Citation Nr: 18156595 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 09-25 715 DATE: December 11, 2018 ORDER Service connection for left shoulder and left upper arm disabilities is denied. Service connection for left hip, left leg, and left foot disabilities is denied. FINDINGS OF FACT 1. The Veteran’s left shoulder and upper arm disabilities are not etiologically related to an in-service injury, event, or disease. 2. The Veteran’s left hip, leg, and foot disabilities are not etiologically related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for left shoulder and upper arm disabilities are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for left hip, leg, and foot disabilities are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from January 1965 to October 1968. He died in August 2017, while the present appeal was pending. The appellant (his daughter) has been substituted for the Veteran for purposes of processing the appeal to completion. These matters are on appeal from a December 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Hartford, Connecticut. In November 2015, the Board denied service connection for left shoulder, left upper arm, left hip, left leg, and left foot disabilities. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a June 2017 memorandum decision, the Court set aside the November 2015 Board decision and remanded the matters for further proceedings. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). 1. Entitlement to service connection for left shoulder and upper arm disabilities. 2. Entitlement to service connection for left hip, leg, and foot disabilities. During the appeal period, the Veteran maintained that arthritis of his left upper and lower extremities was caused by his duties on the flight line. Specifically, he reported that while checking the hydraulics in an aircraft, the engine was running, and he was pulled into the intake of the plane. He stated that the entire left side of his body was stuck in the intake until someone turned off the engine. He then fell onto the tarmac onto his left hip. He stated that after the incident, he had pain in his left arm and left leg. He went to the clinic and was given aspirin and told to “shake it off.” He indicated that although he went back to duty, he continued to experience pain and numbness in the left arm and leg continuously, even after his military discharge. The service treatment records are negative for any complaints, symptoms, findings or diagnosis of an injury or disability of the left upper or left lower extremities. The Veteran’s September 1968 separation physical examination evaluated his upper and lower extremities, feet, spine, and other musculoskeletal systems as clinically normal. It was noted that the Veteran denied any other significant medical or surgical history. On his contemporaneous self-report of medical history, the Veteran denied any cramps in his legs, arthritis, bone or joint deformities, painful or trick shoulder, elbow, or knee, and any foot trouble. A July 2008 VA treatment record shows that the Veteran complained of left shoulder and left leg pain and numbness, which he claimed were all related to his service in the military. The Veteran stated that he had a prolonged history of left shoulder, arm, and leg numbness and discomfort after experiencing a fall during the TET offensive in the Republic of Vietnam. He stated the symptoms bothered him recurrently, but were becoming more frequent and severe. It was noted that the Veteran wanted to be assessed for compensation and pension for this injury. The assessment was chronic left-sided numbness for greater than thirty years. September 2008 X-rays of the left hip and left shoulder found degenerative joint disease (DJD). A November 2012 VA shoulder and hip examination reports show that the examiner reviewed the claims file and considered the Veteran’s reported history. The examiner noted that there was nothing in the Veteran’s service treatment records regarding traumatic injury or symptoms for the left shoulder, hip, or leg. The Veteran reported an injury in service to the left side when he was sucked against a jet intake. He went to a doctor and was given pain medications and sent back to work. He stated that he felt electrical impulses down his left arm to his elbow and noted numbness in the lateral aspect of the left thigh with a limp. He stated he had chronic left hip pain. The Veteran stated that the symptoms had become worse with age. The examiner opined that he was unable to link left shoulder DJD and left hip DJD to service without resorting to speculation because the Veteran did not present to the VA with complaints until 2008, 40 years after service; there was no evidence of an injury or symptoms in the service treatment records; and, the Veteran reported a work-related injury in September 2011 that aggravated his back and shoulder. An October 2014 VA examination report shows that the examiner reviewed the claims file and discussed pertinent evidence. The Veteran reported intermittent pain in the left shoulder and left hip and numbness of the left thigh and leg, which he stated started in the service in 1967 and had been ongoing since. The Veteran stated that he fell about five feet after being stuck to the intake of an engine, causing injury to the left side of the body. He stated that he was treated at a clinic in Thailand and was given aspirin and sent back to duty without the need for further evaluation or treatment. The Veteran denied requiring further medical attention for his injuries. He had always experienced intermittent pain of the left shoulder and left hip and numbness down the left leg, which initially involved the left foot, but currently did not. The Veteran stated that it was never limiting or disabling, and after separating from the service he was able to have continuous employment in various capacities. He worked as a thermoplastics engineer, did installation of interior parts on helicopters, and had worked for the past 15 years delivering auto parts. The Veteran stated that although he had the symptoms since service, he did not seek medical attention until 2008 because he did not think there was anything that could be done about it. It was not until 2008 when another veteran told him that he should seek compensation for his injuries that he decided to get himself checked. The October 2014 VA examiner opined that the Veteran’s left shoulder DJD, left hip DJD, and left lower extremity radiculopathy (due to lumbar spine degenerative disc disease (DDD)/DJD) were less likely as not due to the injury in service as described by the Veteran or any other event or incident during his active service. The examiner stated that service treatment records did not document a left shoulder/left hip/left lower extremity injury, any injury at all, or any left shoulder/left hip/left lower extremity complaints or conditions. The separation examination showed that the Veteran specifically denied shoulder pain, joint pains, and neuritis and the medical provider did not diagnose any conditions. After his military separation, there were no treatment records available for review until 2004, when the Veteran presented to the VA for routine care without any complaints related to the claimed conditions. The Veteran had received medical care at the VA since 2004, and until 2008 all the medical notes showed no complaints, no concerns, and physical examinations were reported as normal. VA medical records from 2004 to 2008 showed an active man engaged in physical activity as strenuous as resistance training in a treatment note from September 2007, without any left shoulder, left hip or left lower extremity complaints. In 2008, approximately 40 years after separation from service, the Veteran reported pain in the left shoulder, left hip, and left lower extremity, and numbness. Although the Veteran reported subjective onset of left shoulder, left hip, and leg symptoms in service as the result of an injury sustained in service when he fell after being stuck in the intake of a jet engine and is competent to report that, the timing of his clinical presentation went against any major trauma in service that would cause DJD of the shoulder/hip and radiculopathy of the left lower extremity. The examiner further stated that one would expect much earlier presentation of symptoms, signs, and disability than at the age of 64 if a joint trauma at the age of 23 was significant to cause traumatic arthritis. Although the treatment notes from 2008 to the present continued to state that the Veteran had traumatic arthropathy of his hip and shoulder and left lower extremity neuropathy from an injury in the service, that diagnosis was based on history provided by the Veteran. There were no medical notes that presented an objective and evidence-based rationale and linked the Veteran’s alleged injury in service and his current left shoulder, left hip, and left lower extremity conditions. The examiner opined that the Veteran’s left shoulder DJD, left hip DJD, and left lower extremity radiculopathy, which were due to lumbar spine DDD/DJD (to include left lower extremity numbness and decreased motor strength of left big toe dorsiflexion), were due to advanced age wear and tear arthritis (degenerative arthritis) and less likely as not due to the injury in service as described by the Veteran or any other event or incident during active service. In June 2018, the Board obtained an expert medical opinion from Dr. D.K., an orthopedist, regarding the Veteran’s disabilities. Dr. D.K. reviewed the record and literature regarding the dangers of engine ingestion near airplanes. For purposes of offering an opinion, he accepted that the reported mechanism of injury, as described by the Veteran, was true. He explained that pain is a subjective perceived symptom with multiple causes and can be due to pathological, protective, emotional, and physical etiologies. Generally, people are credible and competent to describe their perception of pain, but without appropriate evaluation the etiology cannot be determined. After reviewing the record, Dr. D.K. found that the degenerative changes noted in the radiographic reports, considering the Veteran’s age and prior occupation, were more consistent with anticipated wear and tear of an aging population and less consistent with injuries due to trauma. Dr. D.K. concluded that it was less likely than not (i.e., less than 50 percent likely) that the Veteran’s left shoulder, left upper arm, left hip, left leg, and left foot disabilities, to include arthritis, had their onset in, were caused by, or were otherwise etiologically related to his in-service injury. After carefully considering the pertinent evidence, to include the Veteran’s assertions, the Board finds that the preponderance of the evidence weighs against the claims for service connection for left shoulder and upper arm disabilities and for left hip and leg disabilities, to include the foot. Service treatment records are negative for symptoms, complaints, findings, or diagnosis of any left upper or left lower extremity disabilities. On separation, the Veteran specifically reported that he did not have cramps in his legs, arthritis, bone or joint deformities, painful or trick shoulder, elbow, or knee, and any foot trouble. Furthermore, after service, the first documented evidence that the Veteran had complaints pertaining to the left upper and left lower extremities was in July 2008, more than thirty-five years after his discharge from service. Those facts notwithstanding, the Board has accepted the Veteran’s reported mechanism of injury, and his reported symptomatology since service, as true. Even so, however, as noted, a medical expert has opined that it is unlikely that the Veteran’s left shoulder, left upper arm, left hip, left leg, and left foot disabilities had their onset in, were caused by, or were otherwise etiologically related to his in-service injury. The Board finds the opinion probative inasmuch as it based on a review of the evidence and supported by a rationale specific to the facts of the Veteran’s case. It also uncontradicted by other competent opinion evidence of record. The only evidence of record supporting the Veteran’s claim is his own lay statements. However, while the Veteran is competent to describe his symptoms, there is no evidence of record to show that he has the specialized medical education, training and experience necessary to provide a competent medical opinion as to the nature and etiology of the disabilities claimed on appeal. It is apparent from the record that determining the etiology of his current left shoulder and upper arm disabilities and left hip, leg, and foot disabilities is a medically complex matter. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As the preponderance of the evidence is against the Veteran’s claims, the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. R. Watkins, Counsel