SHOULDER IMPAIRMENT OF

Summary

The veteran, who served in the United States Army across multiple periods between March 1983 and December 2004, appeals the denial of service connection for right shoulder impingement syndrome. This claim has been remanded multiple times due to inadequate medical opinions. The most recent VA examination in September 2023 was found insufficient because it failed to adequately address the etiology of the condition, disregarded instructions regarding in-service symptoms, and relied on previous inadequate reports. The examiner concluded the condition was less likely than not due to service, but provided no explanation for this conclusion, particularly in light of the veteran's documented in-service shoulder pain and reduced range of motion in 2004, and a separate grant of service connection for his left shoulder. The Board, recognizing the repeated failures in obtaining an adequate opinion and the presence of some in-service symptomology and a related left shoulder grant, found the evidence in approximate balance. Applying the benefit of the doubt, the Board granted service connection for right shoulder impingement syndrome.

Rationale

In-service onset and continuity of symptoms reported by veteran.; VA treatment records reflect bilateral shoulder pain in service.; Separate grant of service connection for left shoulder condition.; Inadequate VA medical opinions on nexus.; Benefit of the doubt applied due to approximate balance of evidence.

Full Decision Text

Citation Nr: 26003070
Decision Date: 03/06/26	Archive Date: 03/06/26

DOCKET NO. 09-34 297
DATE: March 6, 2026

ORDER

Service connection for right shoulder impingement syndrome is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, his right shoulder impingement syndrome developed due to his military service. 

CONCLUSION OF LAW

The criteria for service connection for right shoulder impingement syndrome have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from March 1983 to March 1986, from September 1990 to June 1991, and from March 2003 to December 2004, with additional service in the Army Reserves.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2009 by the Department of Veterans Affairs (VA) Regional Office in San Juan, Puerto Rico.

This appeal was previously before the Board in May 2013, July 2018, October 2020, April 2022, September 2022, and May 2023. In May 2023, it was remanded in order to obtain a medical opinion which addressed the Veteran's claim for service connection. Such was obtained in September 2023. Unfortunately, the author of that opinion disregarded the instructions provided and simply affirmed that she agreed with the findings made in previous, inadequate examination reports. Thus, the development conducted pursuant to the May 2023 Board remand is also inadequate. However, any deficiency in compliance with the Board's remand is harmless given the full grant of the benefits sought on appeal, set forth below. Stegall v. West, 11 Vet. App. 268, 271 (1998).

Service Connection 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4 th 776 (Fed. Cir. 2021).

The Veteran asserts that his diagnosed right shoulder impingement syndrome began while he was in service, and has continued to the present day, warranting service connection. His available service treatment records indicate that that in May 1991 he reported experiencing pain that radiating into his shoulders since a tour of duty in Saudi Arabia.  VA treatment records from the Veteran's time on active duty reflect treatment for bilateral shoulder pain.  He underwent physical therapy on multiple occasions in 2004, while still on active duty. In March, July, August, and December of that year, records show reports of right shoulder and upper trapezius pain, pain radiating from his cervical spine, and worsening and continuing shoulder pain, which was described as specifically occurring in the right shoulder. 

The Veteran was formally diagnosed with right shoulder impingement syndrome in 2006. As noted in the introduction, this claim has been remanded on multiple occasions in pursuit of a VA examination report which adequately addresses the etiology of that disability. The most recent examiner was asked to discuss whether the Veteran's right shoulder impingement syndrome first manifested in service, or was caused or aggravated by various service-connected disabilities. The examiner was asked to note that the Veteran had right shoulder pain and reduced range of motion while still in service, and was unable to fully articulate his shoulder in November 200
apezius pain, pain radiating from his cervical spine, and worsening and continuing shoulder pain, which was described as specifically occurring in the right shoulder. 

The Veteran was formally diagnosed with right shoulder impingement syndrome in 2006. As noted in the introduction, this claim has been remanded on multiple occasions in pursuit of a VA examination report which adequately addresses the etiology of that disability. The most recent examiner was asked to discuss whether the Veteran's right shoulder impingement syndrome first manifested in service, or was caused or aggravated by various service-connected disabilities. The examiner was asked to note that the Veteran had right shoulder pain and reduced range of motion while still in service, and was unable to fully articulate his shoulder in November 2004, just prior to discharge. 

Unfortunately, the resulting report, authored in September 2023, does not adequately address the Veteran's claim. That examiner concluded that it was less likely than not that the Veteran's condition was due to service. As rationale, she stated that there was no evidence of symptomology in service, and concluded that the Veteran's disability started years after. She then specifically named previous examiners and stated that she agreed with their respective conclusions regarding the etiology of the Veteran's disability. 

The Board finds this report inadequate, as it contains no explanation as to how the examiner came to the conclusion that the Veteran's right shoulder impingement syndrome was due to a post-service injury. 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"). Further, the examiner disregarded the provided instructions-which detailed in-service right shoulder symptoms-and determined that because there were no such symptoms, there could be no link to service. This is in error. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (examination inadequate where the examiner relied on lack of evidence in service treatment records to provide a negative opinion); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (an opinion based upon an inaccurate factual premise has no probative value). Finally, the examiner noted that she agreed with previous examination reports, and cited them in support of her own conclusions. Those examination reports have been found to be inadequate regarding the etiology of the Veteran's right shoulder impingement syndrome, for the various reasons set forth in the Board's six previous remands. Thus, the examiner's reliance on them is of no probative value to the Board. 

To date, there have been six separate medical opinions which have attempted to address the nexus, if any, between the Veteran's military service and his right shoulder impingement syndrome. None of the resulting opinions has adequately done so. Rather than remand for yet another medical opinion, the Board finds instead that the record raises reasonable doubt as to the etiology of the Veteran's disability. He has competently reported an in-service onset, and continued symptomology. The record shows reports of right shoulder pain while in service. The Board also finds it persuasive that the Veteran has been separately granted service connection for a left shoulder condition, based on his in-service duties.

Overall, the evidence currently of record does not satisfactorily prove or disprove that the Veteran's right shoulder impingement syndrome is causally or etiologically due to service. However, yet another remand in order to obtain another addendum opinion that may or may not be adequate serves no benefit to the Veteran. In recognition of such, the Board declines to remand this case again and further delay disposition of this appeal. The United States Court of Appeals for Veterans Claims has reiterated that "[b]y requiring only an approximate balance of positive and negative evidence to prove any issue material to a claim for Veterans benefits, 38 U.S.C. § 5107 (b), the nation, in recognition of our debt to our Veterans, has taken upon itself the risk of error in awarding such benefits." Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (citing Gilbert). 

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Therefore, when resolving all reasonable doubt in the Veteran's favor, the Board finds service connection for right shoulder impingement syndrome is arguably warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra; Lynch, supra. The claim is granted.

 

 

ROBERT C. SCHARNBERGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jeremy J. Olsen, 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
2014) (citing Gilbert). 

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Therefore, when resolving all reasonable doubt in the Veteran's favor, the Board finds service connection for right shoulder impingement syndrome is arguably warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra; Lynch, supra. The claim is granted.

 

 

ROBERT C. SCHARNBERGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jeremy J. Olsen, 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.