DEGENERATIVE ARTHRITIS OF THE KNEE

Summary

The Veteran served from August 8, 1984, to June 5, 1987, and November 8, 1988, to November 7, 1992. The Veteran appealed the denial of service connection for left knee disability, acid reflux disease, urinary incontinence, and bilateral shoulder disabilities. The Board granted service connection for the left knee disability, finding that the evidence was in approximate balance and resolving doubt in the Veteran's favor, citing a favorable VA examination from June 2021 that linked degenerative arthritis to repetitive stress from service. The Board denied service connection for acid reflux disease and urinary incontinence, finding that the evidence persuasively weighed against a nexus to service, noting the lack of contemporaneous treatment for GERD post-service and the significant gap between UTI treatment and current voiding dysfunction. The claims for right and left shoulder disabilities were remanded for a VA examination, as the Veteran reported in-service problems and continuity of symptoms, and her MOS involved physical rigors, but she had not yet received a VA examination for these specific conditions. The Board found a duty to assist error in failing to provide these examinations.

Rationale

Favorable VA examination linked degenerative arthritis to repetitive stress from service; Veteran reported knee pain during service and continuity of symptoms; Benefit of the doubt applied due to approximate balance of evidence

Full Decision Text

Citation Nr: A26040412
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210914-185723
DATE: April 29, 2026

ISSUES

1. Entitlement to service connection for left knee disability (hereinafter, "left knee disability".)

2. Entitlement to service connection for acid reflux disease.

3. Entitlement to service connection for urinary incontinence.

4. Entitlement to service connection for right shoulder (hereinafter, "right shoulder disability".)

5. Entitlement to service connection for left shoulder (hereinafter, "left shoulder disability".

ORDER

Entitlement to service connection for left knee disability is granted, subject to the laws and regulations governing the payment of monetary benefits.

Entitlement to service connection for acid reflux disease is denied.

Entitlement to service connection for urinary incontinence is denied.

REMANDED

Entitlement to service connection for a right shoulder disability is remanded.

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

FINDINGS OF FACT

1. Resolving all doubt in favor of the Veteran, her left knee disability is related to service.

2. The probative evidence of record persuasively weighs against finding that the Veteran's acid reflux had onset during service or is otherwise etiologically related to service. 

3. The probative evidence of record persuasively weighs against finding that the Veteran's urinary incontinence had onset during service or is otherwise etiologically related to service. 

CONCLUSIONS OF LAW

1. The criteria for service connection for a left knee disability have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.303, 3.304.

2. The criteria for service connection for acid reflux have not been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.303, 3.304.

3. The criteria for service connection for urinary incontinence have not been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 8, 1984 to June 5, 1987, and from November 8, 1988, to November 7, 1992.

This matter comes before the Board of Veterans' Appeals (Board) from June 2021 and August 2021 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO).  The June 2021 rating decision denied the Veteran's service connection claim for her left knee disability. The August 2021 rating decision denied the Veteran service connection claims for acid reflux disease, urinary incontinence and bilateral shoulder disabilities (right and left shoulder). 

In a September 2021, VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. A Board hearing was held on May 2025.  

Therefore, the Board may only consider the evidence of record at the time of the June 2021 and August 2021 rating decisions on appeal, as well as any evidence submitted by the Appellant 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.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 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
.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.

Service Connection

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

Certain chronic diseases will be presumed to have been incurred in service if manifested to a compensable degree of at least 10 percent disabling within one year after service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. If a chronic disease enumerated in 38 U.S.C. § 1101(a) or 38 C.F.R. § 3.309 is diagnosed after separation from service, the nexus requirement of a claim for service connection can be proven by evidence of a continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). It follows that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 

Entitlement to service connection for a left knee disability.

The Veteran contends that her left knee disability is related to service.  Alternatively, the Veteran asserts that her left knee disability has been aggravated by her service-connected bilateral pes planus with plantar fasciitis and right knee.  plantar fasciitis and pes planus and right knee.  See May 8, 2025, VA Form 21-4138, Statement in Support of Claim.

In her May 2025, Board Hearing, the Veteran testified that she was diagnosed with tendonitis during service in October 1984. The Veteran also testified that in 1985, she was diagnosed with myalgia. The Veteran testified that her third incident in service came from playing basketball. Further, the Veteran testified that her knee disability is related to participation in field artillery, regularly dropping down to her knees, maintenance related to her MOS, heavy lifting and pulling. The Veteran testified that she sought treatment for her knee during her second tour of duty but could not recall the dates. The Veteran testified that she first went to see a doctor about her knees in 1998 and was told that it was offset arthritis. The Veteran testified that during service, she was offered a separation examination but declined because she was pregnant. The Veteran testified that she continued to have problems with her knee ever since her separation from service and that she has used Icy Hot to help combat knee soreness. See May 2025, Board Hearing transcript, pgs. 4-10.

Regarding a current disability, in the July 2021 rating decision, the AOJ found that the Veteran has been diagnosed with a disability: December 2020 VA treatment records document complaints of knee pain.

Regarding an inservice event or injury, an October 1984 STR documents the Veteran's complaint of bilateral lower leg pain for 3 weeks. It its noted, bilateral foot, hand and legs swell. In an October 1985 STR, it is noted, the Veteran complained of pain, left lower leg, 3 days.  The STR documents' pain is radiating from the hip area down to left foot. The Veteran denies any trauma any past history of complaint. It is noted left hamstring, tight, minimal effusion, knee joint capsule stable. The Veteran is diagnosed with myalgia. The Veteran is placed on a profile to stretch prior to running. February 1987 STR documents, trauma past 72 hours. The Veteran complained of knee soreness after playing basketball. It is noted, no swelling or deformity. 

Regarding a nexus to service in a June 2021, Knee and Lower leg examination, the Veteran was diagnosed with degenerative arthritis of the left knee. The examiner documented the Veteran's report that during
 lower leg, 3 days.  The STR documents' pain is radiating from the hip area down to left foot. The Veteran denies any trauma any past history of complaint. It is noted left hamstring, tight, minimal effusion, knee joint capsule stable. The Veteran is diagnosed with myalgia. The Veteran is placed on a profile to stretch prior to running. February 1987 STR documents, trauma past 72 hours. The Veteran complained of knee soreness after playing basketball. It is noted, no swelling or deformity. 

Regarding a nexus to service in a June 2021, Knee and Lower leg examination, the Veteran was diagnosed with degenerative arthritis of the left knee. The examiner documented the Veteran's report that during service, she had to do a lot field exercises. The examiner documented the Veteran engaged in combat duties where she had to bend and drop down to prone positions.  The examiner documented that Veteran was required to do ruck sack exercise and road marches for about 12 to 15 miles.  The examiner documented that the Veteran had to stand and walk for long periods of time.  The examiner documented the Veteran's report that she started having knee pain during service and she was taking motrin prn. The examiner documented that her knee pain limited what she used to do like running, spin classes, walking, and exercise. See June 1, 2021, Knee and Lower leg examination.  

After reviewing the pertinent evidence of record and conducting a physical examination of the Veteran, the June 2021 examiner rendered a positive nexus opinion.  The examiner reasoned that repetitive stress injuries will cause progressive damage to the joint. The examiner stated that osteoarthritis can affect any joint in the body.  The examiner noted that the Veteran was diagnosed with degenerative joint disease to the bilateral knee that got worse over the years. The examiner noted that pain onset started when Veteran was in service due to extended walking, standing and bending that causes pressure to the joint bilaterally. See June 1, 2021, Medical Opinion.

Following this June 1, 2021 examination and medical opinion, the AOJ obtained a June 30, 2021 VA examination and medical opinion in which the examiner diagnosed the Veteran with left knee tendonitis and documented a similar medical history as noted by the June 1, 2021 examiner.  The June 30, 2021 examiner, however, rendered a negative nexus opinion.  In the June 30, 2021 medical opinion the examiner stated that after reviewing medical records dated February 4, 1987 [referring to the Veteran's basketball related injury during service] and performing a physical exam, it is less likely than not that the Veteran's left knee condition is related to military service as there are no medical records showing diagnosis, treatment for the left knee condition during active duty.

The Board finds the June 1, 2021 VA examination and medical opinion adequate and probative in this adjudication. The Board observes that the examiner conducted a thorough medical history, indicated review of the Veteran's in-service treatment records and fully considered the Veteran's lay statements regarding the onset of pain during service and continuity of symptomology.  The Board notes that the examiner provided adequate rationale to support the conclusion that the Veteran's current left knee disability is related to service, explaining that repetitive stress injuries will cause progressive damage to the joint.  The Board also assigns some probative value to the June 30, 2021 VA examination and medical opinion.  

In light of the foregoing, upon review of the lay and medical evidence, the Board finds that there is at least an appropriate balance of negative and positive evidence to grant this claim; as such, the Board finds that service connection for a left knee disability is warranted, and the claim is hereby granted. See 38 U.S.C. § 5107(b).  As this claim is being granted on a direct service connection theory of entitlement, further discussion regarding secondary service connection is not warranted.

Entitlement to service connection for acid reflux disease.

The Veteran contends that her acid reflux disease is related to service.  

In her May 2025, Board Hearing, the Veteran testified that during service, she was treated for gastritis, upset stomach diarrhea, nausea, and vomiting. The Veteran testified that she was prescribed Gaviscon.  The Veteran testified that she also had acid reflux and they gave her something like TUMS at that time.  The Veteran testified that she is now on medication for the same issues.  The Veteran testified that she was told during service that she had, from what she can remember, acid reflux and gastritis. After separation from service, the Veteran testified that she self-treated her condition with over-the-counter medications. See May 2025, Board Hearing transcript, pgs. 12-14.

Regarding a current disability, in the August 2021 rating decision, the
 Veteran testified that during service, she was treated for gastritis, upset stomach diarrhea, nausea, and vomiting. The Veteran testified that she was prescribed Gaviscon.  The Veteran testified that she also had acid reflux and they gave her something like TUMS at that time.  The Veteran testified that she is now on medication for the same issues.  The Veteran testified that she was told during service that she had, from what she can remember, acid reflux and gastritis. After separation from service, the Veteran testified that she self-treated her condition with over-the-counter medications. See May 2025, Board Hearing transcript, pgs. 12-14.

Regarding a current disability, in the August 2021 rating decision, the RO found that the Veteran has been diagnosed with a disability. VA examination confirmed a diagnosis of gastroesophageal reflux disease (GERD). See June 2021, Esophageal Conditions examination.

Regarding an inservice event or injury, a June 1985 service treatment record (STR) documents the Veteran had pain in her lower abdomen for 1 week after eating. It is noted that the Veteran feels nauseated. On physical examination, there is lower quadrant tenderness.  Her bowel sounds were normal. The Veteran was diagnosed with possible gastritis.  A September 1985 STR documents a diagnosis of gastroenteritis. The Veteran is prescribed Compazine. A July 1986 STR documents a diagnosis of gastritis and a March 1987 STR documents treatment for an upset stomach.

Regarding a nexus to service, as referenced above, a June 2021, Esophageal Condition examination confirmed the Veteran's diagnosis of GERD.  On medical history, the examiner documented the Veteran's report that her GERD began around 1985 in Korea. The examiner documented the Veteran's report that she took over the counter medications.  The Veteran reported that her condition got worse.  The Veteran reported she went to sick call and they gave her Zantac, which helped. The examiner documented the Veteran's report that no testing was done.

 After reviewing the Veteran's medical history, in-service, post-service treatment records and physical examination of the Veteran, the examiner rendered an unfavorable negative nexus opinion.

In a June 2021 medical opinion, the examiner first documented the Veteran's in service treatment for a stomach condition; June 1985 (abdominal pain and nausea, diagnosed gastritis, prescribed Gaviscon); September 1985 (abdominal pain, vomiting, diarrhea, diagnosed gastroenteritis); and July 1986 (abdominal pain upset stomach, diagnosed gastritis).  The examiner also noted post service medical records reveal that the Veteran denied GERD on May 26, 2004, December 13, 2006, and February 13, 2008. The examiner subsequently reasoned that other than in the mid-1980's and in 2021, there is no mention of having anything referable to GERD. Therefore, the examiner determined that the Veteran's GERD is less likely than not incurred in or caused by the acid reflux during service.

The Board finds the June 2021VA examination both adequate and probative.  The Board observes that the examiner conducted a thorough medical history regarding the Veteran's in-service and post-service treatment. The Board notes that the examiner considered the Veteran's lay report of in-service and post service symptoms.

After reviewing both lay and medical evidence, with rationale sufficient for the Board to make an informed decision, the examiner concluded that the Veteran's current diagnosis of GERD is less likely than not related to her in-service treatment for a stomach condition or claimed treatment for acid reflux. The Board observes that the examiner's opinion is not solely based on the absence of contemporaneous medical records showing treatment for GERD post service but also considered the fact that the Veteran denied GERD 12 years, 14 years and 16 post-service, respectively. The Board finds that the examiner provided a well-reasoned analysis for the conclusion reached. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

The Board has considered the Veteran's May 2025 Board hearing testimony regarding her in-service symptoms and claimed continuity of symptomology but observes that the June 2021 examiner's rationale persuasively weighs against finding that the Veteran's acid reflux symptoms began in service and continued to the present, insofar as  the Veteran denied GERD, 12 years, 14 years and 16 years post separation from service
, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

The Board has considered the Veteran's May 2025 Board hearing testimony regarding her in-service symptoms and claimed continuity of symptomology but observes that the June 2021 examiner's rationale persuasively weighs against finding that the Veteran's acid reflux symptoms began in service and continued to the present, insofar as  the Veteran denied GERD, 12 years, 14 years and 16 years post separation from service. The Board also finds that the Veteran has not shown the competence to draw an etiological link between her in-service symptoms and her current disability. The Board observes that the Veteran has not shown that she has the skills or medical training to make such determination. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

At the hearing, the Veteran was informed by the undersigned Veterans Law Judge (VLJ) that she could provide a medical opinion in support of her claim within 90 days of her May 7, 2025 Board hearing. The Board notes that no additional medical opinion was submitted following the hearing. There is no contrary medical opinion of record. The Board finds the June 2021 Medical Opinion persuasive in this adjudication.

In sum, the Board finds the probative evidence of record persuasively weighs against finding that the Veteran's acid reflux had onset during service or is etiologically related to service. As such, the benefit of the doubt doctrine does not apply.  See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).  Accordingly, entitlement to service connection for acid reflux is not warranted.

Entitlement to service connection for urinary incontinence.

The Veteran contends that her urinary incontinence is related to service.

At her hearing, the Veteran testified she was diagnosed about 7 years ago for urinary incontinence. The Veteran testified her urinary incontinence was probably because of heavy lifting, participation in field artillery and the motor pool during service. The Veteran testified that her research showed that heavy lifting weakens pelvic muscles. The Veteran testified she is working with her doctor to get a medical opinion in support of her claim. See May 2025, Board Hearing transcript, pgs. 16-17.

Regarding a current disability, in the August 2021 rating decision on appeal, the AOJ noted that the Veteran has been diagnosed with a disability.  A June 2021 Urinary Tract Examination confirmed a diagnosis of voiding dysfunction. See June 2021, Urinary Tract Examination. 

Regarding an inservice event or injury, the Veteran's STR's document treatment for urinary tract infections.  A June 1991 STR documents treatment for UTI, pain following urination, blood minimal. It is reported, the Veteran states she has a history of UTI.  A January 1991 STR documents treatment for a UTI.

Regarding a nexus service, as referenced above, a July 2021 VA examiner confirmed the Veteran's diagnosis of voiding dysfunction. See July 2021, Urinary Tract Conditions examination. 

In this examination, the examiner documented on medical history, the Veteran began to have occasional bladder leakage in 2019. Current symptoms involved, continued issues with bladder leakage and urgency.

In a subsequent July 2021 Medical Opinion, the examiner rendered an unfavorable nexus opinion. The examiner reasoned that the Veteran's urinary incontinence documented in VA treatment records began around 2019.  The examiner noted that the Veteran separated from service in 1992 and that there is no documentation of leakage/incontinence between 1992 and 2019; therefore, the examiner concluded that the current voiding dysfunction is less likely than not incurred in, caused by, or related to complaints of bladder issues or UTIs during service. See July 2021, Medical Opinion.

The Board finds this medical opinion both adequate and probative.  The Board notes that the examination and medical opinion reflect review of all pertinent evidence of record and considers the Veteran's in-service treatment for UTI's.  

The Board notes that the examiner offers a well-reasoned explanation for the conclusion reached. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the
; therefore, the examiner concluded that the current voiding dysfunction is less likely than not incurred in, caused by, or related to complaints of bladder issues or UTIs during service. See July 2021, Medical Opinion.

The Board finds this medical opinion both adequate and probative.  The Board notes that the examination and medical opinion reflect review of all pertinent evidence of record and considers the Veteran's in-service treatment for UTI's.  

The Board notes that the examiner offers a well-reasoned explanation for the conclusion reached. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

The Board has considered the Veteran's theory that heavy lifting during service caused her current voiding dysfunction. The Board observes however that there is no competent medical evidence indicating that heavy lifting during service caused her current voiding dysfunction.  The Board notes that the Veteran's service treatment records are silent for any complaint, treatment or diagnosis for a voiding dysfunction, and a VA examiner, with rationale sufficiently detailed for the Board to make an informed decision, concluded that the Veteran's treatment for UTI's during service are unrelated to her current voiding dysfunction, particularly when weighed against the 27 year gap between her treatment for UTI's during service  and her current voiding dysfunction.  

While the Veteran believes that her current urinary incontinence is related to service, the Veteran has not shown to have the medical expertise to draw an etiological relationship between heavy lifting and her current disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). 

The Board assigns greater weight to the July 2021 Medical Opinion as to the etiology of this Veteran's urinary incontinence.  In sum, the Board finds that the evidence of record persuasively weighs against a nexus between the Veteran's urinary incontinence and her active service.  As such, the benefit of the doubt doctrine does not apply.  See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).  Accordingly, entitlement to service connection for urinary incontinence is not warranted.

REASONS FOR REMAND

Entitlement to service connection for a right shoulder disability is remanded.

Entitlement to service connection for a left shoulder is remanded.

Remand is permissible only to correct pre-decisional duty to assist errors, or other errors which, if corrected, raise a reasonable possibility of aiding in substantiating the claim.  38 C.F.R. § 20.802. 

Based upon the deficiencies described below, the Board finds that a remand is warranted for correction of pre-decisional error.

The Veteran contends that service connection for a right and left shoulder disability is warranted as a result of her job during service and the physical rigors associated with her military training.  At her Board hearing, the Veteran testified that she always had problems with her shoulder during service, but that she never went to sick call.  The Veteran testified that her shoulder condition continued to get worse after separation. See May 2025, Board Hearing, pgs. 15-16. The Veteran's military occupational specialty (MOS) during service was Material Storage and Handing Specialist (7 years, 10 months). See DD-214. The August 2021 rating decision notes the Veteran's treatment records confirm a diagnosis of right and left shoulder pain. The Board notes that VA examinations afforded to the Veteran for her other musculoskeletal claim (i.e., knee), document the Veteran's lay reports of participation in ruck sack exercises and road marches for about 12 to 15 miles. 

The Veteran has not yet been afforded a VA examination in connection with her service connection claim for a bilateral shoulder disability. VA must provide an examination when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).  Lay testimony as to continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related
 of participation in ruck sack exercises and road marches for about 12 to 15 miles. 

The Veteran has not yet been afforded a VA examination in connection with her service connection claim for a bilateral shoulder disability. VA must provide an examination when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).  Lay testimony as to continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service, and the threshold for finding that the disability (or symptoms of a disability) may be associated with service is low.  Id. at 83.  Furthermore, the Veteran is competent to testify to in-service injuries, symptoms, and events.  Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

Given the Veteran's reports attributing her right and left disability shoulder disability to service in connection with her MOS (See DD-214), and the physical rigors associated with service, in part documented in VA examination for her other musculoskeletal claim, the Board finds that the low threshold of the McLendon standard was met prior to the issuance of the rating decision on appeal, and that the Veteran should have been afforded a VA examination and opinion.  See McLendon, 20 Vet. App. 79, 81 (2006).

Based on this pre-decisional duty to assist error, the Board finds that a remand is warranted prior to adjudication of the claim.

Accordingly, this matter is REMANDED for the following action:

1. Schedule the Veteran for a VA medical examination to determine the nature and etiology of the Veteran's right and left shoulder disability.  All indicated studies should be performed.  The examiner must review the claims file and must note that review in the report.  Following review of the record, the examiner is asked to address the following:

2. For each disability, is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) related directly to service?  Please explain why or why not. The examiner should comment on the significance, if any, of the Veteran's reports of wear and tear during military training and as part of her MOS.

Please note that a medical opinion which concludes that a disease is not related to service solely because there is absence of service records is inadequate.  See Marciniak v. Brown, 10 Vet. App. 198, 200 (1997), citing O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991).

A rationale for any opinion expressed should be set forth.  If the examiner cannot provide the above opinions without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 

 

 

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Little, Calvin

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.