Citation Nr: 21073188 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-1000-00A DATE: December 7, 2021 ORDER Entitlement to service connection for a right hand disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a left shoulder disability is denied. FINDINGS OF FACT 1. The evidence does not demonstrate that the Veteran's right hand disability manifested during active duty service, manifested within one year of separation from service, or is otherwise etiologically related to service. 2. The evidence does not demonstrate that the Veteran's right knee disability manifested during active duty service, manifested within one year of separation from service, or is otherwise etiologically related to service. 3. The evidence does not demonstrate that the Veteran's left knee disability manifested during active duty service, manifested within one year of separation from service, or is otherwise etiologically related to service. 4. The evidence does not demonstrate that the Veteran's left shoulder disability manifested during active duty service, manifested within one year of separation from service, or is otherwise etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right hand disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Navy from November 1954 to October 1958 and from March 1959 to March 1963. These matters are before the Board of Veterans' Appeals (Board) on appeal from a January 2016 Department of Veterans Affairs (VA) regional office (RO) rating decision. These claims were before the Board in June 2018, April 2020, November 2020, and June 2021. Most recently in the June 2021 decision, the Board remanded the claims for an addendum opinion that complies with Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (holding that an examiner may not rely solely on the absence of care/treatment between the Veteran's injuries and his diagnosis). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (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, 1166-67 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38C.F.R. §3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for a right hand disability 2. Entitlement to service connection for a right knee disability 3. Entitlement to service connection for a left knee disability 4. Entitlement to service connection for a left shoulder disability The question for the Board is whether the Veteran has right hand, right knee, left knee, and left shoulder disabilities that began in service, within a year of service, or are otherwise related to service. The Board notes that the Veteran is currently diagnosed with right hand degenerative osteoarthritis with advanced osteopenia, bilateral knee residuals of total knee arthroplasty and chondromalacia, and left shoulder degenerative arthritis. The first Shedden element is thus satisfied as to each claim. As the June 2021 Board decision highlighted, the Veteran's service treatment records also indicate that he was seen for a left shoulder injury in March 1956, right hand injury in August 1956 and March 1958, a swollen right knee in 1957, and was involved in a motor vehicle accident in 1962. Thus, the second Shedden element is satisfied as to each claim. As such, the remaining determination is whether they are linked. In a February 2016 lay statement, the Veteran stated that he was in a Shore Patrol truck and "was driving when we slid out of control on the ice and slammed into the telephone pole. The impact threw me out on the street." The Board has already conceded the in-service event requirement of Shedden as noted above regarding all claims. A May 2020 VA examination was obtained. However, the November 2020 Board decision found that these examinations, with corresponding addendum opinions, had no probative value as the examiner "did not explain why the Veteran's current disabilities were not related to his service; rather, the examiner relied on the absence of medically documented care while not addressing the Veteran's statement, to include whether his in-service motor vehicle accident caused his current disabilities." As these examinations lack probative value, they will not be discussed further. February 2021 and March 2021 VA examinations were also provided. However, and similar to the above, the June 2021 Board decision found that these examinations relied solely on the absence of care/treatment between the Veteran's injuries and his diagnosis, violating Buchanan. As such, these examinations lack probative value and will not be discussed further. In response, September 2021 VA examinations were obtained. Regarding the Veteran's right hand disability, the examiner found that the Veteran was diagnosed with degenerative osteoarthritis with advanced osteopenia. At the examination, the Veteran reported that his right hand pain onset in 2003/2004 "because he no longer has a rotator cuff and has limited range of motion in his right arm which limits his use of his right hand." After review, the VA examiner opined that the Veteran's right hand disability was less likely than not related to service, to include the in-service events described above. The examiner reasoned that the Veteran's arthritis diagnosis is "related to age mediated changes within the joint." The examiner also stated that "due to the Veteran's advanced age this diagnosis is very difficult to connect to any injury" in service. Regarding the bilateral knees, the examiner diagnosed the Veteran with residuals of total knee arthroplasty and chondromalacia. At the examination, the Veteran reported that his bilateral knee pain began hurting him around 1999 with "gradual onset." After review, the examiner opined that the Veteran's bilateral knee disability was less likely than not related to service. The examiner reasoned that these disabilities are "related to age mediated changes within the joint as the Veteran's . . . knee was replaced as a result of arthritis . . . due to the Veteran's advanced age as well as his reported leg length discrepancy which would affect his gait and also contribute to injuries and increased wear and tear on his knees." The examiner also stated that due to his age, this diagnosis is "very difficult to connect to any injury or accident" to his knees in service. Regarding the left shoulder, the examiner diagnosed the Veteran with degenerative arthritis. At the examination, the Veteran reported that his left shoulder pain onset in 1962 after the motor vehicle accident described above and has progressed since. After review, the examiner opined that the Veteran's left shoulder disability was less likely than not related to service. The examiner reasoned that his shoulder arthritis is related to "age mediated changes within the joint and due to the Veteran's advanced age." Similar to the above, the examiner stated that this diagnosis was "very difficult to connect" to any in-service injury or accident due to his age. Upon review of the above evidence, the Board finds that the Veteran is not entitled to direct service connection for his right hand, bilateral knee, and left shoulder disabilities because the third Shedden element of service connection, that of a causal relationship between the Veteran's present disabilities and service, is missing. The Board finds the September 2021 VA medical opinions to be of great probative value as it is well-reasoned and supported by the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). In these examinations, the examiner stated that the Veteran's disabilities were not caused by service, but rather, "age mediated changes within the joint and due to the Veteran's advanced age." These medical conclusions are not contradicted by any medical evidence of record. The Board has also considered whether the Veteran is entitled to presumptive service connection under 38 C.F.R. §§ 3.307 and 3.309. Here, however, although acknowledging that the Veteran's service treatment records well-document injuries to the left hand, bilateral knees, and left shoulder, to include the 1962 accident, the Board does not find that any musculoskeletal symptomatology following that in-service treatment and accident developed into a chronic disability subject to presumptive service connection. The Board notes that the Veteran mainly contends that these disabilities are related to his 1962 accident. However, at the September 2021 VA examinations, he reported that his right hand and bilateral knee pain onset decades after separation from service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (noting that a lengthy period of absence of medical complaints for condition can be considered as a factor in resolving a claim, just not the only or sole factor). The Board further finds that the evidence does not show that the Veteran's arthritic changes of the right hand, bilateral knee, and left shoulder manifested during service or within one year of his separation from service. Furthermore, even though the Veteran believes that his right hand, bilateral knee, and left shoulder disabilities are related to service, to include the 1962 accident, he is not competent to provide a medical nexus opinion linking his time in service to his current disabilities or determine that these symptoms were manifestations of his current arthritis. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Additionally, the September 2021 VA examinations considered the Veteran's reports of pain and nevertheless reached the conclusion that these disabilities are less likely than not related to service, to include his in-service motor vehicle accident. Consequently, the Board gives more probative weight to the September 2021 VA examinations. In sum, the preponderance of the evidence weighs against finding in favor of the Veteran's service connection claims for right hand, bilateral knee, and left shoulder disabilities on a direct or presumptive basis. Therefore, the benefit-of-the-doubt rule does not apply, and the service connection claims must be denied. 38 U.S.C. § 5107(b). Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, Associate 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.