Citation Nr: 21071472 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-09 291 DATE: November 30, 2021 ORDER Service connection for a right shoulder disability, to include as secondary to a service-connected disability, is denied. FINDINGS OF FACT 1. The Veteran does not contend his right shoulder disability stemmed directly from his military service but rather that it is secondary to service-connected disabilities, to include cervical spine and right knee disabilities. 2. The most probative evidence of record shows that the Veteran's right shoulder disability was neither caused nor aggravated by the Veteran's service-connected cervical spine or right knee disabilities. CONCLUSION OF LAW The criteria for service connection for a right shoulder disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served in the United States Air Force on active duty from September 1974 to May 1977. The Veteran testified at a hearing before a Veterans Law Judge (VLJ) in June 2018. A transcript of the hearing has been included with the record. However, this VLJ has since retired from the Board. In March 2021, the Board sent the Veteran a letter giving him an optional new Board hearing. 38 U.S.C. § 7107 (c); 38 C.F.R. § 20.604. The Veteran did not respond within 30 days from the date of the letter therefore, it is assumed the Veteran does ot want another hearing. The Board will consider the case on the evidence of record and will proceed accordingly. In September 2018 and July 2021, the Board remanded this issue for additional development. As the requested development regarding the Veteran's claims have been completed, this matter is now properly returned to the Board for adjudication. See Stegall v. West, 11 Vet. App. 268 (1998). Service connection for a right shoulder disability Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases (to include arthritis) may be presumed to br service-connected if manifested to a compensable degree within a specified period of time following separation from service (one year for arthritis). 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309(a). For chronic diseases listed in 38 C.F.R. § 3.309 (a), nexus to service may be established by showing continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service connection may also be granted where disability is caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends that his right shoulder disability is secondary to his service-connected cervical spine and right knee disabilities. He testified at the June 2018 Board hearing that this service connection claim was not based on a direct theory of entitlement to his military service but that it was secondary to his service-connected cervical spine. Moreover, the evidence of record is against finding that his disability is directly related to service, i.e. service treatment records are negative for a disability and the August 2021 VA examiner specifically determined that the right shoulder disability was not incurred ins service. Therefore, the Board will only discuss the secondary theory of service connection in this decision. Turning to the evidence of record, upon a review of the medical treatment records, a physical examination and consideration of the Veteran's lay statements regarding his symptomatology, an August 2019 VA examiner determined that it was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected cervical spine disorder, to include aggravation beyond its natural progression by a service-connected cervical spine disability. The VA examiner explained that a diagnosis of a right shoulder glenohumeral and acromioclavicular joint osteoarthritis was given but that the medical literature found that the most common causes of these conditions include wear and breakdown of protective cartilage with age and led to arthritis or they can be the result of an old injury or trauma to the joint. While there was documented report of right shoulder pain as early as April 1998, the VA examiner was unable to find any documentation of right shoulder injuries or complaints during the service dates of September 1974 to May 1977. Furthermore, an August 2021 VA examiner also determined the Veteran's right shoulder disability was less likely than not proximately due to or the result of a service-connected condition as there were several non-service etiologies for the Veteran's right shoulder pain which include the Veteran had a history of heavy lifting as a UPS driver, from which he retired for medical issues, and based on evidence he was diagnosed with carpal tunnel syndrome with similar symptoms of numbness in the shoulder with tingling sensation down to his fingers. Additionally, the VA examiner noted that the Veteran may have injured his right shoulder due to falls from his history of vertigo (a nonservice-connected disability). The medical treatment records indicated that the Veteran had a history of frequent falls as a result. Overall, the objective medical evidence of record as well as the VA examination opinions did not support an etiological link between the Veteran's right shoulder disability and his service-connected conditions, specifically his cervical spine and right knee disabilities. These opinions are against the secondary service connection theory of the claims and is uncontroverted. The Board accords great probative weight to the VA examiners' opinions because they were based on an accurate factual premise, and offered clear conclusions with supporting data and reasoned medical explanations. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Notably, the VA examiners reviewed VA treatment records and the Veteran's employment history. The August 2021 VA examiner referred to the June 2013 VA treatment record of an emergency room visit when the Veteran accidently fell down steps and sustained injury to his right shoulder and right chest wall from a history of vertigo. The Veteran reported pain in his right shoulder, right collar bone area, and right lateral chest all. The Board notes the only evidence of record in support of the Veteran's claims consists of his own lay statements. The Board acknowledges the Veteran's belief that his service-connected cervical spine and right knee disabilities led to his right shoulder disability. To this end, he is considered competent to report the observable manifestations of his claimed disabilities. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) ("ringing in the ears is capable of lay observation"). His assertions that he experiences symptoms are also credible. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2013), as to the specific issue in this case, given the complexity of the particular question of etiology and the fact that a nexus opinion may not be rendered based on personal observation, the Board finds that the Veteran is not competent to opine on the presence or etiology of his claimed disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (providing that lay persons not competent to diagnose cancer). Accordingly, the Board finds that the preponderance of the evidence weighs against the claim for service connection for a right shoulder disability, as secondary to a service-connected disability, and the claim is denied. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yoo, 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.