BONE MALUNION OR NONUNION

LAURA E. COLLINS · 2026 · Case ID: 26000715

MIXED

Summary

The Veteran, who served from August 1977 to October 1978, appeals the denial of service connection for a right shoulder disability and seeks service connection for shin, ankle, and foot disabilities. The Board reviewed the evidence, including the Veteran's August 2013 statement detailing shin splints with muscle spasms, difficulty walking, and pain radiating from hip to groin, as well as arthritis in the neck affecting both shoulders. The Veteran also mentioned an in-service accident where he was ejected from a vehicle. The Board considered the legal standards for service connection, including the need for evidence of a current disability, in-service incurrence or aggravation, and a causal relationship, as well as the benefit of the doubt doctrine when evidence is in approximate balance. The Board found that the evidence of record was in approximate balance regarding the Veteran's shin, ankle, and foot conditions, leading to the granting of service connection for these claims. However, for the right shoulder disability, the Board found no competent or probative evidence establishing a causal relationship to service or aggravation by a service-connected disability, and no approximate balance of evidence, resulting in a denial of service connection for this condition.

Rationale

Evidence in approximate balance; Benefit of the doubt applied

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-42 834A

Full Decision Text

Citation Nr: 26000715
Decision Date: 01/20/26 Archive Date: 01/20/26

DOCKET NO. 18-42 834A
DATE: January 20, 2026

ORDER

Entitlement to service connection for a left shin disability is granted.

Entitlement to service connection for a right shin disability is granted.

Entitlement to service connection for a right ankle disability is granted.

Entitlement to service connection for a left ankle disability is granted.

Entitlement to service connection for a right foot disability is granted.

Entitlement to service connection for a left foot disability is granted.

Entitlement to service connection for a right shoulder disability, to include as secondary to lumbosacral strain with arthritis, is denied.

FINDINGS OF FACT

1. The evidence of record is in approximate balance as to whether the Veteran's left shin disability was incurred coincident with service and has continued to the present.

2. The evidence of record is in approximate balance as to whether the Veteran's right shin disability was incurred coincident with service and has continued to the present.

3. The evidence of record is in approximate balance as to whether the Veteran's right ankle disability was incurred coincident with service and has continued to the present.

4. The evidence of record is in approximate balance as to whether the Veteran's left ankle disability was incurred coincident with service and has continued to the present.

5. The evidence of record is in approximate balance as to whether the Veteran's right foot disability was incurred coincident with service and has continued to the present.

6. The evidence of record is in approximate balance as to whether the Veteran's left foot disability was incurred coincident with service and has continued to the present.

7. The evidence of record does not establish a causal relationship between an in-service disease or injury and the Veteran's right shoulder disability, or show causation or aggravation by a service-connected disability. An approximate balance of evidence is not established, because there is no competent and probative evidence for or against the claim. In the absence of any probative nexus evidence supporting the claim, it must be denied.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a left shin disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

2. The criteria for entitlement to service connection for a right shin disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

3. The criteria for entitlement to service connection for a right ankle disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

4. The criteria for entitlement to service connection for a left ankle disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

5. The criteria for entitlement to service connection for a right foot disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

6. The criteria for entitlement to service connection for a left foot disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

7. The criteria for entitlement to service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty service from August 1977 to October 1978.

This appeal comes to the Board of Veterans' Appeals (Board) from a rating decision dated September 2014 issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed.

A Board video hearing was held before the undersigned Veterans Law Judge in April 2022. The hearing transcript has been reviewed and associated with the Veteran's file.

The Veteran's appeal has previously been before the Board. In October 2022 and April 2024, the Board remanded the Veteran's claims to the Agency of Original Jurisdiction (AOJ) for additional development.

Service Connection

In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability
from August 1977 to October 1978.

A Board video hearing was held before the undersigned Veterans Law Judge in April 2022. The hearing transcript has been reviewed and associated with the Veteran's file.

Service Connection

In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303.

Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In order to prevail on the issue of entitlement to secondary service connection, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence, generally medical, establishing a connection between the service-connected disability and the current disability. 38 C.F.R. § 3.310; Wallin v. West, 11 Vet. App. 509, 512 (1998).

If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Relevant Evidence and Procedural History

Relevant to all issues on appeal, in an August 2013 statement, the Veteran wrote:

I have shin splints both legs - calf will have light to intense muscle spasms - can make it very difficult to walk and at times unable to stand I have to wear braces and have worn braces since 1984...The pain is light to severe - the spasms are mild to severe radiating from hip to groin...down the outside of leg to feet - causing different kinds of muscle spasms...hard to walk or stand at times - painful to walk unable to squat or get up...arthritis in neck affects both shoulders...There was an accident where I flew 100 feet out the back of a truck knowing how to parachute landing fall saved my life...I was also treated for a fall down the stairs resulting in hospitalization September/October 1978. I live in pain and have severe bouts of pain daily, weekly, monthly.

In an April 2015 Notice of Disagreement (NOD), the Veteran wrote:

Right and left feet were injured in service. I was issued special boots because of my feet condition in Basic Training because of so much running and marching. The shin splints were also caused by these activities and Airborne Training. I continue to suffer from these conditions to present. I injured both of my shoulders...and both ankles when I fell out of a two and a half ton truck while it was moving when the drive[r] was trying to do a wheelie; I fell and rolled 100 feet before I stopped. I was taken to the Troop Medical Clinic and then to the base hospital...approximately October/November 1977. I received physical therapy at Ft. Benning, GA base hospital up to December 1977 for this condition. I also had a hard landing when my parachute got stuck in the trees and I hurt my shoulder...[and] ankles...during Airborne Training and was treated at the...base hospital approximately October/November 1977. I continue to be in intense pain from the injuries suffered...during Airborne Training October through December 1977...In August/September 1978...my left knee gave out and fell/rolled down two flights of concrete stairs and was taken...to base hospital and was put in full traction for a week for...legs.

In her April 2022 hearing, the Veteran testified that she performed basic
. I received physical therapy at Ft. Benning, GA base hospital up to December 1977 for this condition. I also had a hard landing when my parachute got stuck in the trees and I hurt my shoulder...[and] ankles...during Airborne Training and was treated at the...base hospital approximately October/November 1977. I continue to be in intense pain from the injuries suffered...during Airborne Training October through December 1977...In August/September 1978...my left knee gave out and fell/rolled down two flights of concrete stairs and was taken...to base hospital and was put in full traction for a week for...legs.

In her April 2022 hearing, the Veteran testified that she performed basic training and also had to do extra training twice a day for Airborne training in service. She stated that she had a parachute badge. She performed one jump in service. During this jump, her parachute did not canopy correctly, and she landed in the trees. She injured her shoulder, causing her to go to sick call. She also described an incident where she was thrown out of a truck, injuring her shoulder and shins. She was bruised and had road rash. She described another incident where she fell down the stairs, causing her to further injure her shoulder. She testified that she had to have special boots made for her feet because she had shin splints and trouble with her feet from running on concrete.

In a May 2022 statement, the Veteran's friend wrote that she had watched the Veteran struggle with bilateral foot and shoulder trouble.

In an April 2022 opinion, the Veteran's chiropractor wrote, "My suggestion would be that consideration be given to her...shin, and foot be considered as service related also in light of the lumbar disc extrusion which would be consistent with these symptoms and would make these conditions service related."

In another April 2022 private opinion, the Veteran's chiropractor wrote, "This office has been treating [the Veteran] for many years for pain in her spine and extremities. It is my opinion that there is causality between the pain from osteoarthritis in her feet, ankles, shoulders...and the multiple injuries sustained while in the military."

In its October 2022 remand, the Board acknowledged that the April 2022 opinions from the Veteran's chiropractor supported a positive nexus between the Veteran's bilateral foot disability, bilateral shin disability, and bilateral ankle disability and her service. They also indicate a positive nexus between the Veteran's bilateral foot disability, bilateral shin disability, and bilateral ankle disability and her service-connected lumbosacral strain with arthritis. However, the opinions as written are conclusory and do not clearly explain the medical reasoning supporting the finding that the Veteran's disabilities are related to her service or her service-connected disability. A medical opinion containing only data and conclusions is not entitled to any weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). As a result, the Board determined that it could not rely on the April 2022 private opinions to adjudicate these claims because they do not contain supporting rationale.

1. Entitlement to service connection for a left shin disability

2. Entitlement to service connection for a right shin disability

3. Entitlement to service connection for a right ankle disability

4. Entitlement to service connection for a left ankle disability

5. Entitlement to service connection for a right foot disability

6. Entitlement to service connection for a left foot disability

The Veteran claims entitlement to service connection for bilateral shin, bilateral ankle, and bilateral foot disabilities. Following a thorough review of the Veteran's medical records, the Board finds that awards of service connection are warranted. As the Board is granting the claims in full on the theory of direct service connection, further analysis under other theories is?moot.

As an initial matter, the Board finds that the Veteran has satisfied the first element of service connection, current disabilities. A review of the November 2022 examination for knee and lower leg conditions shows that the Veteran has a current diagnosis of bilateral shin splints. Additionally, a review of the November 2022 examination for ankle conditions shows that the Veteran has current diagnoses of bilateral lateral collateral ligament sprains (chronic/recurrent) and bilateral deltoid ligament sprains (chronic/recurrent). Furthermore, a review of the September 2023 examination for foot conditions shows that the Veteran has a current disability of bilateral degenerative arthritis, other than post-traumatic. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence
the Board finds that the Veteran has satisfied the first element of service connection, current disabilities. A review of the November 2022 examination for knee and lower leg conditions shows that the Veteran has a current diagnosis of bilateral shin splints. Additionally, a review of the November 2022 examination for ankle conditions shows that the Veteran has current diagnoses of bilateral lateral collateral ligament sprains (chronic/recurrent) and bilateral deltoid ligament sprains (chronic/recurrent). Furthermore, a review of the September 2023 examination for foot conditions shows that the Veteran has a current disability of bilateral degenerative arthritis, other than post-traumatic. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of current disabilities.

With regards to the second prong of service connection, evidence of an in-service disease or injury, the Veteran's lay statements and hearing testimony are provided above. An October 1977 service treatment record (STR) documented that the Veteran had bilateral shin pain. In an October 1977 STR, the Veteran complained of left foot pain. In another October 1977 STR, the Veteran complained of tenderness in the dorsum and arches of her feet. An X-ray appeared to be within normal limits.

Turning next to evidence of a causal relationship between the present disabilities and injury during service, the Board finds that the medical and lay evidence of record is in approximate balance as to whether the Veteran's bilateral shin, bilateral ankle, and bilateral foot disabilities manifested while in service and have continued to the present.

In January 2023, an examiner provided negative nexus opinions. Thereafter, in its April 2024 remand, the Board found that the January 2023 direct service connection opinions were inadequate. Following this, in May 2024 and June 2024, examiners provided negative nexus opinions.

The Board acknowledges the Veteran's lay statements that she injured her bilateral shins, ankles, and feet in service and that she has had bilateral shin, ankle, and foot pain and symptoms since service. The Board has no reason to doubt her credibility and that she believes she experienced symptoms of bilateral shin, ankle, and foot disabilities since service. This is also consistent with the October 1977 STRs documenting bilateral shin pain and bilateral foot pain.

The Board finds that the medical and lay evidence of record is in approximate balance as to whether the Veteran's bilateral shin, ankle, and foot disabilities manifested while in service and have continued to the present. In this case, the record contains positive lay evidence that the Veteran injured her bilateral shins, ankles, and feet in service and has had bilateral shin, ankle, and foot pain and symptoms since service. The record also contains negative medical evidence, specifically the May 2024 and June 2024 opinions.

The Veteran has credibly and competently reported that her bilateral shin, ankle, and foot disabilities began while she was in service and have continued to the present. Thus, the competent and credible evidence is in approximate balance as to whether these disabilities were "incurred coincident with service." 38 C.F.R. 3.303(a).

The Board also finds that the Veteran is credible to report a bilateral ankle injury to a doctor during service that was later diagnosed as a chronic condition. Lay evidence can be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Here, the lay evidence describes bilateral ankle symptoms during service that were supported by a later diagnosis of bilateral chronic/recurrent lateral collateral ligament sprains and bilateral chronic/recurrent deltoid ligament sprains by a medical professional. This is probative nexus evidence in favor of the Veteran's claim.

The Board resolves reasonable doubt in the Veteran's favor and finds that service connection for a bilateral shin disability, a bilateral ankle disability, and a bilateral foot disability is warranted. The claims are granted.

7. Entitlement to service connection for a right shoulder disability, to include as secondary to lumbosacral strain with arthritis

The Veteran also claims entitlement to service connection for a right shoulder disability, to include as secondary to lumbosacral strain with arthritis.

Direct Service Connection

7. Entitlement to service connection for a right shoulder disability, to include as secondary to lumbosacral strain with arthritis

The Veteran also claims entitlement to service connection for a right shoulder disability, to include as secondary to lumbosacral strain with arthritis.

Direct Service Connection

As an initial matter, the Board finds that the Veteran has satisfied the first element of direct service connection, a current disability. A review of the November 2022 examination for shoulder and arm conditions shows that the Veteran has a current disability of a right shoulder strain. Therefore, the Board finds that the Veteran has satisfied the first prong of direct service connection, the existence of current disabilities.

With regards to the second prong of direct service connection, evidence of an in-service disease or injury, the Veteran's lay statements and hearing testimony are provided above. In the October 1978 Report of Medical History during her separation examination, the only joints that were reported to be swollen or painful were the back and the knees.

With respect to a causal relationship between the Veteran's current disability and her active duty service, the Board finds the weight of the competent evidence does not support a nexus.

In a May 2012 opinion, a VA examiner determined that the Veteran's bilateral shoulder strain was less likely than not incurred in, caused by, or related to the shoulder pain/treatment in service. The examiner wrote:

Veteran has nonspecific complaint of shoulder pain during active duty. There is no objective evidence of the diagnosis or treatment of a shoulder condition or continuity of symptomatology during or after service. There is no objective evidence of a chronic shoulder condition during active duty. It has been more than 30 years since release from service. Per Veteran and available records she was involved in a motor vehicle accident in 2007 and the possibility of any other intercurrent injury is unknown.

In October 2022, the Board found that additional lay evidence about the Veteran's right shoulder symptoms had been added to the record since the May 2012 opinion was provided and determined that remand was required to obtain an addendum opinion which addressed the lay evidence of record. Thus, the Board remanded the Veteran's claim to obtain an addendum opinion regarding the etiology of the Veteran's right shoulder disability. On remand, the examiner was specifically asked to identify any right shoulder disabilities that had been present at any time since June 2014. The examiner was then asked to determine if the disability began in service and if it was related to the Veteran's active duty service, to include her parachute jump, fall down the stairs, and fall from a truck in service. The examiner was also asked to determine if the Veteran's back disability caused or aggravated the right shoulder disability.

Thereafter, in November 2022, a VA examiner provided a shoulder and arm conditions examination. In January 2023, the examiner provided a negative nexus opinion for the theory of direct service connection. When asked if the Veteran's right shoulder disability was related to her active duty service, to include her parachute jump, fall down the stairs, and fall from a truck in service, the examiner wrote, "There is no objective evidence of a chronic shoulder condition during active duty. Per Vet, available records she was involved in a motor vehicle accident in 2007 and the possibility of any other intercurrent injury is unknown."

The January 2023 examiner based her negative direct service connection opinion solely on the lack of medical evidence regarding a right shoulder disability in service, did not discuss the Veteran's assertions of the in-service parachute jump, fall down the stairs, and fall from a truck, and did not provide an opinion as to whether these incidents may have caused her right shoulder disability. Therefore, in April 2024, the Board found that the January 2023 direct service connection opinion was inadequate and remand was required to obtain an addendum opinion that addressed the Veteran's lay statements of the parachute jump and falls she sustained in service.

Thereafter, in May 2024, an examiner determined that the Veteran's right shoulder disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner wrote:

Veteran is claiming "a right shoulder disability" attributed to reported shoulder pain while on active duty and injuries while on active military duty: parachute jump, fall down the stairs, and fall from a truck in service. There is no documentation of right shoulder pain while on active duty. Records indicated a motor vehicle accident in 2007. In 2016, Veteran reported widespread musculoskeletal pain at a primary care annual visit. In October 2016, Veteran was evaluated for spot on right shoulder and pain after a fall on September 15, 2016. During a C&P exam in November 2022, right shoulder strain was documented as diagnosed without evidence of diagnostic testing. After thorough review of claims files, no evidence was found to indicate a chronic history of right shoulder pathology that was diagnosed while on active duty. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. Therefore, it is less likely than not that the claimed condition was incurred in or caused by right shoulder during service.

In a May 2024 addendum opinion, the same examiner wrote:

There is no documentation of right shoulder pain while on active duty. Records indicated a motor vehicle accident in 2007. In 2016, Veteran reported widespread musculoskeletal pain at a primary care annual visit. In October 2016, Veteran was evaluated for spot on right shoulder and pain after a fall on September 15, 2016. During a C&P exam in November 2022, right shoulder strain was documented as diagnosis. Veteran has had multiple post-service injuries that could have resulted in the current diagnosis of strain. Therefore, it is less likely than not that the claimed condition was incurred in or caused by right shoulder during service.

In another addendum opinion in May 2024, the same examiner wrote:

Statements regarding parachute jump, fall down stairs, and fall from a truck reported by Veteran are unlikely to have caused current claimed condition "right shoulder disability". During a C&P exam in November 2022, right shoulder strain was documented as diagnosed without evidence of diagnostic testing. After thorough review of claims files, no evidence was found to indicate a chronic history of right shoulder pathology that was diagnosed while on active duty. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. Therefore, it is less likely than not that the claimed condition was incurred in or caused by right shoulder during service.

The Board finds that the May 2024 addendum opinions, read together, substantially comply with its remand directives by answering the nexus questions asked, addressing the Veteran's lay statements regarding injuries during service, and giving an adequate rationale for the negative nexus opinion. The examiner acknowledged the Veteran's reported parachute jump and falls in service, but explained that these reported injuries were less likely than not the cause of a current right shoulder disability. The examiner did not reject the Veteran's reports as untrue; rather, the opinion explains that in the absence of any evidence of chronicity of a right shoulder disability in the decades since 1977-78, he finds the evidence does not support a connection between the injuries in service and the current disability. In other words, the jump and falls in service more than 40 years ago are a less likely cause of current symptoms than documented intervening injuries that occurred closer in time to the claim and current symptoms. This opinion is not solely based on an absence of contemporaneous medical records in service; rather, it considers the relevant evidence, including multiple post-service injuries to the shoulder.

The Board finds this opinion is adequate and probative to support a finding that the Veteran's current disability is not related to the in-service falls and parachute jump. It provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board finds that the question of whether a nexus exists between the Veteran's active duty service and her current right shoulder disability is too complex to be addressed by a layperson. This connection or etiology is not amenable to observation alone. Rather it is a medically complex issue requiring specialized medical education or knowledge. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Because the Veteran does not have specialized medical training, experience, or knowledge, her opinion, no matter how sincere
ake, 22 Vet. App. 295, 304 (2008).

In the absence of competent nexus evidence relating the current right shoulder disability to active duty service, service connection cannot be granted. The Board finds that there is no competent and probative evidence supporting the nexus element of the Veteran's claim. However, there is competent and probative evidence weighing against a finding of nexus to service. Therefore, the evidence of record is not in approximate balance and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied on a direct service connection basis.

Secondary Service Connection

As provided above, the Veteran has a current right shoulder disability. Therefore, the Board finds that the Veteran has satisfied the first prong of secondary service connection, the existence of a current disability.

The Veteran is currently service-connected for lumbosacral strain with arthritis, among other disabilities. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection on a secondary basis: evidence of a service-connected disability.

Turning next to evidence of a causal relationship between the current disability and the service-connected disability, the Board finds the weight of the competent evidence does not support a nexus.

The Board finds that the question of whether a nexus exists between the Veteran's lumbosacral strain with arthritis and her current right shoulder disability is too complex to be addressed by a layperson. This connection or etiology is not amenable to observation alone. Rather, it is a medically complex issue requiring specialized medical education or knowledge. See 38 C.F.R. § 3.159 (a)(1). Because the Veteran does not have specialized medical training, experience, or knowledge, her statements, no matter how sincere, are not competent nexus evidence. Jandreau, 492 F.3d at 1376-77.

In this case, while the January 2023 examiner determined that the Veteran's right shoulder disability was less likely than not proximately due to or the result of her service-connected condition, the rationale the examiner provided was based on the theory of direct service connection and did not address the theory of secondary service connection.

Thus, the Board finds that there is no competent and probative evidence against or in favor of the Veteran's secondary service connection claim. A finding that the evidence is in approximate balance requires that there be competent and probative evidence that can be weighed against each other. Here, there is no competent evidence to weigh. Therefore, the evidence of record does not reach approximate balance and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch.

In the absence of competent nexus evidence supporting causation or aggravation of the right shoulder disability by service-connected lumbosacral strain with arthritis, service connection is denied on a secondary basis.

Conclusion

The claim is denied on both direct and secondary service connection theories.

Laura E. Collins

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K.M.

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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