Citation Nr: 21064602 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 16-59 810 DATE: October 20, 2021 ORDER Service connection for a right hand disability is denied. Service connection for a left shoulder disability is denied. Service connection for a left ankle disability is denied. FINDINGS OF FACT 1. The Veteran's right hand disability did not have its initial clinical onset in service and is not otherwise related to his service or to any incident therein. 2. The Veteran's left shoulder disability did not have its initial clinical onset in service and is not otherwise related to his service or to any incident therein. 3. The Veteran's left ankle disability did not have its initial clinical onset in service and is not otherwise related to his service or to any incident therein. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hand disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1980 to September 1983. These matters come to the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) Jackson, Mississippi. Jurisdiction is currently with the Appeals Resource Center (ARC). These matters were previously before the Board at which times they were remanded for further development. SERVICE CONNECTION Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical evidence. VA must also consider all favorable lay evidence of record. See 38 U.S.C. § 5107 (b); see also Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (a Veteran is competent to report on that of which he or she has actually observed and is within the realm of his or her personal knowledge). 1. Entitlement to service connection for a right hand disability In addressing the criterion of a current diagnosis, VA treatment records document a current diagnosis of polyarthralgia after a post-service fall. See October 2017 Biloxi VAMC Records. Resolving all doubt in favor of the Veteran, the Board finds the criterion of a current diagnosis met on this basis. In addressing in-service incurrence, the Veteran's service treatment records (STRs) document right palm and finger lacerations, exposed tendon, and 5th finger numbness. In addressing nexus, the evidence of record includes an opinion from a July 2015 VA examiner which concluded that the Veteran did not have a current diagnosis associated with the claimed condition. In September 2019, the Board remanded the Veteran's claim to obtain an examination of the right hand and a September 2020 VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted laceration to right 5th palmar aspect, exposed tendon, and numbness to 5th digit finger documented in the STRs. In determining that that a relationship to service could not be established, the examiner reasoned that the injury in service completely healed with no residuals; these problems were not current, and the Veteran stated that he had no issues with his right hand. The examiner further reasoned that during service, laceration to the right 5th palmar aspect was acute only; there was no evidence of chronicity of care. The Board finds the September 2020 VA opinion to be highly probative. The opinion was based on a review of the claims file and relevant facts, and the examiner provided a detailed rationale. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board acknowledges that the September 2020 VA opinion did not specifically address the Veteran's post-service polyarthralgia diagnosis. However, the Board finds this omission immaterial as VA treatment records indicate that this diagnosis is related to a post-service fall and the Veteran has never alleged that this post-service injury is related to an injury sustained in service. In sum, without any competent evidence that the Veteran has a right-hand disability related to service, service connection is not warranted. There is no doubt to be resolved in this case. 38 U.S.C. § 5107. 2. Entitlement to service connection for a left shoulder disability In addressing the criterion of a current diagnosis, the evidence of record includes a September 2020 Shoulder and Arm Conditions Examination Report in which the examiner diagnosed the Veteran with history of old distal clavicular fracture. In addressing in-service incurrence, the Veteran contends that he has a left shoulder disability as a result of push-ups during in-service training. The Veteran's STRs document swelling around his left shoulder blade and severe muscle spasm between shoulder blades. In addressing nexus, to the extent that the Veteran has stated that he has a left shoulder disability attributable to service, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the etiology of his disability because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Here, because the etiology of a left shoulder disability may be multifactorial, and he lacks the requisite expertise, he is not competent to offer an opinion as to a relationship to service. The evidence of record otherwise includes an opinion from a July 2015 VA examiner concluding that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran's current left shoulder condition is considered to have been caused totally by his job-related accident in 1986 and cannot be shown to be connected to his military service. There are no STRs to support a left shoulder condition and the Veteran submitted a physician noted from Dr. D.R., Neurologist, which details the work accident where he fell out of a truck and sustained major injuries on February 15, 1986. The impression of the neurology consult was injury to the low back, left knee, trauma to the upper extremities and cervical spine with subsequent weakness and numbness in the left upper extremity predominately in C7, C8 distribution but also involving C6, 7. In September 2019, the Board remanded the Veteran's claim to obtain an addendum opinion addressing swelling around left shoulder blade and severe muscle spasm between shoulder blades documented in the Veteran's STRs and a September 2020 VA examiner again opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran reported a left shoulder injury while doing push-ups in the military. The examiner reasoned that the Veteran's STRs document upper back swelling noted around the left shoulder blade October 14, 1981 and the Veteran was diagnosed with severe muscle spasm. No further documentation was noted in the STRs. The Veteran was diagnosed with history of old distal clavicular fracture found on x-ray on May 21, 2019. However, diagnosis of muscle spasms would not have caused an old clavicular fracture. The examiner further reasoned that a March 1987 private neurological consult indicated that the Veteran had a left shoulder disability related to a job accident. The Board finds the July 2015 and September 2020 VA opinions to be highly probative. The opinions were based on a review of the claims file and relevant facts, and the examiners provided detailed rationales. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In sum, without any competent evidence that the Veteran has a left shoulder disability related to service, service connection is not warranted. There is no doubt to be resolved in this case. 38 U.S.C. § 5107. 3. Entitlement to service connection for a left ankle disability In addressing the criterion of a current diagnosis, the evidence of record includes a September 2020 Ankle Conditions Examination Report in which the examiner diagnosed the Veteran with tendonitis. In addressing in-service incurrence, the Veteran contends that he has a left ankle disability as a result of physical training and jumping out of planes, tanks, and buildings during service. The Veteran's STRs document left ankle pain and swelling and a diagnosis of a left ankle sprain. In addressing nexus, to the extent that the Veteran has stated that he has a left ankle disability attributable to service, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the etiology of his disability because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Here, because the etiology of a left ankle disability may be multifactorial, and he lacks the requisite expertise, he is not competent to offer an opinion as to a relationship to service. The evidence of record otherwise includes an opinion from a July 2015 VA examiner concluding that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran was on 100% disability/social security for a fall out of a truck while at work (after military separation) that resulted in multiple left sided injuries and lower extremity residuals. The examiner reasoned that although the left ankle was sprained and treated during active service, no residuals were documented in the STRs. The Veteran's current left ankle condition was considered to have been caused totally by his job-related accident. In September 2019, the Board remanded the Veteran's claim to obtain an addendum opinion because the 1986 accident treatment note did not document a specific left ankle injury. A September 2020 VA examiner noted that the Veteran reported a left ankle injury as a result of running during physical training and jumping out of airplanes in the military but again opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that objective examination was normal; the Veteran's symptoms were subjective only. The examiner further reasoned that during service the Veteran was diagnosed with an ankle sprain and tendonitis. However, tendonitis was not diagnosed upon examination in May 1989. The diagnosis did not exist in May 1989; therefore, the examiner concluded that there was no chronic diagnosis, and the condition did not have onset in service. The Board finds the July 2015 and September 2020 VA opinions to be highly probative. The opinions were based on a review of the claims file and relevant facts, and the examiners provided detailed rationales. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In sum, without any competent evidence that the Veteran has a left ankle disability related to service, service connection is not warranted. There is no doubt to be resolved in this case. 38 U.S.C. § 5107. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.