Citation Nr: 21031041 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 18-00 106A DATE: May 20, 2021 ORDER Entitlement to service connection for a bilateral shoulder condition is denied. Entitlement to service connection for a bilateral hip condition is denied. Entitlement to service connection for a left knee condition is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's current bilateral shoulder strain disability began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran's bilateral hip disorder is causally or etiologically related to any disease, injury, or incident in service. 3. The preponderance of the evidence is against finding that the Veteran's current degenerative joint disease of the left knee began during active service, manifested within one year of separation, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral shoulder condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a bilateral hip condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a left knee degenerative joint disease have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty from August 1983 to May 1985. These matters come before the Board of Veterans' Appeals (Board) from a June 2013 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a September 2019 hearing. A transcript of this hearing has been associated with the claims file. In February 2021, the Board remanded the above claims for additional development. Such was undertaken and the appeal was returned to the Board. 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, 1131, 5107; 38 C.F.R. § 3.303. Generally, to grant service connection, there must be evidence of these three elements: (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). Pain without an underlying diagnosis may constitute a current disability if the pain results in functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). Additionally, certain chronic diseases, such as arthritis, will be presumed related to service if they were noted or diagnosed as chronic in service; or if they manifested to a compensable degree within a presumptive period (usually one year) following active duty discharge; or if chronicity or continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a)(3). In adjudicating such claims, reasonable doubt that exists because of an approximate balance of positive and negative evidence concerning any point will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Entitlement to service connection for a bilateral shoulder condition is denied. The Veteran contends that his current bilateral shoulder condition is related to his active duty military service. Specifically, the Veteran asserts that his shoulder conditions are a result of the "physical and demanding job" he performed on active duty service as a cannon crewmember. Turning to the evidence of record, VA examination reports reflect a diagnosis of bilateral shoulder strain. See e.g., May 2017 VA examination. As such, the first element of service connection, a current disability, has been met. The Veteran's service treatment records (STRs) do not contain complaints or treatment for either shoulder while in service. Post-service treatment records indicate that the Veteran was seen multiple times for pain and decreased range of motion of both shoulders. The Veteran was first afforded a VA examination in May 2017. In the Board's December 2019 decision, the Board found the May 2017 VA examiner's opinions regarding the Veteran's bilateral shoulder disability to be inadequate and requested an addendum opinion be obtained upon remand. An additional opinion was subsequently obtained in March 2020. The Board's February 2021 decision found the March 2020 VA addendum opinions inadequate as they were not responsive to the Board's original December 2019 remand directives. As such, the claim was remanded again for an additional VA addendum opinion addressing etiology of the Veteran's disability. The VA addendum for a bilateral shoulder condition was obtained in March 2021. The VA examiner opined that the Veteran's bilateral shoulder condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The VA examiner stated that "[the] Veteran's contentions and lay statements that he believes his current musculoskeletal issues are the result of his duties as a cannon crewmember are noted. They are however not supported by the evidence. No records show chronicity of care for a shoulder condition between active duty and 2002, when records show acute right shoulder pain after falling off a ladder. After that visit, no report of chronic shoulder pain is noted. Later in 2011, no chronic shoulder complaints are noted. Lay statements are not supported by evidence. No nexus for current shoulder condition to activities or active duty or active duty otherwise exists." The Board finds that the competent evidence of record does not support the conclusion that the Veteran's bilateral shoulder strain began in service or was otherwise due to service. The Veteran's STRs reflect no injuries or complaints of a shoulder strain for either shoulder. Further, the post-service medical evidence attributes some of the Veteran's complaints regarding shoulder pain to a fall. The March 2021 VA examiner also found against a relationship between the Veteran's current bilateral shoulder disability and his active duty service. The Board finds that this conclusion is consistent with the other competent evidence of record, including the Veteran's competent lay evidence. The first post-service complaint of shoulder pain was the July 2006 VA treatment note indicating that the Veteran experienced pain with range of motion of his left shoulder. There is simply no competent evidence of record that establishes either an earlier onset of the Veteran's current bilateral shoulder strain or a relationship between the disability and his active service. The Board acknowledges the Veteran's contention that his bilateral shoulder disability is due to service, to include the physical labor he performed as a cannon crewmember. However, the Veteran did not present any lay or medical evidence of symptoms or diagnosis between separation from service and 2002, when he reported onset of shoulder pain after falling off of a ladder more than a month prior. The Board notes that the Veteran is competent to report the onset of lay observable symptoms such as pain and accords his statement regarding onset of his current shoulder pain significant probative weight. However, while the Veteran contends that his bilateral shoulder strain is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board therefore finds that the preponderance of the evidence indicates that the Veteran's bilateral shoulder strain was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. 2. Entitlement to service connection for a bilateral hip condition is denied. As above, the Veteran contends that his bilateral hip condition is related to his active duty military service. Turning to the evidence of record, VA examination reports reflect a diagnosis of bilateral hip strain. See e.g., May 2017 VA examination. As such, the first element of service connection, a current disability, has been met. The Veteran's STRs do not contain complaints or treatment for either hip while in service. Post-service treatment records indicate that the Veteran was seen multiple times for pain and decreased range of motion of both hips. See e.g., May 2006 VA treatment note (where the Veteran complained of pain in his hips, causing difficulty with sitting and walking); June 2006 VA physical therapy consult (where the Veteran requested a cane for assistance with ambulation due to antalgic gait as a result of pain in his hips, knees, and back); October 2015 VA physical medicine rehab consult (where the VA treatment provider indicated that the Veteran's hip extension was limited to ten degrees). The Veteran was first afforded a VA examination in May 2017. In the Board's December 2019 decision, the Board found the May 2017 VA examiner's opinions regarding the Veteran's bilateral hip disability to be inadequate and requested an addendum opinion be obtained upon remand. An additional opinion was subsequently obtained in March 2020. The Board's February 2021 decision found the March 2020 VA addendum opinions inadequate as they were not responsive to the Board's original December 2019 remand directives. As such, the claim was remanded again for an additional VA addendum opinion addressing etiology of the Veteran's bilateral hip disability. The VA addendum for a bilateral hip condition was obtained in March 2021. The VA examiner opined that the Veteran's bilateral hip condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The VA examiner stated that "[the] Veteran's contentions and lay statements that he believes his current musculoskeletal issues are the result of his duties as a cannon crewmember are noted. They are however not supported by the evidence. No records show chronicity of care for a hip condition between active duty and 2006, when records show the Veteran experienced hip pain since a motor vehicle accident in the 1990s, not active duty. Later, in 2011, no chronic hip complaints are noted. Lay statements are not supported by evidence. Surely, if complaints were as chronic as noted in the Board hearing, the Veteran would have reported them, yet there are none. No nexus for the current hip conditions to activities of active duty or active duty exists." The Board finds that the competent evidence of record does not support the conclusion that the Veteran's bilateral hip strain began in service or was otherwise due to service. The Veteran's STRs reflect no injuries or complaints of a strain for either hip during his active duty service. Further, the post-service medical evidence attributes some of the Veteran's complaints regarding hip pain following a car accident. The March 2021 VA examiner also found against a relationship between the Veteran's current bilateral hip disability and his active duty service. The Board finds that this conclusion is consistent with the other competent evidence of record, including the Veteran's competent lay evidence. The first post-service complaint of shoulder pain was the May 2006 VA treatment records showing that the Veteran reported hip pain and difficulty walking or sitting. There is simply no competent evidence of record that establishes either an earlier onset of the Veteran's current bilateral shoulder strain or a relationship between the disability and his active service. The Board acknowledges the Veteran's contention that his bilateral hip disability is due to service, to include the physical labor he performed as a cannon crewmember. However, the Veteran did not present any lay or medical evidence of symptoms or diagnosis between separation from service and 2006, when he first reported onset of bilateral hip pain. The Board notes that the Veteran is competent to report the onset of lay observable symptoms such as pain and accords his statement regarding onset of his current hip pain significant probative weight. However, while the Veteran contends that his bilateral hip strain is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board therefore finds that the preponderance of the evidence indicates that the Veteran's bilateral hip strain was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. 3. Entitlement to service connection for a left knee condition is denied. The Veteran contends that his left knee condition is related to his active duty military service. Turning to the evidence of record, VA treatment records reflect a diagnosis of degenerative joint disease of the left knee. See November 2017 VA orthopedic surgery consult (referring to an April 2017 x-ray report). As such, the first element of service connection, a current disability, has been met. The Veteran's STRs do not contain complaints or treatment for the left knee while in service. Notably, there are multiple complaints of pain and treatment for issues involving the Veteran's right knee, which is not before the Board at this time. Post-service treatment records indicate that the Veteran was seen and treated for pain and swelling in the left knee. In 2006, the Veteran underwent MRIs for both knees, which reflected chondromalacia of the left knee. During a June 2013 VA examination, the Veteran reported pain and problems with his left knee and attributed his issues to repetitive PT activities while in military service, as well as "twisting activities" from loading ammo. A treatment note from June 2006 reflects that the Veteran sought physical therapy for pain and limited range of motion in both knees and hips. A July 2006 orthopedic surgery consult note reflects that the Veteran underwent an evaluation for both knees; the left knee being described as "quite symptomatic[.]" The orthopedic treatment provider found a displaced fragment to the left knee and upon physical examination, noted distinct tenderness in the posterior medial corners bilaterally. The Veteran exhibited abnormal or limited range of motion of the left knee during his May 2017 VA examination. Later treatment records reflect that the Veteran continued to manage his pain in the left knee through corticosteroid injections. In December 2017, VA received a statement from the Veteran's private primary care physician, Dr. M. J., dated October 2016. Dr. M. J. indicated that she is currently the Veteran's primary care physician and is board-certified in Internal Medicine. The primary care physician indicated that the Veteran had been under her care for the past two years. Dr. M. J. stated that "[h]e has been treated for degenerative arthritis and joint pain. Service records were reviewed regarding his knee pain, foot pain, and back pain. He has bilateral knee pain, foot pain, and back pain that is at least as likely than not related to his service in the military." The Veteran was first afforded a VA examination for both knees in May 2017. In the Board's December 2019 decision, the Board found the May 2017 VA examiner's opinions regarding the Veteran's left knee disability to be inadequate and requested an addendum opinion be obtained upon remand. An additional opinion was subsequently obtained in March 2020. The Board's February 2021 decision found the March 2020 VA addendum opinions inadequate as they were not responsive to the Board's original December 2019 remand directives. As such, the claim was remanded again for an additional VA addendum opinion addressing etiology of the Veteran's left knee condition. The VA addendum was obtained in March 2021. The VA examiner opined that the Veteran's left knee condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The VA examiner stated that "[the] Veteran's contentions and lay statements that he believes his current musculoskeletal issues are the result of his duties as a cannon crewmember are noted. They are however not supported by the evidence. There was no disruption to the articular surface of the joint at the time of active duty, therefore, the degenerative joint disease of the left knee is most likely a natural aging process. No records show chronicity of care for a left knee condition between active duty and 2006, despite the opportunity to do so (when the Veteran was seeking care) in 2002 and 2003. Notes also indicate [the Veteran] was a truck driver post active duty. There is no evidence of chronicity of care and lay statements/hearing testimony of chronicity of symptoms is not support by the evidence. A nexus to active duty or activities of active duty has not been established." The Board finds that the competent evidence of record does not support the conclusion that the Veteran's left knee condition began in service or was otherwise due to service. The Veteran's STRs reflect no injuries or complaints of a left knee condition during his active duty service. The March 2021 VA examiner also found against a relationship between the Veteran's current left knee disability and his active duty service, indicating that the current degenerative joint disease is more likely related to the natural process of aging. The Board finds that this conclusion is consistent with the other competent evidence of record, including the Veteran's competent lay evidence. The Board acknowledges the nexus opinion submitted by the Veteran's private treatment provider in December 2017. However, the Board affords this opinion little probative weight, as there is no rationale provided for the private treatment provider's opinion and no additional medical evidence as support that the Veteran's knee pain is related to his active military service. The first post-service complaint of left knee pain was the May 2006 VA treatment records showing that the Veteran reported left knee pain and difficulty walking or sitting. There is simply no competent evidence of record that establishes either an earlier onset of the Veteran's current left knee disability or a relationship between the disability and his active service. Degenerative arthritis is a chronic disease subject to presumptive service connection. Such chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service (typically one year); or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In this case, as above, it was not shown or noted during service, and the first evidence of degenerative changes of the knee are long after the Veteran's 1985 separation from service. Therefore, presumptive service connection is not warranted. The Board acknowledges the Veteran's contention that his left knee condition is due to service, to include the physical labor he performed as a cannon crewmember. However, the Veteran did not present any lay or medical evidence of symptoms or diagnosis between separation from service and 2006, when he first reported onset of left knee pain. The Board notes that the Veteran is competent to report the onset of lay observable symptoms such as pain and accords his statement regarding onset of his current left knee condition significant probative weight. However, while the Veteran contends that his left knee degenerative joint disease is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board therefore finds that the preponderance of the evidence indicates that the Veteran's left knee condition was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. M. Lowman, 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.