SHOULDER IMPAIRMENT OF

JOHN Z. JONES · 2025 · Case ID: 25001667

DENIED

Summary

The veteran, who served in the U.S. Army from May 1969 to March 1971, appeals the denial of service connection for a left shoulder disability, right knee disability, and left ankle disability. The veteran contended that the left shoulder condition was due to service, while the right knee and left ankle conditions were claimed as secondary to a service-connected dislocated right ankle. The Board reviewed VA examinations and the veteran's testimony. For the left shoulder, two VA examiners opined it was less likely than not related to service, citing a lack of in-service diagnosis and a silent separation exam, while the veteran attributed pain to carrying heavy equipment and wear and tear. The Board found the veteran's testimony regarding continuity of shoulder pain not credible due to treatment gaps and inconsistencies. For the right knee, the initial VA exam was inadequate, but a subsequent VA exam in July 2023 opined it was less likely than not caused by or aggravated by the service-connected right ankle, citing natural aging and lack of gait abnormality. A private opinion suggesting a link was found not credible due to factual contradictions with treatment records. The veteran's testimony about altered gait and weight gain was also found not credible. For the left ankle, the initial VA exam was inadequate, but a subsequent VA exam in July 2023 opined it was less likely than not caused by or aggravated by the service-connected right ankle, citing normal gait and lack of treatment for aggravation. The veteran's testimony about altered gait was found not credible. The Board found the evidence persuasively against all claims, with the most probative evidence being the VA opinions finding no service connection. The benefit-of-the-doubt doctrine was not applied as the evidence weighed against the claims. Service connection for all three conditions was denied.

Rationale

VA examiners opined less likely than not related to service; Lack of in-service diagnosis and silent separation exam; Veteran's testimony regarding continuity of pain found not credible

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

12-35 576

Full Decision Text

Citation Nr: 25001667
Decision Date: 02/04/25 Archive Date: 02/04/25

DOCKET NO. 12-35 576
DATE: February 4, 2025

ORDER

Service connection for left shoulder disability is denied.

Service connection for right knee disability is denied.

Service connection for left ankle disability is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that a left shoulder disability began during active service or is otherwise related to an in-service injury or disease.

2. The Veteran's right knee disability is not secondary to service-connected dislocated right ankle and is not otherwise related to an in-service injury or disease.

3. The Veteran's left ankle disability is not secondary to service-connected dislocated right ankle and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for right knee disability due to service or service-connected dislocated right ankle are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for left ankle disability due to service or service-connected dislocated right ankle are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 1969 to March 1971.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran attended a virtual hearing before the undersigned in November 2022. In April 2023 and June 2024, the Board remanded this matter for further development.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection for a disability, a Veteran must show: (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 or aggravated during service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

To establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998).

Left Shoulder

The Veteran is seeking service connection for a left shoulder disability that he contends is due to his active service. For the following reasons, the Board finds that service connection is not warranted.

The Veteran has a diagnosis of rotator cuff tear, labral tear, and shoulder impingement. Service treatment records include a report of left shoulder pain. Accordingly, the Board finds the first two elements of service connection on a direct basis are met.

Turning to the third element, medical nexus, the evidence consists of VA examinations and opinions. In July 2009, the Veteran underwent a VA examination for his left shoulder. It was noted that the Veteran was unable to lift his left arm above shoulder level and there was a mention of left shoulder pain in his treatment records in January 2002. The examiner found it less likely than not that the Veteran's claimed left shoulder disability was related to service. Their rationale was that there was only one mention of the left shoulder in his service records with no diagnosis and on discharge there was no mention of shoulder problems. The examiner is competent to provide this opinion, the Board finds them to be credible, and affords the opinion great probative weight.

After a remand, the Veteran underwent another VA examination in July 2023. At this examination he reported a history of intermittent shoulder pain since service. He denied any injury, but believed his current shoulder pain was due to wear and tear from service. It was noted that the Veteran was playing sports until 2003. The examiner found it less
likely than not that the Veteran's claimed left shoulder disability was related to service. Their rationale was that there was only one mention of the left shoulder in his service records with no diagnosis and on discharge there was no mention of shoulder problems. The examiner is competent to provide this opinion, the Board finds them to be credible, and affords the opinion great probative weight.

After a remand, the Veteran underwent another VA examination in July 2023. At this examination he reported a history of intermittent shoulder pain since service. He denied any injury, but believed his current shoulder pain was due to wear and tear from service. It was noted that the Veteran was playing sports until 2003. The examiner found it less likely than not that the Veteran's current left shoulder disability was related to service. Their rationale was that the Veteran's in-service left shoulder pain lacked a diagnosis and that his separation exam is silent for any shoulder conditions. The examiner also noted that there is no diagnosis of a left shoulder condition until 2004 when the Veteran reported a history of right shoulder pain while lifting overhead and falling on his right shoulder. The examiner is competent to provide this opinion, the Board finds them to be credible, and affords the opinion great probative weight.

VA treatment records provide some insight on the history of the Veteran's left shoulder condition. In January 2002, the Veteran presented to the emergency department reporting he pulled his left shoulder. In December 2004, the Veteran was diagnosed with degenerative joint disease in the shoulder. There is a gap in treatment for the left shoulder until July 2015, when he reported problems with his shoulders that date back as fast as 1969 to 1971. He denied any direct trauma and equated the pain to basic training at this appointment. In January 2020 the Veteran reported that he had left shoulder pain for ten years.

At his November 2022 hearing, the Veteran provided testimony on the history of his left shoulder. He associated his shoulder with having to carry heavy equipment during service. The pain began during service, but he toughed it out to avoid negative treatment and the pain had continued since. The Veteran testified he was diagnosed with a rotator cuff tear after service which he attributed to wear and tear from service.

The Board finds the evidence is persuasively against awarding service connection for a left shoulder disability. The most probative evidence of record has found the Veteran's left shoulder disability to not be related to service. The only evidence that suggests there is a relation between the Veteran's current left shoulder condition and service are his own connections. The Board acknowledges the Veteran's contention that his current left shoulder disability was caused by service. However, the Veteran has not shown that he has the requisite medical knowledge to provide a medical nexus opinion for his current disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board affords the Veteran's lay statement less probative weight and affords more probative weight to the July 2009 and July 2023 VA medical opinions.

The Board has considered the Veteran's testimony and statements that he has had left shoulder pain since service. The evidence though does not support this. VA treatment records first mention left shoulder pain in January 2002 which he associated with pulling his left shoulder. There is then a gap in treatment specifically for the left shoulder until 2015 when he first claims he had left shoulder pain since service. However, the Veteran obtained repeated treatment for his right shoulder and at no point did he report he was also having pain in his left shoulder until July 2015. If the Veteran was suffering from bilateral shoulder pain since service as he claimed in July 2015, the Board would expect him to receive treatment for both shoulders instead of only one. As such, the Board does not find the Veteran's contention that he had shoulder pain since service to be credible and affords his statements and testimony regarding continuity of shoulder pain no probative weight.

Accordingly, the Board finds that the evidence of record weighs persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for left shoulder disability is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Right Knee

The Veteran is seeking service connection for a right knee disability that he contends is due to his service-connected dislocated right ankle. For the following reasons, the Board finds that service connection is not warranted.

The Veteran has a diagnosis of degenerative arthritis in the right knee. He is also service connected for dislocated right ankle. Accordingly
, the Board finds that the evidence of record weighs persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for left shoulder disability is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Right Knee

The Veteran has a diagnosis of degenerative arthritis in the right knee. He is also service connected for dislocated right ankle. Accordingly, he satisfies the first two elements of service connection on a secondary basis.

Turning to the third element, medical nexus, the evidence consists of multiple VA examinations and opinions and a private opinion submitted by the Veteran. In March 2014, the Veteran underwent a VA examination for his claim. The examiner found the Veteran to be a poor historian. The Veteran denied a history of trauma to his right knee and reported experiencing pain and popping of the right knee. The examiner found it less likely than not that the Veteran's current right knee disability was due to his service-connected dislocated right ankle. Their rationale was that there are no accepted medical studies supporting a relationship that favoring one lower extremity will result in injury to the opposite lower extremity. The examiner found the Veteran to have degenerative changes in the body suggesting his right knee disability was due to the general aging process rather than traumatic arthritis. The Board notes that the examiner failed to opine on whether the Veteran's service-connected dislocated right ankle aggravated his right knee disability beyond its natural progression. As such, the opinion is incomplete and cannot be considered adequate. Accordingly, the Board affords the March 2014 opinion little probative weight.

After a remand, the Veteran underwent another VA examination in July 2023. At this examination he reported pain in his knees for years and that he stopped running or jogging in 2013. The Veteran denied a knee injury and believed his right knee pain was secondary to his right ankle pain. The examiner opined that it was less likely than not that the Veteran's right knee disability was caused by or aggravated beyond its natural progression by his service-connected dislocated right ankle. Their rationale was that the Veteran was able to engage in regular activities of civilian life including sports until 2005 and was not diagnosed with degenerative arthritis until 2014 which is due to the natural aging process. They also found that the Veteran had not abnormal gait pattern or deformity to suggest biomechanical pain aggravation from the right ankle. The examiner is competent to provide this opinion, the Board finds them to be credible, and affords the opinion great probative weight.

The Veteran submitted a private opinion dated March 2021 in support of his claim. A private clinician reviewed the Veteran's treatment records and opined it was as likely as not that the Veteran's right knee disability was caused by his service-connected right ankle disability. Their rationale was that the Veteran reported his ankle ruined the way he walked affecting his knees and it led to him having a sedentary lifestyle leading to obesity. However, the Board notes that VA treatment records at the time of the private opinion all document the Veteran having a normal gait. Treatment records also show that the Veteran's body mass index never exceeded 30, and there is no finding that he was obese. There is no indication that the private clinician personally examined the Veteran and observed him having an abnormal gait. As the private clinician's rationale is contradicted by the Veteran's treatment records, the Board fits it to not be credible and affords it no probative weight.

The Veteran submitted a statement dated March 2019 reporting that he has a knee brace and walks with a cane. However, an October 2015 VA treatment record shows that the Veteran requested the cane for his back and because of a recent fall, not his right knee. He was also found to have a normal gait in January 2019. If the Veteran is suggesting that his use of a cane is because of his right knee disability, the evidence does not support this contention and the Board affords this statement no probative weight.

At his November 2022 hearing, the Veteran testified that he noticed knee pain during service after physical activities. He stated that he had pain on discharge and did not seek treatment until seven or eight years after service and was given a cane when he sought treatment. The Board notes that there is no record of the Veteran using a cane until he requested one in October 2015 for his back. The Veteran also testified that his right ankle
his right knee. He was also found to have a normal gait in January 2019. If the Veteran is suggesting that his use of a cane is because of his right knee disability, the evidence does not support this contention and the Board affords this statement no probative weight.

At his November 2022 hearing, the Veteran testified that he noticed knee pain during service after physical activities. He stated that he had pain on discharge and did not seek treatment until seven or eight years after service and was given a cane when he sought treatment. The Board notes that there is no record of the Veteran using a cane until he requested one in October 2015 for his back. The Veteran also testified that his right ankle disability changed the way he walked and caused him to gain weight. The Board again points out that VA treatment records consistently found the Veteran to have a normal gait. As the Veteran's testimony is not supported by his treatment records and is at times contradicted by his treatment records, the Board finds it is not credible and affords it testimony no probative weight.

The Board finds the evidence is persuasively against awarding service connection for a right knee disability. The most probative evidence of record has found the Veteran's right knee disability to not be caused by or aggravated beyond its natural progression by his service-connected right ankle disability. The only positive opinion is based on incorrect facts as described above and the Board has afforded it no probative weight. The Board has considered the Veteran's contention that his service-connected right ankle disability changed the way he walked affecting his right knee, but as explained above his statements have been found not credible as they are contradicted by multiple treatment records documenting him to have a normal gait. The Veteran also has not shown that he has the requisite medical knowledge to provide a medical nexus opinion for his current disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board affords more probative weight to the July 2023 VA examiner's opinion.

Accordingly, the Board finds that the evidence of record weighs persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for right knee disability is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Left Ankle

The Veteran is seeking service connection for a left ankle disability that he contends is due to his service-connected right ankle. For the following reasons, the Board finds that service connection is not warranted.

The Veteran has a diagnosis of degenerative arthritis in the left ankle, and he is service connected for dislocated right ankle. Accordingly, he satisfies the first two elements of service-connected on a secondary basis.

Turning to the third element, medical nexus, the evidence consists of VA examinations and opinions. In March 2014, the Veteran underwent a VA examination. The examiner noted the Veteran to be a poor historian. The Veteran reported that he developed pain in his left ankle, denied any history of trauma to the left ankle, and he believed his ankle pain to be from overuse of the right ankle. The examiner opined it was less likely than not that the Veteran's left ankle disability was due to his service-connected dislocated right ankle. Their rationale was that medical literature reveals no accepted medical studies that support a relationship that favoring one lower extremity will result in injury to the opposite lower extremity. The examiner found it more likely than not that underlying degenerative changes in the left ankle would manifest over time, but a relationship is not that the injured right ankle contributing to an injury of the left ankle. They explained that the Veteran had degenerative arthritis and that this was due to general aging process. The Board notes that the examiner failed to opine on whether the Veteran's service-connected dislocated right ankle aggravated his left ankle disability beyond its natural progression. As such, the opinion is inadequate, and the Board affords it little probative weight.

After a remand, the Veteran underwent another VA examination in July 2023. At this examination he reported a history of pain in the left ankle for years. He worked in retail after service which required walking. The Veteran also reported playing baseball, basketball, and football until 2005 or 2007. He stated he has been unable to run or jog since retirement and denied a left ankle injury. The examiner found it less likely than not that the Veteran's left ankle disability was caused by or aggravated beyond its natural progression by his service-connected dislocated right ankle. Their rationale was that there was no significant abnormality found on examination besides pain. Calcaneal enthesophytes were found on imaging which the examiner noted can cause tendinosis and pain. They found the Veteran to have no leg length discrepancy or abnormal gait pattern to suggest biomechanical pain from the right ankle and that there was no treatment for aggravation in the available medical records. The examiner is competent to provide this opinion, the Board finds them to be credible, and affords the opinion great probative weight.

At his November 2022 hearing, the Veteran provided testimony on his left ankle disability. He testified that he noticed pain in his left ankle after having to shift weight away from the right ankle. He related his left ankle pain to altered gait and eight gain from right ankle. The Board notes that multiple VA treatment records and VA examinations have found him to have a normal gait. As the Veteran's testimony regarding an altered gait is directly contradicted by his treatment records and examinations, the Board finds it to not be credible and affords the testimony no probative weight.

The Board finds the evidence to be persuasively against awarding service connection for a left ankle disability. The most probative evidence of record has found the Veteran's left ankle disability to not be caused by or aggravated beyond its natural progression by his service-connected dislocated right ankle. The only evidence in favor of service connection are the Veteran's own contentions. However, the Board has found the Veteran's testimony regarding altered gait to not be credible. Also, the Veteran has not shown that he has the requisite medical knowledge to provide a medical nexus opinion for his current disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board has afforded more probative weight to the July 2023 VA examiner's opinion.

Accordingly, the Board finds that the evidence of record weighs persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for left ankle disability is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Chandeck, Michael A. (he/him/his)

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.

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