Citation Nr: 0001545 Decision Date: 01/19/00 Archive Date: 01/28/00 DOCKET NO. 95-10 689 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Anchorage, Alaska THE ISSUE Entitlement to service connection for a left shoulder disability as secondary to a service-connected left elbow disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Marisa Kim, Associate Counsel INTRODUCTION The veteran had active military service from June 1965 to July 1968. This appeal arises from September 1993 and June 1999 rating decisions from the Anchorage, Alaska, Department of Veterans Affairs (VA) Regional Office (RO), that denied service connection for a left shoulder disability. In May 1997, the Board of Veterans' Appeals (Board) remanded the case to obtain additional medical records and a VA examination to determine the nature and etiology of any left shoulder disabilities. This matter is before the Board for final appellate review. FINDINGS OF FACT 1. The veteran has a current left shoulder disability. 2. There is no medical evidence of a nexus between the post- service left shoulder disability and a disability of service origin or an in-service event. CONCLUSION OF LAW The claim of entitlement to service connection for a left shoulder disability as secondary to a service-connected left elbow disability is not well grounded. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The May 1965 enlistment examination report stated that the veteran's upper extremities and spine and musculoskeletal systems were normal, and no left shoulder disability was noted. The veteran denied a history of any painful or "trick" shoulder or elbow. The veteran was hospitalized in September 1966 because he fell off of a horse and underwent surgery of the left elbow. Physical examination was within normal limits except for examination of the left elbow. There was much swelling around the left elbow, and the veteran was tender over his radial head. There was no neurologic deficit, and he had a bounding radial pulse. Laboratory work was within normal limits, and x-rays revealed a comminuted fracture of the radial head. The examiner opined that the veteran probably dislocated his elbow at the time of the injury and relocated it when he flexed it, causing extreme swelling about his elbow and ecchymosis. After 3 weeks, he was discharged from the hospital to light duty. The final diagnosis was a comminuted fracture of the left radial head that did not exist prior to enlistment. The July 1968 separation examination report noted a normal spine and musculoskeletal system and abnormal upper extremities. The veteran underwent a VA examination in June 1993. He reported that he lost the distal segment of his left ring finger from an accident at age 17 but had no trouble with this since that time. He reported that he did heavy equipment work since he left service. He reported injuring his left elbow and shoulder in September 1966 and denied any other accidents or illnesses. The veteran reported considerable trouble with weakness and paresthesia in his left arm and pain in his left shoulder since the left elbow surgery. He reported that the muscle mass had decreased in size and that he took occasional aspirin or Advil. An orthopedic consultant further evaluated the veteran's left elbow. The veteran reported that, after surgery, he had left upper extremity problems, including arm weakness and decreased grip strength. He reported that his arm had been shrinking and that he had numbness from the elbow to the ring and small finger. He also reported pain in his elbow and some shoulder aching. The diagnostic impression was status post radial head resection for fracture with decreased range of motion, weakness, and mild ulnar neuropathy, and x-ray evidence of some arthritic change involving the residual joints of the left elbow. The veteran reported weakness and a lot of pain most of the time in his left arm and shoulder. Physical examination revealed that the pectoral girdle was normal; however, there was point tenderness over the spine of the left scapula and over the left rotor cuff. There was no tenderness over the elbow areas. There was a very inconspicuous approximately 5-inch scar over the left elbow joint but no point tenderness in this area. Reflexes were active and equal and there was some muscle wasting of the left upper arm and left lower arm when compared to the right. However, the veteran could put his hands on top of his head and up behind the back of his head. He could put them up behind his back without difficulty. He could also oppose his thumb to each finger bilaterally successively. Physical examination of the back was normal. Neurological examination was well within normal limits without pathological signs or abnormalities. The veteran reported that he had some paresthesia in the left arm and the last 2 fingers associated with his elbow/shoulder injury. The diagnosis was a history and positive evidence of problems with the left elbow and left shoulder. A service friend's June 1993 statement recalled that the veteran was unable to finish training exercises due to a left elbow injury in late August or early September 1966. The January 1995 appeal alleged that the veteran lost the use of his left elbow in 1966, and since then, the rotation and supporting movements of his arm had been performed by his left shoulder. He alleged that his left arm shrunk to one- half the strength and size of his right arm and that he experienced constant aching and numbness of the left shoulder, arm, and hand. In January 1997, the VA Medical Center (VAMC) of Sheridan, Wyoming, confirmed that the veteran had been at the medical center from December 1984 but that records could not be located. The veteran underwent a VA examination by an orthopedic consultant in October 1997. The veteran reported that, in 1989-1990, he noticed shoulder pain related to lifting and pulling and having his arm in certain positions. He reported that the pain was getting worse and that he noted trouble working above the shoulder level. He reported using his left arm to steady things rather than perform particular activities. He reported that after the 1966 surgery he noted arm weakness, decreased grip, numbness going from the elbow to the ring and small fingers, pain in the elbow, and a feeling that his arm was shrinking. He reported that the situation was worsening and that more often the middle finger was involved with the numbness. The diagnostic impression was status post radial head resection of the left elbow with symptoms compatible with some ulnar nerve dysesthesia and osteoarthritic change involving the acromioclavicular joint and possibly also the glenohumeral joint of the left shoulder. The orthopedic consultant opined that increasing complaints from the elbow down were possibly related to the previous elbow injury, surgery, and ulnar nerve involvement. The examiner opined that he did not see any medical connection between the elbow injury and the subsequent left shoulder symptomatology. Criteria The Court has held that a well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has held that a well-grounded claim requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Epps v. Brown, 126 F.3d. 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (1999). When there is aggravation of a nonservice-connected condition which is proximately due to or the result of service-connected disease or injury, the claimant will be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where a veteran claims a new disease or disability that is the result of his service-connected disability, competent evidence must be submitted to make the claim well grounded. See Jones (Wayne) v. Brown, 7 Vet. App. 134 (1994). Analysis The medical evidence shows that the veteran has a current left shoulder disability. The October 1997 diagnostic impression included osteoarthritic change involving the acromioclavicular joint and possibly the glenohumeral joint of the left shoulder. Nonetheless, the claim for service connection for a left shoulder disability as secondary to a service connected left elbow disability is not well grounded because there is no medical evidence of a nexus between the current left shoulder disability and the veteran's service connected left elbow disability. The veteran contended that the 1966 elbow surgery caused left arm weakness, decreased grip strength, shrinking, numbness, and pain. However, while the veteran, as a lay person is competent to provide evidence on the occurrence of observable symptoms during and following service, such a lay person is not competent to make a medical diagnosis or render a medical opinion which relates a medical disorder to a specific cause. Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). Thus, although the veteran is competent to make observations about his lifting and pulling motions and the size of his arm, his statements regarding the cause of his current left shoulder disability are not probative. The probative medical evidence is the opinion of the October 1997 examiner that addressed the possibility of a relationship between the veteran's left shoulder disability and the left elbow disability. The orthopedic physician opined that there was no medical connection between the elbow injury and the subsequent left shoulder symptomatology. Therefore, the claim is not well grounded on a secondary basis. The claim for service connection for a left shoulder disability is not well grounded on a direct basis because the medical evidence does not show an in-service diagnosis of a left shoulder disability and it is not otherwise contended. The record shows the first diagnosis of a left shoulder disability in October 1997. Although the veteran worked with heavy equipment since separation from service, according to the October 1997 examination report, he noticed shoulder pain in 1989-1990, or over 20 years after separation from service. Even if the missing Sheridan VAMC records were to reveal diagnosis of or treatment for a left shoulder disability, such diagnosis or treatment would have occurred over 15 years after separation from service. Therefore, the claim is not well grounded on a direct basis. The foregoing discussion is sufficient to inform the veteran of the elements necessary to complete an application to reopen the claim. See Graves v. Brown, 8 Vet. App. 522 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). The VA cannot assist in any further development of the claim because the claim is not well grounded. 38 U.S.C.A. § 5107(a); Morton v. West, No. 96-1517 (U.S. Vet. App. July 14, 1999). ORDER The claim of entitlement to service connection for a left shoulder disability as secondary to a service-connected left elbow disability is denied as not well grounded. V. L. Jordan Member, Board of Veterans' Appeals