Citation Nr: 21074352 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 15-44 477 DATE: December 15, 2021 ORDER Service connection for a left shoulder disability is granted. Service connection for a right shoulder disability is granted. FINDINGS OF FACT 1. The competent and probative evidence is at least in equipoise as to whether the Veteran's current left shoulder disability had its onset in or is otherwise related to his period of active service. 2. The competent and probative evidence is at least in equipoise as to whether the Veteran's current right shoulder disability had its onset in or is otherwise related to his period of active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left shoulder disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 2. The criteria for service connection for a right shoulder disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1970 to January 1972, and also periods of active duty for training (ACDUTRA). This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing in May 2018. A transcript of the hearing has been associated with the virtual file and reviewed. This case was most recently before the Board in March 2021, at which time it was remanded for further development, as discussed below. As the requested development has been substantially completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). SERVICE CONNECTION Service connection may be granted for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.306. The term active military, naval, or air service includes: (1) active duty, (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and (3) any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6(a). 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; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (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 - which is the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a left shoulder disability. 2. Entitlement to service connection for a right shoulder disability. The Veteran contends that service connection is warranted for left and right shoulder conditions. A March 2021 Board decision remanded the claims of service connection for a right shoulder disability and left shoulder disability and directed the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion to determine the etiology of the Veteran's bilateral shoulder disability. The Board noted that the October 2020 VA medical opinion did not specifically consider documents showing periods of active duty in May 2008 and August 2008, as well as medical records documenting right and left shoulder pain during a period of ACDUTRA. Accordingly, the Board further directed the clinician to provide opinions as to whether any shoulder condition is at least as likely as not caused by a disease or injury in service, as well as opinions as to whether any shoulder condition is at least as likely as not proximately due to or aggravated by the by any service-connected disability, to include another shoulder condition. Additionally, the clinician was specifically directed to review and document such review of the Veteran's records documenting periods of ACDUTRA and consider that the Veteran competent and credible to describe shoulder cracking and pain while doing pushups. 03/10/2021, BVA Decision. The record reveals documents showing periods of active duty training for 21 days in May 2008, as well as defense finance and account service (DFAS) leave and earning statements showing ACDUTRA from May 11, 2008 until May 31, 2008, and ACDUTRA from August 3, 2008 until August 23, 2008. Also, the record includes medical records documenting right and left shoulder pain and the Veteran describing feeling a cracking in his left shoulder while doing pushups, which was recorded on August 20, 2008, during a period of ACDUTRA. See 8/27/2019, Military Personnel Record May; 8/27/2019, DFAS Payment Worksheet May, p. 1; 8/27/2019, DFAS Payment Worksheet August, p. 1. Additionally, the Veteran credibly described shoulder cracking and pain while doing pushups. See 5/16/2018, Hearing Testimony, p. 3-4; 08/27/2019 Medical Treatment Record Gov't Facility, at p. 3. In a May 2021 VA medical opinion, the clinician opined that the Veteran's bilateral shoulder disabilities are less likely than not related to his periods of active service. The clinician also opined that the Veteran's bilateral shoulder disabilities are less likely than not proximately due to or aggravated by a service-connected disability. The rationale for all of the opinion was entirely based on the lack of evidence in the service treatment records documenting any shoulder condition. 05/13/2021, C&P Exam. However, the clinician did not specifically consider documents showing periods of active duty in May 2008 and August 2008, as well as medical records documenting right and left shoulder pain during a period of ACDUTRA, as required by the August 2020 Remand directives. Subsequently, a November 2021 medical opinion from a private clinician considered the Veteran's service records from his periods of active duty training, as well as the VA treatment records and examinations. The clinician opined that the Veteran's left and right shoulder conditions are at least as likely as not related to his periods of active duty. Specifically, the clinician noted the service treatment records showing that the Veteran experienced shoulder pain during his period of active duty training in 2008, which has persisted continuously thereafter. Additionally, the Veteran was diagnosed with tears in his shoulders shortly after complaining of shoulder pain and has since undergone shoulder surgeries to treat the conditions. The clinician indicated that the treatment records show a clear indication of the onset of shoulder problems during the Veteran's active duty training in 2008. 11/23/2021, Medical Treatment Record Non-Government Facility. The Board finds that the evidence is at least in equipoise regarding whether the Veteran's bilateral shoulder disabilities are related to his active service. For example, the Board places more weight on the November 2021 private medical opinion, as the clinician considered the Veteran's service records from his periods of active duty training. The Board places less weight on the May 2021 VA medical opinion, as it did not consider documents showing periods of active duty in May 2008 and August 2008, as well as medical records documenting right and left shoulder pain during a period of ACDUTRA. The evidence for service connection is at least in equipoise and the benefit of the doubt applies. 38 C.F.R. § 3.102. Therefore, as all three service connection elements have been established, the Board finds that service connection for left and right shoulder conditions is warranted. 38 C.F.R. § 3.303. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Han 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.