Citation Nr: 21011993 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 14-40 311 DATE: March 3, 2021 ORDER 1. Entitlement to service connection for a chronic left shoulder disorder is denied. 2. Entitlement to service connection for a chronic left hand disorder is denied. FINDING OF FACT A chronic left shoulder disorder or a chronic left hand disorder was not manifested in service; left shoulder or left hand arthritis was not manifested within one year following the Veteran’s discharge from service; and the preponderance of the evidence is against that the Veteran’s current left shoulder and left hand disorders are etiologically related to his active service or were caused or aggravated by his service-connected left hand scar. CONCLUSIONS OF LAW 1. Service connection for a eft shoulder disorder is not warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303, 3.309, 3.310. 2. Service connection for a left hand disorder is not warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSIONS The appellant is a Veteran who had active service from August 1973 to April 1977. This matter is before the Board on appeal from an October 2013 Department of Veteran’s affairs rating decision. In October 2018 the matters were remanded for additional development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To substantiate a claim of service connection requires competent evidence showing: (1) the existence of a current claimed disability; (2) incurrence or aggravation of a disease or injury in service; 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 be service-connected if manifested to a compensable degree within a specified period of time following service (one year for arthritis). 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Under 38 C.F.R. § 3.303(b), for diseases listed in 38 C.F.R. § 3.309(a), service connection may also be established continuity. See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Secondary service connection may be established for a disability which was caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a). To prevail on the claim of secondary service connection, there must be (1) evidence of a current claimed disability; (2) evidence of a service-connected disability; and (3) competent evidence that the service-connected disability caused the current disability claimed. Wallin v. West, 11 Vet. App. 509 (1998). The Veteran has asserted that his left shoulder disorder and left hand disorder are due to a fall on ice during his active service. At an April 2017 DRO hearing, he testified that after the fall on ice during his active service, he started having pain. The Veteran’s service treatment records (STRs) show that at on 1973 service entrance examination, his upper extremities were normal on clinical evaluation. In February 1974, he was seen for a left hand laceration, and received sutures, which were removed the following month. On March 1977 service separation examination, his upper extremities were normal on clinical evaluation. He specifically denied having any shoulder symptoms and did not report any residuals from his left hand laceration. He reported that he was in good health. His STRs do not show any complaints, treatment, or diagnosis for either left shoulder or left hand problem (other than the scar) during his active service. Following service, the Veteran’s medical records show that he first reported left shoulder pain in June 1998, over two decades after his separation from active service. He reported that the left shoulder pain began about five weeks previously upon golfing. Left shoulder x-rays showed arthritis. In November 2013, the Veteran’s physician (Dr. G.B.) reported that he has a diagnosis of hand arthritis. Dr. G.B. did not offer an opinion regarding the etiology of the Veteran’s left shoulder disorder or left hand disorder. On April 2017 VA examination, upon review of the Veteran’s claims file, and interview and examination of the Veteran, the examiner opined that the Veteran’s left shoulder and left hand disorders are less likely than not due to his active service. The examiner noted that the Veteran worked for over 20 years as a carpenter, and opined that his left shoulder and left hand disorders are most likely related to his many years of working as a carpenter. In March 2018, the Veteran stated that while he worked for over 20 years for VA, and only worked as a carpenter for seven years. The April 2017 examination opinion was deemed by the Board to be inadequate (because based on an inaccurate premise), and in October 2018 the matters were remanded for further development, to include another VA examination and medical advisory opinion. On October 2019, VA examination, the Veteran reported that he injured his left shoulder and left hand in a fall slipping on ice during active service. He related that he worked as a carpenter for five years from 1996 to 2001. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner opined that the Veteran’s left shoulder disorder could not be corroborated as having occurred during his active service. The examiner noted that the Veteran’s STRs did not show a left shoulder injury during active service. The examiner noted that the first evidence of a left shoulder condition was in 1998 (some 21 years after his separation from active service) upon golfing. The examiner opined that the left shoulder disorder was most likely the result of his employment as a carpenter and not due to his left hand laceration in 1974. The examiner also opined that the Veteran’s left hand disorder could not be corroborated as having occurred (due to injury or disease) during his active service. The examiner noted that while the Veteran’s STRs showed he sustained a left hand laceration in service, there was otherwise no evidence of a left hand injury during active service. The examiner noted that the first evidence of a left hand disability was in 2013, some 36 years after the Veteran’s separation from active service, and opined that the Veteran’s left hand disorder was most likely from his employment as a carpenter and not due to the left hand laceration in 1974. The examiner stated that the occurrence of a left shoulder disorder and a left hand disorder due to a left hand laceration during active service was lacking (i.e., that record provides no basis for relating the claimed disabilities to a hand laceration injury early during the Veteran’s service). The Board finds the October 2019 VA examiner’s opinions to be probative evidence in the matter. The examiner included rationale that cited to clinical evidence in the record, including that a left shoulder of left hand (other than the laceration early in service) injury was not shown; that the service separation examination did not find a left hand or left shoulder disability (and related complaints were not then reported; that there were lengthy intervals between the current disabilities and the first postservice evidence of the current disabilities; and that there were more likely postservice etiological factors for the current disability, such as a golfing injury and an occupation (carpentry) that it may be reasonably assumed places stress and strain on the upper extremities. The rationale is consistent with what is shown by the evidentiary record. The Veteran’s own opinion that the current claimed disabilities were either due to undocumented injuries sustained in the same incident that resulted in his scar is not probative evidence in the matter. His attempts to support the claim by allegations of continuity of pain symptoms (of arthritis) since a fall in early service are inconsistent with the absence of documentation of related injury and complaints when the event occurred, that he served 3 or 4 years thereafter with no notation of complaints or impact on service functioning during such period, that the service separation examination did not found any hand or shoulder abnormality (and no such complaints were then reported), that the earliest postservice notation of left shoulder complaints was following an apparent golfing injury (an activity that would appear to be inconsistent with a long-standing chronic shoulder disability), and that a hand disability was first documented decades after service (a factor for consideration of itself weighing against a finding of service-connection), after he had been employed for at least 5 years in an occupation (carpentry), that may also reasonably be assumed to be inconsistent with a long-standing chronic hand or shoulder disability. The Board also observes that arthritis is not that disease that is capable of diagnosis by lay observation, it is diagnosed based on examination by a medical provider (informed by diagnostic studies, such as X-ray). And the etiology of an insidious disease such as arthritis (whether it may be related to a remote and undocumented injury that is not supported by evidence in the record) is a medical question beyond the realm of common knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran is a layperson, and has not presented any competent (medical) evidence supporting his alleged theory of entitlement. He has cited to any medical text or treatise supporting that somehow a laceration scar may cause, or contribute to increase in severity of, the claimed hand and shoulder disabilities. Considering the foregoing, the Board finds that a chronic left shoulder disability in service or a shoulder or hand injury that may have resulted in a current left shoulder or hand disability such as arthritis is not shown; that arthritis of the left hand or shoulder was not manifested to a compensable degree within a year following the Veteran’s discharge from active duty; and that the preponderance of the evidence is against any finding that a current left should or left hand (other than a laceration scar) disability, to include arthritis is etiologically related to the Veteran’s service or was caused or aggravated by his service-connected left hand laceration scar. Considering the foregoing, the Board concludes that the preponderance of the evidence is against these claims. Therefore, the appeals in these matters must be denied. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berryman, 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.