Citation Nr: 21070143 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 17-15 108 DATE: November 23, 2021 ORDER Entitlement to service connection for a left shoulder disorder is denied. FINDING OF FACT The Veteran's left shoulder disorder, diagnosed as acromioclavicular joint osteoarthritis, was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1978 to March 1981. On appeal is a June 2015 rating decision that denied reopening the Veteran's claim for service connection for a left shoulder disorder, finding the evidence submitted was not new and material. A videoconference hearing was held in this matter in August 2019 before the undersigned Veterans Law Judge, and a transcript of the proceedings is associated with the claims file. Following that hearing, in a June 2021 decision and remand, the Board of Veterans' Appeals (Board) found that new and material evidence had been submitted and re-opened the claim of service connection for a left shoulder disorder. The Board then remanded the claim for a VA examination to determine if the claimed left shoulder disorder began in service, within one year of service separation, or is otherwise related to his active duty service, to include his reported fall. The requested development has been completed and the case has been returned to the Board for adjudication. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In addition, certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for a left shoulder disorder. The Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no evidence that may serve as a nexus between the Veteran's service and his current left shoulder disorder, which has been diagnosed as acromioclavicular joint osteoarthritis. Service treatment records are associated with his claims file. These records are silent for any complaint, diagnosis or treatment of a left shoulder disorder. The November 1977 entrance Report of Medical Examination reflects the Veteran had a normal upper extremities exam and was determined to be fit for duty. In the companion November 1977 entrance Report of Medical History, the Veteran specifically denied painful or trick shoulder or elbow. A February 1980 record reflects the Veteran has a complaint of painful left elbow after he fell on ice 2 weeks ago; x-ray of the elbow was negative; and a contusion was noted. Post service VA treatment records from the Fresno VAMC and the Reno VAMC are associated with the Veteran's claims file. In summary, these records reflect the Veteran has reported left shoulder pain over the years, with the earliest complaint of left shoulder pain documented in May 2003. The May 2003 record noted left shoulder pain for 6 months with no known injury. A June 2015 record reflects the Veteran complained that his shoulder pain was worsening. June 2015 x-rays showed no acute fracture or dislocation but very mild degenerative joint disease along the inferior aspect of the acromioclavicular joint along with a small keel spur along the inferior acromion. A July 2015 MRI showed impingement on the subacromial space and underlying rotator cuff; mild degenerative joint disease at the AC joint with impingement; tendinosis; and a small paralabral cyst. The MRI also contained a note that the Veteran provided a history of injury, indicating he fell out of a helicopter during service and has had pain in the left shoulder along the mid clavicle. A July 2017 record reflects the Veteran was having pain in the left shoulder because his shoulder was re-injured at work. It was noted the Veteran was initially injured while on active duty working on aircraft. With heavy lifting and overhead work the left shoulder will flare up on occasion. The Veteran works in construction and his primary job is working with sheet metal. Private treatment records from Functional Integrated Therapy Medical Corporation were also associated with the Veteran's claim file. A February 2015 Initial Report reflects the Veteran had a diagnosis of left shoulder and upper quadrant pain. He reported an injury while serving in the U.S. Army in 1980 in which he fell off a ladder while working on a helicopter. An April 2015 record reflects the Veteran was in physical therapy for left shoulder pain. The Veteran underwent a VA examination for his left shoulder in July 2021. The examiner diagnosed the Veteran with acromioclavicular joint osteoarthritis. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. As rationale, the examiner stated the Veteran's AC and glenohumeral joint osteoarthritis and tendinopathy of rotator cuff were less likely than not incurred in or caused by the reported fall. In so finding, the examiner noted that the Veteran stated that he fell from a ladder in 1980 while working on a helicopter and injured his left shoulder. Service treatment records do not show an injury of the left shoulder from a fall off a ladder, although the records do document a left elbow injury due to a fall on ice. The Veteran states he did not want to go to sick call for the injury because he did not want to feel disabled. Primary care note from May 2003 indicates the Veteran had left shoulder pain for 6 months. February 2015, July 2017, and 2019 treatment notes report the Veteran states he injured his left shoulder from a helicopter fall. The examiner found that the history of the left shoulder condition is unclear as there are no service treatment records for a left shoulder injury and the 2003 treatment notes specifically state the left shoulder injury occurred 6 months prior to the visit. After a thorough review of the medical records and an in-person exam, the examiner opined that the Veteran's left shoulder disorder was less likely than not incurred in or caused by service, to include the reported fall. Lay evidence is also associated with the Veteran's claim file. The Veteran reported in his initial June 2009 claim that his left shoulder condition was brought on by injuring it in Korea while working on a helicopter. In his July 2015 Notice of Disagreement (NOD), the Veteran stated he injured his shoulder in the fall from a helicopter when he was in the service. In his March 2017 substantive appeal, the Veteran stated his shoulder has been injured for years due to his fall on an aircraft. At the August 2019 hearing, the Veteran testified that, "By me working on helicopters and airplanes and working with the ladders, I had a ladder tip over and I fell. I fell and landed on my elbow. And it just hurt the whole side really." Presumptive Service Connection The Veteran has a current diagnosis of acromioclavicular joint osteoarthritis of the left shoulder. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331.The Board finds, however, that the Veteran's left shoulder arthritis was not shown as chronic since service and did not manifest to a compensable degree within the presumptive period of one year. VA and private treatment records show the Veteran was not diagnosed with arthritis of the shoulder until the June 2015 x-rays showed very mild degenerative joint disease, over 30 years after his separation from service and decades outside of the applicable presumptive period. Thus, entitlement to service connection for the Veteran's left shoulder disorder on a presumptive basis, or on the basis of continuity of symptomatology since service that is attributable to a chronic disease, is denied. Direct Service Connection The Board finds that the preponderance of the evidence is against finding that a medical nexus exists between the Veteran's left shoulder disorder and an in-service injury, event or disease. Here, the contentions of the Veteran are outweighed by the findings of the July 2021 VA examiner, who provided a thorough rationale for the conclusion that the Veteran's current left shoulder disorder is less likely than not related to service. As noted above, the examiner noted that there are no service treatment records documenting a left shoulder injury, as opposed to a left elbow injury due to a fall on ice. The examiner further noted that 2003 treatment notes clearly state that the Veteran reported the left shoulder injury occurred 6 months prior to the visit. The Board finds the rationale persuasive as the fact remains the Veteran's earliest documented complaint of left shoulder pain in 2003, over 20 years after his active duty service. Further, at that time he explicitly reported that the injury occurred six months prior, not many years earlier during service. The Board has considered the Veteran's lay statements, including his testimony at the August 2019 Board hearing, that he injured his left shoulder in service. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, etiology of the Veteran's current left shoulder disorder, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of a left shoulder disorder, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id.; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board also notes that while the Veteran's lay statements have been considered, less probative weight is given to these statements because of inconsistencies about the etiology of his claimed left shoulder disorder. In his initial claim filed in June 2009, the Veteran stated his left shoulder condition was brought on by injuring it while working on a helicopter. The May 2003 Fresno VAMC record reflects the Veteran had left shoulder pain for six months with no known injury. The February 1980 STR reflects the Veteran fell on ice, injuring his left elbow (not his shoulder). Private physical therapy records note the Veteran reported he fell off a ladder while working on a helicopter. At the August 2019 Board hearing in this matter, the Veteran testified that he had a ladder tip over and he fell, landing on his elbow. The Board concludes that, while the Veteran has a current diagnosis of a left shoulder disorder, the preponderance of the evidence is against finding that this disorder began during active service, or is otherwise related to an in-service injury, event, or disease. The evidence weighs against the Veteran's claim. Service connection for a left shoulder disorder must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jiggetts, Tenisha 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.