Citation Nr: 18155751 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 11-06 843 DATE: December 6, 2018 ORDER Entitlement to service connection for a left shoulder disability is denied. FINDING OF FACT 1. The Veteran is currently diagnosed with degenerative arthritis in the left shoulder. 2. The evidence weighs against a finding that the Veteran’s left shoulder disability had its onset during active duty service, manifested to a compensable degree within one year of separation from service, or was otherwise etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1972 to December 1983. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In August 2016, May 2017, and October 2017, the Board remanded the case for further development. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that he is entitled to service connection for his currently diagnosed degenerative arthritis in the left shoulder. At various points during the appellate period, the Veteran has alleged numerous theories as to in-service causation of his left shoulder disability. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be: (1) medical 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, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1166–67 (Fed. Cir. 2004). Certain chronic diseases, to include degenerative arthritis, are subject to presumptive service connection if the chronic disease manifested to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). If there is no manifestation within one year of service, service connection for a recognized chronic disease can still be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Continuity of symptomatology requires that the chronic disease have manifested in-service. 38 C.F.R. § 3.303(b). In-service manifestation means a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. The service treatment records (STRs) indicate that in February 1974, the Veteran complained of chest pain, which he described as starting in his left shoulder, after lifting heavy objects. An impression of a muscle strain was provided by the VA physician. The remainder of the Veteran’s STRs are silent as to any injuries, complaints, or symptoms associated with his left shoulder during his time in the military. Additionally, in the September 1983 separation examination, the Veteran reported that he did not have a painful or “trick” shoulder or elbow. Post-service private treatment records from 1997 note shoulder pain. A May 1998 progress note indicates that the Veteran had pain in his left shoulder and the assessment was mild spasm in the suprascapular area on the left shoulder. The Veteran’s VA medical records indicate that in June 2007 the Veteran reported worsening left shoulder pain, which began one month prior. Importantly, the VA physical therapist noted that the Veteran denied any trauma or injury and that he denied having this pain before. In July 2007, the Veteran sought VA treatment for neck and left shoulder pain, which he reported had been hurting for seven to eight months. In October 2008, a VA neurosurgery consult report indicates that the Veteran experienced trouble with his left shoulder for 20 years and that he first experienced neck and shoulder pain during physical training at Fort Hood in 1980. In June 2012, the Veteran was diagnosed in a VA examination with degenerative joint disease of the left shoulder. The Veteran stated that he jammed his left shoulder in a warehouse door in 1975 or 1976. The examiner opined that that Veteran’s left shoulder disability was less likely than not incurred in or caused by any claimed in-service injury, event or illness. It was noted that the VA examiner was unable to find any documentation in the claims file regarding the Veteran’s left shoulder to suggest that his current condition originated while in-service. The Veteran was afforded an additional VA examination in November 2016. He was diagnosed with degenerative arthritis. The Veteran reported that he injured his left shoulder in 1975 or 1976. The VA examiner noted that the STRs were silent as to any shoulder condition and that there was no mention of shoulder pain in the Veteran’s 1983 physical examination. The examiner opined that the Veteran’s condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner concluded that the degenerative changes and impingement were more likely caused by age and use/manual labor over the past 33 years that the Veteran has been out of the military. Pursuant to a May 2017 and October 2017 Board remand, the Board requested the VA examiner to address the February 1974 in-service report of left shoulder pain as well as the Veteran’s lay statements regarding the onset and continuing symptomatology of his left shoulder condition. In a November 2017 medical addendum, the VA examiner specifically noted that he reviewed the February 1974 STR entry as well as the Veteran’s lay statements. The examiner opined that the isolated February 1974 STR entry for a mild, self-limited left shoulder strain, in conjunction with a normal X-ray in 2005 and no evidence for chronic left shoulder disability for 22 years after active duty, argues against there being any nexus to connect the isolated STR with any claimed left shoulder disability. The examiner noted that there was no associated examination regarding the 1974 left shoulder strain and the Veteran did not require an X-ray, treatment or follow up investigation. Additionally, the Veteran’s STRs indicate that the Veteran did not have any injuries, complaints or symptoms associated with his left shoulder pain during his remaining nine years of service. Lastly, the examiner noted that the Veteran’s lay statements provide no support to his contention that his left shoulder condition occurred during service. The Board finds that there is no probative link between the Veteran’s active service and his left shoulder condition. The Veteran’s 1973 separation examination did not report any complaints of left shoulder pain or make any findings of such conditions being present. The VA examiner reviewed the Veteran’s lay statements, STRs including the February 1974 entry, as well as post-service treatment records and found that there was no nexus to connect the Veteran’s isolated 1974 muscle strain to his current disability. The examiner reasoned that the Veteran did not require additional medical attention for his left shoulder during service and that his 1983 examination was silent as to any complaints or symptoms associated with left shoulder pain. Furthermore, the Veteran did not make continued complaints of left shoulder pain or disability within a year of his separation from service. The first documented evidence of record for the Veteran’s left shoulder pain post-service was in his 2007 private medical records, almost 24 years after separation from service. The passage of many years between discharge from active service and the documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board has considered the Veteran’s lay statements and notes that he is certainly competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). However, while the Veteran is competent to describe the observable symptoms of his left shoulder disability he has not demonstrated that he has the requisite specialized knowledge, training, or credentials to relate his current disability to his military service. Jandreau v. Nicholson, 491 F.3d 1372 (Fed. Cir. 2007). As such, his lay assertions are not competent to provide an opinion as to the etiology of his left shoulder disability, and thus, offers little probative value. Regarding the Veteran’s statements as to in-service causation, the Board notes that the Veteran has made numerous inconsistent statements as to the date of onset and thus finds the Veteran’s contentions of continuity of left shoulder symptoms to not be credible. A July 2007 medical treatment record indicates that the Veteran noted that his neck and shoulder pain began approximately seven or eight months earlier with an unrelated injury. During an October 2008 neurosurgery consult, the Veteran reported that he had been experiencing trouble with his left shoulder for the past 20 years due to physical training at Fort Hood. During the June 2012 VA examination for his left shoulder disability, the Veteran stated that his left shoulder jammed in a warehouse door while stationed in Korea in 1975 or 1976. During the November 2016 VA examination, the Veteran reported that he injured his left shoulder in 1975 or 1976. No specifics were given as to what occurred during that time to cause the Veteran’s left shoulder condition. In his March 2011 substantive appeal, the Veteran stated that he had been experiencing trouble with his left shoulder since his motor vehicle accident in 1982. These multiple inconsistent statements regarding date of onset render the Veteran’s statements not credible as to onset, to include regarding continuity of symptomatology. The November 2017 medical opinion adequately considers all medical and lay finding relevant to the medical question of the cause of the current disability, and the examiner who provided this opinion supported the opinion with adequate rationale. The Board finds that this is the most probative evidence of record and relies on it in finding that the current disability is not related to service.   As the preponderance of the evidence is against the claim for service connection, the benefit-of-the-doubt-rule is not for application, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Robinson, Associate Counsel