Back to BVA DecisionsGRANTEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 250113-507617
SHOULDER IMPAIRMENT OF
REBECCA N. POULSON · 2026 · Case ID: A26034607
Summary
The veteran, who served from September 1990 to January 1998, appeals the denial of service connection for a right shoulder disability claimed as secondary to his service-connected bilateral knee disabilities. The veteran consistently reported that his right shoulder pain began after falls caused by his unstable knees, with his earliest statement attributing the pain to a 2001 fall, predating his claim. While multiple VA examiners addressed the claim, their opinions focused on the inability of knee issues to directly cause shoulder problems, failing to address the veteran's theory of injury from falls. The Board found these opinions inadequate because they were based on inaccurate factual premises and did not consider the veteran's specific contentions. The Board determined that the evidence was in equipoise, giving the veteran the benefit of the doubt. Service connection for the right shoulder disability is therefore granted.
Rationale
Veteran's consistent reports of falls due to knee instability; Early statements predating claim corroborate injury theory; VA opinions inadequate for failing to address Veteran's theory
Full Decision Text
Citation Nr: A26034607 Decision Date: 04/14/26 Archive Date: 04/14/26 DOCKET NO. 250113-507617 DATE: April 14, 2026 ORDER Service connection for a right shoulder secondary to service connected bilateral knee disabilities is granted. FINDING OF FACT The Veteran's right shoulder disability was caused by falls due his to service-connected bilateral knee instability. CONCLUSION OF LAW The criteria for secondary service connection for a right shoulder disability are met. 38 U.S.C. §§ 1101, 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.310 (2025). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1990 to January 1998. This appeal is before the Board of Veterans' Appeals (Board) from a January 2025 rating decision of the agency of original jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO). In July 2024, the Veteran submitted a supplemental claim requesting readjudication of service connection for a right shoulder disability, most recently addressed in a July 2022 higher-level review (HLR) decision. In October 2024, the AOJ issued a supplemental claim decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. In November 2024, the Veteran requested HLR of this denial. In a November 2024 HLR decision, the higher-level reviewer determined that there had been a duty to assist error and returned the claim to the supplemental claim decision review option for additional development. The January 2025 rating decision on appeal confirmed the denial of service connection. In his January 2025 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 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the January 2025 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, he 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. The Board recognizes that in December 2025 the Veteran submitted a request under the Privacy Act that VA has acknowledged but not fulfilled. Pending requests under the Privacy Act must be reviewed and processed before the Board can adjudicate an appeal. 38 C.F.R. § 20.1200. Here, however, the Veteran withdrew the request several days after submitting it, and the Board is granting the claim in full. Thus, the Board finds no prejudice in adjudicating his appeal. Entitlement to service connection for a right shoulder right shoulder disability, to include as secondary to bilateral knee disabilities The Veteran claims service connection for a right shoulder disability. The October 2024 rating decision found that new and relevant evidence had been received to readjudicate this claim. This is a favorable finding by the AOJ, and the Board will proceed to the address the claim on the merits. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c). 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 requires: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due 3.303(a). Service connection requires: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury." See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023). For "aggravation of non-service-connected disabilities" it is enough to show that a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. For certain chronic diseases, such as arthritis, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Service treatment records do not reflect any symptoms of or treatment for a right shoulder disability. No such abnormality was noted at the Veteran's November 1997 separation examination, and in the accompanying report of medical history he expressly denied having ever experienced a painful or trick shoulder. At a June 1999 VA examination for the joints, the Veteran described left shoulder pain but did not report any right shoulder symptoms. Private treatment records reflect that in September 2006 the Veteran reported significant right shoulder pain. An MRI ruled out cervical radiculopathy. In December 2006 he underwent arthroscopic anterior capsulolabral repair and rotator interval closure. He returned in January 2012, reporting a history of right shoulder pain since a 2001 fall. He stated that he underwent surgery in 2004 and 2006. He was diagnosed with a subscapularis sprain, bicipital tenosynovitis, and rotator cuff tendonitis or bursitis. In November 2012 he reported continued pain and problems in his right shoulder. In December 2012 he underwent labral repair biceps release. He was diagnosed with a superior labrum anterior and posterior (SLAP) lesion, shoulder osteoarthritis, and rotator cuff tendonitis and bursitis. In January 2013 he reported that he fell a few days prior, landing on his right shoulder against a set of stairs. In June 2013 he reported continued stiffness in his shoulder. In January 2014 he reported increased pain with snow shoveling and heavy lifting. In March 2014 he reported pain and weakness in the shoulder girdle. In April 2014 his orthopedist found that he had plateaued with in his right shoulder. In December 2012 he underwent labral repair biceps release. He was diagnosed with a superior labrum anterior and posterior (SLAP) lesion, shoulder osteoarthritis, and rotator cuff tendonitis and bursitis. In January 2013 he reported that he fell a few days prior, landing on his right shoulder against a set of stairs. In June 2013 he reported continued stiffness in his shoulder. In January 2014 he reported increased pain with snow shoveling and heavy lifting. In March 2014 he reported pain and weakness in the shoulder girdle. In April 2014 his orthopedist found that he had plateaued with continued significant pain and limitations in the right shoulder. An MRI showed no obvious tear in his rotator cuff. In September 2014 he reported increased right shoulder pain. He was diagnosed with a partial thickness tear of the right rotator cuff. He reported worsening pain in November 2014. He underwent nerve studies which were effectively normal. In December 2014 he underwent surgery, specifically a right shoulder capsular release procedure. In July 2015 he reported reduced pain but felt he did not have great ranges of motion. He was diagnosed with right shoulder bursitis. In October 2015 he reported intermittent episodes of discomfort with reaching activities. He was diagnosed with right shoulder bursitis with a history of adhesive capsulitis and resolving right ulnar neuropathy. In April 2016 he reported that he reinjured his shoulder at the end of March when he lifted something at work. An MRI showed an intact rotator cuff. In June 2016 he was diagnosed with bursitis. VA treatment records reflect that at an April 2017 orthopedic consultation, the Veteran reported a history of four arthroscopic debridements in his right shoulder. Private treatment records reflect that in October 2017, while the Veteran was being treated several months following his left shoulder surgery, he reported increased pain in both shoulders. In December 2017 he was diagnosed with bilateral shoulder bursitis with arthritis in the right shoulder. In March 2018 he underwent arthroscopic debridement. He reported improvement thereafter until October 2018, when he reported increased pain at rest. In December 2018, he underwent total shoulder replacement surgery. In January 2019 he reported that he tripped and fell, concerned that he might have reinjured something. He reported improvement thereafter. In August 2019, his orthopedist found that he had reached maximal medical improvement. In his December 2021 initial claim, the Veteran attributed his bilateral shoulder disabilities to falls caused by his service-connected instability of the knees. The Veteran underwent a VA examination in December 2021. He reported an onset of right shoulder pain in 2006-07 due to falls caused by knee instability. He was diagnosed with status post right shoulder tendon repair and right ulnar nerve transposition. The examiner opined that the disability was less likely than not caused by his service-connected knee disabilities. This opinion was based on the rationale that the conditions were not medically related with no support for a causal relationship in the medical literature. At a separate December 2021 VA examination for his knee disabilities, he reported that he used to fall a lot due to his instability, injuring himself and causing more pain. He was diagnosed with recurrent patellar instability. In May 2022, the AOJ obtained a medical opinion from another VA examiner based on review of the record. The examiner opined that the Veteran's disability was less likely than not caused by his service-connected knee disabilities. This opinion was based on the rationale that there was no clear evidence from review of the orthopedic literature to suggest that an injury to one joint would have any significant impact on another uninjured limb unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shorting of the injured limb resulting in a leg length discrepancy causing an obvious Trendelenburg gait. The examiner explained that this level of severity is not supported by the record. The examiner further addressed his claim that his shoulder condition was the result of frequent falls, stating that there was no documentation within the claims file to support the claim that a fall resulted in his shoulder injury. In his July 2024 supplemental claim, the Veteran again stated that his right shoulder disability was the result of his service-connected instability of the bilateral knees. The Veteran underwent another VA examination in October 2024. He reported that in 2004 his knee gave out, and as he was falling, he grabbed something off a truck to catch himself and felt pain in his right shoulder. He was initially diagnosed with a right Trendelenburg gait. The examiner explained that this level of severity is not supported by the record. The examiner further addressed his claim that his shoulder condition was the result of frequent falls, stating that there was no documentation within the claims file to support the claim that a fall resulted in his shoulder injury. In his July 2024 supplemental claim, the Veteran again stated that his right shoulder disability was the result of his service-connected instability of the bilateral knees. The Veteran underwent another VA examination in October 2024. He reported that in 2004 his knee gave out, and as he was falling, he grabbed something off a truck to catch himself and felt pain in his right shoulder. He was initially diagnosed with a right shoulder strain. Later that year, as he went to move something his shoulder popped, and his arm turned purple. He was diagnosed with a torn ligament. He underwent surgery in November 2004, followed by another fall with a second injury to his right arm, tearing his ligaments and requiring additional surgery in 2006. He had subsequent pain and additional surgeries. The examiner diagnosed degenerative arthritis, a shoulder strain, bursitis, a partial shoulder replacement, and status post tendon repair and ulnar nerve transposition. The examiner opined that the disability was less likely than not caused by his knee instability. This opinion was based on the rationale that there was no clear evidence from review of the orthopedic literature to suggest that an injury to one joint would have any significant impact on another uninjured limb unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shorting of the injured limb resulting in a leg length discrepancy causing an obvious Trendelenburg gait. The examiner explained that this level of severity is not supported by the record. This rationale was almost word-for-word identical to the first half of the May 2022 rationale, though it omitted the portion that actually addressed the Veteran's theory of service connection. In December 2023, the AOJ obtained a medical opinion from another VA examiner based on review of the record. The examiner opined that the Veteran's disability was less likely than not caused by his service-connected knee disabilities. This opinion was based on the rationale that review of the medical literature did not support a causative relationship. Later that month, the examiner was requested to provide an addendum opinion to address the Veteran's contentions. The examiner provided a second opinion which again completely failed to address the Veteran's contentions of a shoulder injury due to falls caused by knee instability. The Board finds that the evidence is at least in equipoise as to whether the Veteran's right shoulder disability was caused by his service-connected instability of the bilateral knees. He has consistently reported that his right shoulder pain began after a fall due to his unstable knees. These reports are consistent with a January 2012 treatment record, in which he attributed his shoulder pain to a fall he experienced in 2001. Notably, this statement was made nearly 10 years before his initial December 2021 claim, and as such could not have been made for the purpose of obtaining benefits. Multiple VA examiners have addressed this claim, and all of them focus their rationales on the fact that a knee disability cannot "spread" to the shoulder, which the Veteran has never contended. The May 2022 VA examiner addressed the Veteran's theory at the end of the rationale, erroneously stating that there was no documentation in the claims file of the shoulder injury being related to a fall. Medical opinions have no probative value when they are based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 548 (1993). The Board finds that none of the VA opinions that have been provided are adequate for adjudication and cannot be afforded any probative weight. Moreover, in light of the multiple attempts to obtain an adequate opinion that addresses the Veteran's contention, the Board determines that remand would be futile. The Board finds the most probative evidence to be the Veteran's own statements as corroborated by his treatment records. For these reasons, the Board finds that the evidence is at least in equipoise as to whether the Veteran's right shoulder disability was caused by his service-connected instability of the bilateral knees. Service connection is therefore granted. Rebecca N. Poulson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Gallagher, 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. corroborated by his treatment records. For these reasons, the Board finds that the evidence is at least in equipoise as to whether the Veteran's right shoulder disability was caused by his service-connected instability of the bilateral knees. Service connection is therefore granted. Rebecca N. Poulson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Gallagher, 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.