SHOULDER IMPAIRMENT OF

M. PRYCE · 2026 · Case ID: A26027495

MIXED

Summary

The veteran, who served in the United States Marine Corps from November 2017 to November 2021, appeals the denial of service connection for bilateral shoulder, ankle, and knee disabilities, and a thoracolumbar spine disability. The veteran also claimed service connection for hypertension. The veteran failed to attend scheduled VA examinations for the musculoskeletal claims on January 14, 2025, without providing good cause, despite having notice of the examination requirements and prior experience with the claims process. The Board found the veteran's arguments regarding illness at the time of the examinations unpersuasive, noting he had been briefly hospitalized for a respiratory infection but was discharged without distress and participated in a psychotherapy session on the same day as the missed examinations, indicating he was capable of attending. The Board concluded that the evidence did not establish a current diagnosis for any of the claimed musculoskeletal conditions, denying these claims. For hypertension, the Board found service connection warranted based on an in-service diagnosis in July 2021 and continuity of symptoms, despite the missed January 2025 examination. The Board noted the veteran was prescribed blood pressure medication during service and had a documented diagnosis with a multi-year history by June 2023, confirming an in-service incurrence with continuity.

Rationale

Failure to report for scheduled VA examination; No current diagnosis of chronic shoulder disability established; No evidence of functional impairment from reported pain

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250422-559749

Full Decision Text

Citation Nr: A26027495
Decision Date: 03/26/26 Archive Date: 03/26/26

DOCKET NO. 250422-559749
DATE: March 26, 2026

ORDER

Entitlement to service connection for bilateral shoulder disabilities is denied.

Entitlement to service connection for bilateral ankle disabilities is denied.

Entitlement to service connection for bilateral knee disabilities is denied.

Entitlement to service connection for a thoracolumbar spine disability is denied.

Entitlement to service connection for hypertension is granted.

FINDINGS OF FACT

1. The Veteran failed to report for a scheduled examinations of his shoulders, knees, ankles, spine, and hypertension on January 14, 2025. The Veteran did not offer good cause for failing to report or request that the examination be rescheduled.

2. The probative evidence of record does not establish a current diagnosis of bilateral shoulder disabilities.

3. The probative evidence of record does not establish a current diagnosis of bilateral ankle disabilities.

4. The probative evidence of record does not establish a current diagnosis of bilateral knee disabilities.

5. The probative evidence of record does not establish a current diagnosis of a thoracolumbar spine disability.

6. The Veteran's current hypertension was incurred during his period of active service with continuity to the present.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral shoulder disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for bilateral ankle disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for bilateral knee disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a thoracolumbar spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Marine Corps from November 2017 to November 2021.

The rating decision on appeal was issued in January 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that 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.

Failure to Report for Examination

Under 38 C.F.R. § 3.655(a), when entitlement to a benefit cannot be established without a current VA examination or reexamination and a veteran, without good cause, fails to report for such examination or reexamination, action shall be taken in accordance with 38 C.F.R. § 3.655(b) or (c) as appropriate. 38 C.F.R. § 3.655(b) applies to original or reopened claims or claims for increase, while 38 C.F.R. § 3.655(c) applies to running awards, when the issue is continuing entitlement. More specifically, 38 C.F.R. § 3.655(b) states "when a [veteran] fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a re-opened claim for benefit which was previously denied, or a claim for increase, the claim shall be denied." Examples of good cause include, but are not limited to, the illness or hospitalization of the Veteran, and death of an immediate family member. See 38 C.F.R. § 3.655.

In January 2025, the Veteran was scheduled to attend VA examinations regarding his claims for service connection for bilateral shoulder disabilities, bilateral ankle disabilities, bilateral knee disabilities, a thoracolumbar spine disability, and hypertension. The Veteran failed to report for the examination, did not request to reschedule his examinations, and did not provide good cause for his failure to report. The Veteran's claims for service connection are claims of original compensation. Accordingly, the Veteran's claims will be decided based on the evidence of record.

The Board acknowledges that the Veteran's April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), contained an argument by the Veteran that he missed the scheduled examination due to physical and mental health issues he was experiencing at the time. The Veteran argued that the examinations should be rescheduled, stating that he would attend. The Board does not find this argument persuasive.

That the Veteran was having physical and psychiatric difficulties at the time of the schedule examinations is not disputed. However, in his argument he states that he was "closed off from the world," and also had been recently hospitalized, which interfered with his ability to attend his examinations as scheduled. The Board does not find that the evidence of record at the time of the examination supports the finding of good cause to miss his examinations as scheduled or to not request that they be rescheduled in a timely manner.

The Veteran's VA treatment records, available at the time of the decision on appeal, document that he complained of flulike symptoms on a telehealth visit on January 4, 2025. The following day he attended a VA examination in connection with his claim of service connection for a psychiatric disability, which was granted in the decision also containing the claims now on appeal. At that time, he was found to have occupational and social impairment due to mild or transient symptoms that decreased ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. On January 10, 2025, he was briefly admitted to a VA medical facility with symptoms of an upper respiratory infection, but he was discharged the same day. Upon discharge, the nurse noted that he was not in any distress and he was alert and oriented. On January 14, 2025, the same date as the examinations scheduled in connection with the disabilities currently on appeal, the Veteran participated in a 44-minute psychotherapy session with a VA practitioner, in which he reported feeling "better after a brief stay on a medical floor for viral illness." At that time, he was found to exhibit a pleasant mood and he demonstrated logical, linear thought processes.

The evidence of record also includes a copy of the notice sent to the Veteran informing him of the date and time of his scheduled examinations, and the ability to request they be rescheduled, if needed. It also notified him that if he did not make a request to reschedule within five days of the original appointment date, his file would be returned for review. Further, in December 2024, the Veteran was notified in a separate rating decision that denied service connection for hearing loss that the denial was based on his failure to appear for the relevant examination. This further confirms that he had notice of the requirement to appear for his examinations or request they be rescheduled in a timely manner.

In this case, the Board does not find good cause has been established to miss the examinations as scheduled. While the record does document he was being treated for a respiratory infection and his service-connected psychiatric condition around the time of the scheduled examinations, there is no indication that he was so ill as to not be able to attend, or at the very least, request they be rescheduled. He had been briefly admitted to the hospital several days before for a respiratory infection, but there is no indication that it continued to significantly impact his health in the days after, and he was found to be without distress at the time of his discharge. In fact, the day of the examinations he participated in a psychotherapy session with a VA practitioner that found him to be of sound mind which indicates that he was alert and oriented and able to engage in his own medical treatment. The fact that he attended a VA examination in connection with his psychiatric disability claim less than two weeks prior to the missed examinations and also sought in-person medical treatment roughly four days prior, also demonstrates that he was capable of participating in the examination process at that time. Thus, there is no indication that he could not have attended the examinations as scheduled, or request they be rescheduled at a time when he could attend.

VA's duty to assist is not a one-way street and a Veteran must make efforts to comply with VA when it takes steps to develop his or her claim. Wood v. Derwinski, 1 Vet. App. 190 (1991). The Veteran has not argued that he did not receive notice of the examinations as scheduled, and the notice provided clear instructions on how to request they be rescheduled and notified him of the potential outcome of not attending. The Board is satisfied that VA met its duty to assist in providing examinations to the Veteran and if he was unable to attend as scheduled, he was obligated to timely notify VA of that fact such that it could provide him with new examinations and a more convenient time.

Accordingly, the Board does not find good cause has been established to miss the examinations and it will move forward with adjudicating the claims based on the evidence of record.

As noted above, if the Veteran would like VA to consider any new evidence in support of rescheduling the examinations in connection with the claims on appeal, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501.

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. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

In addition, certain chronic diseases, including hypertension, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309.

For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Regardless of whether a condition is listed as chronic for presumptive purposes, a continuity of symptoms from the time of service is a factor to consider in assessing any claim.

Service connection may also be granted for a condition which clearly and unmistakably preexisted service, where there is
.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309.

Service connection may also be granted for a condition which clearly and unmistakably preexisted service, where there is a finding that the disability increased during service, and that increase was not due to the natural progression of the disease. 38 U.S.C.A. §§ 1111, 1153; 38 C.F.R. §§ 3.304 (b), 3.306(a).

1. Entitlement to service connection for bilateral shoulder disabilities

2. Entitlement to service connection for bilateral ankle disabilities

3. Entitlement to service connection for bilateral knee disabilities

4. Entitlement to service connection a thoracolumbar spine disability

In the present case, the Veteran claims service connection for bilateral shoulder disabilities, bilateral ankle disabilities, bilateral knee disabilities, and a thoracolumbar spine disability.

As an initial matter the Board acknowledge the following favorable findings in the rating decision that it will not disturb: an in-service complaint of pain affecting the back, left and right ankles and left and right knees in July 2021.

As noted above, the Veteran did not attend the January 2025 VA examinations regarding his claimed disabilities.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

At present, the probative medical evidence of record does not establish a current diagnosis of bilateral shoulder disabilities, bilateral ankle disabilities, bilateral knee disabilities, or a thoracolumbar spine disability. The Veteran's VA treatment records note a single treatment for acute left shoulder pain, however, there was no diagnosis of a chronic shoulder disability reported. VA treatment records also note a Veteran provided history of bilateral knee and ankle swelling in March 2023, however, there was no diagnosis of chronic, bilateral knee or ankle disabilities reported. The medical treatment records available at the time of the decision on appeal were silent as to the right shoulder and low back.

To the extent that the Veteran, by virtue of his claims for these disabilities, asserts current pain affecting his ankles, shoulders, knees and back, he is competent to report observable symptoms in those joints. However, as a lay person, the Veteran is not competent to provide a diagnosis for his disability. Layno v. Brown, 6 Vet. App. 465, 471 (1994); Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007).

Further, while pain alone can constitute a disability for VA compensation purposes, that pain must result in some sort of "functional impairment," or in other words, must be compensable in nature. See Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018). Here, the evidence does not suggest that his pain, as reported, has actually caused functional impairment such that a disability could be established (i.e., loss or limitation of use of the joint). The medical evidence does not provide such detail beyond noting pain in several of the claimed joints, and the Veteran has not provided any description such that the Board could make a finding that he is truly limited by his pain for purposes of establishing functional loss.

In light of this, the Board must conclude that the evidence does not support a finding of a current disability in either the right or left shoulders, right or left ankles, right or left knees, and thoracolumbar spine. Thus, the primary criteria of service connection, namely a current disability, has not been established. When a disability has not been established based on the evidence of record, the Board need not evaluate the claim further.

or limitation of use of the joint). The medical evidence does not provide such detail beyond noting pain in several of the claimed joints, and the Veteran has not provided any description such that the Board could make a finding that he is truly limited by his pain for purposes of establishing functional loss.

Accordingly, entitlement to service connection for bilateral shoulder disabilities, bilateral ankle disabilities, bilateral knee disabilities, and/or a thoracolumbar spine disability is not warranted and the claims are denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

5. Entitlement to service connection for hypertension

The Veteran claims entitlement to service connection for hypertension.

As an initial matter, the Board recognizes the following favorable findings of the RO in its rating decision, which the Board will not disturb: (1) an in-service service diagnosis of hypertension on July 12, 2021, and (2) the condition is a chronic disease for purposes of presumptive service connection and the Veteran's length of service meets the criteria for a grant of service connection on a presumptive basis.

While the Veteran did not attend his VA examination in January 2025, the evidence of record, to include his VA treatment records clearly document a history of diagnosed hypertension between June 2023 and January 2025. Thus, the Board is satisfied that the Veteran has a current hypertension disability.

The RO has made a favorable finding of hypertension in a July 2021 in-service examination. A review of his service treatment records also indicate that by July 2021 he had been prescribed blood pressure medication.

The Veteran's entrance examination on June 19, 2017, does make a notation of elevated blood pressure. However, the record makes clear that this was a single incident of elevated blood pressure, and he was found to have an "elevated blood pressure reading without diagnosis of hypertension." Thus, the entrance examination rules out hypertension as pre-existing service. Further, subsequent blood pressure readings between June 19 and June 22, 2017, document sustained blood pressure below the statutory definition of that disease. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1) (Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm). Thus, the Board is satisfied that the Veteran was sound on entrance to service and did not have hypertension that preexisted service.

As noted above, the Veteran did not attend the January 2025 VA hypertension examination. However, even without this examination report, the Board is satisfied that the evidence supports a grant of service connection on a presumptive basis.

The evidence in this case clearly supports that the Veteran was first diagnosed with hypertension during active service, and was being medically treated for that condition with oral medication at the time of separation. VA treatment records from June 2023 document a diagnosis of hypertension with a several year history of that disorder. His condition continues to be documented through January 10, 2025, when he was hospitalized for an upper respiratory infection and confirmed to have a current diagnosis of hypertension. Although there is no confirmed medical documentation of hypertension between separation in November 2021, and the June 2023 documentation of hypertension in his VA treatment records, at that time the VA clinician found that the condition had existed for several years which corresponds to the 2021 in-service diagnosis. The Board finds that this confirms an in-service incurrence of the Veteran's hypertension with continuity to the time of the claim. As such, the criteria for a presumptive grant of service connection has been met and the claim should be granted.

As the Board is granting the claim on a presumptive basis, it need not also consider the claim on
he was hospitalized for an upper respiratory infection and confirmed to have a current diagnosis of hypertension. Although there is no confirmed medical documentation of hypertension between separation in November 2021, and the June 2023 documentation of hypertension in his VA treatment records, at that time the VA clinician found that the condition had existed for several years which corresponds to the 2021 in-service diagnosis. The Board finds that this confirms an in-service incurrence of the Veteran's hypertension with continuity to the time of the claim. As such, the criteria for a presumptive grant of service connection has been met and the claim should be granted.

As the Board is granting the claim on a presumptive basis, it need not also consider the claim on a direct basis.

M. Pryce

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. Riordan, 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.

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