Citation Nr: 22014487 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 18-21 659 DATE: March 14, 2022 ORDER Entitlement to service connection of degenerative arthritis of the right knee is granted. Entitlement to service connection of degenerative arthritis of the left knee is granted. Entitlement to service connection of degenerative arthritis of the right shoulder is granted. Entitlement to service connection of degenerative arthritis of the left shoulder is granted. FINDINGS OF FACT 1. The Veteran has a diagnosis of degenerative arthritis of the bilateral knees. 2. The Veteran has a diagnosis of degenerative arthritis of the bilateral shoulders. 3. The evidence is at least in equipoise as to whether symptoms of the Veteran's degenerative arthritis of the bilateral knees and shoulders began to manifest in service and have continued to manifest to the present day. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection of degenerative arthritis of the bilateral knees have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309. 2. The criteria for entitlement to service connection of degenerative arthritis of the bilateral shoulders have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection 1. Entitlement to service connection of degenerative arthritis of the bilateral knees and degenerative arthritis of the bilateral shoulders is granted. The Veteran had active service from June 1997 to July 2001. These matters come before the Board of Veterans' Appeals (Board) on appeal of a December 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) that denied entitlement to service connection of claimed disabilities of the right and left knees (bilateral knees) and right and left shoulders (bilateral shoulders). These matters were previously before the Board in August 2021 at which time the Board remanded the Veteran's bilateral knee and shoulder claims to obtain VA examinations to determine the nature and etiology of his claimed knee and shoulder disabilities. A remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). Once VA undertakes the effort to provide an examination when developing a claim, the examination must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran was afforded a VA examination in relation to his knee and shoulder claims in December 2021. The examiner offered medical opinions as to the etiology of the Veteran's knee and shoulder disabilities. As discussed further below, the Board finds the December 2021 VA examiner's opinions to be inadequate and of limited probative value. However, as the Board finds the evidence of record sufficient to warrant grants of service connection for the claimed knee and shoulder disabilities, there is no prejudice to the Veteran in proceeding to adjudicate the claims without remand to obtain adequate VA medical opinions. The Board notes that it has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as deemed appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. In September 2015 the Veteran filed a claim of service connection of, in pertinent part, disabilities claimed as "trouble with knees" and "pain in shoulders." Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. In adjudicating claims for VA benefits, the burden of proof only requires an "approximate balance" of the evidence for and against a claim. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1991). This low standard of proof is "unique" to the VA adjudicatory process, and "the nation, 'in recognition of our debt to our veterans,' has 'taken upon itself the risk of error' in awarding such benefits." Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). In evaluating a claim for disability benefits, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The Veteran's Form DD 214 reflects that he separated from active service in July 2001, having served as an aviation boatswain's mate. At his February 2021 Board hearing the Veteran testified to working 16-hour days, 7 days a week, for 6 months at a time carrying and pulling heavy equipment. In its August 2021 remand the Board determined that the Veteran's testimony on this point was competent and credible. At his February 2021 hearing, and in a written statemen to VA received in March 2021, the Veteran stated that his bilateral knee and bilateral shoulder pain began in service and has continued to the present. A December 2021 VA examiner documented diagnoses of degenerative arthritis of the bilateral knees and shoulders. The Board here notes that arthritis is among those disabilities for which VA may presume a nexus between an in-service incurrence or event and a current disability provided there is a showing of continuity of symptomatology. 38 C.F.R. §§ 3.303(b), 3.309(a). The December 2021 VA examiner opined that it was less likely than not that the Veteran's bilateral knee and shoulder arthritis was the result of an event, injury, or occurrence during the Veteran's active service, or that it had its onset during the Veteran's active service. However, the Board finds these opinions to be of minimal probative value. It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). VA must consider all lay and medical evidence of record. 38 U.S.C. § 1154(a); 38 U.S.C. § 5107; 38 C.F.R. § 3.303. The December 2021 VA examiner's opinions as to both the Veteran's bilateral knees and bilateral shoulders reads as follows: "After review of medical records it is determined that the Veteran's [knee/shoulder] condition is less than 50% likely due to his time in service. Records are completely silent for any [knee/shoulder] issues or complaints. Separation exam from 5/8/01 denies any [knee/shoulder] problems per Veteran." The December 2021 examiner's opinion documents a report by the Veteran that his symptoms began in 2002. However, the examiner's report does not reflect any consideration of the February 2021 and March 2021 statements by the Veteran that his bilateral knee and shoulder symptoms began in service. (Continued on the next page) At best, the December 2021 VA examiner's opinion is predicated on evidence that the Veteran's symptoms began post-service. This evidence must be weighed against the Veteran's earlier statements to the Board concerning in-service onset of symptoms; evidence that the Board has already determined is competent and credible. At worst, the December 2021 VA examiner's opinion is inadequate in that it does not reflect consideration of all evidence of record (i.e., the Veteran's February 2021 and March 2021 statements regarding in-service onset of symptoms). In light of the foregoing, the Board finds that the evidence is at least in equipoise as to whether the Veteran has continuously experienced symptoms of his degenerative arthritis of the bilateral knees and shoulders since the time of his active service. As arthritis is a chronic disease under 38 C.F.R. § 3.309(a), an award of service connection is permissible based solely on continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) Accordingly, the Board concludes that the criteria for entitlement to service connection of degenerative arthritis of the right knee, left knee, right shoulder, and left shoulder are met, and the same is hereby granted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sametshaw, Eric C. 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.