Citation Nr: 22045191 Decision Date: 08/09/22 Archive Date: 08/09/22 DOCKET NO. 19-02 598 DATE: August 9, 2022 ORDER Entitlement to service connection for a left shoulder acromioclavicular joint disorder is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his left shoulder acromioclavicular joint disorder began during active service. CONCLUSION OF LAW The criteria for service connection for a left shoulder acromioclavicular joint disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from March 2009 to December 2016. This matter comes before the Board of Veterans Appeals (Board) on appeal from a March 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2022, the Veteran testified at a hearing before the undersigned. A transcript of this hearing has not yet been associated with the claims file. However, the absence of the transcript is not prejudicial to the Veteran as the Board is granting the benefit sought on appeal. Service Connection Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Every veteran is presumed to be in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities or disorders noted at the time of the examination, acceptance and enrollment or where clear and unmistakable evidence demonstrates the injury or disease existed prior to service and was not aggravated by service. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Only such conditions as are recorded in examination reports are to be considered as "noted" for the purpose of this analysis. 38 C.F.R. § 3.304(b). This presumption is only rebutted where the evidence clearly and unmistakably shows that the Veteran's disability (1) existed before acceptance and enrollment into service and (2) was not aggravated by service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); Bagby v. Derwinski, 1 Vet. App. 225 (1991); 38 C.F.R. § 3.304(b). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. If the preponderance of the evidence is against the claim, the claim is to be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to service connection for a left shoulder acromioclavicular joint disorder The Veteran contends his left shoulder acromioclavicular joint disorder began after an injury in service. The Board finds that the evidence of record supports a grant of service connection for a left shoulder acromioclavicular joint disorder. First, there is evidence of a current disability. A January 2017 VA examination notes a diagnosis of left shoulder strain. Post service treatment records document chronic left shoulder pain and treatment. Second, there is evidence of an in-service event, disease, or injury. The Veteran contends he injured his left shoulder and eventually needed surgery during service. He reports falling on his shoulder during a training exercise. The Veteran's service treatment records reflect a left shoulder acromioclavicular joint injury and subsequent treatment including physical therapy and acromioclavicular joint surgery in 2014. Third, the Board finds that the evidence is at least in equipoise as to whether the Veteran's current left shoulder acromioclavicular joint disorder is related to service. The Veteran submitted private medical records from March 2019 onwards. The examiner noted the Veteran had an acromioclavicular joint resection in service and it is still painful over that area. The physician explained that prior to service the Veteran had left shoulder glenohumeral instability which required open shoulder reconstruction. After the glenohumeral surgery, the condition has been uneventful, pain-free, and without instability since that time. The examiner stated the Veteran's acromioclavicular joint is in a different area, in a separate, distinct part of the shoulder, that required operative intervention while in service. The examiner further noted the Veteran had no chronic problems from a glenohumeral stabilization standpoint. He concluded that the Veteran's current acromioclavicular joint disorder is a different problem than the glenohumeral joint issue the Veteran had prior to service. See Medical Treatment Records Non-Government Facility, received January 2022 and May 2019. The Veteran received a VA examination and opinion in January and February 2017. The examiner provided a negative opinion, concluding the Veteran's left shoulder condition was not aggravated during service. This was based on the assumption that the Veteran's left shoulder condition existed prior to service. As noted above, however, the evidence establishes that the Veteran's pre-existing glenohumeral disorder is a distinct condition from his acromioclavicular joint disorder. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). This is further corroborated in the Veteran's service treatment records. Service treatment records reflect a left shoulder injury and establish that his symptoms are consistent with acromioclavicular joint degeneration after a traumatic sprain in service. The records further establish that the Veteran consistently reported pain in the left acromioclavicular joint and underwent left acromioclavicular joint surgery in service. Additionally, the record reflects that the Veteran experienced residual left acromioclavicular joint arthritis after a traumatic fall on his left shoulder in service. Imagining results in service note no significant abnormalities of the left glenohumeral joint but do document mild left acromioclavicular joint osteoarthropathy. Pursuant to the "benefit-of-the-doubt" rule, where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. 38 U.S.C. § 5107. While the VA examiner provided a negative opinion, for the above stated reasons, it has limited probative value. The evidence of record shows the Veteran's acromioclavicular joint disorderas opposed to the unrelated glenohumeral disorderdid not exist prior to service and was the result of an injury in service and subsequent surgery. Based on the above, the Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for a left shoulder acromioclavicular joint disorder is warranted. See Gilbert, 1 Vet. App. at 49, 55. The claim is granted. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Javed, 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.