Citation Nr: 22011522 Decision Date: 03/01/22 Archive Date: 03/01/22 DOCKET NO. 17-55 745 DATE: March 1, 2022 ORDER Service connection for a left shoulder disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from September 1971 to October 1980. 2. A left shoulder disorder, diagnosed as degenerative joint disease (DJD), epicondylitis, rotator cuff tendonitis, and left shoulder strain, was not shown in service, was not continuous since service, was not shown to a compensable degree within one year of separation from service and is not causally or etiologically related to service. CONCLUSION OF LAW A left shoulder disorder was not incurred in service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, in June 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In August 2021, the Board remanded the appeal for additional development. The appeal now returns to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may also be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3)( by showing that the disorder manifested itself to a degree of 10 percent or more within one year of the date of separation from service. See 38 C.F.R. § 3.307. Next, service connection may be granted on a secondary basis for a disease which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. DJD is a chronic disorder under 38 C.F.R. § 3.309(a); as such, presumptive service connection on the basis of continuity of symptomatology is for application. Additionally, direct service connection will be discussed. In a January 2022 statement, the Veteran argued secondary service connection as well; however, his statement was simply a legal recitation rather than actual contentions or arguments related to his appeal. Moreover, the record does not support secondary service connection so it will not be addressed further. Turning first to direct service connection, the Veteran has been diagnosed with DJD, epicondylitis, and rotator cuff tendonitis. Further, a January 2016 VA examiner diagnosed a left shoulder strain. Accordingly, a current diagnosis has been shown and the first element of service connection has been met. A review of the service treatment records (STRs) reveals that the Veteran complained of trauma to the left shoulder in April 1972 and February 1976 from playing softball and tripping over a rug, respectively. Clinicians diagnosed a muscle strain and a sprain and reported that he had left shoulder pain. Based on the above, an in-service incurrence has been shown and the second element of direct service connection has been met. Turning to nexus, the Veteran offered in November 2015 and April 2017 statements that, as a result of his in-service injuries, he had a rotator cuff tear. He said that he had an in-service X-ray but asserted that he was misdiagnosed, as the X-ray was unable to detect his rotator cuff tear. He further testified in June 2021 that he had experienced left shoulder pain since his in-service injuries; however, he stated that he became used to the pain and did not inform his clinicians of his shoulder disorder until 2016. In multiple medical treatment notes between July 2014 and October 2016, clinicians reported a medical history that the Veteran had injured his left shoulder in service and since that time experienced longstanding shoulder pain and weakness. The clinicians acknowledged the Veteran's assertion that the left shoulder disorder stemmed from his in-service shoulder injury. However, the clinicians did not opine as to whether it was at least as likely as not that the left shoulder disorder was caused by an in-service injury. Accordingly, the medical treatment neither support nor weigh against the appeal. In a July 2016 medical opinion, a private clinician found that the Veteran's shoulder pain had worsened over time and opined that, while "it [was] difficult to determine acuity based on [an] MRI alone, it [was] just as plausible as not that [the Veteran's left shoulder] tear occurred during his military service." However, the clinician did not provide a rationale and, as such, the private medical opinion is assigned lesser probative value. In January 2016, a VA examiner diagnosed a left shoulder strain and recounted that the Veteran pulled his left shoulder in service and had it placed in a sling. The examiner opined that the left shoulder disorder was less likely than not incurred in or caused by in-service shoulder. The examiner reasoned that the Veteran had complaints of left shoulder pain in 1972 and 1976 but otherwise had no further complaints in service. The examiner further reported that the Veteran had no chronic problems or continuity of care until 2016. Ultimately, the examiner offered that the Veteran's left shoulder strain was caused by aging and genetic predisposition rather than the in-service complaints. In April 2017, the Veteran argued that the examiner's opinion was "irrelevant" as the examiner was "not present in 1974 or 1975 and could not properly diagnosis [sic] my injury." Nonetheless, lay witnesses, like the Veteran, are not competent to determine the "proper" diagnoses of their medical conditions. Moreover, the January 2016 examiner had the requisite medical expertise to render diagnoses and opine as to their etiologies. Further, the examiner thoroughly reviewed the claims file and addressed the evidence of record, to include whether there was a nexus between the Veteran's left shoulder disorder and service, considered the Veteran's assertions, and provided a thorough supporting rationale for the conclusions reached. As such, the January 2016 examination is assigned high probative value and the medical evidence does not support service connection on a direct basis. As to presumptive service connection based on chronicity or continuity of symptomatology, a left shoulder disorder did not manifest to a compensable degree within a year of separation from service. In multiple medical treatment notes and June 2021 testimony, the Veteran indicated that he injured his left shoulder in service and that he had continued left shoulder pain since that time. The Veteran is competent to report symptoms capable of lay observation, such as left shoulder pain, but is not competent to determine whether they manifested to a compensable degree. To this end, even assuming that the symptoms of his left shoulder disorder manifested within a year of separation from service, the medical evidence does not indicate that he developed DJD to a compensable degree. Therefore, the medical evidence does not support service connection on a one-year presumptive basis. Next, the record does not establish continuity of symptomatology under 38 C.F.R. § 3.309(a). As noted above, the symptoms of the Veteran's left shoulder disorder did not manifest to a compensable degree within a year of separation from service. The medical evidence subsequently shows that he complained of bilateral shoulder pain that was particularly prominent in his left shoulder in a February 2010 treatment note. Therefore, the medical evidence shows that left shoulder DJD did not manifest to a compensable degree until February 2010 nearly 30 years after separation from service with documentation beginning at the same time. In light of the above, the medical evidence does not support service connection based on chronicity or continuity of symptomatology. In sum, while the Veteran experienced in-service left shoulder injuries, to include left shoulder pain, the evidence does not establish that the symptoms of his current left shoulder DJD either stemmed directly from the in-service injuries or continuously manifested to a compensable degree since separation from service. Accordingly, the medical evidence does not support service connection on either a direct or presumptive basis. The Board has considered the medical article submitted by the Veteran concerning the inability of X-rays to detect rotator cuff tears; however, the article cited does not address his specific case or establish a nexus between the current left shoulder disorder and service. Moreover, no health care professional has established such a relationship based on the medical article. Moreover, there was no suggestion by the in-service clinicians that a rotator cuff tear was present based on the presenting symptomatology. Thus, an inference cannot be made that the inability of an X-ray to detect a rotator cuff tear means that it was present in service. Next, as noted above, the evidence does not support secondary service connection. While the Veteran is service connected for left knee, low back, lower extremity radiculopathy, and contact dermatitis, the medical evidence does not support or even suggest a connection between the service connected disabilities and the left shoulder disorder. Therefore, the medical evidence does not support secondary service connection. The Board has also considered lay statements submitted by the Veteran regarding the etiology of his left shoulder disorder. Lay witnesses are competent to report symptoms because this requires personal knowledge as it comes to them through their senses. However, they are not competent to offer opinions as to the etiology of any current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by STRs and clinical records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. Based on the above, the appeal is denied., Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Spigelman, 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.