Citation Nr: 21012882 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-27 642 DATE: March 5, 2021 ORDER Entitlement to service connection for a right shoulder disability is denied. FINDING OF FACT The Veteran’s right shoulder disability did not manifest during service, was diagnosed more than one year after service, and is etiologically not related to service. CONCLUSION OF LAW The right shoulder disability did not manifest during service, may not be presumed to have been incurred therein, and is unrelated to service. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1967 to September 1971. A Report of General Information in October 2018 shows that the Veteran cancelled his Board hearing. Entitlement to service connection for a right shoulder disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran contends that his right shoulder was injured during service when a radio he was removing from the rack slipped and he was not able to turn it loose quickly enough, noting that the physician who initially treated the injury predicted it would cause more problems in the future. See, e.g., August 2011 statement. On his Form 9 Appeal received in July 2015 the Veteran noted that after he injured his right shoulder during service, he was placed in a sling for about two weeks and given light duty. He stated that since service overhead movement has caused pain. The Veteran’s DD 214 shows that his military occupational specialty during service was Morse Intercept Operator Specialist. The service treatment records show no complaints of, or treatment for a right shoulder disability. The May 1971 separation examination evaluated the Veteran’s upper extremities as normal. After service, VA treatment records in April 2011 show an assessment of degenerative changes of the right shoulder based on x-ray findings. Private medical records show that in October 2015, the Veteran received treatment for right shoulder pain from Dr. W.W., who noted that right shoulder pain symptoms had been present for six months. The physician pointed out that the Veteran was seen for the same problem at the Perry VA Outreach Clinic. X-rays were also afforded during this visit. The Veteran was diagnosed with “pain, right shoulder with rotator cuff tendinitis and acromioclavicular joint degenerative disc disease.” The report also shows that the claimed 1971 in-service injury was noted. On VA examination in October 2019, the diagnosis was glenohumeral joint osteoarthritis and acromioclavicular joint osteoarthritis of the right shoulder. In the September 2020 remand, the Board found that the opinion provided on the October 2019 examination was ambiguous and unclear as the examiner stated that “(i)t is at less likely as not that the Veteran has a diagnosis a right glenohumeral osteoarthritis, right acromioclavicular osteoarthritis, and right rotator cuff tendinopathy that are as likely as not incurred in or caused by the Veteran’s moving of radios receivers.” Thus, the Board remanded the issue for an addendum opinion to be obtained regarding the nature and etiology of the Veteran’s right shoulder disability. In a VA opinion in November 2020, the examiner after reviewing the claims folder opined that the Veteran’s right shoulder disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In the rationale the examiner explained that there was no evidence of a chronic shoulder injury during service. He stated that a blow to the shoulder of the nature described by the Veteran would not cause degenerative joint disease (GH/AC) of the shoulder based on established medical knowledge and practice. He pointed out the separation exam was negative for any shoulder disability, both historically and at exam, and the Veteran denied all medical and surgical conditions. The examiner found it significant that there was no evidence of a shoulder disability until decades after service. He noted that a right acromioclavicular degenerative joint disease was diagnosed on x-ray on December 18, 2017 and glenohumeral and acromioclavicular arthritis was diagnosed on October 15, 2019. The examiner determined that the fact that the Veteran has bilateral degenerative joint disease suggests the usual natural cause, wear and tear. The examiner explained that degenerative joint disease is age-related in the absence of documented injury to the internal joint space, such as partial separation or dislocation. The examiner stated that there was no evidence of such in the records and a blow to one shoulder with the radio would not cause bilateral degenerative joint disease. Therefore, the examiner concluded that it was less likely than not that the Veteran’s right shoulder disability, including degenerative joint disease, is due to or incurred in service, including due to the Veteran’s claimed injury of being struck by the radio. In an opinion in December 2020, the Veteran’s private doctor, Dr. W.W., noted that the Veteran injured his right shoulder during service in 1971 and has had problems ever since to include pain and throbbing. The April 2016 MRI showed rotator cuff tendinitis, acromioclavicular joint arthritis, subluxation of the biceps tendon, and a subscapularis tear. The current diagnosis was right shoulder pain with rotator cuff tendinitis and subscapularis tendon tear, biceps tendinitis with subluxation, and acromioclavicular joint arthritis. He opined that he believed to a reasonable degree of medical certainty that the initial injury occurred during service and continued to progress and worsen as the years have gone on. Considering the relative merits of the analytical findings and the details of the opinions, the Board places more weight on the unfavorable VA opinion in November 2020 than the favorable opinion in December 2020 as the private examiner did not provide a rationale for the conclusion reached. Conversely, the November 2020 VA opinion was based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The VA examiner considered the nature of the Veteran’s right shoulder disability in proffering the opinion. The opinion also is consistent with the other medical evidence of record. As a lay person, the Veteran is competent to report symptoms pertaining to his right shoulder disability. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of the right shoulder disability falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran’s right shoulder disability is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorder. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent, the matter of whether it is credible is not reached.   Arthritis is included among the chronic diseases under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). To the extent that the Veteran is asserting continuity of symptomatology, his assertions are outweighed by the evidence of record discussed above. Accordingly, because the preponderance of the evidence is against the claim of service connection for the right shoulder disability, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.