records (STRs) shows multiple in-service foot complaints. Specifically, the August 1984 enlistment examination shows that he incurred a mild sprain in his right foot and that mild tenderness in the dorsum was present. The following month, in September 1984, he injured his right foot after stepping in a hole and developed tenosynovitis (inflammation of the tendon sheath). The records show that this injury continued past this date, as he was diagnosed in October 1984 with a tender instep and plantar flexion. Finally, in November 1985, he reported a history of foot pain and the examiner diagnosed plantar fasciitis. Therefore, an in-service incurrence has been shown with respect to the right foot. However, with respect to pes planus, the evidence does show that it was aggravated in service. In a September 2012 VA examination specifically undertaken to address the aggravation issue, the examiner stated that pes planus was not aggravated beyond its natural progression. The examiner reasoned that it was noted to moderate at both entry and separation from service. Moreover, the STRs do not show any complaints related to pes planus. This medical evidence weighs against the claim. As to tenosynovitis and plantar fasciitis, the medical evidence does not reflect that either disorder is currently shown. As to the current diagnosis of metatarsalgia, it was not shown in service and not shown for many years. Moreover, the examiner did not find that it was related to an in-service event. Based on the above, the medical evidence does not support the claim. Left and Right Shoulders As an initial matter, the Veteran has not asserted that his left and right shoulder disorders, claimed as degenerative joint disease (DJD) were caused or aggravated by a service-connected disability; therefore, secondary service connection will not be considered. However, because DJD is a chronic disease under 38 C.F.R. § 3.309(a), presumptive service connection is for application. Finally, direct service connection will be addressed. As to the first element of service connection, current diagnoses have been shown. Specifically, a September 2012 VA clinical record noted “narrowing of AC joint compatible with mild DJD” in the left shoulder and “DJD at right AC joint” in the right shoulder. Therefore, current disorders have been shown. As to in-service incurrence, STRs indicate that the Veteran was seen for a left shoulder injury in February 1985 and August 1986 after playing basketball. Further, in October 1986, he was diagnosed with left shoulder bicipital tenderness after reporting a popping sensation. Finally, the STRs reflect that he injured his left shoulder in a motor vehicle accident (MVA) in August 1987. Therefore, the second element of service connection has been shown. As to a medical nexus regarding the left shoulder, the evidence does not support a nexus between his current left shoulder disorder and the injuries he sustained in service. Specifically, in a September 2012 VA examination, the examiner determined that “the claimed condition was less likely than not incurred in or caused by the claimed in-service injury.” The examiner reasoned that the STRs showed that this injury improved over time, making it unlikely that the Veteran would be currently affected by this condition. This medical opinion weighs against the claim and there is no contradictory medical evidence of record. Therefore, the medical evidence does not support direct service connection. As to the right shoulder, while STRs indicate that the Veteran incurred left shoulder injuries while in service, they are silent as to an in-service right shoulder injury. Specifically, the February 1985 treatment note related that he was seen for a left shoulder injury. The right shoulder was also examined and was determined to have full range of motion. Therefore, the second element of service connection has not been satisfied as to the right shoulder and the medical evidence does not support direct service connection. As to presumptive service connection, as noted, the Veteran has been diagnosed with DJD of both shoulders, which is entitled to presumptive service connection if shown to be chronic in service, or with continuous symptoms since service, or if it manifested to a degree of 10 percent or more within one year of service separation. However, the medical evidence does not support presumptive service connection. A review of the record shows that, despite incurring left shoulder injuries while in-service, the Veteran was not diagnosed with DJD of either shoulder while in service. He was not diagnosed with DJD within one year after separation from service, as the first diagnosis was dated in September 2012. The evidence of record also does not establish continuity of symptomatology. Post-service treatment records are negative for complaints of, treatment for, or a diagnosis related to the left or right shoulder for many years after service separation. Specifically, the most recent diagnoses were in September 2012. Therefore, the medical evidence does not support presumptive service connection. Cervical Spine Disorder As an initial matter, the Veteran has not asserted that his cervical spine disorder was caused or aggravated by a service-connected disability; therefore, secondary service connection will not be considered. Further, because cervical strain is not a chronic disease under 38 C.F.R. § 3.309(a), presumptive service connection does not apply. Therefore, only direct service connection will be addressed. As to a current diagnosis, the September 2012 VA examiner diagnosed a remote cervical strain in 1988. While this is outside of the appeal period, this examination shows that the Veteran’s cervical spine pain has resulted in functional loss and/or functional impairment, which can constitute a current disability. See Saunders v. Wilkie, No. 17-1466 (Fed. Cir. 2018). Therefore, the first element of service connection has been shown. As to an in-service event, the STRs reflect that the Veteran was involved in two MVAs while in service, one in August 1987 and another in January 1988. The latter incident resulted in a diagnosis of cervical strain in February 1988. Therefore, the second element of service connection – in-service incurrence – has been shown. However, the medical evidence does not support a nexus between the in-service incident and current symptomatology. Specifically, in the September 2012 VA examination, the examiner determined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury. The examiner reasoned that the STRs showed muscle strain improvement, which led him to conclude that the Veteran’s current symptoms were not related to the injuries sustained in the MVAs. A review of STRs dated February 1988 are consistent with the examiner’s findings, as these records note that the cervical strain was resolving. Low Back Disorder As an initial matter, the Veteran has not asserted that his low back disorder, claimed as DJD is caused or aggravated by a service-connected disability; therefore, secondary service connection will not be considered. However, DJD is a chronic disease under 38 C.F.R. § 3.309(a); therefore, presumptive service connection is for application. Finally, direct service connection will be addressed. As to a current diagnosis, in a September 2012 clinical record, the clinician diagnosed DJD in the lumbar spine. Therefore, a current disability has been shown. As to in-service incurrence, STRs indicate that the Veteran was in two MVAs (one in August 1977 and another in January 1988) resulting in lumbar strains. A February 1988 X-ray also noted mild levoscoliosis. Therefore, the second element of service connection has been shown. However, no nexus has been shown between the Veteran’s current disability and the injuries he sustained in service. In a September 2012 VA examination, the examiner determined that the disorder was less likely than not incurred in or caused by the claimed in-service injury. The examiner reasoned that the STRs showed muscle strain improvement, which led him to conclude that the current low back condition was not related to the injuries sustained in the MVAs. There is no contradictory medical evidence of record. Therefore, the medical evidence does not support direct service connection. As to presumptive service connection, as noted, the Veteran has been diagnosed with DJD of the lumbar spine, which is entitled to presumptive service connection if shown to be chronic in service, or with continuous symptoms since service, or if it manifested to a degree of 10 percent or more within one year of service separation. However, the medical evidence does not support presumptive service connection. A review of the record shows that, despite incurring low back strains while in-service, the Veteran was not diagnosed with DJD of the lumbar spine while in service. He was not diagnosed with DJD within one year after separation from service, as the first diagnosis was dated in September 2012. The evidence of record also does not establish continuity of symptomatology. Post-service treatment records are negative for complaints of, treatment for, or a diagnosis related to the low back for many years after service separation. Specifically, the diagnosis was in September 2012. Therefore, the medical evidence does not support presumptive service connection. Right and Left Knees As an initial matter, the Veteran has not asserted that his knee disorders are caused or aggravated by a service-connected disability; therefore, secondary service connection will not be considered. However, DJD is a chronic disease under 38 C.F.R. § 3.309(a); therefore, presumptive service connection is for application. Finally, direct service connection will be addressed. Turning first to the left knee, a July 2012 VA examination request shows that the Veteran was diagnosed with left knee patellofemoral syndrome in 1988, which is outside the appeal period. However, July 2012 X-ray report reflected an essentially normal left knee. Further, VA clinical records dated in June 2013 list impressions of bilateral knee pain caused by no specific injuries. Because the records do not show that this left knee pain reaches a level of functional impairment of earning capacity, it is not sufficient to constitute a current disability. See Saunders No. 17-1466 (Fed. Cir. 2018). As no current disorder is shown, the medical evidence does not support service connection for a left knee disorder. As to a right knee disorder, a September 2012 VA clinical record shows mild DJD at the patellofemoral joint of the right knee. Therefore, a current disorder has been shown. As to in-service incurrence, the record shows that the Veteran incurred knee injuries while in service. Specifically, he was diagnosed with right patellofemoral pain syndrome is 1988. Therefore, the element of in-service incurrence has been met. However, no nexus between this in-service incurrence and a current disability has been found. In the September 2012 VA examination, the examiner determined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury. The examiner reasoned that the STRs showed that the Veteran’s knee disorder improved over time, making it unlikely that he was still affected by the disorder. This evidence weighs against direct service connection and there is no contradictory medical evidence of record. As to presumptive service connection, as noted, the Veteran has been diagnosed with DJD of the right knee, which is entitled to presumptive service connection if shown to be chronic in service, or with continuous symptoms since service, or if it manifested to a degree of 10 percent or more within one year of service separation. However, the medical evidence does not support presumptive service connection. A review of the record shows that, despite incurring right knee symptoms while in-service, the Veteran was not diagnosed with DJD while in service. He was not diagnosed with DJD within one year after separation from service, as the first diagnosis was dated in September 2012. The evidence also does not establish continuity of symptomatology. Post-service treatment records are negative for complaints of, treatment for, or a diagnosis related to the right knee for many years after service separation. Specifically, the diagnosis was in September 2012. Therefore, the medical evidence does not support presumptive service connection. With respect to all the claims, the Board has considered lay statements and testimony submitted by the Veteran asserting that his disorders began in service. He is competent to report symptoms because this requires only personal knowledge, as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. In light of the above discussion, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As service connection is not warranted, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not   required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ragofsky, Legal Clerk