Citation Nr: 21051643 Decision Date: 08/20/21 Archive Date: 08/20/21 DOCKET NO. 18-20 384 DATE: August 20, 2021 ORDER Entitlement to service connection for left shoulder strain, claimed as secondary to service-connected left elbow epicondylitis is denied. FINDING OF FACT The Veteran's left shoulder strain was not caused or aggravated by service-connected left elbow epicondylitis. CONCLUSION OF LAW The criteria for service connection for left shoulder strain, claimed as secondary to service-connected left elbow epicondylitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1980 to July 2002. This case initially came to the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified during a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. In May 2020, the Board remanded the matters for further evidentiary development. The agency of original jurisdiction obtained a December 2020 opinion which was adequate to decide the claim. Thus, there has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (only substantial rather than strict compliance with the Board's remand directives is required under Stegall). While in remand status, in a January 2020 rating decision, the RO granted service connection for other specified depressive and anxiety disorder and granted a 50 percent rating effective August 9, 2017. The grant of service connection for other specified depressive and anxiety disorder constitutes a full award of the benefits sought on appeal with respect to the issue. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of downstream elements such as the disability rating or effective date assigned). The record currently available to the Board contains no indication that the Veteran initiated an appeal with the initial rating or effective date assigned for other specified depressive and anxiety disorder. Thus, the matter is not in appellate status. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a),(b). 1. Left Shoulder Strain As a preliminary matter, with regard to the claim of service connection for left shoulder on a direct basis, the evidence does not reflect, nor has the Veteran contended, that his left shoulder strain was incurred in or caused by his military service. Specifically, the Veteran's service treatment records (STRs) are negative of complaints or findings of left shoulder strain. At his May 2002 retirement examination, no pertinent abnormalities were noted. There is no indication that left shoulder strain manifested until many years after service. There is also no evidence or allegation of a relationship between left shoulder strain and active service or any incident therein, and the Veteran has not contended otherwise. Consequently, no theory of entitlement other than secondary service connection, as indicated in his February 2017 claim, has been raised by the Veteran or the evidence of record with regard to the claim for service connection for left shoulder strain. The Board now turns to the discussion of secondary service connection. The Veteran contended in his February 2017 claim that his left shoulder strain is secondary to his service-connected left elbow epicondylitis. At his February 2020 Board hearing, the Veteran asserted that his left shoulder was giving him problems, then it spread to his left shoulder. He noted that the doctors have not told him they think shoulder is related to the elbow, but they keep checking his nerve. In May 2017, the Veteran underwent a VA examination. He reported that he has had left shoulder pain for one year. The Veteran stated he now things he has left rotator cuff issue for the past year, because symptoms remind him of the he had with the right shoulder. The examiner diagnosed left shoulder strain and opined that the Veteran's left shoulder condition was less likely than not proximately due to or the result of his service-connected left elbow disability. The examiner explained that the Veteran is 58 years old and left the service 15 years ago. The Veteran reports his left shoulder symptoms for about a year which he said reminded him of the symptoms he had with the right rotator cuff, which is also a new issue unrelated to military service. The examiner noted the Veteran reports chronic left epicondylitis symptoms since military service although exam of elbows today is benign. The examiner concluded that the development of shoulder symptoms more than a decade post military service is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected left elbow epicondylitis. In December 2020, the Veteran underwent a VA examination. The examiner opined that the Veteran's left shoulder strain is less likely than not aggravated by his service-connected condition. The examiner also opined that the Veteran's left shoulder strain is less likely than not proximately due to or the result of the Veteran's service-connected left elbow epicondylitis. The examiner explained that review of records shows that the Veteran was with left shoulder condition in 2016 which is 14 years after separating service. The examiner noted no peer-reviewed studies linking elbow epicondylitis to shoulder strain. The examiner further noted that he reviewed the Veteran's medical information provided in electronic form, as well as, interviewed and examined. The examiner concluded that the Veteran's left shoulder strain is less likely than not aggravated beyond progression by left elbow epicondylitis, and also that the Veteran's left shoulder strain is less likely than not proximately due to or the result of the Veteran's service-connected left elbow epicondylitis. As the May 2017 and December 2020 VA examiners explained the reasons for their conclusions based on an accurate characterization of the evidence, to include consideration of the Veteran's statements of no left shoulder symptoms since 2016 and the onset of symptoms after separation from active service, their opinions are entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). Moreover, there is no contrary medical opinion in the evidence of record. The Board notes that, although the May 2017 VA examiner's opinion was inadequate because it did not address secondary aggravation, this did not negate the probative weight of the opinion as to secondary causation. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight"; "it may be given some weight based upon the amount of information and analysis it contains"). To the extent that the Veteran asserts that left shoulder strain is related to service-connected left elbow epicondylitis, he is competent to attest to his observations and the etiology of simple medical matters. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). He is not, however, competent to opine on complex medical matters such as the etiology of left elbow epicondylitis and the potential relationship to left shoulder strain, which are questions that relate to internal medical process that extend beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Jandreau, 492 F.3d at 1377, n.4 (sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer). To the extent that the Veteran's statements are competent, the specific reasoned opinions of the May 2017 and December 2020 VA examiners are of greater probative weight than the Veteran's more general lay assertions. For the foregoing reasons, the weight of the evidence reflects that the Veteran's left shoulder strain is neither caused nor aggravated by his service-connected left elbow epicondylitis. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.