Citation Nr: 25009072 Decision Date: 07/11/25 Archive Date: 07/11/25 DOCKET NO. 16-52 099 DATE: July 11, 2025 ORDER Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a left shoulder disability is denied. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that any right shoulder disability began during active service; is otherwise related to an in-service injury or disease; or is secondary to (caused or aggravated by) a service-connected disability. 2. The evidence of record persuasively weighs against finding that any left shoulder disability began during active service; is otherwise related to an in-service injury or disease; or is secondary to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. The criteria for entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1983 to July 1986. In June 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. The Board remanded this case in January 2022 and February 2023. In relevant part, the January 2022 remand directed the regional office (RO) to afford the Veteran an opportunity to complete a VA Form 21-4142 for private treatment providers referenced in in his VA treatment records; make appropriate efforts to obtain the documents referenced in the VA treatment records as having been scanned into VistA Imaging or other repository; and obtain an addendum opinion as to whether the Veteran's obesity acted as an intermediate step between his service-connected disabilities and his claimed left shoulder and right shoulder disabilities. Pursuant to the remand, the RO obtained the Veteran's updated VA treatment records, sent the Veteran letters in February 2022 and April 2022 asking him to complete VA Forms 21-4142; and obtained an opinion in July 2022 as to whether the Veteran's obesity acted as an intermediate step between his service-connected disabilities and his claimed shoulder disabilities. The February 2023 remand found that in only obtaining the Veteran's updated VA treatment records, the RO did not substantially complete the January 2022 remand directive to obtain the documents referenced in the VA treatment records as having been scanned into VistA Imaging or other repository. The Board therefore again remanded the case with instructions to the RO to make appropriate efforts to obtain the documents referenced in the VA treatment records as having been scanned into VistA Imaging or other repository. Pursuant to the February 2023 remand, the RO obtained the Veteran's updated VA treatment records and made efforts to obtain the documents scanned into digital repositories. In March 2023, the RO informed the Veteran that it was unable to locate all of his private treatment records despite efforts to obtain them. The letter asked the Veteran to submit any documents he may have in his possession. It also again asked the Veteran to complete a VA Form 21-4142 for those records. The Veteran did not respond to the February 2022, April 2022, and March 2023 requests for VA Forms 21-4142. In May 2023, the Board issued a decision that, in relevant part, denied entitlement to service connection for right and left shoulder disabilities. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In April 2024, the Court vacated the May 2023 Board decision and remanded the issues for further consideration consistent with a Joint Motion for Partial Remand (JMPR) filed by counsel for the Veteran and the VA Secretary. The parties to the April 2024 JMPR agreed that the July 2022 VA opinion concerning whether the Veteran's obesity may act as an intermediate step between his service-connected disabilities, to include a service-connected traumatic brain injury, and his claimed right and left shoulder disabilities is inadequate for adjudication purposes to the extent that it does not properly apply the factors set forth in Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020). Namely, the July 2022 VA opinion does not address whether the Veteran's service-connected disabilities may have aggravated his obesity and, if so, whether the Veteran's obesity caused or aggravated his claimed right and left shoulder disabilities. In September 2024, the Board remanded this case, directing the RO to obtain an addendum opinion addressing the Walsh factors consistent with the April 2024 JMPR. In April 2025, the Board noted that December 2024 VA opinions addressed the Walsh factors, but were not adequate in view of evidence submitted along with an April 2025 written brief presentation. Specifically, that evidence includes the report for a medical study entitled, "Obesity, Inflammation, and Immune System in Osteoarthritis", which states, in part, that obesity increases the risk of osteoarthritis in both weight-bearing joints and non-weight-bearing joints, which contradicts the supporting rationale for the December 2024 VA opinions. Therefore, the Board again remanded the case so that a further opinion could be obtained in consideration of the additional evidence submitted along with the April 2025 brief. In April 2025, the RO obtained opinions that adequately address the Walsh factors and the evidence submitted along with the April 2025 brief. Accordingly, the Board finds that VA at least substantially complied with the prior Board remands and the April 2024 JMPR. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Neither the Veteran nor his representative has raised any specific issues with regard to the duty to notify or duty to assist as they pertain to the issues denied in this decision. 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). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Service Connection 1. Entitlement to service connection for a right shoulder disability 2. Entitlement to service connection for a left shoulder disability The Veteran seeks to be service connected for right and left shoulder disabilities. He contends that the disabilities are directly related to in-service parachute jumps or strenuous exercises he performed as part of the Infantry. He has also submitted evidence indicating that his service-connected disabilities may have prevented him from exercising, that he gained weight due to the lack of exercise, and that the weight gain in turn caused or aggravated his shoulder disabilities. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Regarding direct service connection, the Board concludes that although the Veteran has current diagnoses for disabilities of the shoulders and the Veteran is credible in his reports of engaging in strenuous exercises and in parachute jumps during his active service, including one parachute jump in which he injured his neck, the evidence of record persuasively weighs against finding that the Veteran's current shoulder disabilities began during service or are otherwise related to an in-service injury, event, or disease. The service treatment records show that in September 1985, the Veteran was seen after hitting his head while jumping out of a plane. X-rays of the cervical spine, skull, mandible, and right shoulder at that time showed no significant abnormality. Records pertaining to the Veteran's treatment following that injury do not show that he reported ongoing symptoms in the shoulders in relation to the injury, and instead show that he was diagnosed only with closed head injury, cervical strain, and concussion. Subsequent service treatment records show that the Veteran had gradually improving cervical spine range of motion but continued to report headaches. In January 1986, five months following the parachuting accident, the Veteran reported continued thoracic spine and muscle pain with activity. At a May 1986 medical examination for separation from active service, the Veteran had a normal clinical evaluation of the upper extremities. On a May 1986 report of medical history for separation from active service, the Veteran denied current or past painful or "trick" shoulder. Thus, the service treatment records do show that the Veteran suffered a parachuting accident in September 1985. However, they do not show that the Veteran reported shoulder symptoms at any time during his active service. Furthermore, the Veteran denied any such current or prior symptoms on the May 1986 report of medical history and no such symptoms were noted at the May 1986 medical examination. At a December 1986 VA examination, the Veteran reported that he had neck, upper back, and right shoulder pain following the in-service parachuting injury, and that his right shoulder continued to be sore. However, he indicated that he had no difficulty at work driving a forklift. In addition, his physical examination was deemed normal, and no diagnosis was assessed for the right shoulder. Thus, the December 1986 VA examination, which was conducted shortly after the Veteran's separation from active service, shows that the Veteran reported ongoing soreness in the right shoulder, but that he did not have a diagnosable right or left shoulder disability or functional loss in either shoulder at that time. The VA treatment records show that the Veteran initiated care with VA in March 2003. At his initial treatment visit, he reported persistent pain in the neck, upper back, and low back with numbness and tingling in the legs since the in-service parachuting injury. He also reported left otitis media. He denied any other complaints. An examination of his joints was considered to be within normal limits. Accordingly, the earliest VA treatment records, which date many years after the Veteran's separation from active service, do not show complaints of or treatment for a shoulder condition. The Veteran was afforded a VA examination as to his claimed right shoulder disability in August 2017. At the examination, the Veteran reported that he had dull achiness in the front of his shoulders with lifting out and away from his body. The examiner noted the service treatment records showing the Veteran's report that he landed on his right shoulder in the parachuting accident and the Veteran's denial of current or prior trick shoulder at the time of his separation from active service. He further noted the post-service treatment records showing that the Veteran injured his left shoulder while wrestling with his children in November 2005, reported a one-year history of left shoulder pain after a fight in September 2006, and reported a one-day history of left shoulder pain after falling from a four-wheeler in July 2008. The examiner opined that the claimed right shoulder disability was less likely than not incurred in service or caused by an in-service injury, event, or illness. As a rationale for that opinion, the examiner explained that radiographs obtained at the time of the September 1985 parachuting injury were negative. The service treatment records show that the Veteran was treated appropriately and that his symptoms resolved during his active service. The Veteran has a current diagnosis of degenerative arthritis of the shoulder. The degenerative changes shown on current X-rays are consistent with a person who leads a sedentary life and when active has to perform manual labor. The degenerative changes should be considered part of the natural aging process and have no relationship to the Veteran's active service, including high physical demand of being in the Infantry and in the Airbourne. The Veteran was afforded a VA examination as to his claimed left shoulder disability in March 2018. At the examination, the Veteran reported that he had left shoulder pain after the in-service parachuting injury, but that he recovered and that his left shoulder did not bother him until about 15 years prior to the examination. He further reported that he owned a construction company but stopped doing manual labor around 1998 because he had to run the company and did not have time to do actual physical work. The examiner noted the in-service parachute injury and normal right shoulder X-ray in September 1985. She also noted the same November 2005, September 2006, and July 2008 post-service treatment records as noted by the August 2017 VA examiner. She responded in the negative as to whether it is at least as likely as not that the Veteran's current left shoulder condition was incurred while he was on active service. As a rationale for that opinion, she explained that there is no record of a left shoulder problem or of chronic left or right shoulder issues in the service treatment records, the Veteran was negative for left or right shoulder issues at the time of his separation medical examination, and the medical treatment records show several post-service injuring events to the left shoulder. The Board finds the August 2017 and March 2018 VA examiners' opinions to be probative because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The August 2017 VA examiner explained that the record shows that the Veteran's in-service right shoulder symptoms resolved, that the Veteran's current right shoulder condition began well after his separation from active service, and that the current right shoulder condition is part of the natural aging process and not related to the Veteran's active service. The March 2018 VA examiner explained that the record does not show a chronic left shoulder condition in service, but does show that the Veteran had a number of post-service left shoulder injuries. The opinions provide insight into the nature of the Veteran's current disabilities and why they are not at least as likely as not related to an in-service event, injury, or disease. The Board acknowledges the April 2025 opinion from one of the Veteran's VA care providers, who says, "After reviewing the patient's history and looking at the x-rays and MRI evaluation of his shoulders, it is more than likely related to his time in the service and injuries he suffered during his time in service. He did suffer a fall when parachuting where he landed on his head and shoulders. That type of the fall and injury is very likely to cause the injuries he is dealing with now." The Board affords far less probative value to the April 2025 opinion than to the August 2017 and March 2018 VA examiners' opinions because it is based entirely on the Veteran's description of the in-service injury and does not reflect consideration of the Veteran's full medical history, including the service treatment records showing no should disability at the time of separation from active service, the Veteran's denial of current or prior shoulder conditions on the May 1986 report of medical history, the March 2003 VA treatment note showing that the Veteran denied any current should condition, and the medical treatment records showing multiple post-service shoulder injuries. The Board also acknowledges the other statements in the Veteran's medical treatment records to the effect that his current shoulder disabilities are related to in-service parachute jumps and parachuting injuries. Most, if not all, of those statements appear to be mere transcriptions of the Veteran's own provided history rather than the medical opinions of the attending physicians. To the extent that they may actually be the medical opinions of the attending physicians, they are not supported by rationale or explanation and therefore are also not probative. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (for a medical opinion to be adequate for decision-making purposes, it must be supported by a rationale and explanation for the conclusion reached). The Board further acknowledges the Veteran's belief that his current shoulder disabilities are related to his active service, to include his in-service parachute jumps, the September 1985 parachuting injury, and strenuous in-service activities. However, the Veteran is not considered competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the cause and progression of specific musculoskeletal conditions. It is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, his statements in that regard are not probative and do not weigh against the VA examiners' opinions. Regarding secondary service connection, the question for the Board is whether the Veteran's obesity is proximately due to, the result of, or aggravated by a service-connected disability and, if so, whether his current right shoulder disability and/or left shoulder disability was in turn proximately due to, the result of, or aggravated by that obesity. The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's obesity was caused or aggravated by his service-connected disabilities. The July 2022 VA examiner opined that the Veteran's obesity is less likely than not caused by his service-connected disabilities. In support of that opinion, the examiner explained that the Veteran's obesity developed due to poor dietary choices. His obesity resulted due to caloric intake. The Veteran does not carry any diagnosis of an eating disorder. Fundamentally, the Veteran did not adjust his caloric intake appropriately for his activity level (calories in greater than calories expended). VA treatment records reveal that the Veteran is capable of weight loss in spite of his service-connected conditions. Specifically, they reveal that in 2013 the Veteran weighed 286 pounds. In 2018, the Veteran had lost weight down to 262 pounds. This is a 24 pound weight loss. This weight loss was possible even with the Veteran's service-connected disabilities. The Veteran had become obese due to not regulating calorie intake rather than an inability to lose weight due to his service connected disabilities. Therefore, based upon review of the available records to include the Veteran's reports, the Veteran proved he could have successful weight loss in spite of his service-connected disabilities individually or corporately. The Board finds the examiner's opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. The examiner explained that the record shows the Veteran has actually been able to lose weight despite his service-connected disabilities. Therefore, his gain in weight is not due to lack of exercise due to the service-connected disabilities, but rather due to consuming more calories than he expends. See Nieves-Rodriguez, 22 Vet. App. at 295. The Board accepts the examiner's opinion as probative evidence that the Veteran's obesity was not caused by his service-connected disabilities. The Board acknowledges the March 2019 statement from J. McDaniel, resident, that the Veteran's in-service head injury "may have limited his ability to exercise leading to weight gain which would increase his risk of arthritis, erectile dysfunction, and sleep apnea." That opinion is not probative because it is equivocal and is not supported by appropriate rationale. See Stefl, 21 Vet. App. at 123. Therefore, it does not weigh against the July 2022 VA examiner's opinion. The February 2025 VA examiner opined that it is at least as likely as not that the Veteran's service-connected disabilities aggravated his obesity, explaining that weight gain may occur as a result of chronic pain, and that chronic pain is one of the major reasons that obese patients list for their weight gain. The Board affords probative value to that opinion. The question remaining, therefore, is whether the Veteran's obesity, which was aggravated beyond its natural progression by his service-connected disabilities, caused or aggravated his claimed right shoulder disability and/or left shoulder disability. See Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020). The evidence submitted along with the April 2025 brief includes the report for a medical study entitled, "Obesity, Inflammation, and Immune System in Osteoarthritis", which states, in part, that obesity increases the risk of osteoarthritis in both weight-bearing joints and non-weight-bearing joints. Later in April 2025, a VA examiner noted that she reviewed the evidence attached to the April 2025 brief. She explained that current studies show that obesity can disrupt immune homeostasis, which potentially contributes to osteoarthritis. However, the findings in those studies do not establish a robust or direct link between obesity and the development of mechanical structural injuries in non-weight bearing joints such as in tendon injuries and labral tears of the shoulders. In this case, the Veteran worked as a carpenter for many years after his active service, which involved frequent overhead lifting, repetitive shoulder use, and mechanical strain. This prolonged physical labor likely contributed to cumulative microtrauma and overuse of the shoulder joints, serving as a plausible aggravating factor. Although age-related wear and tear is expected, the combination of occupational overuse and the clinical trajectory of the condition suggests aggravation beyond the natural history of the Veteran's musculoskeletal disorders. The Veteran's shoulder conditions of degenerative joint changes, tendonitis, labral tears, and SLAP lesions are common in the general population with increasing age and are often the result of natural wear and tear, decreased vascular supply, and age-related tendon degeneration. Therefore, it is less likely than not that the Veteran's bilateral shoulder conditions are due to or aggravated by chronic inflammation or immune system dysfunction related to obesity. Rather, the Veteran's diagnosed shoulder disabilities are more likely caused by age-related degeneration and occupational overuse related to post-service employment including carpentry and would have occurred with or without obesity. The Board affords probative weight to the April 2025 VA examiner's opinion. She explained that in view of the Veteran's particular occupational and medical history it is less likely than not that his obesity, which was aggravated by his service-connected disabilities, caused or aggravated his current right and left shoulder disabilities. See Nieves-Rodriguez, 22 Vet. App. 295; Prejean, 13 Vet. App. 444. The Board acknowledges the Veteran's belief that his shoulder disabilities were caused or aggravated by weight gain from lack of exercise due to his service-connected disabilities. The Veteran is competent to report pain and other symptoms from his service-connected disabilities and to report a history of weight gain. However, he is not considered competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the likely functional effects of certain disabilities, the cause and natural progression of weight gain, and the possible causes of the current shoulder disabilities. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the skills or medical training to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24 Vet. App. 428. Finally, the Board acknowledges the June 2025 written brief presentation, which states, "The veteran is service connected for TBI, the ankles, knees, and back with sciatica. It is not surprising that the veteran has falls and that his shoulders were injured in these falls." The Veteran has not contended, and the evidence does not show, that he has fallen due to his service-connected and that those falls caused or aggravated his claimed shoulder disabilities. They do show falls for other reasons. For example, a March 2025 VA treatment note states that the Veteran injured his right shoulder in a "slip and fall". There is no indication that the "slip and fall" was due to the Veteran's service-connected disabilities. Moreover, the representative has not identified any specific falls that were due to the service-connected and that may have caused or aggravated the claimed shoulder disabilities. The June 2025 written brief presentation also includes an article written by a doctor describing how a professional baseball player's toe injury eventually led to a career-ending shoulder injury due to "the kinetic chain." Following the article, the representative discusses entries from the Oxford Textbook of Trauma and Orthopaedics on injuries and biomechanics, asserts that that textbook does not list a grossly visible abnormal gait as a requirement for one joint to affect another, and concludes "the unaided naked eye is not enough to spot a mechanical issue." The representative does not make any specific allegations as to mechanical issues that the Veteran may have or explain how the article on the professional baseball player pertains to the Veteran's particular case. As such, the brief amounts to what appears to be a vague and unsupported argument that the Veteran's claimed shoulder disabilities are related to his service-connected musculoskeletal disabilities due to a gait disturbance or disturbance along "the kinetic chain". To the extent that the representative has made that argument, there is no indication that the representative is competent to provide a medical opinion. Therefore, the brief itself is not probative evidence on the matter. Moreover, although medically competent evidence is not always required to trigger VA's duty to assist in providing a VA examination, a conclusory generalized lay statement suggesting a nexus between a current disability and service-connected disabilities does not suffice to meet the standard of 38 C.F.R. § 3.159(c)(4)(i)(B), as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010). The representative's vague and unsupported argument is a conclusory generalized lay statement. The medical treatment records do not show that the Veteran has reported or demonstrated a gait disturbance due to his service-connected disabilities. Accordingly, the brief does not provide a sufficient indication that the Veteran's claimed shoulder disabilities may be related to his other service-connected disabilities, even when considered with the other evidence of record, to have triggered VA's duty to assist in providing an examination or opinion. In summary, the evidence of record persuasively weighs against finding that any right shoulder disability or left shoulder disability began during active service; is otherwise related to an in-service injury or disease; or is secondary to a service-connected disability, to include with obesity acting as an intermediate step. In view of the foregoing, the Board concludes that the evidence for and against the claims is not in approximate balance, but rather weighs against the claims. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. J. Anthony, 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.