Citation Nr: 21041624 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 16-32 004 DATE: July 9, 2021 ORDER Service connection for a right shoulder condition is denied. Service connection for a left shoulder condition is denied. Service connection for a neck condition is denied. Service connection for a low back condition is denied. Service connection for a left hip condition is denied. FINDINGS OF FACT 1. The Veteran has current disabilities of both shoulders, the neck, the low back, and the left hip. 2. A preponderance of the evidence does not demonstrate that any of these current disabilities were incurred in, caused by, or otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder condition are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a left shoulder condition are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a neck condition are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a low back condition are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a left hip condition are not met. 38 U.S.C. §§ 1110, 5107(b); 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 in the United States Navy from October 1966 to April 1970, to include service. The Veteran was awarded the Vietnam Service Medal, the Vietnam Campaign Medal, and the Combat Action Ribbon. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Reno, Nevada. Jurisdiction of the Veteran's claims file currently resides with the Jackson, Mississippi RO. In March 2016, the Veteran and his spouse testified at a VA RO before a Decision Review Officer (DRO). Thereafter, in November 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). Transcripts of both hearings are of record. Thereafter, in January 2020, the Board found that new and material evidence had been received to reopen the issues of service connection for the neck, low back, and left hip. The Board then remanded the issues of service connection for right and left shoulder conditions, a neck condition, a low back condition, and a left hip condition for additional development. The Board again remanded the case in December 2020 and the case has returned for appellate review. Service Connection As a general matter, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires credible and competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). In this case, the Veteran has contended that (1) he did not have any shoulder, neck, low back, or left hip conditions prior to service, and (2) his current disabilities are due to an incident in service where he fell while performing duties on the signal bridge on the USS Turner Joy. See Board Hearing Tr. at 2-3. After reviewing the record, the Board concludes that the evidence of record does not support a grant of service connection for any disability currently on appeal. As such, the Veteran's appeal is denied. See 38 C.F.R. § 3.303. In support of this determination, the Board first notes that the Veteran has current disabilities of both shoulders, the neck, the low back, and the left hip. See March 2020 VA Shoulder and Arm Conditions Examination Report (indicating current diagnoses of right shoulder degenerative arthritis; tendon tear with impingement syndrome, status post arthroscopic release of coracoacromial ligament and acromioplasty, left side; and supraspinatus tendon tear, right side); March 2020 VA Hip and Thigh Conditions Examination Report (noting a diagnosis of left hip avascular necrosis); July 2018 VA Primary Care Initial Evaluation Note (providing a diagnosis of mild degenerative disc disease and facet arthropathy of the lumbosacral spine); February 2016 Southwest Medical Associates Radiology Diagnostic Report (noting that x-rays of the cervical spine revealed extensive degenerative changes with degenerative disc disease at multiple levels). Accordingly, the Board finds the first service connection requirement for all pending issues to be satisfied. Turning to the next requirement of an in-service incurrence, the Board acknowledges that the Veteran's service treatment records (STRs) do indicate that he sought treatment for orthopedic complaints associated with an injury in service. Specifically, in August 1967, the Veteran sought medical treatment as he reported falling down a ladder and injuring his left leg. The STR noted that the request for treatment originated from the USS Sterett. A physical examination of the Veteran at that time revealed some swelling and much apparent tenderness lateral to the left knee. X-rays of the left knee were negative. The treating medical provider assessed the Veteran with a sprained knee with contusions. Notably, the Veteran did not reportand a medical professional did not observeany problems with the shoulders, neck, back, and left hip as a result of this fall in August 1967. The Veteran addressed a fall in-service at the November 2019 Board hearing. Firstly, the Veteran testified that he fell while performing duties on the signal bridge on the USS Turner Joy. Board Hearing Tr. at 3. He stated that he fell off the bridge in rough seas, fell down a flight of stairs, landed on the gun-mount deck, and injured his back, shoulders, left knee, and left hip. Id. at 3, 6. He then elaborated that, at that time he was in his early 20s and recovered well from the fall and was not thoroughly examined at the time of the injury. Id. at 3. The Veteran next stated that, after he separated from service, he did not have many symptoms, but, as he became more active over the years, he started to have discomfort. Id. The Veteran elaborated that while he may have experienced slight discomfort around the time of his separation from service, he only formally sought medical treatment when his symptoms became severe. Id. at 7-8. While the Veteran's STRs may only document (1) an injury to the left knee in August 1967 aboard the USS Sterett; (2) no injuries pertaining to a fall on the USS Turner Joy; and (3) no back, neck, shoulder, or hip issues at the time of his March 1970 separation examination, the Board notes that, as a layperson, the Veteran is competent to report and describe his in-service experiences. See Layno v. Brown, 6 Vet. App. 465 (1994). Thus, while the August 1967 STR may only document an injury to the left knee, the Board finds it plausible that the Veteran may have injured other areas of his body at the time of the August 1967 fall or during a separate incident. Thus, the Board finds the in-service incurrence requirement for service connection to also be satisfied in the instant case. Lastly, regarding the remaining requirement of nexus, the Board notes that there is one competent, adequate opinion of record addressing the etiology of the Veteran's current shoulder, neck, low back, and left hip disabilities. Specifically, in March 2020, a VA examiner opined that it was less likely than not that the Veteran's current low back, neck, left hip, and bilateral shoulder conditions were caused by, incurred in, or otherwise related to service. In support of this opinion, the March 2020 VA examiner first stated that there was a lack of documentation of an injury to the low back, neck, left hip, and bilateral shoulders in service due to a fall down a flight of stairs in service. Additionally, the examiner remarked that there were no documented injuries to the low back, neck, left hip, and bilateral shoulders in connection with the rigors of the Veteran's duties as a leading signalman. The examiner next explained that this lack of medical treatment records addressing such injuries both during and after service was highly suggestive that any injures to the Veteran's contended areas in connection with the fall were "minor and did not result in functional deficits or a chronic sequelae involving the low back, neck, left hip, and bilateral shoulder[s]." The examiner next stated that, in a typical biological response to an acute injury, "symptoms would not wait or lie dormant for 20 or more years before manifesting or resulting in a late effect, chronic condition or related complications." The examiner then noted that the Veteran himself reported that he was able to bowl, play golf, and play tennis for many years after service. The examiner addressed a lay statement from J.H. regarding observations that the Veteran had a limp and could not play basketball to such an extent as he could prior to service. The examiner indicated that J.H.'s statement in and of itself did not establish that the Veteran had a chronic disability or residual condition associated any falls in service. Lastly, the examiner stated that the evidence of record overwhelmingly supported a cause and effect relationship between current conditions of the shoulders, low back, neck, and left hip with one or more non-service-related activities, injuries, or other risk factors. The Board finds the March 2020 opinion to be adequate for adjudicative purposes as it was based on a consideration of the Veteran's entire medical history, described the Veteran's conditions in detail, and included an explanatory rationale in support of its conclusion that the Veteran's current disabilities were not incurred in, caused by, or otherwise related to service. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Specifically, in support of the ultimate conclusion that the Veteran's current left shoulder condition was related to non-service-related activities, injuries, or other risk factors, the Board notes that, in a September 2000 VA treatment record, the Veteran reported the onset of left shoulder pain in March 1999. Additionally, regarding the right shoulder and the neck, the Veteran reported in a February 2007 VA neurosurgery clinic note that he began experiencing neck pain and bilateral shoulder pain around 2005. In August 2014, the Veteran reported during a visit with a VA physician medicine practitioner that his neck pain began in the late 1990s. Similarly, regarding the low back, during a March 2020 VA back conditions examination, the Veteran reported that he first sought treatment for low back pain in the 1990s. The earliest documented complaint of back pain associated with the claims file is from December 1996, when the Veteran told a VA provider that he recently began experiencing back pain following a bowling outing. Lastly, regarding the left hip, the Veteran underwent left hip core decompression surgery in March 2003 due to a diagnosis of left hip avascular necrosis. Prior to the performance of this procedure, as documented in a pre-anesthesia note, it was noted that the Veteran was involved in a significant car accident in 1977 that caused his first hip injury. In none of the above records of treatment, excluding the March 2020 VA back conditions examination, did the Veteran indicate that he injured his shoulders, neck, low back, and left hip in service following a fall down a flight of stairs. Rather, consistent with the conclusion of the March 2020 opinion, the record demonstrates that the Veteran's current disabilities were caused by or related to events, injuries, or other risk factors outside the context of the Veteran's military service. Accordingly, as there are no competent, adequate opinions of record linking the Veteran's currently diagnosed shoulder, neck, low back, and left hip conditions to service, the Board concludes that service connection is not warranted in the instant case. See 38 C.F.R. §§ 3.303. The Veteran's appeal is denied. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.S. Pettine, 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.