SHOULDER IMPAIRMENT OF

Summary

The veteran, who served from September 1977 to August 1981 and November 1982 to April 1991, appeals the denial of service connection for a left shoulder disability and an inguinal hernia. The veteran claimed the left shoulder disability was secondary to his service-connected left knee condition, arguing that favoring his knee due to the in-service injury led to the shoulder issue. However, the Board found no competent medical opinion to support this claim. The veteran's own testimony regarding the onset and cause of his shoulder pain was deemed not probative, as he is not a medical expert. Furthermore, the Board noted inconsistencies in the veteran's reported onset of shoulder pain and found his lay testimony did not establish continuity of symptomatology, thus the duty to provide a VA examination was not triggered. For the inguinal hernia claim, the Board found no competent medical opinion linking the hernia to service or to the service-connected knee condition. The veteran's own opinion was again deemed not probative. The Board also noted that the hernia was surgically repaired in July 2009 with no reported lasting effects until occasional pain in November 2015, raising questions about a current disability during the period on appeal. The Board also noted that the AOJ made a favorable finding of a current hernia in a prior rating decision, but this did not necessitate a VA exam for the Board's decision given the lack of competent nexus evidence. The Board denied both claims, finding the evidence weighed against entitlement and the benefit-of-the-doubt doctrine was not applicable.

Rationale

No competent medical opinion linking left shoulder disability to service or left knee disability.; Veteran's lay opinion regarding nexus is not probative.; Lack of credible continuity of symptomatology for shoulder pain.; Duty to provide VA exam not triggered.

Full Decision Text

Citation Nr: A26006819
Decision Date: 01/26/26	Archive Date: 01/26/26

DOCKET NO. 200506-189086
DATE: January 26, 2026

ORDER

Entitlement to service connection for a left shoulder disability is denied.

Entitlement to service connection for an inguinal hernia is denied.

FINDINGS OF FACT

1. Neither the Veteran's service nor his left knee disability caused or aggravated his left shoulder disability.

2. Neither the Veteran's service nor his left knee disability caused or aggravated an inguinal hernia 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. § 1110; 38 C.F.R. §§ 3.303, 3.310.

2. The criteria for entitlement to service connection for an inguinal hernia have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1977 to August 1981 and from November 1982 to April 1991. In addition, the Veteran's left knee disability was incurred during a period of active duty for training.

This matter comes to the Board on appeal of an April 2020 statement of the case (SOC) issued to the Veteran under the previous Legacy appeals system. In lieu of appealing that decision in the Legacy system, the Veteran opted into the Appeals Modernization Act (AMA) system, after some clarification, via a September 2021 notice of disagreement (NOD). Although that NOD was submitted more than one year after the SOC on appeal, this was done following an August 2021 request for clarification on which system the Veteran intended to proceed under, and submitted during the period provided to the Veteran to make clear his intention to appeal under the AMA. In the September 2021 NOD, the Veteran selected the Hearing Review option. A hearing was held on May 12, 2025.

Therefore, the Board may only consider the evidence of record at the time of the April 2020 SOC, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the April 2020 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted and the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Entitlement to service connection for a left shoulder disability is denied.

The Veteran contends that he is entitled to service connection for a left shoulder disability as secondary to his service-connected left knee disability. 

Factual Background

The Veteran's service treatment records are silent for complaints of a left shoulder issue. 

The first record of a left shoulder complaint in the medical evidence came in July 2011 when the Veteran reported to VA medical center staff that he had left shoulder pain. Imaging done in September 2011 showed that the Veteran suffered from degenerative changes of the shoulder and calcific tendinitis. In November 2011, the Veteran reported to VA medical center staff that his left shoulder had pained him for several years. 

In October 2015, the Veteran first submitted his claim for a left shoulder disability as secondary to his left knee disability. The Veteran had continued to complain of left shoulder pain before and after submission of this claim. In December 2017, the Veteran reported to VA medical center staff that he'd had left shoulder pain for about 10 years. Later that month, it was noted that he had full range of motion in his left shoulder, but did suffer from left shoulder tendonitis. 

At his May 2025 hearing, the Veteran argued that his left shoulder disability was a result of favoring his left knee while working as a heavy equipment operator and performing a lot of heavy lifting and manual labor. Also at that hearing, though, the Veteran stated that his left shoulder had bothered him
 submitted his claim for a left shoulder disability as secondary to his left knee disability. The Veteran had continued to complain of left shoulder pain before and after submission of this claim. In December 2017, the Veteran reported to VA medical center staff that he'd had left shoulder pain for about 10 years. Later that month, it was noted that he had full range of motion in his left shoulder, but did suffer from left shoulder tendonitis. 

At his May 2025 hearing, the Veteran argued that his left shoulder disability was a result of favoring his left knee while working as a heavy equipment operator and performing a lot of heavy lifting and manual labor. Also at that hearing, though, the Veteran stated that his left shoulder had bothered him from before his left knee injury in 2003.

Analysis

Generally, a grant of service connection requires showing a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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 - the nexus requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another disorder. 38 C.F.R. § 3.310(b).

Here, there is no basis on which to grant service connection for a left shoulder disability on either a direct or secondary basis. 

The record shows that the Veteran has a current left shoulder disability, and that his claimed primary left knee disability is service-connected. The Veteran has contended that his in-service left knee injury caused or aggravated his left shoulder disability. These facts may establish the current disability element of the Shedden test described above, and establish that the Veteran has a primary service-connected disability necessary to show entitlement to secondary service connection.  Putting aside whether the in-service injury to the left knee qualifies as an in-service event for direct service connection, either theory of entitlement fails for lack of a competent nexus opinion - either that service directly caused or aggravated the left shoulder disability, or that the left knee disability caused or aggravated the left shoulder disability. 

The only opinions in the record which purport to establish such a nexus are provided by the Veteran in his claims or at his hearing testimony. However, while the Veteran is competent to report his symptoms, he is not competent to make a conclusive statement that his left knee injury caused or aggravated his left shoulder disability. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating disabilities or their etiologies, and so this opinion is not competent medical evidence and lacks probative value. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). This does not, then, establish a probative positive nexus. At the May 2025 hearing, the Veteran was advised that his claim was missing a nexus opinion and he stated that he would submit one within the evidentiary window following the hearing. No such opinion was added into evidence in that timeframe. 

Without a probative nexus opinion, the Board is unable to grant service connection on either a direct or secondary basis. In making this determination, the Board notes that the Veteran was not provided with a VA examination for his claimed left shoulder disability before the April 2020 SOC here on appeal. 

An exam and opinion are necessary for making a decision when the record shows competent evidence of a current disability and there is an indication that the claimed disability may be related to the Veteran's active service. The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006).

Here, the VA had no duty to provide such an opinion. As discussed above, the Veteran's lay opinion is the only positive nexus opinion in the record, but this was not a competent medical opinion, and is insufficient to support even the tenuous link that McLendon requires. Further, the Veteran's reports of pain do not credibly establish continuity
 a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006).

Here, the VA had no duty to provide such an opinion. As discussed above, the Veteran's lay opinion is the only positive nexus opinion in the record, but this was not a competent medical opinion, and is insufficient to support even the tenuous link that McLendon requires. Further, the Veteran's reports of pain do not credibly establish continuity. In the post-service medical record, the Veteran first reported pain in 2011, and described it as having arisen a couple years earlier. Elsewhere in the medical record, the Veteran claims that his left should pain began around 2007. However, at his hearing, the Veteran alleged that his left shoulder pain had actually begun prior to his left knee injury in 2003 and that the left knee injury only worsened the left shoulder pain. These statements as to onset are thus of limited credibility, and do not establish continuity of symptomatology nor otherwise credibly support that the left knee injury impacted the Veteran's left shoulder. The duty to provide an examination under McLendon, then, did not arise and it was not a pre-decisional duty to assist error not to provide such an exam.

For the above reasons, the evidence persuasively weighs against the claim of a left shoulder disability, and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim is denied.

2. Entitlement to service connection for an inguinal hernia is denied.

The Veteran contended that he has a current inguinal hernia disability caused or aggravated by his left knee disability. 

Factual Background

Prior to 2009, the Veteran's service treatment records are silent for report of a hernia. 

In July 2009, the Veteran was diagnosed an inguinal hernia by a private medical provider, who noted that the hernia occurred in June 2009. The hernia was repaired surgically in July 2009. 

A Report of Medical History from March 2010 in the Veteran's service medical records noted that the Veteran had a historical hernia which had been repaired in July 2009. The examiner also noted that since the surgical repair the Veteran had no ongoing hernia-related issues. 

In May 2010, the Veteran was provided with a physical exam at a VA medical center. He reported at this exam that he'd had a hernia repair surgery the year prior and currently had no pain or other complaints. 

In November 2015, the Veteran reported to VA medical center staff that he still had some occasional pain from his hernia. 

At his May 2025 hearing, the Veteran asserted that his hernia occurred while working for a county department of transportation with heavy equipment and "overdid" it which caused his hernia in 2009. 

In a June 2024 rating decision, the Board notes, the AOJ made the favorable finding that the Veteran had a current hernia disability. The Board can consider this rating decision as adjudicative determinations are not evidence. See, e.g., Green v. McDonough, 37 Vet. App. 127, 136 (2024).

Analysis

Generally, a grant of service connection requires showing a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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 - the nexus requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another disorder. 38 C.F.R. § 3.310(b).

Central to a claim for service connection is a disability which was current during the pendency of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 
 disease or injury - the nexus requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another disorder. 38 C.F.R. § 3.310(b).

Central to a claim for service connection is a disability which was current during the pendency of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013); McKinney v. McDonald, 28 Vet. App. 15 (2016); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Here, the record does not show entitlement to service connection for a hernia disability. 

As with the left shoulder disability above, the record does not contain a probative medical opinion which shows that the Veteran's service directly caused or aggravated his hernia, nor that the Veteran's left knee disability caused or aggravated the claimed hernia. Instead, the only opinion to this effect is that of the Veteran, but - as discussed above - he is not competent to provide such an opinion. The Veteran was counseled at the May 2025 hearing that he should submit a competent medical opinion to this effect, but none was received by VA during the post-hearing evidentiary window. As above, this is sufficient to show non-entitlement to service connection for a claimed hernia disability on both direct and secondary bases.

The Board also notes that the record during the period on appeal does not conclusively show a current disability during the pendency of the appeal. The medical record currently before the Board shows that the Veteran incurred an inguinal hernia in June 2009 which was surgically repaired in July 2009, and had no lasting effects as of May 2010. However, the Veteran did report occasional pain in November 2015, and implicitly claimed that he had a current disability or compensable residuals simply by filing the claim. Because a decision on this element is not necessary to the disposition of the claim, the Board will not here opine on whether the Veteran did have a current disability prior to the rendering of the April 2020 SOC here on appeal, and there is not sufficient evidence to clearly rebut the favorable finding of the June 2024 rating decision which found a current disability which is likely based on evidence to which the Board cannot turn given the procedural posture of this claim stream. See 38 C.F.R. § 3.104.  However, the Board notes this issue for the Veteran's benefit should he later be granted service connection on this issue and claim an effective date prior to the SOC on appeal as later decisions will have a broader evidentiary window to view and to make a fully-informed decision as to whether the Veteran's hernia disability persisted after it was surgically repaired. 

The Board also notes that the Veteran was not provided with a VA examination for this claim prior to the SOC here on appeal. However, again, VA's duty to provide an exam under McLendon as described above was not triggered. Prior to the 2020 SOC on appeal, there was no competent evidence of a current disability, and the AOJ had not yet made a favorable finding that the Veteran had current disability. The competent evidence instead only established that the Veteran had a hernia  in 2009 which was repaired that same year. The medical record does not reflect any ongoing complaints - and in fact denies post-surgery issues - until the Veteran described occasional pain in November 2015. A report of occasional pain does not itself constitute a disability, and the pain itself does not constitute a disability unless the Veteran can show that it had a functional impact on him during the pendency of the claim. Cf. Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018) (holding that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity" in the context of joint pain). Further, even were the Board to recognize a current disability during the claim stream here on appeal, the only evidence suggestive of a link is the Veteran's opinion, which has no probative value and so is insufficient to trigger the duty to provide a VA examination. 

For the above reasons, the evidence persuasively weighs against the claim of an inguinal hernia disability, and the benefit-of-the-doubt doctrine is not for application. 38 U.S
7-69 (Fed. Cir. 2018) (holding that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity" in the context of joint pain). Further, even were the Board to recognize a current disability during the claim stream here on appeal, the only evidence suggestive of a link is the Veteran's opinion, which has no probative value and so is insufficient to trigger the duty to provide a VA examination. 

For the above reasons, the evidence persuasively weighs against the claim of an inguinal hernia disability, and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim is denied.

Finally, the Board notes that in a September 205 rating decision, the AOJ recognized the Veteran's participation in a toxic exposure risk activity (TERA). During the period on appeal, the Veteran was not provided with a VA examination to determine whether the Veteran's participation in a TERA, and resulting exposures, caused or aggravated the Veteran's claimed disabilities. However, without deciding whether either of the claimed disabilities would be entitled to such an opinion, the duty to provide this type of opinion arose as part of the PACT Act, which became effective in August 2022. It was thus not a pre-decisional duty to assist error not to provide such an opinion before the April 2020 SOC here on appeal. 

 

 

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Kronick

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.