SHOULDER IMPAIRMENT OF

L.M. YASUI · 2026 · Case ID: A26039499

DENIED

Summary

The veteran, who served from August 2010 to August 2014, including Gulf War Service and deployment for Operation Enduring Freedom, appeals the denial of service connection for left shoulder strain, left knee strain, hemorrhoids, and right shoulder paralabral cysts. The veteran testified to an in-service left shoulder injury from a rock hitting his backpack and a left knee injury from stepping into a hole during training. He also reported a diagnosis of internal hemorrhoids during service. However, service treatment records showed only a left shoulder contusion, no record of knee injury treatment, and only intermittent hemorrhoid issues without ongoing care. Post-service records and VA examinations in September 2018 found no significant abnormalities in the left shoulder or knee, and negative nexus opinions for all claimed conditions, citing lack of chronicity, inconsistent reports, and absence of degenerative changes. The Board found the evidence weighed against service connection for the left shoulder, left knee, and hemorrhoids. For the right shoulder paralabral cysts, the veteran claimed secondary service connection due to overcompensation for the left shoulder, but since the left shoulder claim was denied, this secondary claim was also denied as a matter of law. Service connection for all claimed conditions was denied.

Rationale

No record of ongoing care following in-service injury; Negative recent x-rays; No record of degenerative changes

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210707-170528

Full Decision Text

Citation Nr: A26039499
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210707-170528
DATE: April 28, 2026

ORDER

Entitlement to service connection for left shoulder strain (claimed as left shoulder pain/cysts) is denied.

Entitlement to service connection for left knee strain (claimed as left knee pain/dislocation) is denied.

Entitlement to service connection for hemorrhoids is denied.

Entitlement to service connection for right shoulder paralabral cysts (claimed as right shoulder pain/dislocation), to include as secondary to left shoulder strain, is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that left shoulder strain (claimed as left shoulder pain/cysts), left knee strain (claimed as left knee pain/dislocation) or hemorrhoids began during active service or are otherwise related to an in-service injury or disease.

2. The Veteran's right shoulder paralabral cysts disability (claimed as right shoulder pain/ dislocation) is not secondary to left shoulder strain and is not otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

1. The criteria for service connection for left shoulder strain (claimed as left shoulder pain/cysts), left knee strain (claimed as left knee pain/dislocation), and hemorrhoids, and right shoulder paralabral cysts (claimed as right shoulder pain/ dislocation), are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

2. The criteria for service connection for right shoulder paralabral cysts (claimed as right shoulder pain/ dislocation) are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served active duty from August 2010 to August 2014, including Gulf War Service and deployment for Operation Enduring Freedom.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2021rating decision (RD) issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned Veterans Law Judge on October 31, 2024, and a transcript associated with the claims file.

Therefore, the Board may only consider the evidence of record at the time of the April 2021 agency of original jurisdiction (AOJ) decision on appeal, 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 decision on appeal 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 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 claims, 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 thoroughly reviewed all evidence in the Veteran's file. In every decision, the Board must provide a statement of the reasons and bases for its determination, adequate to enable an appellant to understand the precise basis for the Board's decision, as well as to facilitate review by the Court. 38?U.S.C. §?7104(d)(1). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15?Vet. App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?
38?U.S.C. §?7104(d)(1). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15?Vet. App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?Vet. App.?122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

Service connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

1. Entitlement to service connection for left shoulder strain (claimed as left shoulder pain/cysts)

2. Entitlement to service connection for left knee strain (claimed as left knee pain/dislocation)

3. Entitlement to service connection for hemorrhoids

The Veteran contends entitlement to service connection for left shoulder and left knee disabilities based on in-service injuries. He testified that his left shoulder was injured in 2010 during boot camp when a chunk of concrete was kicked and it hit on the backpack strap over his left shoulder. The Veteran further testified that cysts were found in his left shoulder joints after separation. He contends shoulder pain and limited range of motion continued in October 2024. See October 2024 Hearing transcript, pgs. 4, 8. 9. The Veteran testified that his left knee was injured in his first few months of training at Camp Lejeune when he stepped into a hole and again when he later jumped off a tailgate and his ankle landed crookedly. Id. at 9, 12. He contends continuous knee pain and that he was told he would need a knee replacement in the future. Id. at 9. The Veteran contends entitlement to service connection for hemorrhoids based on diagnosis in 2011 during active service. He contends flare-ups continued every week or two in October 2024. See October 2024 Hearing transcript, pg. 13, 14.

It is undisputed that the Veteran has a current diagnosis of left shoulder strain, left knee strain, and hemorrhoids. See September 2018 VA examinations.

The question for the Board is whether the Veteran has current disabilities that began during service or are at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of left shoulder strain, left knee strain, and hemorrhoids, and evidence shows that the Veteran was treated for a left shoulder injury and hemorrhoids in service and his separation report of medical examination noted left knee and rectal bleeding, the evidence of record persuasively weighs against finding that the Veteran's left shoulder strain, left knee strain, and hemorrhoid disabilities began during service or are otherwise related to an in-service injury, event, or disease.

The Veteran's November 2009 report of medical examination for enlistment indicates neck, upper and lower extremities, spine, other musculoskeletal systems, and anus and rectum systems were normal. See VBMS entry document type "STR," receipt date 07/26/2018, pg. 59. In October 2010, the Veteran reported left shoulder pain after being hit by a medium sized rock. He was diagnosed with left shoulder contusion with intact skin. See VBMS entry document type "STR," receipt date 07/26/2018, pgs. 48, 49. While on leave after completing boot camp and one month of combat training, the Veteran sought care in a private emergency room in January 2011 for emotional distress. He denied medical conditions and physical examination of neck, back, and extremities was normal. See VBMS entry document type "Medical Treatment Record-
systems were normal. See VBMS entry document type "STR," receipt date 07/26/2018, pg. 59. In October 2010, the Veteran reported left shoulder pain after being hit by a medium sized rock. He was diagnosed with left shoulder contusion with intact skin. See VBMS entry document type "STR," receipt date 07/26/2018, pgs. 48, 49. While on leave after completing boot camp and one month of combat training, the Veteran sought care in a private emergency room in January 2011 for emotional distress. He denied medical conditions and physical examination of neck, back, and extremities was normal. See VBMS entry document type "Medical Treatment Record-Non-Government Facility," receipt date 07/02/2018, pgs. 2, 7, 8.

On a January 2011 arrival screening form, the Veteran reported that he was treated at the medical clinic during basic training after being hit with a rock. See VBMS entry document type "Medical Treatment Record-Non-Government Facility," receipt date 07/02/2018, pg. 21. In October 2011, the Veteran reported two episodes of bloody stools and was diagnosed with internal hemorrhoids. See VBMS entry document type "STR," receipt date 07/26/2018, pg. 15. The Veteran reported on the July 2014 report of medical assessment for separation that he had suffered injury of his back, left knee and left ankle, with pain and popping of the joints, for which he did not seek medical care. He was found medically fit for separation. See VBMS entry document type "Medical Treatment Record-Non-Government Facility," receipt date 07/02/2018, pgs. 45-46. The service treatment records contain no documentation of issues with the left shoulder, left knee, or hemorrhoids other than that discussed above.

Post-service, VA primary care provider noted the Veteran's report in January 2017 of right shoulder and left knee and ankle muscle or joint pain and stiffness. See VBMS entry document type "CAPRI," receipt date 04/16/2021, pg. 708, 709. Bilateral shoulder and bilateral knee x-rays in April 2017 revealed no osseous or articular abnormalities. Id. at 684. The Veteran began physical therapy in June 2017 for right shoulder pain for four to six years. Id. at 637. In July 2017, the Veteran reported to his VA mental health care provider that he had a history of knee dislocation. Id. at 565. Right shoulder, left ankle, and bilateral knee pain were reported by the Veteran in August 2017. Id. at 595. A September 2017 magnetic resonance imaging (MRI) of the left shoulder revealed minimal left shoulder joint effusion and no acute rotator cuff tear. Id. at 532. VA orthopedic treating provider noted in October 2017 the Veteran's report of bilateral shoulder pain, right greater than left, and found tenderness of the acromioclavicular joints, but no edema or deformity, on examination. Bilateral shoulder arthralgia was diagnosed. Id. at 485. In October 2019, the Veteran reported lower back and left ankle pain, reporting he had injured his ankle when he stepped in a hole during service, without mention of knee issue. Id. at 141. No further complaints or treatment for shoulder or knee issues were noted in the VA treatment records for the period on appeal. Despite consistent treatment at the VA from January 2017 and throughout the period on appeal, there is no mention of hemorrhoids or over the counter use of medications to treat hemorrhoids.

Following the October 2024 Board hearing, the Veteran submitted medical records from a private primary care provider. The Veteran sought care in January 2019 to establish care and to obtain a second opinion disability evaluation for VA compensation. However, the provider indicated he did not perform disabilities evaluations. The Veteran reported a history of back and knee arthritis; tissue and muscle damage in his right shoulder with painful motion and lifting; and frequent, intermittent diarrhea that is worse with fatty foods or when he is anxious. He denied melena. The provider included hemorrhoids as an active problem and diagnosed irritable bowel syndrome. Chronic right shoulder pain was also diagnosed, and the Veteran was referred to orthopedics. See VBMS entry document type "Medical Treatment Record-Non-Government Facility," receipt date 01/21/2025. No diagnosis of the left shoulder, left knee, or hemorrhoids were provided.

The Veteran was afforded a VA examinations in September 2018 for left shoulder, left knee, and hemorrhoid disabilities.

The Veteran denied injury to his left shoulder and reported he was diagnosed with
and muscle damage in his right shoulder with painful motion and lifting; and frequent, intermittent diarrhea that is worse with fatty foods or when he is anxious. He denied melena. The provider included hemorrhoids as an active problem and diagnosed irritable bowel syndrome. Chronic right shoulder pain was also diagnosed, and the Veteran was referred to orthopedics. See VBMS entry document type "Medical Treatment Record-Non-Government Facility," receipt date 01/21/2025. No diagnosis of the left shoulder, left knee, or hemorrhoids were provided.

The Veteran was afforded a VA examinations in September 2018 for left shoulder, left knee, and hemorrhoid disabilities.

The Veteran denied injury to his left shoulder and reported he was diagnosed with cysts in the shoulder. He reported current symptoms of pain radiating from the left shoulder into his neck, intermittent pain provoked with certain movements, and constant feeling of weakness in the right shoulder. The VA examiner for shoulder disability noted that "the Veteran's subjective report of injury to his right shoulder during service was inconsistent with objective evidence in the service treatment records of injury which occurred to the left shoulder. Veteran also reported cysts in the left shoulder, however, MRI reports reviewed are positive for paralabral cysts in right shoulder only." A negative nexus opinion regarding the left shoulder was provided based on acute condition during service, no chronicity of care following the in-service injury, denial of chronic shoulder pain on the separation medical report, and MRI of the left shoulder showing no significant abnormality to the left shoulder.

The Veteran reported he injured his knee in March 2011 and was told he had a pulled tendon. There is no record in the service treatment records in evidence of treatment for a knee injury in March 2011. His current symptoms were pain on both sides of the left patella with swelling. The VA examiner noted diagnosis of left knee strain. A negative nexus opinion regarding the left knee was provided based on no record of ongoing care following the inservice injury, negative recent x-rays, and no record of degenerative changes in the left knee.

The Veteran reported diagnosis of hemorrhoids in service for which he was given Preparation H. He reported some improvement in symptoms with recurrent flareups. On examination small or moderate external hemorrhoids were noted. A negative nexus opinion regarding hemorrhoids was provided based on an acute condition during service with no record of ongoing or chronicity of care inservice or after separation.

The September 2018 VA examiners possessed the necessary education, training, and expertise to provide the requested opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the examiners provided detailed rationales for their opinion, which were based on thorough review of the service treatment records, post-service treatment records, and lay statements of the Veteran. The September 2018 VA examiners' opinions considered an accurate history, were definitive, and were supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodrigues v. Peake, 22 Vet. App. 295 (2008). Thus, the Board affords the September 2018 VA examinations for shoulder, knee, and hemorrhoid disabilities significant probative value.

Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claims for service connection for shoulder, knee, or hemorrhoid disabilities. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991).

In summary, the Board finds the probative and persuasive evidence does not support a finding of service connection for the Veteran's left shoulder strain, left knee strain, or hemorrhoids.

Specifically, service treatment records show the Veteran was treated in October 2010 for a left shoulder contusion, in October 2011 for hemorrhoids, and the Veteran reported treatment in March 2011 for a left knee injury. No evidence of further treatment for left shoulder, knee, or hemorrhoids issues during service is in the claims file. Separation medical report in May 2014 noted the left knee and rectal bleeding issues but did not include left shoulder issues. Post-service, the Veteran reported right shoulder and left knee pain in January 2017. Bilateral shoulder and bilateral knee x-rays in April 2017 revealed no osseous or articular abnormalities. A September 2017 magnetic resonance imaging (MRI) of the left shoulder revealed minimal left shoulder joint effusion and no acute rotator cuff tear. Id. at 532. In September 2018, the Veteran denied injury to the left shoulder and reported to the VA examiner that his issues involved his right
of further treatment for left shoulder, knee, or hemorrhoids issues during service is in the claims file. Separation medical report in May 2014 noted the left knee and rectal bleeding issues but did not include left shoulder issues. Post-service, the Veteran reported right shoulder and left knee pain in January 2017. Bilateral shoulder and bilateral knee x-rays in April 2017 revealed no osseous or articular abnormalities. A September 2017 magnetic resonance imaging (MRI) of the left shoulder revealed minimal left shoulder joint effusion and no acute rotator cuff tear. Id. at 532. In September 2018, the Veteran denied injury to the left shoulder and reported to the VA examiner that his issues involved his right shoulder. He then sought a second opinion for VA compensation regarding right shoulder disability and frequent diarrhea from a private provider in January 2019 without left shoulder or knee complaints and no diagnosis provided for left shoulder, left knee, or hemorrhoids.

The Veteran believes his left shoulder, left knee, and hemorrhoid disabilities are related to service. However, the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical records and medical examinations with associated opinions.

As discussed above, the September 2018 VA examiners' opinions are probative, as they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

For all the reasons discussed above, the weight of the probative evidence is against the claim for service connection for left shoulder strain, left knee strain, and hemorrhoids. Accordingly, the benefit of the doubt doctrine is not for application, and the Veteran's claim for service connection is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

4. Entitlement to service connection for right shoulder paralabral cysts (claimed as right shoulder pain/ dislocation)

The Veteran contends entitlement to service connection for right shoulder disability because overcompensating for injury to his left shoulder caused issues with his right shoulder. See October 2024 Hearing transcript, pg. 6.

Service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. However, in light of the decision above that denied entitlement to service connection for a left shoulder disability, the claim of secondary service connection for right shoulder disability must be denied. Where the underlying disability is not service connected, the claim of secondary service connection has no foundation and must be denied as a matter of law. 38 C.F.R. § 3.310; see Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the Board should deny the claim on the ground of lack of legal merit).

It is undisputed that the Veteran has a current diagnosis of right shoulder paralabral cysts identified by MRI in September 2017. See VBMS entry document type "C&P Exam," receipt date 10/03/2018, pg. 2; VBMS entry document type "CAPRI," receipt date 04/16/2021, pg. 532.

The Veteran's November 2009 report of medical examination for enlistment indicates neck, upper and lower extremities, spine, and other musculoskeletal systems were normal. See VBMS entry document type "STR," receipt date 07/26/2018, pg. 59. While on leave after completing boot camp and one month of combat training, the Veteran sought care in a private emergency room in January 2011 for emotional distress. He denied medical conditions and physical examination of neck, back, and extremities was normal. See VBMS entry document type "Medical Treatment Record-Non-Government Facility," receipt date 07/02/2018, pgs. 2, 7, 8. The Veteran reported on the July 2014 report of medical assessment for separation that he had suffered injury of his back, left knee and left ankle, with pain and popping of the joints, for which he did not seek medical care. He was found medically fit for separation. Id. at 45-46. The service treatment records contain no documentation of issues with right shoulder.

Post-service, VA primary care provider noted the Veteran's report in January 2017 of right shoulder muscle or joint pain and stiffness. See VBMS entry document type "CAPRI," receipt date 04/16/2021, pg. 708. Bilateral shoulder x-rays in April 2017 revealed no osseous or articular abnormalities. Id. at 684. The Veteran began physical therapy in June 2017 for right shoulder pain he reported had begun four to six years before. Id. at 637. VA orthopedic treating provider noted in October 2017 the Veteran's report of bilateral shoulder pain, right greater than left, and found tenderness of the acromioclavicular joints, but no edema or deformity, on examination. Bilateral shoulder arthralgia was diagnosed. Id. at 485. VA polytrauma traumatic brain injury evaluation in January 2019 included a diagnosis of right shoulder bicipital tendinitis with impingement syndrome. Id. at 382. No further complaints or treatment for shoulder issues were noted in the VA treatment records for the period on appeal.

The Veteran was afforded a VA examination in September 2018 regarding a claim for left shoulder disability. The VA examiner noted that "the Veteran's subjective report of injury to his right shoulder during service was inconsistent with objective evidence in the service treatment records of injury which occurred to the left shoulder. Veteran also reported cysts in the left shoulder, however, MRI reports reviewed are positive for paralabral cysts in right shoulder only."

A review of the records in evidence does not indicate, and the Veteran does not contend, that his right shoulder disability is directly related to service. Instead, the Veteran only contends this condition is related to his non-service-connected left shoulder disability. Thus, the Board finds that the Veteran's right shoulder disability is denied as a matter of law.

L.M. YASUI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Spears, J.E.

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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