Citation Nr: 21070718 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 16-45 072 DATE: November 24, 2021 ORDER Service connection for a left shoulder disability is denied. VETERAN'S CONTENTIONS The Veteran contends that he has a current left shoulder disability related to an in-service incident in which he was injured while playing football. Alternately, the Veteran contends that he has a current left shoulder disability related to an in-service incident in which he was injured while riding an all-terrain vehicle (ATV). FINDING OF FACT 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. CONCLUSION OF LAW 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. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1979 to May 1999. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) via videoconference in June 2019 and November 2020. The transcripts of the hearings have been associated with the claims file. This matter was previously before the Board at which time it was remanded for further development. Entitlement to service connection for a left shoulder disability 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). Service connection may also be granted through the application of statutory presumptions for chronic conditions, such as arthritis. See 38 U.S.C. §§ 1101 (3), 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303 (b), 3.307(a)(3), 3.309(a). Arthritis is included under 38 C.F.R. § 3.309 (a); therefore, 38 C.F.R. § 3.303 (b) also applies. 38 C.F.R. § 3.307; Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013). Presumptive service connection for "chronic diseases" must be considered on three bases: chronicity during service, continuity of symptomatology since service, and manifestations within one year of the claimant's separation from service. 38 C.F.R. § 3.303 (b); Walker, 708 F.3d at 1336-38. The application of these presumptions operates to satisfy the "in-service incurrence or aggravation" element and establish a nexus between service and a current disability, which must be found before entitlement to service connection can be granted. 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). In addressing the criterion of a current diagnosis, the evidence of record includes a November 2013 Shoulder and Arm Conditions Disability Benefits Questionnaire in which the examiner diagnosed the Veteran with left shoulder acromioclavicular arthrosis, rotator cuff tear, and impingement. In addressing in-service incurrence, as indicated above, the Veteran contends that he has a current left shoulder disability related to an in-service incident in which he was injured while playing football. Alternately, the Veteran contends that he has a current left shoulder disability related to an in-service incident in which he was injured while riding an all-terrain vehicle (ATV). The Veteran's service treatment records (STRs) document left shoulder separation, and left shoulder tender and swelling after a fall from an ATV. 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 the 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 November 2013 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 STRs document left shoulder separation with mild AC separation in 1982; confirmed by x-ray. However, the Veteran completed 14 more years in service without further documentation of left shoulder treatment. The examiner explained that arthritis of a major joint, such as the left shoulder, occurs over time as a result of repeated trauma and overuse and in this case was first documented in 2010, more than two decades post in-service injury. In determining that the current condition was less likely than not related to the in-service injury, the examiner reasoned that symptomology related to a rotator cuff tear of the left shoulder would occur closer to time of the inciting event, not two and one-half decades later. Additionally, examiner opined that the Veteran's left shoulder impingement was more likely than not related to his rotator cuff tear and disuse of left shoulder. Therefore, it was less likely than not that the Veteran's arthritis left shoulder, left rotator cuff tear, or left shoulder impingement are related to the one incident of left shoulder separation in 1985. In October 2019, the Board remanded the Veteran's claim to obtain an addendum opinion addressing the positive opinion from Dr. TR and the Veteran's competent lay statements. A December 2019 VA examiner considered the positive opinion and the Veteran's competent lay statements and again concluded that the condition claimed 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 STRs span 20 years of service from 1970 to 1999, the in-service injury was a mild left shoulder AC separation in 1985 and the rest of the STRs are silent on any left shoulder symptoms or treatments. The original clinician indicated that the Veteran denied any other injuries or dislocations of the left shoulder. The examiner further reasoned that there was a latency period of 14 years which is indicative that the mild AC separation healed without residual, as is common for such injury after rest, which was prescribed for the week following the injury. The examiner found Dr. TR's opinion unpersuasive because it did not include an adequate nexus statement linking the in-service injury to the present-day condition. With regard to the question of whether the in-service injury rendered his left shoulder more susceptible to injury. The examiner stated that the original injury healed without significant residuals and hence did not render the Veteran's left shoulder more susceptible to injury. As for the issue of clinical onset within one year of discharge, in 1999, the original examiner noted arthritis left shoulder, a condition that occurs over time as a result of repeated trauma and overuse, was first documented in 2010, more than two decades post injury. The Board finds the November 2013 and October 2019 VA opinions to be highly probative. The opinions were based on a review of the claims file, examination of the Veteran, and review of relevant facts, and the examiners provided detailed rationales. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board acknowledges that Dr. TR opined that the Veteran's left shoulder disability is caused by or a result of an injury during active duty. However, Dr. TR did not provide a rationale for this opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning, and neither an examination report nor a medical opinion is entitled to any weight if it contains only data and conclusions). 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. 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.