Citation Nr: 21015768 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 17-36 481 DATE: March 18, 2021 ORDER Service connection for a right shoulder disability is granted. REMANDED Service connection for hypertension is remanded. Service connection for a left shoulder disability is remanded. FINDING OF FACT The weight of the evidence supports a finding that the Veteran has a right shoulder disability that is etiologically related to active duty service. CONCLUSION OF LAW The criteria for service connection for a right shoulder disability have been met. 38 U.S.C. §§ 1110, 1111, 1153; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1994 to February 1997. The Veteran had additional service in the United States Army Reserve (Reserve) and in the United States Air National Guard (Guard). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from two rating decisions of the Agency of Original Jurisdiction (AOJ). An October 2016 rating decision denied service connection for hypertension. A January 2018 rating decision denied service connection for a left shoulder disability and a right shoulder disability. The Veteran participated in a September 2020 hearing before the undersigned, and a transcript of this hearing has been associated with the record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Veteran sought treatment for right shoulder pain during service. In March 1996, the Veteran sought treatment for right shoulder pain that had persisted for over two months, and a clinician diagnosed the Veteran with tendonitis or bursitis of the right acromioclavicular joint. The Veteran otherwise has a current right shoulder disability, with, for example, an October 2020 x-ray showing osteoarthritis and calcific tendinitis of the right shoulder. In October 2020, a private clinician opined that the Veteran’s right shoulder disability related to his active duty service, explaining that the Veteran’s lay history, the examination data, and x-ray examination report all supported such a finding. Thus, with evidence supporting a connection between the Veteran’s in-service right shoulder injury and his current disability, the Board finds that service connection is warranted. REMANDED Further development is required before the Board may address the Veteran’s claims for service connection for a left shoulder disability and hypertension. On remand, the Agency of Original Jurisdiction (AOJ) should determine the Veteran’s periods of ACDUTRA and INACDUTRA service with the Reserve and Guard. With respect to a left shoulder disability, a February 2017 x-ray of the Veteran’s left shoulder showed moderate to severe arthropathy of the left acromioclavicular joint. The Veteran has argued that his left shoulder disability is the secondary result of his right shoulder disability, which is now service connected. An opinion is needed to address that medical question. With respect to hypertension, the Veteran has been assessed, for example in June 2012, with hypertension, and the Veteran, at that time, took medication in treatment of that condition. However, during his September 2020 hearing, the Veteran argued that there was a correlation between the stresses (physical and mental) and his hypertension. He vaguely recalled that the first time he experienced increased/elevated blood pressure was when he entered service. The Veteran has not been afforded a VA examination addressing the nature and etiology of his hypertension, and such an examination should be conducted on remand. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following actions: 1. Determine all of the Veteran’s periods of active duty service for training (ACDUTRA), and inactive duty service for training (INACDUTRA). 2. Ensure that all pertinent VA treatment records have been associated with the Veteran’s claims file, and afford the Veteran with the opportunity to identify private clinicians who have treated his left shoulder and hypertension disabilities. 3. Then, afford the Veteran with examinations to address the nature and etiology of his left shoulder disability and hypertension. The examiners should address the following questions: (a.) Is it at least as likely as not (that is, a probability of 50 percent or greater), that the Veteran’s left shoulder disability is caused by his service-connected right shoulder disability? (b.) Is it at least as likely as not (that is, a probability of 50 percent or greater), that the Veteran’s left shoulder disability underwent any incremental increase in disability, regardless of its permanence, due to the Veteran’s service-connected right shoulder disability?   An “incremental increase in disability” is an additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. (c.) Is it at least as likely as not (that is, a probability of 50 percent or greater), that the Veteran’s hypertension had its onset during active service or a period of ACDUTRA service, or is otherwise related to any in-service disease, event, or injury? The examination report must include discussion of whether the Veteran demonstrated blood pressure readings that represented the initial   onset of hypertension. Further, to the extent possible, the examiner should identify when hypertension was first diagnosed. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Flynn, 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.