Citation Nr: 21022400 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-08 006 DATE: April 15, 2021 ORDER Entitlement to service connection for right shoulder arthritis is denied. Entitlement to service connection for left shoulder arthritis is denied. FINDINGS OF FACT 1. The Veteran’s right shoulder arthritis is not etiologically related to service. 2. The Veteran’s left shoulder arthritis is not etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for right shoulder arthritis have not been met. See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for left shoulder arthritis have not been met. See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1984 to April 1986 and from October 1986 to March 2006. This matter comes to the Board of Veterans’ Appeals (Board) from an April 2014 rating decision which, in pertinent part, denied service connection for right and left shoulder arthritis. In December 2015, the Veteran attended a conference with a Decision Review Officer. A summary of the conference is of record. In August 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In January 2020, the Board remanded the claims for further development. In December 2020, the Board remanded the claims for further development. The Board finds substantial compliance with the December 2020 remand. Following the remand, the AOJ obtained outstanding VA treatment records and an addendum opinion. The AOJ also attempted to obtain private treatment records several months earlier in October 2020, but no response was received from the Veteran. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (stating that a veteran has a duty to assist and cooperate with the AOJ in developing evidence). Service connection, generally Service connection may be granted for a disability related to active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, a veteran must establish: (1) evidence of a current disability; (2) in-service incurrence or aggravation of an injury; and (3) a causal relationship between the current disability and the injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established for the chronic disease of arthritis if it is shown in service or manifests to a compensable degree in the presumptive period of one year from the separation of service. See 38 C.F.R. §§ 3.303(b), 3.307(a)(2)-(3), 3.309(a). Alternatively, service connection may be established based on a continuity of symptomatology where the evidence shows (1) arthritis noted during service or in the presumptive period; (2) post-service continuity of the same symptoms; and (3) medical or, in some circumstances, lay evidence of a nexus between the current disability and the post-service symptoms. See Fountain v. McDonald, 27 Vet. App. 258, 263-64 (2015); see also 38 C.F.R. § 3.303(b). A veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. §§ 3.102, 4.3. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Service connection for right and left shoulder arthritis A March 1984 entrance examination showed no abnormalities in the upper extremities or shoulder defects. Periodic service examinations, to include December 1984, April 1992, October 1997, October 2004, and December 2005, also showed no abnormalities in the upper extremities or shoulder defects. On several occasions, to include October 2004 and December 2005, the Veteran reported a painful elbow or an arthritic knee. The Veteran’s service treatment records did not mention any diagnoses of shoulder arthritis. A January 1995 service treatment record noted a follow up for acute cervical strain while lifting and a diagnosis of trapezius strain. A May 1997 service treatment record noted cervical diagnoses after the Veteran reported neck pain that radiated to his midback and shoulders. At several VA sessions in April 2007, the Veteran reported neck pain, shoulder pain, and left hand numbness. He reported longstanding shoulder discomfort going back to active service when he was in the infantry and carried heavy packs. An x-ray of the left shoulder showed a normal acromioclavicular (AC) joint and no periarticular soft tissue calcifications or calcified tendinitis. The provider stated the x-ray was normal. The impression was mild osteoarthritis of the cervical spine with left shoulder and neck pain, with a possible nerve impingement syndrome. At a June 2007 VA examination, the Veteran reported neck pain that radiated into the right shoulder and right chest as well as left upper extremity numbness. The examiner diagnosed cervical scoliosis with degenerative disc disease and decreased range of motion. At a June 2007 private neurosurgery consultation, the Veteran reported neck, left upper extremity, and interscapular pain. The provider stated that the cause of the left upper extremity symptoms was unclear. An August 2007 bone scan stated that the sites of increased radiotracer activity involving the AC joints, the sternoclavicular joints, and cervical spine were most consistent with sites of degenerative or “arthritic” radiotracer accumulation. At an October 19, 2007, private neurosurgery consultation, the Veteran reported neck pain that spread out to his trapezius muscles; right upper extremity pain that began in his lateral neck and went down the right arm to the shoulder; left upper extremity pain that went all the way down to his fingers; and interscapular pain. The neurosurgeon stated the bone scan showed marked increased signals in the AC joints of both shoulders and the facet joints of the cervical spine. The neurosurgeon could not explain the etiology for the upper extremity radiating symptoms, but that it was possibly referred pain from bad shoulder arthritis and AC joint arthritis. At an October 31, 2007, VA orthopedic consultation, the Veteran reported pain in the left side of his neck, weakness, and difficulties with his left shoulder. He did not recall any specific injuries to his neck or shoulder, but reported that the symptoms had been present since 1995 and were getting worse. The orthopedist diagnosed cervical spine arthritis with radiation of symptoms down the arm, possibly due to foraminal stenosis. On October 31, 2007, x-rays of the right and left shoulders showed normal glenohumeral joints and approximately preserved joint spaces. At a November 2007 EMG consultation, the Veteran was diagnosed with neck and upper back pain with pain and paresthesias radiating to the left arm and occasional right hand paresthesias. At a November 2007 VA examination, the Veteran reported left-sided neck and left shoulder pain that began around 1996 when he was a drill instructor. He also reported left interscapular pain of the back. The examiner stated the bone scan showed some uptake in the cervical spine consistent with osteoarthritis. The examiner clarified that the diagnosis at the June 2007 VA examination should have been cervical spondylosis, not cervical scoliosis. The examiner diagnosed thoracic outlet condition, double crush syndrome, and cervical spine osteoarthritis. At a March 2011 VA session, the Veteran was diagnosed with stable osteoarthritis of the cervical spine after he reported chronic stable pain in the spine, especially in the upper shoulders and cervical spine. At the December 2015 conference, the Veteran asserted that service connection was warranted due to the rigors of service and airborne jumps. He reported not seeking treatment for painful shoulders during service. He reported experiencing stiffness and aching during service and progressive symptoms to the present. At the August 2019 hearing, the Veteran reported that his shoulder pain began in the early to mid-1990s due to carrying heavy rucksacks. He reported going to medical, but being given only Motrin. The representative asserted that an April 2007 x-ray showed longstanding shoulder pain and that, while outside the presumptive period, the Veteran was diagnosed with arthritic shoulders in the AC joints in October 2007. In September 2020, x-rays of the right and left shoulders showed minimal osteoarthritic/degenerative changes of the AC joints. At an October 2020 VA examination, the VA examiner reviewed the electronic folder and performed an in-person examination of the Veteran. The Veteran reported that he always had issues with his shoulders. He reported that he was never seen for his shoulder pain during service and that his shoulder issues were evaluated when he was seen for his neck or back. He reported that his pain was in the posterior upper lateral soft tissue area, and he reported tenderness to palpation over this area. He also reported tenderness to palpation to soft tissues of the trapezius, supraspinatus, and rhomboids. He reported that he did six airborne jumps and that he minimized his activity during the last four years of service. The examiner diagnosed bilateral degenerative shoulder arthritis. The examiner opined that it was less likely than not that the Veteran’s right and left shoulder arthritis were related to service. The examiner noted that the Veteran’s service treatment records were silent for bilateral shoulder issues. The examiner noted the April and October 2007 x-rays and stated that the findings of the August 2007 bone scan were not verified on the October 2007 x-ray. The examiner noted that the September 2020 x-rays showed only minimal osteoarthritic/degenerative changes of the right and left AC joints and that these findings were more likely due to wear and tear over the years than to airborne jumps during service. In December 2020, the October 2020 VA examiner provided an addendum opinion to consider the Veteran’s reports of carrying heavy rucksacks and to consider reports of longstanding shoulder discomfort back to April 2007. The examiner continued to opine that it was less likely than not that the Veteran’s right and left shoulder arthritis were related to service. The examiner noted her prior rationale and stated that it was more likely than not that the findings were related to generalized wear and tear and not to military service. The examiner then stated that, at the October 2020 VA examination, the Veteran identified his shoulder pain by pointing to the bilateral upper trapezius areas, not the glenohumeral or AC joints. The examiner explained that this area of discomfort “would not be consistent with bilateral shoulder conditions nor the minimal AC joint arthritis noted on the September 28, 2020 bilateral shoulder x-rays.” The examiner stated that this upper trapezius area was identified in the April 2007 session. The examiner also stated that degenerative changes were not noted on shoulder x-rays in October 2007 when the Veteran was seen by orthopedics for left-sided neck pain and left shoulder issues that were felt to be related to cervical spine arthritis. As a preliminary matter, the Board finds that the Veteran was in sound condition when he entered service based on the March 1984 examination showing no abnormalities in the upper extremities or shoulder defects. The Board finds that the competent and credible evidence shows a current disability and an in-service event. The October 2020 VA examiner diagnosed bilateral degenerative shoulder arthritis based on 2020 x-rays showing minimal osteoarthritic/degenerative changes of the AC joints. The Veteran has credibly reported that he carried large rucksacks and performed airborne jumps during service. The Board must then consider whether the Veteran’s current disabilities are related to service. Before discussing whether the Veteran’s current disabilities are related to service, the Board must clarify the lay evidence that is relevant to this case. The Board notes that the Veteran has reported experiencing “shoulder” symptoms during service and increased symptoms since service. However, in the December 2020 addendum opinion, the October 2020 VA examiner stated that the Veteran identified his shoulder pain by pointing to the bilateral upper trapezius areas, not the glenohumeral or AC joints. The examiner explained that this area of discomfort “would not be consistent with bilateral shoulder conditions nor the minimal AC joint arthritis noted on the September 28, 2020 bilateral shoulder x-rays.” The examiner also noted medical evidence from 2007 identifying similar symptoms. While the Veteran is competent to report his symptoms, he is not competent to provide a diagnosis. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board assigns probative weight to the VA examiner’s opinion that the Veteran’s reported symptoms are unrelated to right and left shoulder arthritis. The Board notes that medical evidence from 2007, to include the August 2007 bone scan and the October 2007 private treatment record, mentions shoulder arthritis. However, neither the interpreter of the bone scan nor the neurosurgeon reviewed the Veteran’s entire claims file. Moreover, neither provider considered the subsequent October 2007 x-rays or 2020 x-rays. By contrast, the October 2020 VA examiner comprehensively reviewed the Veteran’s entire claims file and stated that the findings of the bone scan were not verified on the October 2007 x-ray. Indeed, the VA examiner explained that the 2020 x-rays, thirteen years later, documented only minimal osteoarthritic/degenerative changes of the right and left AC joints. Accordingly, the Board assigns limited probative weight to the medical evidence in 2007 suggesting shoulder arthritis and finds that it is outweighed by the VA examiner’s opinion. For the reasons explained below, the Board finds that the Veteran’s current disabilities of right and left shoulder arthritis are not related to service. To begin, the Board assigns probative weight to the October 2020 VA examiner’s opinion and addendum opinion that it was less likely than not that the Veteran’s right and left shoulder arthritis were related to service. The VA examiner reached this opinion after extensively discussing the evidence of record and performing an in-person examination of the Veteran. The examiner noted that the Veteran’s service treatment records were silent for bilateral shoulder issues and that x-rays in 2007 did not show arthritis. The examiner then noted that x-rays in 2020 showed only minimal osteoarthritic/degenerative changes of the right and left AC joints and explained that these findings were more likely due to wear and tear over the years than to active service. The examiner also stated that the Veteran’s reported symptoms were not consistent with bilateral shoulder conditions or the x-rays. The Veteran asserts that his current disabilities are related to service, to include as due to airborne jumps and carrying heavy rucksacks, but the VA examiner considered these lay statements in reaching the negative nexus opinion. While the Veteran is competent to report his symptoms, he is not competent to diagnose arthritis or provide a nexus of arthritis to active service. See Jandreau, 492 F.3d at 1377. The Board instead assigns probative weight to the VA examiner’s opinion. The Board further finds that service connection is not warranted for a chronic condition that manifested during service or in the presumptive period, or is based on a continuity of symptomatology. The October 2020 VA examiner comprehensively reviewed the evidence of record and considered the Veteran’s reports of longstanding shoulder discomfort back to April 2007. The VA examiner, however, opined that arthritis did not manifest during service or in the presumptive period; that arthritis was not “noted during service” based on the evidence of record, to include the 2007 and 2020 x-rays; and that there was not a continuity of symptomology because the Veteran’s reported symptoms, while consistent with prior treatment records, were unrelated to his right and left shoulder arthritis. While the Veteran is competent to report his symptoms, he is not competent to provide a diagnosis. See Jandreau, 492 F.3d at 1377. The Board instead assigns probative weight to the VA examiner’s opinion. The Board has considered the representative’s assertions at the August 2019 hearing. While the representative asserts that the April 2007 x-ray shows a longstanding shoulder condition, the Board notes that the April 2007 VA provider and the October 2020 VA examiner stated that the x-ray was normal. While the representative notes the October 2007 diagnosis of arthritic shoulders in the AC joints, the Board previously explained its consideration of this evidence. Because the preponderance of the evidence is against the Veteran’s claim of service connection for right and left shoulder arthritis, there is no reasonable doubt to be resolved, and the claim must be denied. While the Board finds that the Veteran’s reported symptoms are unrelated to right and left shoulder arthritis, the Veteran can file an increased rating claim if he determines that his symptoms are related to his cervical spondylosis (claimed as upper back degenerative disk condition). K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ormson, Associate 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.