Citation Nr: 21069193 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 14-23 078 DATE: November 17, 2021 ORDER Entitlement to service connection for a right shoulder disability is granted. Entitlement to service connection for a left shoulder disability is granted. Entitlement to service connection for a right knee disability is granted. Entitlement to service connection for a left knee disability is granted. FINDINGS OF FACT 1. The evidence is at least equipoise that the Veteran's current right shoulder disability is related to his period of service. 2. The evidence is at least equipoise that the Veteran's current left shoulder disability is related to his period of service. 3. The evidence is at least equipoise that the Veteran's current right knee disability is related to his period of service. 4. The evidence is at least equipoise that the Veteran's current left knee disability is related to his period of service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for service connection for a left shoulder disability have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 3. The criteria for service connection for a right knee disability have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 4. The criteria for service connection for a left knee disability have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the United States Army from August 1957 to March 1959. In August 2017, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. A copy of the transcript has been associated with the claims file. In November 2017, the Board remanded the appeal for further development. In July 2019, the Board issued a decision which denied the claims on appeal. The Veteran filed a timely appeal to the Court of Appeals for Veterans' Claims (Court). In an August 2020 Joint Motion for Remand, the parties agreed to remand the appeal to the Board for further development. SERVICE CONNECTION 1. Service connection for a right shoulder disability 2. Service connection for a left shoulder disability The Veteran contends that his right and left shoulder disabilities are due to his period of service. The Board concludes that the Veteran has current diagnoses of acromioclavicular joint osteoarthritis of the right and left shoulders that are related to his period of service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Board notes that in a March 2010 response to a Request for Information, the National Personnel Records Center (NPRC) advised the RO that the Veteran's service treatment records are fire-related and unavailable for review. The Board also notes that in an April 2011 VA Memorandum, VA issued a formal finding of unavailability of federal Social Security Administration (SSA) records. In a July 2010 response to a Request for Information, the NPRC reported that the Veteran's personnel record indicates admittance to Madigan Army Hospital between November 1958 to January 1959. In an April 2010 lay statement, the Veteran asserted that he was treated for a left and right shoulder injury in Madigan Hospital following an injury during service. The Veteran reported that he was told that his left shoulder was injured but not enough for surgery. The Veteran further stated that he may have received a shot in his left shoulder. He stated that he was informed that he would probably have pain from time to time and more than likely develop arthritis later. The Veteran noted that he was released to light duty. He also noted that he was discharged from service a couple of months later. In May 2010, the Veteran submitted a January 1959 medical record showing that the Veteran was admitted to Madigan Hospital from January 1, 1959 to January 7, 1959. The record does not contain further information regarding the reason for the Veteran's admittance. In an April 2011 response to a Request for Information, NPRC advised that records for the Veteran regarding his admittance to Madigan Army Hospital were not located. In an August 2017 Board hearing, the Veteran reasserted that his bilateral shoulder disability was due to a fall that occurred during service. The Veteran stated that he landed on his right shoulder and then flipped over, causing him to hurt his knees and left shoulder. The Veteran stated that he was hospitalized for about six weeks. The Veteran stated that he did not receive treatment following separation because he did not know to further treat his disabilities. The Veteran's wife stated that the Veteran complained about his knees and shoulders occasionally, but would then let it go. She stated that the Veteran just lived with the pain because he had a family to support. In March 2019, the Veteran was afforded a VA examination. The examiner gave a diagnosis of acromioclavicular joint osteoarthritis of the right and left shoulders. The examiner opined that the Veteran's current shoulder disabilities were not due to his period of service. The Board notes that the March 2019 VA opinion has been found to be inadequate. Therefore, no further analysis of this evidence is necessary. In an August 2021 private medical opinion, the examiner stated that the Veteran described his in-service injury, recalling that in 1958, he and other soldiers unloaded track vehicles onto the shore. The examiner noted that the Veteran recalled that he was on top of the track when it suddenly stopped, at which point he fell down in front of the motor. The examiner noted that the Veteran reported accidently touching the hot motor with his hands, causing him to lose balance and fall to the ground. The examiner noted that the Veteran estimated that the tracks were about eight or nine feet high and his shoulders were hurt the second he hit the ground. The examiner stated that the Veteran reported being brought to a medic ship on a gurney because he was completely immobile. The examiner stated that the Veteran was told his shoulder would resolve itself because he was young, but since his injury, his shoulder conditions have only gotten worse. The examiner stated that the service records and medical documentation corroborate that he has had shoulder symptoms since his 1958 injury. The examiner noted that the Veteran's service personnel record indicates admittance to Madigan Army hospital in November 1958. The examiner cited the Veteran's April 2010 lay statement in which he reported being in the hospital from November 1958 to January 1959 after hurting his shoulders. The examiner stated that a January 2005 treatment note reported left shoulder pain, a July 2007 treatment record indicated a history of left shoulder pain due to an old trauma, and an x-ray from July 2007 showed mild degenerative changed of the AC joint with spurring inferiorly with calcific peritendinitis of the supraspinatus tendon with diffuse osteopenia. The examiner noted that the Veteran reported that he was admitted to the Army hospital in service after hurting his right shoulder in an April 2010 lay statement. The examiner further noted a November 2011 medical record which reported left AC joint degenerative changes. The examiner went on to cite a November 2011 x-ray showing calcification of the right AC joint. The examiner noted that the March 2019 VA examination reported a diagnosis of right shoulder AC joint osteoarthritis and cited symptoms of abnormal range of motion, pain with weight bearing, tenderness and reduced muscle strength. The examiner further noted abnormal range of motion, functional loss, pain with weight bearing and inability to reach far in any direction, and tenderness of the joint documented in the March 2019 examination of the shoulder. The examiner stated that based on the mechanism of injury of falling from a height of eight or nine feet and the constant pain that the Veteran has endured since his in-service injury to his shoulders, it is more likely than not that his right and left shoulder disabilities began developing during his military service. The examiner explained that without addressing the conditions properly initially, the initial injuries only worsened over time, propagating to the current severe degeneration in the shoulders. The examiner went on to state that although degeneration of the shoulder can be age-related, the Veteran's degeneration is more severe than what would be seen in the natural aging process. The examiner stated that in situations with such severe degeneration, there is typically a specific injury or accident which begins the cascade of degeneration. The examiner noted that the Veteran indicated that he has had pain and limited motion in his shoulders since his initial injury in 1958. Therefore, the examiner concluded that the Veteran's in-service injury more likely than not began the degenerative cascade in his right and left shoulder disabilities. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current right and left shoulder disabilities are related to his period of service. The August 2021 medical opinion indicates a positive nexus between the Veteran's shoulder disabilities and his period of service. The limited service records support the conclusions reached in this opinion. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left and right shoulder disabilities is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service connection for a right knee disability 4. Service connection for a left knee disability The Veteran contends that his right and left knee disabilities are due to his period of service. The Board concludes that the Veteran has current diagnoses of right and left knee osteoarthritis that are related to his period of service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Board notes that in a March 2010 response to a Request for Information, the National Personnel Records Center (NPRC) advised the RO that the Veteran's service treatment records are fire-related and unavailable for review. The Board also notes that in an April 2011 VA Memorandum, VA issued a formal finding of unavailability of federal Social Security Administration (SSA) records. In a July 2010 response to a Request for Information, the NPRC reported that the Veteran's personnel record indicates admittance to Madigan Army Hospital between November 1958 to January 1959. In an April 2010 lay statement, the Veteran asserted that he injured his knees while unloading a ship during service. The Veteran stated that he was unable to walk following the accident. The Veteran reported that he was transferred by medic ship to Madigan Hospital. The Veteran stated that the doctors operated on his left knee and bandaged his right knee. He further reported that his leg was raised up in traction during his hospital stay. The Veteran stated that he was given a cane to walk with following discharge because one leg was sympathetic to the other, causing a limp. The Veteran noted that he was released to light duty. He also noted that he was discharged a couple of months later. In April 2010, the Veteran submitted a January 1959 medical record showing that the Veteran was admitted to Madigan Hospital from January 1, 1959 to January 7, 1959. The record does not contain further information regarding the reason for the Veteran's admittance. In May 2010, the Veteran submitted an April 1987 SSA record, which stated that the medical evidence reveals that the Veteran injured his right leg in early August 1984 when he fell and that he was treated for an infected bruise. The record notes that the Veteran has persistently complained of pain in the right lower extremity subsequent to that time. The record stated that the Veteran underwent a right knee arthroscopy in May 1985. Moreover, the record noted that in January 1986, the Veteran's treating physician reported that the Veteran walked with a cane but was able to walk short distances without a cane. The physician gave a diagnosis of reflex sympathetic dystrophy which caused right antalgic gait and noted that treatment would result in moderate improvement. The record further noted that in June 1986, the Veteran's treating physician concluded that the Veteran's subjective complaints were not really substantiated by the objective physical findings. The physician noted that the Veteran had full extension of both knees with limited flexion to about 60 degrees, no atrophy, no effusion, and normal sensation. The physician stated that x-rays of the knees reveal minor degenerative changes. In a January 2003 private medical examination, the Veteran reported pain in both legs frequently. The examiner noted that there may be multiple causes for it. The examiner stated that the Veteran had a severe injury at work and subsequent abscess formation requiring incision and drainage of a large area. The examiner also noted that the Veteran had left knee pain for a long period of time and had arthroscopy surgery done. In an April 2011 response to a Request for Information, NPRC advised that records for the Veteran regarding his admittance to Madigan Army Hospital were located. In an August 2017 Board hearing, the Veteran reasserted that his bilateral knee disability was due to a fall that occurred during service. The Veteran stated that he landed on his right shoulder and then flipped over, causing him to hurt his knees and left shoulder. The Veteran stated that he was hospitalized for about six weeks. The Veteran stated that he did not receive treatment following separation because he did not know to further treat his disabilities. The Veteran's wife stated that the Veteran complained about his knees and shoulders occasionally but would then let it go. She stated that the Veteran just lived with the pain because he had a family to support. In a March 2019 VA examination, the examiner gave a diagnosis of knee joint osteoarthritis of the right and left knees and residuals of left total knee arthoplasty. The examiner determined that it was less likely than not that the Veteran's bilateral knee disability is related to his period of service. The Board notes that the March 2019 VA opinion has been found to be inadequate. Therefore, no further analysis of this evidence is necessary. In an August 2021 private medical opinion, the examiner stated that the Veteran reported that he injured his knees in 1958 while in service. The examiner noted that the Veteran recalled that he was on top of the track when it suddenly stopped, at which point he fell down in front of the motor. The examiner noted that the Veteran reported accidently touching the hot motor with his hands, causing him to lose balance and fall to the ground. The examiner noted that the Veteran estimated that the tracks were about eight or nine feet high and his knees were hurt the second he hit the ground. The examiner stated that the Veteran reported being completely immobile. The examiner stated that the Veteran reported that he was hospitalized for six weeks. The examiner also stated that the Veteran recalled that some surgeries and procedures were performed on his legs, but he could not remember exactly what was done as he was in and out of consciousness. The examiner further noted that the Veteran reported that he was placed on special duty after discharge from the hospital and his knees have only worsened since then. The examiner noted that the Veteran's service personnel record indicates admittance to Madigan Army hospital in November 1958. The examiner cited the Veteran's April 2010 lay statement in which he reported being in the hospital from November 1958 to January 1959 after hurting his knees. The examiner reported that, following his discharge from service, he was seen for moderate osteoarthritis and chondrocalcinosis of his knees in July 1997 and complaint of bilateral knee pain in February 2003. The examiner noted decreased range of motion in his knees in January 2006. The examiner stated that by December 2014, the Veteran reported knee pain with weight bearing activities, and in June 2015, severe knee arthritis was noted. The examiner further reported continued treatment of the knees via cortisone injections. The examiner reported total left knee replacement in 2017 and total right knee replacement in 2019. The examiner noted evidence of continued experience of constant pain and severe swelling in March 2019. The examiner opined that, based on the mechanism of injury of falling from a height of eight or nine feet and the objective and subjective findings regarding the knee, it is more likely than not that the Veteran's right and left knee disabilities began in service as a direct result of his injury falling from a track vehicle in 1958. The examiner noted that while the previous VA medical opinion did not find evidence of right knee injury prior to the Veteran's 1984 work-related injury, this examiner concluded that the Veteran's 1958 hospitalization was likely related to knee injuries preceding the work related injury. The examiner noted that the Veteran subjectively noted knee issues including pain and instability before the 1984 injury. Taking into account the nature of the Veteran's 1958 accident and the Veteran's continued knee pain over the years, the examiner concluded that Veteran's knee disabilities are related to the in-service injury in 1958. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current right and left knee disabilities are related to his period of service. The August 2021 medical opinion indicates a positive nexus between the Veteran's knee disabilities and his period of service. The limited service records supported the conclusions reached in this opinion. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left and right knee disabilities is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ford 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.