Citation Nr: 20007802 Decision Date: 01/31/20 Archive Date: 01/29/20 DOCKET NO. 12-33 969A DATE: January 31, 2020 ORDER Service connection for a left arm, shoulder, and elbow disability, to include as secondary to a cervical spine disorder, is denied. FINDING OF FACT The Veteran’s left arm, shoulder, and elbow disability is not secondary to a service-connected cervical spine disability, and it is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left arm, shoulder, and elbow disability due to service or service-connected cervical spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1982 to December 1982 and November 1983 to April 2005. Service connection for a left arm, shoulder, and elbow disability, to include as secondary to a cervical spine disorder, is denied. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the Veteran has a current diagnosis of acromioclavicular joint osteoarthritis, the preponderance of the evidence weighs against finding that the Veteran’s disability began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records reflect that in December 2003, the Veteran reported a two-day history of “left shoulder/back/neck pain.” He was assessed with musculoskeletal pain and a mild trapezius sprain. There is no evidence of follow-up treatment. In March 2005, the Veteran completed a Report of Medical History in which he reported numbness or tingling in his shoulder, elbow, or wrist. The separation examination yielded normal findings. The Veteran underwent a VA examination in February 2010. He reported that his left arm problems are connected to his cervical spine disability. He reported weakness, which impacts pushing, lifting, reaching, and everyday activities. The examiner opined that it was less likely than not caused by or a result of his cervical spine disability. The examiner’s rationale was that the claims file contained no information regarding a cervical spine injury or chronicity of a disability. The Veteran underwent another VA examination in October 2017. He reported that he has a history of left shoulder numbness related to his elbow. He stated that his shoulder has been in pain, but it was not in pain at the time of the examination. He reported limited range of motion and stiffness. He stated that symptoms are worse in the morning, with bad weather conditions, with elevation or reaching movements, and overhead movements. The examiner noted that x-rays dated December 2012 revealed mild acromioclavicular degenerative changes. The examiner opined that the disability was less likely than not due to service because the current disability is shoulder impingement syndrome, unlike the trapezius spasm documented in the service treatment records. The Veteran underwent a third VA examination in February 2019. As instructed, the examiner noted the December 2003 in-service treatment and the March 2005 report of numbness and tingling. The examiner opined that the December 2003 musculoskeletal pain and trapezius spasm is less likely than not responsible for the Veteran’s current shoulder impingement syndrome. The examiner noted that a review of the medical literature is silent for any mechanism by which a left trapezius muscle spasm may cause or aggravate bilateral shoulder impingement syndrome. The examiner also noted that the Veteran’s separation examination was silent for any chronic disability with regard to the Veteran’s cervical spine. With regards to whether the current disability is secondary to the Veteran’s cervical spine disability, the examiner stated that the shoulder impingement syndrome is a stand-alone entity, neither due to or aggravated by his service-connected degenerative arthritis of the cervical spine or active military service. He stated that a review of medical literature is silent for any mechanism by which degenerative osteoarthritis of the cervical spine may cause or aggravate bilateral shoulder impingement syndrome. He stated that when the arm is raised, the subacromial space (the gap between the anterior edge of the acromion and the head of the humerus) narrows, and the supraspinatus muscle tendon passes through this space. He stated that causes of impingement syndrome include bony structures such as subacromial spurs, osteoarthritic spurs on the acromioclavicular joint, variations in the shape of the acromion, and thickening or calcification of the coracoacromial ligament. Finally, the examiner opined that the Veteran’s current disability is less likely than not related to a June 1987 motor vehicle sustained during service. He noted that the service treatment records were silent for a diagnosis or treatment of degenerative osteoarthritis of the left acromioclavicular joint, and review of the June 1987 treatment report is silent as to any injury to the left shoulder or acromioclavicular joint. He stated that the Veteran’s degenerative osteoarthritis is consistent with normal and expected aging. The Veteran believes his disability is related to an in-service injury or disease. He is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiners. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a left arm, shoulder, and elbow disability, to include as secondary to a cervical spine disorder must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Prem, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.