Citation Nr: 0003157 Decision Date: 02/08/00 Archive Date: 02/15/00 DOCKET NO. 98-01 844A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Whether a claim of entitlement to service connection for a right shoulder disorder is well grounded. 2. Whether a claim of entitlement to service connection for a left shoulder disorder is well grounded. 3. Whether a claim of entitlement to service connection for a right knee disorder is well grounded. 4. Whether a claim of entitlement to service connection for a right elbow disorder is well grounded. 5. Whether a claim of entitlement to service connection for a disorder of the right hand and fingers (other than the forefinger) is well grounded. 6. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for residuals of a fractured right forefinger. 7. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a left side disorder. REPRESENTATION Appellant represented by: Mississippi Veterans Affairs Board WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD P.M. DiLorenzo, Counsel INTRODUCTION The veteran served on active duty from June 1953 to April 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 1998 and July 1999 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi, that denied the above- noted claims. In a July 1999 VA Form 9, the veteran indicated that he wanted to be scheduled for a hearing before a Member of the Board in Washington, D.C. However, in an October 1999 VA Form 9, he stated that he did not want a Board hearing. FINDINGS OF FACT 1. No medical evidence has been presented or secured to render plausible a claim that any current right shoulder, left shoulder, right elbow, right knee, or right hand and finger disorders are the result of a disease or injury incurred in service. 2. In December 1974, the RO denied entitlement to service connection for finger and left side disorders. The RO notified the veteran of its decision and of his appellate rights. He did not appeal. 3. Evidence has not been presented or secured since the December 1974 RO decision that is so significant that it must be considered in order to fairly decide the merits of the claims for service connection for finger and left side disorders. CONCLUSIONS OF LAW 1. The claims for service connection for right shoulder, left shoulder, right elbow, right knee, and right hand and finger disorders are not well grounded and there is no statutory duty to assist the veteran in developing facts pertinent to these claims. 38 U.S.C.A. § 5107(a) (West 1991). 2. The December 1974 RO decision that denied entitlement to service connection for finger and left side disorders is final. 38 U.S.C.A. § 7105(b)(1), (d)(3) (West 1991); 38 C.F.R. §§ 20.200, 20.302(b), 20.1103 (1999). 3. Evidence received since the December 1974 RO decision that denied entitlement to service connection for finger and left side disorders is not new and material, and the veteran's claims are not reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual background The veteran's service medical records are not available and are presumed destroyed in a fire at the National Personnel Records Center (NPRC) in 1973. The veteran claimed entitlement to service connection for finger and left side disorders in May 1974. He stated that he was treated for a finger disorder on two occasions in Germany in the winter of 1954. He was treated for a left side disorder in 1955 in Jackson, Mississippi. The RO denied entitlement to service connection for finger and left side disorders in December 1974. The veteran was notified of this decision and of his appellate rights by letter dated January 8, 1975. He did not appeal. In July 1997, the veteran stated that he was injured in a half-track carrier accident in Germany. He reportedly broke a finger and injured his right shoulder. He also fell on the ice in Germany and injured a shoulder. He still had shoulder problems. In August 1997, the veteran reported that he was treated for a broken shoulder, knee and finger during service at a field hospital in Germany in 1954 or 1955. After service, he was treated for shoulder and knee problems by Drs. Harrison, Crocker and Nickopoulos from the 1950s to the 1990s. Drs. Harrison and Crocker were deceased and Dr. Nickopoulos was retired. Thereafter, private medical records from Barry Jones, M.D. dated in 1997 were associated with the claims folder. These records showed that the veteran complained of joint pains in his knees, right shoulder and wrist. Pertinent diagnoses included osteoarthritis versus systemic lupus erythematosus (SLE) versus gouty arthritis. Hypertrophic changes secondary to degenerative joint disease of the knees and hands were also noted. Additional private treatment records of the veteran (including from Dr. Nickopoulos), dated from 1986 to 1996, were obtained in October 1997. In April 1990, the veteran was diagnosed as having a hiatal hernia. He complained of arthritis all over, including of the left knee, right shoulder and right elbow in June 1990. A bone scan showed increased activity in the right shoulder, left elbow, left wrist, left knee and right foot, suggesting the possibility of arthritic changes. In December 1990 and February 1991, the veteran stated that he hurt his right shoulder and broke his finger in a tank accident. He continued to seek treatment for multiple joint complaints. Pertinent diagnoses included arthritis, rheumatoid arthritis, and degenerative joint disease. An August 1998 patient summary report from the Tupelo Pain Clinic revealed that the veteran complained of bilateral arm and leg pain, including of the shoulders, elbows, knees and hands. He stated that he was involved in a tank accident and slipped on ice and fell on his left shoulder during active service in 1954. An x-ray of the right knee revealed a marked degenerative change. The doctor, John W. McFadden, M.D., diagnosed "ARTHRITIS; DEGENERANT RIGHT KNEE; DERANGEMENT SHOULDERS BILATERALLY; DERANGEMENT RIGHT ELBOW - ALL BY HISTORY WHEN INJURED IN THE MILITARY." The veteran also submitted several lay statements in support of his claims from I.R., C.T., G.H., E.M. and B.H. They stated that the veteran wrote home to his parents and discussed being injured in a tank accident during service. He reportedly broke his finger, and his shoulder and knee hurt. The veteran also reportedly fell on the ice at an ammo dump in Germany and injured a shoulder. After service, he was treated by a private doctor for knee problems. He had problems with his shoulders and knees since service. B.H. also stated that he recalled that the veteran had problems with his shoulders and knees prior to active service. The veteran and his wife testified at a personal hearing at the RO in April 1999. The veteran stated that he injured the forefinger of his right hand while riding in a personnel carrier when the driver hit a hole. He sought treatment, and the finger was reportedly broken. He also injured his right elbow, right shoulder, right hand and right knee at that time and was placed on limited duty. He had problems with his injuries since that time. His wife said that she observed his symptoms, i.e., he broke out in sweats. She also read letters that he had written home to his parents about the injuries. Concerning his left side, the veteran stated that he injured his left knee and shoulder playing football prior to active service. He stated that he had a hernia in the left side. During service, he re-injured his left shoulder when he fell on ice. His hernia hurt during service, and he had it repaired after service in the 1960s. He did not seek treatment for it during service. In August 1999, documents were received showing that the veteran completed courses of leadership and command and armorers school in 1954. II. Legal analysis A. Right shoulder, left shoulder, right elbow, right knee, and right hand and finger disorders Establishing service connection for a disability requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may also be established for a current disability on the basis of a "presumption" under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C.A. §§ 1110, 1112 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a) (1999). Service connection for arthritis may be established based on a legal "presumption" by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. § 1112 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). Service connection for a disability may be established based on aggravation of disease or injury which preexisted service when there is an increase in disability during service unless the increase is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1999). Establishing service connection for a disability based on aggravation requires (1) evidence sufficient to show that a disease or injury preexisted military service; (2) evidence showing an increase in disability during service sufficient to raise a presumption of aggravation of the disability; and (3) an absence of clear and unmistakable evidence to rebut the presumption of aggravation which may include evidence showing that the increase in severity was due to the natural progress of the disease. 38 C.F.R. § 3.306(b) (1999). Concerning item (1), a disorder may be shown to have preexisted service if it is noted at entrance into service or where clear and unmistakable evidence rebuts the legal presumption of sound condition at service entrance for disorders not noted when examined at entrance. History provided by the veteran of the pre-service existence of conditions recorded at the time of the entrance examination does not, in itself, constitute a notation of a preexisting condition. 38 C.F.R. § 3.304(b)(1) (1999); Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1995). The first responsibility of a person seeking entitlement to VA benefits is to state a well-grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). Establishing a well-grounded claim for service connection for a particular disability requires more than an allegation that the disability is service connected; it requires evidence relevant to the requirements for service connection and of sufficient weight to make the claim plausible, i.e., meritorious on its own or capable of substantiation. See Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The kind of evidence needed to make a claim well grounded depends upon the types of issues presented by a claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). For some factual issues, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Id. at 93. A well-grounded claim for direct service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 504-06 (1995). The United States Court of Appeals for Veterans Claims (formerly the U.S. Court of Veterans Appeals) (Court) has held that the second and third Caluza elements can also be satisfied under 38 C.F.R. § 3.303(b) by (a) evidence that a condition was "noted" during service or during an applicable presumption period; (b) evidence showing post-service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See 38 C.F.R. § 3.303(b); see also Brewer v. West, 11 Vet. App. 228, 231 (1998); Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). Alternatively, under 38 C.F.R. § 3.303(b), service connection may be awarded for a "chronic" condition when: (1) a chronic disease manifests itself and is identified as such in service (or within the presumption period under 38 C.F.R. § 3.307) and the veteran presently has the same condition; or (2) a disease manifests itself during service (or during the presumptive period), but is not identified until later, and there is a showing of continuity of related symptomatology after discharge, and medical evidence relates that symptomatology to the veteran's present condition. Savage, 10 Vet. App. at 495-98. For purposes of determining whether a claim is well grounded, the evidence is generally presumed to be credible. See Robinette v. Brown, 8 Vet. App. 69, 75- 76 (1995), citing King v. Brown, 5 Vet. App. 19, 21 (1993). Here, the veteran has reported that he injured his left shoulder prior to active service. B.H. further stated that he recalled that the veteran had left shoulder and right knee problems prior to active service. However, these lay statements are insufficient to establish the onset of chronic left shoulder and right knee disabilities prior to active service. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); see also Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1995). The medical evidence of record indicates that the veteran currently suffers from right shoulder, left shoulder, right elbow, right knee, and right hand disorders. These disabilities were first diagnosed many years after service in the 1990s. For example, a 1990 bone scan showed increased activity in the right shoulder suggesting the possibility of arthritic changes. Barry Jones, M.D. noted hypertrophic changes secondary to degenerative joint disease of the veteran's knees and hands in 1997. In 1998, John W. McFadden, M.D., diagnosed the veteran as having arthritis of the right knee and derangement of the shoulders and right elbow. There are also several diagnoses of generalized arthritis of record. Therefore, the Board finds that there is sufficient medical evidence of a current disability, and the first element of a well-grounded claim has been satisfied. The veteran maintains that he injured his right shoulder, left shoulder, right elbow, right knee, and right hand during active service. He also provided lay statements from others who recall his complaints of shoulder and knee injuries during service. In view of the foregoing, the Board finds that there is sufficient lay evidence of incurrence of injuries during service, and the second element of a well- grounded claim has been satisfied. However, the veteran has not satisfied the third element of a well-grounded claim for service connection. He has reported that he has suffered from multiple joint pain since his inservice injury. Several acquaintances and/or relatives have stated that they noticed and/or heard about his symptoms after service. Presuming the history of continuity of symptomatology since active service to be credible for the purpose of establishing a well-grounded claim, there is still no medical evidence of record of a nexus between the present disabilities and the post-service symptomatology. Savage, 10 Vet. App. at 497 (holding that veteran's own testimony that he sustained a back injury in service, walked with a limp ever since, and received heat treatments over the years is presumed credible for the purpose of establishing a well grounded claim because it is not inherently incredible or beyond the competence of a lay person to observe and continuity of symptomatology had therefore been established even if the record did not contain service medical records showing treatment in service for a back problem); see Holbrook v. Brown, 8 Vet. App. 91, 92 (1995) (per curiam order noting Board's fundamental authority to decide a claim in the alternative). Medical expertise is required to relate the present disabilities etiologically to the veteran's post- service symptoms. However, there are no medical opinions contained in any of the veteran's post-service medical records relating the current right shoulder, left shoulder, right elbow, right knee, and right hand disorders to any inservice disease or injury or to the post-service symptomatology. In August 1998, Dr. McFadden diagnosed the veteran as having arthritis of the right knee and derangement of the shoulders and right elbow, all by history when injured in the military. Dr. McFadden was merely recording information provided by the veteran. The diagnosis does not demonstrate that based upon his medical expertise, he found any disability relating back to service. See Sanchez-Benitez v. West, No. 97-1948 (U.S. Vet. App. Dec. 29, 1999); LeShore v. Brown, 8 Vet. App. 406 (1995). The veteran is not competent to ascribe his post-service difficulties to active service. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Although the veteran may have continuously experienced joint symptomatology since active service, there is no medical evidence in the record at all tending to show that there were underlying chronic disabilities which caused the symptoms in service and that that underlying disabilities also have caused all the intermittent complaints of symptomatology experienced since service. Similarly, there is no medical evidence tending to show that the inservice symptoms represented chronic right shoulder, left shoulder, right elbow, right knee, and right hand disorders rather than acute and transitory conditions. Because no medical evidence has been presented or secured to render plausible a claim that the right shoulder, left shoulder, right elbow, right knee, and right hand disorders diagnosed more than 35 years after service had their onset in service or are the result of, or related to, any disease contracted or injury sustained in active military service, the Board concludes that these claims are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). The presentation of a well-grounded claim is a threshold issue, and the Board has no jurisdiction to adjudicate a claim on the merits unless it is well grounded. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). There is no duty to assist further in the development of these claims because such additional development would be futile. See Murphy v. Derwinski, 1 Vet. App. 78 (1990). Where a claimant refers to a specific source of evidence that could make his claim plausible, VA has a duty to inform him of the necessity to submit that evidence to complete his application for benefits. See Epps v. Brown, 9 Vet. App. 341, 344-45 (1996), aff'd Epps v. Gober, 126 F.3d. 1464, 1468 (Fed. Cir. 1997). The Board finds VA has no outstanding duty to inform the appellant of the necessity to submit certain evidence to complete his application for VA benefits. 38 U.S.C.A. § 5103(a) (West 1991). Nothing in the record suggests the existence of evidence that might well ground the veteran's claims for service connection. It appears that the veteran may have applied for Social Security Administration (SSA) benefits in 1994. He also stated that he had an appointment at the Memphis VA Medical Center (VAMC) in July 1997. While the RO did not obtain the veteran's SSA or VA records, additional development to obtain these records is unnecessary in view of the medical evidence currently of record. See Franzen v. Brown, 9 Vet. App. 235 (1996) (VA's obligation under 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained). There is no basis for speculating that such records dated many years after service would produce nexus evidence necessary to well ground the veteran's claims for service connection. Brewer v. West, 11 Vet. App. 228 (1998); see Grivois v. Brown, 6 Vet. App. 136, 139-40 (1994) (noting that "implausible claims should not consume the limited resources of the VA and force into even greater backlog and delay those claims which . . . require adjudication."). The veteran has also reported that his private post-service doctors are deceased and/or their records are not available. The RO has undertaken efforts to obtain additional service medical records, including requesting Surgeon General's Office records, essentially without success. See M21-1, Part III, 4.22, 4.23, 4.25; Cf. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Accordingly, the Board concludes that VA did not fail to meet its obligations with regard to the veteran's claims under 38 U.S.C.A. § 5103(a) (West 1991). B. Residuals of a fractured right forefinger, left side disorder A decision of a duly-constituted rating agency or other agency of original jurisdiction is final and binding as to all field offices of the Department as to written conclusions based on evidence on file at the time the veteran is notified of the decision. 38 C.F.R. § 3.104(a) (1999). Such a decision is not subject to revision on the same factual basis except by a duly constituted appellate authority. Id. The veteran has one year from notification of a decision of the agency of original jurisdiction to file a notice of disagreement (NOD) with the decision, and the decision becomes final if an NOD is not filed within that time. 38 U.S.C.A. § 7105(b) and (c) (West 1991); 38 C.F.R. §§ 3.160(d) and 20.302(a) (1999). By letter dated January 8, 1975, the RO notified the veteran of the December 1974 rating decision denying entitlement to service connection for finger and left side disorders. The veteran was also advised of his appellate rights, and did not appeal. Therefore, the RO's decision became final. 38 U.S.C.A. § 7105(c) (West 1991); 38 C.F.R. §§ 3.160(d), 20.200, 20.302 (1999). In order to reopen a claim which has been previously denied and which is final, the claimant must present new and material evidence. 38 U.S.C.A. § 5108 (West 1991). New and material evidence means evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (1999); see also Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). When presented with a claim to reopen a previously finally denied claim, VA must perform a three-step analysis. Elkins v. West, 12 Vet. App. 209 (1999). First, it must be determined whether the evidence submitted by the claimant is new and material. Second, if new and material evidence has been presented, it must be determined, immediately upon reopening the claim, whether the reopened claim is well grounded pursuant to 38 U.S.C. § 5107(a) based upon all the evidence and presuming its credibility. The Court concluded in Elkins that the Federal Circuit in Hodge effectively "decoupled" the relationship between determinations of well-groundedness and of new and material evidence by overruling the "reasonable-possibility-of-a-change-in- outcome" test established by Colvin v. Derwinski, 1 Vet. App. 171 (1991). There is no duty to assist in the absence of a well-grounded claim. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997) cert. denied, sub nom. Epps v. West, 118 S.Ct. 2348 (1998). See also Winters v. West, 12 Vet. App. 203 (1999). Third, if the reopened claim is well grounded, VA may evaluate the merits of the claim after ensuring that the duty to assist under 38 U.S.C. § 5107(b) has been fulfilled. The evidence received subsequent to December 1974 is presumed credible for the purposes of reopening the veteran's claims unless it is inherently false or untrue, or it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216, 220 (1995); Justus v. Principi, 3 Vet. App. 510, 513 (1992). See also Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995). At the time of the December 1974 RO rating decision, the evidence consisted, in pertinent part, of the veteran's lay statements that he incurred finger and left side disorders during active service. There was no evidence of post- service, or current, finger or left side disorders and of a nexus between the post-service disabilities and any inservice disease or injury. Therefore, in order to be material, there would have to be competent evidence showing diagnoses of a current finger and left side disorders and that these conditions had their onset during active service or within any appropriate presumptive period (if arthritis) or were associated with an inservice disease or injury. Any "new" evidence would have to bear directly and substantially upon this matter and be so significant that it must be considered in order to fairly decide the merits of the claims. To the extent that the veteran contends that he has current right forefinger or left side disorders that were incurred during service, this evidence is not new. His statements are essentially a repetition of his previous assertions, and are basically cumulative and not new. See Paller v. Principi, 3 Vet. App. 535, 538 (1992) (distinguishing corroborative evidence from cumulative evidence). Moreover, the lay statements concerning the onset of these conditions are not competent. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); see also Moray v. Brown, 5 Vet. App. 211 (1993) (lay assertions of medical causation cannot serve as the predicate to reopen a claim under 38 U.S.C.A. § 5108). The veteran's statements concerning having a left side disorder, i.e., a hernia, that was aggravated during service are new. However, again, his statements are insufficient to establish the onset of a chronic left side disorder prior to active service, and the aggravation thereof during service, and are therefore not material. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Concerning the lay statements of relatives and/or acquaintances of the veteran, these statements are cumulative and not new. There was sufficient lay evidence of record at the time of the December 1974 rating decision showing that the veteran suffered finger and left side injuries during service. To the extent that the medical records show treatment for and/or diagnoses of a right forefinger and left side disorders (i.e., arthritis of the right hand and a hiatal hernia) many years after service, they are new. However, they are not material, or so significant that they must be considered in order to fairly decide the merits of the claims. These records do not in any way provide a medical linkage of current right forefinger and left side disabilities with the veteran's active duty military service. Medical records and lay statements, including from the veteran, that do not mention right forefinger or left side disorders, even if new, are not material. This evidence is not so significant that it must be considered in order to fairly decide the merits of the claim. The fact that the veteran is presently or was impaired due to other medical problems is not a matter in dispute. The documents showing that the veteran completed certain courses during service, although new, are also not material, as they do not pertain to the onset of right forefinger or left side disorders during active service. Accordingly, the Board finds that the evidence received subsequent to December 1974 is not new and material and does not serve to reopen the veteran's claims for service connection for finger and left side disorders. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. § 3.156(a) (1999). Where a claimant refers to a specific source of evidence that could reopen a finally denied claim, VA has a duty to inform him of the necessity to submit that evidence to complete his application for benefits. See Graves v. Brown, 6 Vet. App. 166, 171 (1994). VA has no outstanding duty to inform the veteran of the necessity to submit certain evidence, 38 U.S.C.A. § 5103(a) (West 1991), in this case, because nothing in the record suggests the existence of evidence that might reopen the finally denied claims of entitlement to service connection for finger and left side disorders. While the RO did not obtain the veteran's SSA or VA records, additional development to obtain these records is unnecessary in view of the medical evidence currently of record. There is no basis for speculating that such records dated many years after service would produce evidence necessary to reopen the veteran's claims. As noted above, the veteran has reported that his private post-service doctors are deceased and/or their records are not available, and the RO has undertaken efforts to obtain additional service medical records, including requesting Surgeon General's Office records, essentially without success. Accordingly, the Board concludes that VA did not fail to meet its obligations with regard to these claims under 38 U.S.C.A. § 5103(a) (West 1991). ORDER Having found the claim not well grounded, entitlement to service connection for a right shoulder disorder is denied. Having found the claim not well grounded, entitlement to service connection for a left shoulder disorder is denied. Having found the claim not well grounded, entitlement to service connection for a right knee disorder is denied. Having found the claim not well grounded, entitlement to service connection for a right elbow disorder is denied. Having found the claim not well grounded, entitlement to service connection for a disorder of the right hand and fingers (other than the forefinger) is denied. New and material not having been submitted, the claim of entitlement to service connection for residuals of a fractured right forefinger is not reopened, and the appeal is denied. New and material not having been submitted, the claim of entitlement to service connection for a left side disorder is not reopened, and the appeal is denied. J. SHERMAN ROBERTS Member, Board of Veterans' Appeals