Citation Nr: 21006750 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 14-27 866A DATE: February 5, 2021 ORDER Entitlement to service connection for a left shoulder disorder, characterized as rotator cuff tendonitis and degenerative joint disease, is denied. FINDING OF FACT The Veteran’s left shoulder disorder, characterized as rotator cuff tendonitis and degenerative joint disease, was not shown in service or for many years thereafter and is not otherwise etiologically related to active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left shoulder disorder, characterized as rotator cuff tendonitis and degenerative joint disease, 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 October 1974 to April 1976. This matter returns to the Board of Veterans’ Appeals (Board) following the issuance of a May 2018 Board remand decision which directed the Regional Office (RO) to conduct additional development. 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. § 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); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). “In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Additionally, certain chronic diseases, including arthritis of the knees, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Moreover, for such chronic diseases, an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a); See 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2014). Entitlement to service connection for a left shoulder disorder, characterized as rotator cuff tendonitis and degenerative joint disease The Veteran is seeking service connection for a left shoulder disorder. He specifically claims that his left shoulder disorder stems from a 1975 in-service injury. As an initial matter, the Board notes that the Veteran has been diagnosed with rotator cuff tendonitis in December 2018 and degenerative joint disease in February 2010. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not etiologically related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303 (a), (d), 3.304, 3.307, 3.309. The Board determines that the evidence of record does not support finding that the Veteran’s left shoulder disorder is related to service, as such, service connection is not warranted for a left shoulder disorder. First, the Veteran’s service treatment records do show treatment for a left shoulder injury in January and May 1975 following a fall. The treating physician noted some tenderness and limitation of motion but no swelling. The treating physician also notated that it was possible that the Veteran had a nondisplaced fracture of the acromioclavicular process and ordered that be x-rays taken. The Veteran did not report for the x-rays. The remaining service treatment records are silent for any signs, symptoms, treatment, or a diagnosis of a shoulder disorder, this includes the Veteran’s February 1976 separation examination, and the Veteran’s April 1976 statement of medical condition which indicated no change in his medical status. There is no indication of a chronic or continuing left shoulder disorder stemming from the May 1975 injury, this is indicative of a self-limiting injury which had resolved by the time of the Veteran’s separation from service. The Veteran’s post service evidence does not show treatment for any left shoulder disorder or injury until February 2009 following the Veteran’s fall from a horse. In fact, the Veteran’s social security records draw a direct line between the Veteran’s February 2009 fall and his left shoulder pain as well as pain and tingling in his left arm and hand. Therefore, service connection based upon continuous symptoms include the chronic disease presumption under 3.307 is not warranted. The Board recognizes the statements from the Veteran regarding his history of his shoulder symptoms since service. While the Veteran is competent to report that he experienced these symptoms, including pain, limitation of motion, and weakness, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his current disorders. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In any event, the Board determines that the Veteran’s reported history of continued symptomatology since active service, while competent, is nonetheless insufficient in establishing a relationship between his disorders and service. Specifically, in addition to the fact that decades elapsed between active duty service and his current diagnoses and claim, it is of importance to the Board that he was given the opportunity to mention any such symptoms at his separation physical examination in February 1976. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014) (The Board may weigh silence in a medical record against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated). Moreover, the Board notes that the Veteran filed claims for VA education benefits in 1975 and 1992 and for entitlement to service connection for an acquired psychiatric disorder, skin disorder, and knee disorder in 2003, many years prior to filing the claims on appeal. Therefore, the fact that the Veteran was aware of the VA benefits system and sought out a claim for other benefits but made no reference to the disorders he now claims, weighs heavily against his credibility. Next, although continuous symptoms have not been shown, service connection may nonetheless be established if the evidence otherwise indicates a nexus between active duty service and his current symptoms. In this case, however, the competent evidence fails to establish a relationship between active duty and the Veteran’s current symptoms. Here, the Board places significant value on the opinions of the June 2011, December 2018, December 2019 VA medical examiners, as well as the July 2020 VA physician who authored an addendum opinion. The June 2011 VA medical examiner endorsed a diagnosis of mild degenerative arthritis. The Veteran reported pain and noted his in-service fall and current shoulder pain and tingling. The examiner opined that the Veteran’s left shoulder disorder is less likely than not related to active duty service noting that while he was treated for an injury in-service, there was no evidence of arthritis in service. Next, the December 2018 medical examiner endorsed a diagnosis of rotator cuff tendonitis but not a diagnosis of arthritis for the Veteran’s left shoulder. Furthermore, the examiner did not endorse a diagnosis of an acromioclavicular disorder. The Veteran endorsed pain and tingling in his left shoulder and arm and spoke to his treatment in 1975 following his in-service injury. The examiner opined that while the Veteran received acute treatment in service for a shoulder injury, the type of disorder he has currently is caused by repetitive motion and not trauma. The examiner also noted the lack of treatment of the Veteran’s left shoulder in a fashion that would match a disorder that became chronic in service. The December 2019 examiner noted the Veteran’s left shoulder disorder and diagnosed rotator cuff tendonitis and degenerative joint arthritis. The Veteran noted pain and paresthesias since his February 2009 injury, he also reported neck pain and weakness on his left-hand side since that injury. The examiner opined that neither of the Veteran’s diagnosed left shoulder disorders were more likely than not related to service. The examiner noted that the Veteran’s in-service injury was a soft tissue injury and not one that would in most cases result in a long-term problem. The examiner also noted that the Veteran’s medical records did not indicate a left shoulder problem until February 2009 following his fall from a horse, which the examiner indicated was much more likely the cause of the Veteran’s current left shoulder disorder than his in-service injury. Finally, an addendum opinion was sought by the RO in July 2020 to resolve some ambiguity with the December 2019 VA examiner’s report. The physician who authored this opinion noted that the Veteran was treated for a shoulder injury while in service, but that the injury appeared to resolve before separation. Furthermore, they indicated that a soft tissue injury, like what the Veteran was treated for in-service, would not result in a long-term disorder, especially one of which the Veteran is currently diagnosed with. Finally, the examiner noted that it was less likely than not that the Veteran’s current left shoulder disorder is related to his active duty service. The Board notes that the Veteran has not provided sufficient evidence, including private opinions and/or medical evidence, to establish a relationship between his left shoulder disorder and active service. In arriving at this conclusion, the Board acknowledges the Veteran’s statements that his current disorder was caused by his 1975 left shoulder injury. The Federal Circuit has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to testify regarding the etiology of his left shoulder disorders. See Jandreau, 492 F.3d 1372 at 1377, n.4. Because such disorders are not diagnosed by unique and readily identifiable features, they do not have a simple identification that a layperson is competent to make. The Veteran is not competent to identify a nexus between his service and his current disorders. While the Board does not dispute the Veteran’s sincerity in describing his symptoms, the weight of the medical evidence is against a finding that they are etiologically related to his active service. Therefore, the Veteran’s lay statements that his current left shoulder disorders are related to his service are found to lack competency. Therefore, the Board finds that the weight of the competent evidence does not attribute the Veteran’s left shoulder disorders to an event, injury, or disease incurred in service. Therefore, service connection must be denied. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Hernan, Associate Counsel