Citation Nr: 21001437 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 09-50 405 DATE: January 8, 2021 ORDER Entitlement to service connection for left shoulder disability is granted. FINDING OF FACT The Veteran’s left shoulder disability had its onset in active service. CONCLUSION OF LAW The criteria for service connection for left shoulder disability have been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from September 1973 to September 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2014, April 2016, and April 2019, the Board remanded the matter on appeal for additional development. The matter has been returned to the Board for review. Service connection for left shoulder disability Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In order to establish service connection on a direct basis, the record must contain competent evidence of: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran asserts that his current left shoulder disability had its onset during active service. He reported that he first experienced left shoulder pain in the 1980s during service, attributed his shoulder symptoms to heavy lifting and duty assignments, and indicated that his disability had a gradual onset and has continued to the present time. First, the Board acknowledges that the Veteran provided a history of dislocating his shoulders prior to entry into active service. However, the presumption of soundness attaches as the enlistment examination report shows that the Veteran’s upper extremities were evaluated as normal. 38 C.F.R. § 3.304(b). There is no clear and unmistakable evidence that demonstrates that the Veteran’s disability preexisted service to rebut that presumption and, therefore, the Board will consider service connection on a direct basis. The evidence reflects that the Veteran is diagnosed with rotator cuff tendonitis, glenohumeral joint osteoarthritis, and acromioclavicular joint osteoarthritis. Service treatment records (STRs) do not contain explicit reference to the left shoulder. Instead, the Veteran’s right shoulder was examined after an injury in 1991 and, in April 1993, the Veteran was assessed with a subluxating right shoulder. However, several reports of medical history show that the Veteran reported a painful or trick shoulder without reference to which shoulder was affected. The separation examination report shows that the Veteran’s upper extremities were evaluated as normal. In 1995, shortly after separation from active service, the Veteran sought treatment for his right shoulder, but also reported pain radiating into his left shoulder. Other private medical treatment records dated in 2003 addressed the chronic nature of the Veteran’s bilateral shoulder arthritis and the Veteran has reported that he experienced left shoulder symptoms since service. Concerning etiology, the Board has requested multiple medical opinions regarding the etiology of the Veteran’s left shoulder disability. However, as explained by the April 2019 remand, the Board found the October 2014 VA examination to be inadequate, the June 2016 addendum opinion to that examination to be inadequate, and determined that the May 2018 and September 2018 opinions provided by an expert from the Veterans Health Administration (VHA) were inadequate. In April 2019, the Board again remanded to obtain a medical opinion as to whether the Veteran’s left shoulder disability was related to an in-service injury, event, or disease, including repetitive work, lifting, and carrying as part of his military occupational specialty (MOS). In January 2020, the Veteran was provided another VA examination and he again reported that his left shoulder began to be a problem in the late 1980s, never resolved, and that he had problems ever since it started in the service. The January 2020 VA examiner provided a negative opinion, noting that there was no objective evidence to support the Veteran’s statements concerning chronicity and that there was not enough medical evidence, including the Veteran’s lay evidence, to make a nexus relationship. The examiner stated that there should reasonably be at least some objective record to support the Veteran’s claim. The Board finds the opinion to be inadequate. The examiner did not address the report of pain radiating to the left shoulder in 1995 or the reports of medical history that indicated a shoulder problem, but without reference to which shoulder. As a result of the examiners’ repeated failings, there is no adequate nexus opinion. Accordingly, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s left shoulder disability had its onset in active service. Again, STRs show reports of a painful or trick shoulder without reference to which shoulder and, therefore, the Board may not assume that those references only pertain to the right shoulder. In addition, the Board finds the Veteran competent and credible to report the onset and chronic nature of his left shoulder symptomatology, which has been consistent. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Though there is no adequate medical opinion as to whether the Veteran’s left shoulder disability is related to service, given the evidence of record and the Veteran’s statements, the Board will resolve doubt in his favor, and finds that his left shoulder disability had its onset in active service. Accordingly, service connection is warranted for a left shoulder disability. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Seay, 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.