Citation Nr: 21002657 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 15-27 581A DATE: January 14, 2021 ORDER Entitlement to service connection for a right shoulder strain as secondary to service-connected right knee disabilities is granted. Entitlement to service connection for a right shoulder disability other than right shoulder strain to include as secondary to service-connected bilateral knee and ankle disabilities is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. The Veteran has a right shoulder strain that was caused by the Veteran’s service-connected right knee disabilities. 2. A right shoulder disability other than right shoulder strain did not manifest in service and is not attributable to service; osteoarthritis of the right shoulder did not manifest within one year of separation from service. 3. A right shoulder disability other than right shoulder strain is not caused or aggravated by service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for right shoulder strain as secondary to service-connected right knee disabilities have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. § 3.310. 2. The criteria for service connection for a right shoulder disability other than right shoulder strain have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1968 to July 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from February 2012 (right shoulder disability) and November 2015 (TDIU) rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran and his spouse testified at a videoconference hearing. The transcript of the hearing is of record. By way of background, in November 2018, the Board adjudicated the Veteran’s claim for entitlement to an increased rating for service-connected bilateral knee disability and remanded the claims for entitlement to service connection for a right shoulder disability and entitlement to a TDIU for further evidentiary development and adjudication. The Veteran’s claims returned to the Board, and in September 2019, the Board again remanded the Veteran’s claims for evidentiary development. The Veteran’s claims folder has returned to the Board for further appellate consideration. Service Connection To establish a right to compensation for a present disability, a veteran must show: “(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”- the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For certain chronic disorders, including arthritis, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Any increase in severity of a non-service connected disease or injury that is proximately due to or the result of a service connected disease or injury, and not due to the natural progress of the nonservice connected disease or injury will be service connected. For secondary service connection to be granted, generally there must be (1) evidence of a current disability; (2) evidence of a service-connected disease or injury; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Right shoulder strain At the May 2018 hearing, the Veteran attested that he injured his right shoulder as a result of his service-connected bilateral ankle and knee disabilities. The Veteran reported that the instability of his bilateral ankles caused him to fall. The Veteran stated that in February 2009 he was walking down a flight of stairs when he lost his balance. He tried to stop his body from falling down the stairs by reaching back with his right hand to grab the rail. The Veteran stated that his body weight jerked his shoulder out. The Veteran affirmed that his right shoulder disability was not sustained in service, but rather from this incident. The Board notes that the Veteran has been diagnosed with a right shoulder strain. See a June 2019 VA examination report. Further, he is service connected for right knee, limited extension associated with osteoarthritis of the right ankle; osteoarthritis of the right ankle; osteoarthritis of the left ankle; right knee instability associated with ostearthritis of the right ankle; laxity of the left ankle; laxity of the right ankle; and arthritis of the left knee. A probative medical opinion is of record concerning the issue of nexus for the Veteran’s right shoulder strain. Specifically, after review of the Veteran’s medical history, the February 2020 VA examiner concluded that it is “highly likely” that the Veteran’s fall was caused by right quadriceps weakness/failure secondary with subsequent collapse of his right knee. Therefore, the examiner opined that it was the Veteran’s quadriceps muscle that failed and then the Veteran’s right knee collapsed under him which led to the right shoulder strain. Accordingly, there is a competent and credible basis to conclude that the Veteran’s current right shoulder strain disability is caused by his service-connected right knee disabilities, particularly when reasonable doubt is resolved in his favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for right shoulder strain, as secondary to the Veteran’s service-connected right knee disabilities, is warranted. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. Right shoulder disability other than right shoulder strain As discussed above, the Veteran contends that he has a right shoulder disability other than right shoulder strain that is related to service or is alternatively secondary to his service-connected bilateral knee and ankle disabilities. The Board notes that the Veteran has been diagnosed with right shoulder arthropathy and impingement, right rotator cuff tendonitis, and right acromioclavicular joint osteoarthritis. See November 2011 VA Examination and June 2019 C&P Exam. To the extent that the Veteran contends that these right shoulder disabilities are related to service, the Board finds that the objective evidence outweighs this contention. Crucially, the Veteran’s service treatment records indicate no suggestion of treatment for or complaints of symptoms related to the right shoulder. Additionally, his June 1970 separation examination indicated a normal examination of the right shoulder. Indeed, the earliest indication of a right shoulder disability dating back to service is in 2009 when the Veteran reported injuring his right shoulder from the fall down stairs. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence can have greater probative value than history as reported by the veteran). This is more than 35 years after the Veteran’s discharge from service. Therefore, to the extent that the Veteran asserts that his right shoulder disability other than right shoulder strain is related to service, the Board finds that the more probative evidence is against any such assertion. The Board also notes that while the Veteran currently evidences osteoarthritis of the right shoulder, in as much as the service treatment records reveal normal orthopedic examinations, he did not have characteristic manifestations sufficient to identify the chronic disease entity during service or within one year of separation. 38 C.F.R. § 3.303(b). The Veteran has not contended otherwise. The Board has carefully evaluated the evidence and, for reasons stated immediately below, finds that a preponderance of the competent and probative evidence of record is also against a finding that the Veteran’s current right shoulder disability other than right shoulder strain is due to or aggravated by his service-connected right and left knee and ankle disabilities and service connection is therefore not warranted on a secondary basis. Specifically, a VA medical opinion was obtained in February 2020 regarding the etiology of the Veteran’s right shoulder disability. After review of the Veteran’s medical history, the VA examiner concluded that it is “highly likely” that the Veteran’s report of his knee (not ankle) “giving out” caused him to start to fall on a staircase, grab the handrail to catch himself, and cause injury to his right shoulder. However, the examiner noted that it seems the only likely result from this event was a right shoulder strain. Additionally, the examiner opined that the Veteran has underlying shoulder pathology (acromioclavicular arthritis with subacromial entrapment of the supraspinatus tendon and supraspinatus tendinosis) that does not occur after a one-time, acute injury. The February 2020 VA opinion report was based upon thorough consideration and analysis of the Veteran’s pertinent medical history. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician’s statement is dependent, in part, upon the extent to which it reflects “clinical data or other rationale to support his opinion”). The Veteran has not submitted a medical opinion to contradict the VA examiner’s opinion that his current right shoulder disability other than right shoulder strain is not caused or aggravated by the service-connected right and left knee and ankle disabilities. Here, the preponderance of the evidence is against the claim and there is no doubt to be resolved. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for a right shoulder disability other than right shoulder strain, to include as secondary to service-connected bilateral knee and ankle disabilities. The benefit sought on appeal is accordingly denied. REASONS FOR REMAND TDIU As discussed above, the Veteran has been granted service connection for right shoulder strain. The disability rating and effective date for this grant may impact his TDIU claim but must be assigned by the Agency of Original Jurisdiction in the first instance. Therefore, the TDIU claim must be remanded. The matter is REMANDED for the following action: 1. Implement the grant of service connection for right shoulder strain. 2. Thereafter, readjudicate the claim for TDIU. If it remains denied, issue a supplemental statement of the case to the Veteran and his representative. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Nadia Kamal, 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.