BVA9501551 DOCKET NO. 93-07 132 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE Entitlement to service connection for arthritis of the right shoulder as secondary to a service-connected left knee disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. B. Wirt, Associate Counsel INTRODUCTION The veteran served on active duty from September 1965 to August 1968. This appeal arises from a January 1993 rating decision of the Department of Veterans Affairs (VA) Jackson, Mississippi, Regional Office (RO), which denied the veteran entitlement to service connection for arthritis of the right shoulder as secondary to a service-connected left knee disability. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he injured his right shoulder in June 1990, when his service-connected left knee gave way while he was stacking boxes at work. He contends that he continues to have pain in his right shoulder. 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 the preponderance of the evidence is in favor of the grant of entitlement to service connection for arthritis of the right shoulder as secondary to a service-connected left knee disability. FINDINGS OF FACT 1. The veteran is service connected for a left knee disability, currently evaluated as 10 percent disabling. 2. The veteran's right shoulder injury, and subsequent development of arthritis in that shoulder, was proximately due to or the result of his service-connected left knee disability. CONCLUSION OF LAW The veteran's right shoulder injury, and subsequent development of arthritis in the right shoulder, was proximately due to or the result of his service-connected left knee disability. 38 C.F.R. § 3.310(a) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the statutory duty to assist mandated by 38 U.S.C.A. § 5107(a). The veteran has appealed a denial of entitlement to service connection for arthritis of the right shoulder, as secondary to his service-connected left knee disability. Service connection may be established for disabilities resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1993). Service connection may also be established for disabilities that are proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The veteran originally injured his left knee in 1964 playing football prior to service. He apparently underwent a left medial meniscectomy in the summer of 1964. He then reinjured his knee during an obstacle course exercise in basic training in November 1965. He underwent a left knee arthrotomy in service in March 1966, and was found to have left chondromalacia patella, and left chondromalacia of the lateral femoral condyle. Service connection for the condition was granted, effective since April 1991, based on in-service aggravation in service of a pre-service injury. The veteran contends that he injured his right shoulder in June 1990 when his service-connected left knee gave out while he was stacking boxes of chickens in the meat freezer at work. The veteran was an employee of a supermarket at the time. He was seen June 1, 1990, apparently by Dr. Alvaro Moreno, for a complaint of an injury to his back in the incident. He was seen again three days later, still complaining of pain, and was referred to Douglas W. Rouse, M.D., an orthopedic surgeon. In a letter to Dr. Moreno, dated June 4, 1990, Dr. Rouse reported that the veteran was tender in his right lumbosacral muscle mass radiating in the sacroiliac joint area. A motor and sensory examination was normal and symmetrical in both lower extremities. X-rays reportedly revealed no specific bony injuries. Dr. Rouse placed the veteran on rest, muscle relaxers and anti-inflammatory medication, and recommended a follow-up in one week if symptoms persisted. The veteran was seen again by Dr. Moreno on June 5, 1990, because he wanted to return to work. Dr. Moreno commented that his only problem was muscle pain and that he could therefore return to work the next morning. On June 25, 1990, the veteran was again seen by Dr. Moreno, this time complaining of pain in his right shoulder at the joint area. He complained of having pain all the time. No specific diagnosis was made. The veteran was hospitalized in March 1991, apparently at the VA Medical Center (VAMC) in Biloxi, Mississippi, for fractures of his right tibia and fibula. A chest X-ray taken at that time incidentally revealed degenerative changes of the right acromioclavicular joint with inferior spurring of the clavicle. His right shoulder was X-rayed in April 1991, and the report indicates that there was no evidence of fracture or dislocation. Moderate degenerative changes were identified at the acromioclavicular joint. There was no soft tissue calcification. The veteran underwent a VA examination in July 1991. He complained of having intermittent right shoulder pain. On examination, he had a full range of motion in his right shoulder. The relevant diagnoses were degenerative joint disease of the right acromioclavicular joint, and degenerative joint disease of the glenohumeral joint by history. The veteran was hospitalized in November 1991 at the Audie L. Murphy Memorial Veterans Hospital in San Antonio, Texas, for a bone graft due to nonunion of his right tibia fracture. On admission the veteran also complained of right shoulder pain. His right shoulder was found to have forward flexion of 160 degrees, external rotation of 50 degrees, internal rotation of "L1," and a mild 4/5 weakness to external rotation in his supraspinatus. More X-rays of the veteran's right shoulder were taken in March 1992 at the Biloxi VAMC. Views of the shoulder in neutral and external rotation positions demonstrated well-mineralized bony structures without evidence of fracture or dislocation. The glenohumeral joint was well-maintained. There was a small osteophyte projecting from the lateral aspect of the distal clavicle which the examiner commented should be correlated for impingement syndrome. No abnormal calcification was identified in the tendon of the rotator cuff. The veteran underwent another VA examination in September 1992. He reported right shoulder pain since he injured the shoulder in June 1990 when the left knee gave way and he fell. The diagnoses included degenerative joint disease of the right acromioclavicular joint. X-rays taken the same day revealed that his right glenohumeral joint was grossly intact. The acromioclavicular joint showed minimal cortical build-up or hypertrophic changes. There was no evidence of recent or acute bone injury. The radiologist's impression was minimal hypertrophic arthritis of the right acromioclavicular joint. The veteran has submitted statements from two of his co-workers from the supermarket regarding his claimed right shoulder injury. Both statements corroborate the veteran's account of his injury (that his left knee buckled while he was stacking boxes, causing the right shoulder injury), and verify that the injury occurred in June 1990. In light of the above, the Board of Veterans' Appeals (Board) finds that service connection for arthritis of the right shoulder, as secondary to the service-connected left knee disability, is warranted. Although the veteran did not complain of right shoulder pain immediately following the June 1990 incident at the supermarket, or on three subsequent doctor's visits, he did complain of such 25 days later. This is clearly documented in the relevant medical records. He also submitted two statements from co-workers who verified his account of how the injury occurred. His complaints of right shoulder pain have been consistently documented in his various medical records since the incident, and he has been diagnosed repeatedly as having degenerative joint disease of the right acromioclavicular joint, by both physical and radiological examinations. ORDER Entitlement to service connection for arthritis of the right shoulder, secondary to a service-connected left knee disability, is granted. NANCY I. PHILLIPS 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.