Citation Nr: 0005751 Decision Date: 03/03/00 Archive Date: 03/14/00 DOCKET NO. 91-37 555 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Entitlement to service connection for residuals of a right shoulder injury. REPRESENTATION Appellant represented by: Pamela J. Jones, Attorney WITNESSES AT HEARING ON APPEAL Appellant and S. J. ATTORNEY FOR THE BOARD William W. Berg, Counsel INTRODUCTION The veteran served on active duty from March 1969 to November 1970 with subsequent service in the Army Reserve that included a period of active duty for training from June 27 to July 19, 1976, and a period of inactive duty training in April 1977. In a statement received in March 1996 in response to an inquiry from the regional office, the veteran said that he had served in the Army Reserve from 1970 to 1986 and that he had never served with the National Guard. When this matter was previously before the Board of Veterans' Appeals (Board) in August 1997, it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, for additional development. Following the requested development, the RO continued its denial of the claimed benefit. The matter is now before the Board for final appellate consideration. The veteran and S. J. testified before the undersigned Board member at a hearing in Washington, D.C., in March 1992. A transcript of that hearing is of record. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. No competent evidence has been submitted relating any current right shoulder disability to service or to any incident of service origin. CONCLUSION OF LAW The veteran has not submitted evidence of a well-grounded claim for service connection for residuals of a right shoulder injury. 38 U.S.C.A. §§ 101(24), 106, 1110, 1131, 5107(a) (West 1991); 38 C.F.R. §§ 3.6, 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The medical evidence of record prior to April 1977, including the veteran's service medical records, is silent for complaints or findings referable to a right shoulder disorder. The record shows that the veteran was seen at a VA outpatient clinic on April 14, 1977, with a complaint of injury to his right shoulder and arm when he landed in a ditch in a parachute jump. A request for an orthopedic consultation on that date noted that the veteran had injured his shoulder two weeks previously in a parachute jump, when he fell on the shoulder and apparently sustained a contusion, which began to improve. However, he was experiencing pain in the region of the brachial nerve down the hand, which had some mild swelling. The referring physician did not see any gross fracture on X-rays of the right upper extremity. A VA orthopedic consultation on April 27, 1977, resulted in an impression of status post contusion of the right shoulder; a partial tear of the deltoid muscle on the right was to be ruled out. A request for further orthopedic evaluation, dated April 28, 1977, indicates that the veteran landed on his right shoulder three weeks previously when parachuting. He complained of pain in the right deltoid area, which still hurt when he moved his shoulder. X-rays were reported as negative for evidence of fracture. In July 1977, the veteran was evaluated by a physician from the surgical service of the Hampton, Virginia, VA Clinic. X- rays were interpreted as within normal limits. An examination culminated in an impression of possible partial tear, but it was felt that the veteran's symptoms were improving. The physician found no evidence of a dislocating shoulder or biceps tendonitis. Of record are medical reports from the hospital at Langley Air Force Base, Virginia, dated in October 1978 indicating that the veteran was seen, apparently while serving on active duty for training, for a complaint of pain and loss of motion in the right shoulder when he fell or landed on his right deltoid area on October 14, 1978, while parachuting. When seen in the orthopedic clinic five days after the injury, it was reported that he had pain and limitation of motion of the right shoulder but that X-rays did not visualize fracture or dislocation. In May 1979, the veteran was admitted to a VA hospital after injuring his right shoulder on the day of admission when he attempted to catch a ball during a softball game. He developed pain in the right shoulder and some swelling in his hand, as well as tingling of the hand. X-rays of the right shoulder and humerus revealed no evidence of bony change. However, he had persistent pain and tenderness about the shoulder region extending into the scapula rotators and base of the neck on the right. He had point tenderness over the acromioclavicular joint, as well as over the tip of the acromion. The veteran indicated that he had sustained an injury of his right arm following a parachute jump in April 1977 with a partial tear of the biceps tendon. Cervical spine X-rays revealed no evidence of bony pathology. It was felt that the veteran had sustained a contusion of his right shoulder with some brachial plexus traction injury and strain over the scapula of the shoulder musculature. The diagnoses on discharge from the hospital were contusion of the right shoulder and torn lateral head of the right biceps tendon. On an annual physical examination for the Army Reserve in May 1981, the veteran exhibited limited range of motion of the right shoulder and thumb. He gave a history of having injured his right shoulder in a parachute accident in April 1977. He reported that he stayed home from work for 45 days as a consequence. In May 1984, the veteran was examined for active duty for training. A history of post-traumatic arthritis in the right shoulder after a parachute accident was noted. However, the veteran's upper extremities were normal on clinical examination. A P-2 physical profile was assigned, but the veteran was found qualified for retention. When seen at a VA outpatient clinic in April 1987, the veteran complained of pain in the right shoulder with a tingling sensation extending down toward the hand. He also complained of a decreased range of motion of the shoulder secondary to pain, and pain and swelling of the right 2nd and 3rd phalanges. A history of trauma to the right shoulder and arm in 1977 was noted. The assessment was probable degenerative changes secondary to old trauma. The veteran was seen at a VA outpatient clinic in July 1988, when he complained of pain and swelling in the right hand. He gave a history of having fallen in his garage, hitting the wall with his right hand. X-rays revealed a "Boxer's fracture" of the 5th right metacarpal. When hospitalized by VA in August 1990 for an unrelated disorder, a physical examination was unremarkable, except for a limited range of motion of the right shoulder and first digit of the right hand, in addition to right scapula "winging". A VA orthopedic examination in August 1993 culminated in a diagnosis of bursitis of the right shoulder. X-rays of the shoulder were normal, and the examiner was of the opinion that except for acute bursitis, the veteran had a major psychogenic musculoskeletal reaction. However, magnetic resonance imaging at a private orthopedic clinic in March 1994 was interpreted as suggestive of impingement of the supraspinatus tendon; an unusual Hill- Sachs deformity involving the anatomical neck of the humerus could not be ruled out. There was no evidence of a joint fluid collection, but acromioclavicular joint hypertrophy was seen. The pertinent diagnosis of a VA physician in June 1994 was rotator cuff impingement on the right. When the veteran was seen at a VA orthopedic clinic in December 1994, it was thought that he exhibited reflex sympathetic dystrophy-type symptoms of the right upper extremity, but the assessment was chronic pain syndrome involving the back and right upper extremity. The presence of reflex sympathetic dystrophy was never confirmed. On VA orthopedic examination in February 1997, the veteran again indicated that he had injured his right shoulder in a parachute jump in 1977. The veteran's service pay records for the period from April to December 1977, which were submitted by the attorney- representative in March 1998, indicate that the veteran performed inactive duty training in April 1977 that included jump training. The veteran's service personnel records show that in 1976, he completed two weeks of basic airborne training at Fort Devens, Massachusetts, and that he qualified as a parachutist in June 1976. His decorations include the Parachute Badge. Analysis As indicated above, the service medical records for the veteran's initial period of active duty are completely negative for complaints or findings of a right shoulder disorder. The veteran does not contend otherwise. Rather, he asserts that he has residuals of a right shoulder injury sustained in a parachute jump in April 1977 while performing inactive duty training. Service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty for training or injury incurred or aggravated while performing inactive duty training. 38 U.S.C.A. §§ 101(24), 106, 1110, 1131; 38 C.F.R. § 3.6. However, the threshold question that must be addressed in this case is whether the veteran has presented evidence of a well-grounded claim for service connection for residuals of a right shoulder injury. A well-grounded claim is a plausible claim, one that is meritorious on its own or capable of substantiation. Murphy v Derwinski, 1 Vet. App. 78, 81 (1990). There must be more than mere allegation; the claim must be accompanied by supporting evidence. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). A well-grounded service connection claim generally requires medical evidence of a current disability; medical or, in certain circumstances, lay evidence of inservice incurrence or aggravation of a disease or injury; and medical evidence of a nexus between an inservice injury or disease and a current disability. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997), cert. denied sub nom. Epps v. West, 524 U.S. 940 (1998). If a claim is not well grounded, the appeal must fail with respect to it, and there is no duty to assist the claimant further in the development of facts pertinent to the claim. Struck v. Brown, 9 Vet. App. 145, 156 (1996). The record indicates that the veteran sustained an injury of his right shoulder in a parachute jump during inactive duty training in April 1977 and reinjured the shoulder in a separate incident in October 1978, apparently again while parachuting. However, on both occasions, only acute and transitory injuries appear to have been sustained. See 38 C.F.R. § 3.303(b). Although the veteran had symptoms of injury following the training incidents, even disease or injury is not entitled to service connection unless chronic residuals constituting a disability result therefrom. The United States Court of Appeals for Veterans Claims has specifically so held. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (Congress specifically limits entitlement to service connection for disease or injury to cases where such incidents have resulted in disability). The record in this case suggests that the veteran acquired a disability - permanent residuals of injury - only after the injury to his right shoulder in May 1979, for it was then that he sustained an injury of the brachial plexus and strain over the scapula of the shoulder musculature. It is reasonably inferable from the evidence that a chronic injury of the right shoulder would have made playing softball problematic, to say the least. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (Board has fact-finding authority to assess the quality of the evidence before it, including the duty to analyze its credibility and probative value, as well as authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence). It is of course possible that the injury in May 1979 simply aggravated an underlying right shoulder disorder, but the record, although thick with medical evidence, is nevertheless devoid of any medical evidence or opinion attributing any current right shoulder disorder to the parachute jumps during service training periods. Such evidence is especially crucial in this case in light of the injuries that the veteran sustained to his right upper extremity in May 1979 and thereafter. Although the veteran has asserted an etiologic relationship between the incidents in service and his current right shoulder problems, he has not provided any medical opinion establishing any such relationship. Although a lay witness is competent under the law to describe symptoms he has seen or experienced, he is not competent to render a diagnosis, or to offer a medical opinion attributing a disability to service, as this requires medical expertise. See Stadin v. Brown, 8 Vet. App. 280, 284 (1995); Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In the absence of competent medical evidence relating any current right shoulder disorder to service or to an incident of service origin, the claim for service connection for residuals of a right shoulder injury is not well grounded. Epps v. Gober, 126 F.3d at 1468. The claim must, accordingly, be denied. See Edenfield v. Brown, 8 Vet. App. 384 (1995) (en banc). ORDER Service connection for residuals of a right shoulder injury is denied. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals