Citation Nr: 21031456 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 15-13 224 DATE: May 21, 2021 ORDER Service connection for left elbow gout is granted. Service connection for left shoulder disability, other than service-connected left shoulder gout, is denied. Service connection for sinusitis is denied. REMANDED Service connection for bilateral eye disability, other than service-connected right eye pterygium, is remanded. Service connection for urinary disability is remanded. FINDINGS OF FACT 1. The preponderance of the evidence supports finding the Veteran's left elbow gout manifested during service. 2. The preponderance of the evidence is against finding left shoulder disability, other than left shoulder gout, manifested during service or is related to service. 3. The preponderance of the evidence is against finding sinusitis disability manifested during service or is related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for left elbow gout are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left shoulder disability, other than service-connected left shoulder gout, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for sinusitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to December 1985. The Veteran appeared for a hearing before the undersigned Veterans Law Judge in August 2015. The hearing transcript is associated with the claims file. The Veteran initially claimed service connection for urethritis. The Veteran's claim has been recharacterized to encompass any urinary disability. Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled); see also Brokowski v. Shinseki, 23 Vet. App. 79 (2009). The Board notes the Veteran requested VA provide him a list of his service-connected disabilities and assigned ratings as documentation to request a reduction in his property tax. See January 2021 letter. A January 2021 VA letter acknowledged receipt of the information request and provided a reference number. As this information request is not relevant to adjudication of his service connection claims, the Board will proceed with adjudication. 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. 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). 1. Service connection for left elbow gout The Veteran contends left elbow disability related to service. Service treatment records (STR) show a January 1968 visit for elbow injury after falling on the ice. A June 1972 visit diagnosed contusion to the scapula and left elbow after an incident where the Veteran was a passenger in a car that was hit by another car. A March 2019 VA medical opinion found the Veteran's gout is at least as likely as not caused by elevated uric acid noted during service. The clinician noted October 1985 lab findings showed elevation of uric acid on his separation examination and post-service outpatient medical records diagnosed gout in 1991. The clinician cited to medical literature showing that gout progresses through four clinical phases, which is consistent with the Veteran's medical history. A March 2021 VA examination diagnosed left elbow gout. The examiner stated that although the Veteran suffered injuries to his elbow on multiple occasions during the service, there were not residual effects from these incidents. The clinician opined his left elbow symptoms were likelier than not related to gout. The Board gives probative weight to the March 2019 and March 2021 VA medical opinions finding the Veteran's gout was as likely as not related to service and the Veteran's left elbow symptoms were likely related to gout. These medical opinions are consistent with the Veteran's reported symptoms and medical history. There is not competent evidence showing other left elbow disability during the appeal period. Accordingly, service connection for left elbow gout is granted. 2. Service connection for left shoulder disability, other than service-connected left shoulder gout The Veteran contends left shoulder disability related to service. The Veteran is already service connected for left shoulder gout. STR show a June 1972 visit diagnosed contusion to the scapula and left elbow after an incident where the Veteran was a passenger in a car that was hit by another car. At the August 2016 Board hearing, the Veteran reported left shoulder symptoms of tingling sensation and pain when it is cold. The Veteran's wife reported his shoulder sometimes hurts if he is laying down. A March 2021 VA clinician diagnosed left rotator cuff tendonitis. The clinician opined it is less likely than not the Veteran's current left shoulder rotator cuff tendinopathy is caused by injuries or events during the service. The clinician noted the Veteran suffered injury to his shoulder during service, but there is no evidence of residual symptoms from this incident. The clinician noted the Veteran reported his shoulder problems began in the 1990s and it is unlikely that an injury from 1972 would start to show long-term effects after a 20-year period of quiescence. The clinician stated that rotator cuff injuries are very common phenomenon in aging individuals. The Board gives probative weight to the March 2021 VA medical opinion finding it is less likely than not the Veteran's left shoulder rotator cuff tendinopathy is caused by injuries or events during the service. The opinion is based on an accurate medical history and provided an explanation with a clear conclusion and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, there is not a competent opinion of record showing his left rotator cuff tendonitis manifested during service or is related to service. Accordingly, as the preponderance of the evidence is against the claim, service connection for left shoulder disability, other than service-connected left shoulder gout, is denied. 3. Service connection for sinusitis The Veteran contends sinusitis disability related to service. The Veteran is already service connected for recurrent pharyngitis with residual of recurrent tonsillitis. STR are silent for sinus complaint or diagnosis. The Veteran pointed to a June 25, 1969 STR for chills, sore throat, fever, dizziness, and sinus. See May 2017 correspondence. However, a review of the June 25, 1969 STR notes fever, chill, dizziness, and sore throat since last night. The Veteran was assessed with tonsillitis. There was no mention of sinus disability. At the August 2015 hearing, the Veteran stated he was not treated for sinusitis during service, but did complain about pain and rashes to his hands. A March 2021 VA examination diagnosed chronic sinusitis. The clinician opined the Veteran's recurrent sinusitis is less likely than not caused by service. The clinician noted the Veteran did not have any episodes of sinusitis during service and did not have complaints of sinus problems on his separation exam. The clinician opined the likeliest cause of the Veteran's sinusitis based on his known risk factors is a history of tobacco use. The Board gives probative weight to the March 2021 VA examination finding the Veteran's chronic sinusitis is less likely than not caused by service. The opinion is based on an accurate medical history and provided an explanation with a clear conclusion and supporting data. The finding is consistent Veteran reports during VA treatment visits of tobacco use from 1965 to 2000. Accordingly, as the preponderance of the evidence is against the claim, service connection for sinusitis is denied. REASONS FOR REMAND 1. Service connection for bilateral eye disability, other than right eye pterygium The Veteran contends bilateral eye disability related to an incident during service where he was hit by a bus and hit his head. See August 2015 hearing testimony. A June 1967 STR notes the Veteran was hit by bus and had swelling to forehead and lightheadedness. A March 2021 VA examination opined the Veteran's eye disabilities, other than right eye pterygium, were less likely than not incurred in or caused by service. The examiner did not address the Veteran's contention that his vision symptoms were related to the June 1967 service incident involving being hit in the head by a bus. The Board requests an addendum opinion addressing the Veteran's contention. 2. Service connection for urinary disability is remanded. A March 2021 VA examination noted the Veteran was diagnosed with gonococcal urethritis during service in 1969. The clinician noted the Veteran reported current lower urinary tract symptoms, which were of unknown etiology, but not related to urethritis. The clinician noted the likeliest cause of the Veteran's voiding dysfunction was a prostate etiology, but it could not be determined with certainty from the available information and a prostate examination was outside the scope of the current exam request. The Board requests an addendum examination and medical opinion on the etiology of the Veteran's urinary symptoms. Any testing or imaging deemed necessary by the clinician should be performed. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's eye disabilities. An in-person examination is not required unless deemed necessary by the clinician. The clinician should answer: (a.) Identify any eye disability found during the appeal period. (b.) For any diagnosis considered a refractive error, whether it is at least as likely as not (50 percent or greater probability) the refractive error was subjected to a superimposed injury or disease in service that resulted in an additional disability of the eye? (c.) For any diagnosis not considered a refractive error, whether it is at least as likely as not the disability began during service or is related to service, to include a June 1967 STR showing the Veteran was hit in the head and had swelling to forehead? 2. Schedule a VA examination for the Veteran's urinary symptoms. Any testing or imaging deemed necessary by the clinician should be performed. The clinician should answer: (a.) Identify any urinary disability found during the appeal period. (b.) For each urinary disability, is it at least as likely as not the disability began during service or is related to service, to include April 1969 STR showing burning urination and a diagnosis of urethritis? If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Winkler, 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.