BVA9500679 DOCKET NO. 92-04 545 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for residuals of a left shoulder injury. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C.A. Skow, Associate Counsel INTRODUCTION The appellant served on active duty from December 1980 to March 1988. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a March 1991 decision of the Cleveland, Ohio, Department of Veterans Affairs Regional Office (VARO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that he currently experiences subluxation of the left shoulder as a result of an injury in service to his left shoulder. He further contends that he was placed on light duty because of his shoulder injury. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that entitlement to service connection for residuals of a left shoulder injury is not warranted. FINDINGS OF FACT 1. The appellant served on active duty from December 1980 to March 1988. 2. Service medical records show that the appellant injured his left shoulder while setting up a tent in March 1986. Clinical findings were negative for acromioclavicular separation, edema, discoloration, or deformity, although pain on abduction and decreased motion secondary to pain were noted. 3. Reenlistment examination in April 1986 and Physical Evaluation Board examination in November 1987 were negative for complaints, findings, or manifestations of a left shoulder disability. 4. On VA examination in July 1990, August 1991, and May 1993, recurrent subluxation of the left shoulder was found. VA examination in May 1993 ruled out a possible relationship between the appellant's shoulder condition and his service-connected left wrist condition. 5. There is no objective evidence of record to establish a relationship between the findings of subluxation of the left shoulder noted on VA examinations in July 1990, 1991, and 1993 and the left shoulder injury in service. CONCLUSION OF LAW A chronic left shoulder condition was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1131, 1157 (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v Derwinski, 1 Vet.App. 78 (1990). Furthermore, the undersigned believes that this case has been adequately developed for appellate purposes by VARO and that a disposition on the merits is in order. Background Service medical records dated March 1986 reflect that the appellant injured his left shoulder while setting up a tent. An examination at that time revealed pain on abduction and reduced range of motion secondary to pain. The appellant was given a sling and was instructed to perform specified exercises. Approximately six weeks later in April 1986, the appellant underwent a reenlistment examination. This examination was negative for complaints, findings, or manifestations of a left shoulder disorder. A Physical Evaluation Board examination in November 1987 was similarly negative for complaints, findings, or manifestations of a left shoulder disorder. In March 1988, the appellant received a medical discharge for a right knee and a left wrist disability. In January 1990, the appellant filed a claim for service connection for a left shoulder disorder and a VA examination was scheduled. At a VA examination in July 1990, the appellant complained that his left shoulder "locks." The appellant reported working as a lift truck mechanic and a janitor since his discharge. The clinical impression was post-traumatic subluxation of the left shoulder. In August 1991, a personal hearing was conducted. The appellant testified that he injured his left shoulder in service. He claimed that he was placed on light duty for about two weeks and prescribed inflammatory type drugs. He indicated that his shoulder was tender and swollen after the injury, and that the discomfort occasionally recurred but he treated it with a heating pad. The appellant testified that he reinjured his left shoulder approximately one month before his reenlistment examination although he did not remember the manner in which the left shoulder was reinjured or whether he had sought treatment. He reportedly did not mention his left shoulder difficulty during his reenlistment examination because he feared it would ruin his chances for reenlistment. In addition, the appellant indicated that, after his reenlistment, he was seen by a Physical Evaluation Board (PEB) for a possible discharge due to right knee and left wrist injuries. The appellant noted that he did not mention his left shoulder condition to the PEB because the PEB had already been postponed once due to the wrist injuries he sustained in a motorcycle accident in June 1987. The appellant indicated that post-service he was not treated for his left shoulder condition until he filed for compensation with the VA because of the expense. In August 1991, a VA examination was conducted. The appellant complained of "recurrent subluxation" of the shoulder. By history, the appellant's shoulder subluxates if he extends his arms overhead or places any weight overhead. The impression was recurrent subluxation of the left shoulder. An x-ray study revealed no significant abnormality of the bone, joints or adjacent soft tissues of the left shoulder. Consistent with a Board remand dated February 1993, VARO attempted additional development of the appellants claim by searching for records of a light duty assignment due to a left shoulder injury and scheduling a VA examination. Although additional service medical records were obtained, there was no indication that the appellant received a "light duty" assignment due to his left shoulder injury. On VA examination in May 1993, the appellant complained of left shoulder pain on lifting more than 50 pounds of weight. By history, the appellant reported a right knee and left wrist injury occurring in 1987, and subluxation of the left shoulder beginning in 1985. The appellant's left shoulder reportedly subluxates once or twice a week. Range of motion was 160 degrees on abduction, 180 degrees on flexion, and 35 degrees on extension. Appellant was unable to perform internal/external rotation for fear of subluxation of the left shoulder. Clinical findings were negative for swelling, deformity, or other impairment of the left shoulder. The appellant was diagnosed with recurrent subluxation of the left shoulder. The examiner remarked that there is no relationship between the appellant's left shoulder disorder and his service-connected wrist disability. Analysis The appellant seeks service connection for a left shoulder disorder. Service-connection may be granted for a disability resulting from disease or injury incurred in or aggravated while on active duty. 38 U.S.C.A. § 1131 (West 1991). Furthermore, for a 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, as distinguished from mere isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact shown to be chronic or where the diagnosis of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1993). In weighing the evidence of record, the undersigned concludes that the weight of evidence is against entitlement to service connection for chronic residuals of a left shoulder injury. The service medical record dated March 1986 supports that the appellant sustained a left shoulder injury during service. However, reenlistment examination in April 1986 and Physical Evaluation Board report dated in November 1987 were negative for complaints or findings related to a left shoulder disorder. In view of the above, the Board finds that, while the evidence of record supports an episode of left shoulder pain during service, the injury was acute and transitory in nature. Where chronicity of a left shoulder condition in service has not been established, a showing of continuity of symptomatology after service discharge is required to establish service connection for residuals of a left shoulder injury. After review of the entire evidence of record, including the appellant's statements and the pertinent medical evidence, the Board has determined that they are of insufficient probative value to serve as the basis for service connection when weighed in light of the lack of objective findings of chronic residual disability associated with the appellant's period of service. The Board notes that in April 1986 the appellant was deemed fit for reenlistment and there is no record of a restricted duty assignment related to the appellant's left shoulder injury. We do accept, of course, that some form of light duty was performed for about two weeks based on his sworn testimony. When the appellant appeared before the Physical Evaluation Board in 1987 for a determination of whether or not he should be medically discharged, the appellant made no mention of any left shoulder disability on examination and was ultimately medically discharged for a right knee and left wrist disability. Furthermore, the appellant testified that he has not sought post-discharge treatment for his left shoulder disorder. The appellant first indicated the presence of a left shoulder disorder on VA examination for compensation purposes in July 1990. Although VA examinations conducted in July 1990, August 1991, and May 1993 indicate subluxation of the left shoulder, absent significant abnormality of the bone, joints or adjacent soft tissues, the clinical findings do not establish a relationship between the appellant's present left shoulder disorder and the injury in service. Additionally, on VA examination in May 1993, the examiner remarked that the appellant's left shoulder disorder was not related to his service-connected residuals of a left wrist fracture. The Board concludes that the lack of documented findings of a left shoulder disability on reenlistment examination in April 1986 and on Physical Evaluation Board examination in November 1987, coupled with the lack of complaints, findings, or manifestations of pertinent symptomatology until VA examination in July 1990 weigh against a finding that a chronic left shoulder disability was incurred in service. Furthermore, medical evidence reflected on VA examinations in July 1990, August 1991, and May 1993 do not establish or suggest that the appellant's current left shoulder disability is related to his period of service. VA examination in May 1993 showed no more than mild limitation of motion and subluxation of the left shoulder, absent significant abnormalities of the bones, joints or adjacent soft tissues. Accordingly, in view of the lack of findings of residuals of a left shoulder injury from April 1986 until VA examination in July 1990, the undersigned concludes that the weight of evidence is against the appellant's claim to service connection for residuals of a left shoulder injury. Furthermore, the Board believes that VARO has complied fully with its statutory duty to assist by requesting all pertinent records. See 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R § 3.159(b) (1993). ORDER Service connection for residuals of a left shoulder injury is denied. KENNETH R. ANDREWS, JR. Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.