Citation Nr: 21055313 Decision Date: 09/07/21 Archive Date: 09/07/21 DOCKET NO. 99-17 593 DATE: September 7, 2021 ORDER Entitlement to service connection for bilateral acromioclavicular joint osteoarthritis, as secondary to service-connected cervical spine spondylosis, on an aggravation basis, is granted. FINDING OF FACT The probative evidence of record is at least in relative equipoise as to whether the Veteran's bilateral acromioclavicular joint osteoarthritis is aggravated by her service-connected cervical spine spondylosis. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bilateral acromioclavicular joint osteoarthritis, as secondary to service-connected cervical spine spondylosis, on an aggravation basis, have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served with the Army Reserve, to include a period of active duty for training (ACDUTRA) from September 1983 to March 1984. This matter initially came before the Board of Veterans' Appeals (Board) on appeal of a November 1997 rating decision. This case was previously remanded by the Board in March 2007, December 2010, July 2013, July 2014, January 2017, August 2018, and February 2021. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The case has been returned to the Board for review. Neither the Veteran nor her representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issue decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Entitlement to service connection for bilateral shoulder disability. The Veteran contends that she has a bilateral shoulder disability that is directly related to her active service or secondary to her service-connected cervical spine disability. Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). "Active military, naval, or air service" includes active duty, any period of ACDUTRA during which the individual concerned was disabled from a disease or injury incurred in the line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled from an injury incurred in the line of duty. 38 U.S.C. § 101 (21), (24); 38 C.F.R. § 3.6 (a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A disability which is proximately due to, or chronically aggravated by, a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). The evidence of record shows that the Veteran has a current diagnosis of bilateral acromioclavicular joint osteoarthritis. See May 2021 VA examination. Therefore, there is evidence of a current bilateral shoulder disability. As to the Veteran's theory of direct service connection, her service treatment records reflect that she complained of shoulder and neck pain in June 1989, during a period of ACDUTRA. The Veteran has been provided several VA examinations related to her bilateral shoulder disability. February 2015 and February 2017 VA examiners opined that the Veteran's current bilateral shoulder disability is less likely than not related to her military service. As rationale, the VA examiners explained that the Veteran's current bilateral shoulder disability does not correlate with active military service or ACDUTRA since the current disability was diagnosed several years after her military service. Additionally, the VA examiners explained that the Veteran's disability is an expected change related to the normal aging process. The Board has considered the Veteran's contentions that her current bilateral shoulder disability began during her active service. However, the Board does not attach any weight to those statements because they are controverted by the contemporaneous evidence of record which includes a report of evaluation at separation from service which noted the Veteran had a normal upper extremity evaluation. Additionally, the Veteran was provided a periodic examination in March 1991, after her period of ACDUTRA noting a shoulder injury, which reflects normal upper extremities. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (upholding Board decision assigning more probative value to a contemporaneous medical record report than subsequent lay statements); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding Board decision giving higher probative value to a contemporaneous letter the Veteran wrote during treatment than to his subsequent assertion years later). As such, the statements made by the Veteran do not constitute evidence that her bilateral shoulder disability began during her active military service. As to whether the current bilateral shoulder disability is related to the Veteran's service-connected cervical spine disability, the Board finds that such is a complex medical issue requiring medical knowledge and expertise the Veteran has not been shown to possess. Therefore, the Veteran is not considered competent to address such an issue, see Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007), and the Board turns to the competent medical opinion evidence to determine whether such an etiological link exists. In that regard, the Board finds that there is no competent evidence of record causally relating the Veteran's bilateral shoulder disability to her service-connected cervical spine disability. The only competent opinion of record regarding whether the Veteran's current bilateral shoulder disability is caused by her service-connected cervical spine disability is an April 2021 opinion. The VA examiner examined the Veteran, reviewed the record, and opined that the Veteran's current bilateral shoulder disability is less likely than not proximately due to or the result of her service-connected cervical spine disability. As rationale, the VA examiner explained that the Veteran's current bilateral shoulder disability is more likely caused by the degenerative aging process. As such, there is no competent evidence of record causally relating the Veteran's bilateral shoulder disability to her service-connected cervical spine disability. With respect to whether the Veteran's current bilateral shoulder disability is aggravated by her service-connected cervical spine disability, the Board notes that the record contains conflicting medical opinions. The United States Court of Appeals for Veterans Claims has stated that the probative value of a medical opinion is based on the expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Further, the credibility and weight to be attached to these opinions are within the province of the adjudicator. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). As such, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). The Veteran was provided a VA opinion in October 2020. The VA examiner noted that it would not be anticipated that cervical muscle spasms would aggravate bilateral shoulder tendonitis or ACJ DJD. As such, the VA examiner opined that the Veteran's bilateral shoulder disability is less likely than not aggravated by her service-connected conditions. The examiner who conducted the April 2021 VA examination provided an aggravation opinion in June 2021. The VA examiner noted that the Veteran's cervical spine disability originated in the trapezius muscles that extend and insert in the lateral third of the clavicle, acromion and in the scapula. The VA examiner explained that any cervical condition affects this muscle producing painful spasms or inflammation that irradiate in the shoulders. Therefore, the VA examiner concluded that any condition in the cervical spine most likely will produce pain in the shoulders and the Veteran's bilateral shoulder disability is aggravated beyond natural progression by her service-connected cervical spine disability. The Board finds the June 2021 VA opinion to be probative in showing that the Veteran's bilateral shoulder disability is aggravated by her service-connected cervical spine disability. The June 2021 VA examiner examined the Veteran in person and reviewed her medical records. Also, the conclusions are consistent with the Veteran's treatment records which show complaints of bilateral shoulder pain radiating from her cervical spine. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In addition, the Board finds no reason to afford greater probative value to the October 2020 VA examiner's opinion that the Veteran's bilateral shoulder disability is less likely than not aggravated by her service-connected cervical spine disability. In summary, the record shows that the Veteran has a current diagnosis of bilateral acromioclavicular joint osteoarthritis. The evidence does not show that the Veteran's bilateral acromioclavicular joint osteoarthritis is directly related to the Veteran's active service or is caused by a service-connected disability. However, the Board finds that the probative evidence of record is at least in relative equipoise as to whether the Veteran's bilateral acromioclavicular joint osteoarthritis is at least as likely as not aggravated by her service-connected cervical spine disability. Therefore, as the reasonable doubt created by this relative equipoise in the evidence must be resolved in the Veteran's favor, service connection for bilateral acromioclavicular joint osteoarthritis, as secondary to service-connected cervical spine spondylosis, on an aggravation basis, is warranted. (CONTINUED ON NEXT PAGE) As there is medical evidence of the baseline level of the shoulder disability in the treatment records previously of record, this award of service connection is consistent with 38 C.F.R. § 3.303 (b). Moreover, as explained above, there is no adequate or probative evidence indicating that secondary service connection is warranted on a causation basis or that the Veteran's claimed bilateral shoulder disability is directly related to service. Brian J. Elwood Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. G. LeMoine, 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.