Citation Nr: 18115877 Decision Date: 07/03/18 Archive Date: 07/03/18 DOCKET NO. 15-17 066 DATE: July 3, 2018 ORDER New and material evidence having been received, reopening of the claim of entitlement to service connection for a right shoulder disability is granted. Entitlement to service connection for right shoulder disability is denied. FINDINGS OF FACT 1. An unappealed March 1978 rating decision denied service connection for right shoulder injury. 2. A right shoulder fracture was noted upon the Veteran’s entry into active service. 3. The Veteran’s pre-existing right shoulder injury did not increase in severity as a result of active service. CONCLUSIONS OF LAW 1. New and material evidence sufficient to reopen a claim of entitlement to service connection for a right shoulder disability has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 2. The criteria for entitlement to service connection for a right shoulder disability have not been satisfied. 38 U.S.C. §§ 1110, 1153 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1971 to June 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs Regional Office (RO) in Honolulu, Hawaii. 1. New and Material Evidence In a March 1978 rating decision, the RO denied entitlement to service connection for a right shoulder injury based on a finding that the disability was not found on current examination. The Veteran did not appeal that decision. The evidence that has been received since the March 1978 rating decision include post-service VA and private treatment records documenting treatment for Veteran’s right shoulder, a 2014 diagnosis of a right shoulder rotator cuff tear, and a 2014 VA examination and a 2014 VA medical opinion. The Board finds that the additional evidence is new and material as it has not been previously considered by VA and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a right shoulder disability. Therefore, reopening of the claim is warranted. 2. Entitlement to service connection for a right shoulder disability The Veteran asserts that he has a right shoulder disability that is related to his active service. Service treatment records (STRs) show that the Veteran was afforded an enlistment examination in June 1971. At that time, the Veteran reported that he had a history of broken bones on his Report of Medical History. The examining clinician further commented that the Veteran has a prior right shoulder fracture without residuals. Further, the Veteran’s upper extremities were noted to be clinically normal upon physical examination at that time. Further review of the STRs shows that the Veteran was seen in medical in December 1973, March 1974, and April 1974. Following these complaints, the Veteran received a physical profile advising against heavy lifting and prolonged exposure to cold. In December 1973, the Veteran was seen at a VA orthopedic clinic. X-ray testing revealed that the right shoulder was within normal limits, with inflammation but no trauma. April 1974 separation examination revealed recurrent right shoulder pain. A July 1975 private referral note remarked that a clicking sound came from the shoulder joint on abduction and external rotation. X-rays were otherwise unremarkable. That same month, the Veteran had an arthrogram on his right shoulder that reflected no evidence of a rotator cuff injury. The Veteran was afforded a VA examination for his right shoulder in March 1978. The examiner assessed the Veteran with residuals of injury to right shoulder, citing X-ray results that revealed no evidence of disease or injury in the right shoulder. The examiner noted that the Veteran had full range of motion in both shoulders, some crepitus under the right scapular, and tenderness under the right scapula with deep palpitation. The Veteran did not endorse tenderness at the shoulder joint, and there were no signs of muscle atrophy. The Veteran underwent another right shoulder X-ray in May 2010. Degenerative changes at the distal right clavicle and acromioclavicular (AC) joint, but no fracture or other acute osseous abnormality were revealed. In March 2014, a magnetic resonance imaging scan (MRI) disclosed a rotator cuff tear in the right shoulder and an osteophyte in the right AC joint. The Veteran was afforded a VA examination in April 2014. The physician provided a diagnosis of right shoulder strain and opined that the Veteran’s pre-existing condition was clearly and mistakably aggravated beyond its natural progression during active duty. As support, the examiner noted that a right fracture scapular was noted upon entry, as well as complaints of shoulder pain during service and upon separation. However, the physician conveyed that the Veteran did not have an AC joint disability or degenerative arthritis despite MRI results from a month earlier that showed differently. Since the examiner did not account for the Veteran’s full medical picture, the Board deems the opinion inadequate for adjudication purposes. As a result of the conflicting information provided by the April 2014 VA examiner, a subsequent April 2014 addendum opinion was obtained. The examiner concluded that the Veteran’s right rotator cuff tear and AC joint degenerative changes were not the result of aggravation that occurred during active service. In this regard, the examiner noted that the Veteran’s pre-existing right shoulder disability was minimally symptomatic during service, but, as reflected by medical evidence, did not manifest in chronic injury or disease. In support of that finding, the examiner cited to diagnostic imaging during service and shortly after the Veteran’s separation from service, both of which did not reveal any right shoulder abnormalities. The examiner noted that instead, the Veteran’s current diagnoses of right rotator cuff tear and AC joint arthritis appeared many years after the Veteran left service and were not related to an acute and transitory strain that was diagnosed in service. The Board finds that the April 2014 VA addendum medical opinion is adequate because the examiner thoroughly reviewed the claims file and discussed the relevant evidence, considered the contentions of the Veteran, and provided a thorough supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, the April 2014 addendum opinion is the most probative evidence of record. While the Veteran is competent to report observable symptoms of right shoulder pain, he is not competent to provide an opinion that a pre-existing disability was aggravated during service, as that requires medical expertise and is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. The Board notes that VA regulations do not permit aggravation to be conceded where the evidence does not show that the pre-existing injury underwent an increase in severity. Based on the record, the Board concludes that the Veteran’s pre-existing right shoulder, described as residual of right shoulder fracture, did not undergo an increase in severity during the Veteran’s active service. The Board has considered evidence of the Veteran’s complaints of right shoulder pain, as well as physical examinations and diagnostic testing that took place in December 1973, July 1975, and March 1978 that showed no evidence of injury or disease. Additionally, the Board has considered that the Veteran’s right rotator cuff tear and AC arthritis appeared over 30 years after separation. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a right shoulder disability is not warranted. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Sami, Arooj