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Right Shoulder Pain Secondary to Left Shoulder Disability: A Win for Overcompensation

Learn how a veteran won secondary service connection for a right shoulder condition, even when an examiner said it was 'less likely than not' caused by their service-connected left shoulder.

What Happened

This case involves a veteran who served on active duty from February 1985 to September 2002. The veteran had an existing service-connected disability for their left shoulder, specifically rotator cuff tendonitis with degenerative arthritis. Over time, the veteran developed problems with their *right* shoulder, including a rotator cuff tear, bicipital tendonitis, and acromioclavicular arthritis. The veteran filed a claim for service connection for their right shoulder condition, arguing it was secondary to their service-connected left shoulder disability. This means they believed their right shoulder problems were caused or made worse by their already service-connected left shoulder. The VA Regional Office (RO) initially denied this claim in July 2021. The veteran then appealed this decision to the Board of Veterans' Appeals (BVA) under the Appeals Modernization Act (AMA) system, choosing the 'Evidence Submission' docket. During the appeal process, the veteran explained that their right shoulder disability developed due to overusing it to compensate for the pain and limitations in their service-connected left shoulder. A VA examiner reviewed the case and noted that while the right shoulder issues showed significant wear and tear from work and daily activities, the overcompensation due to the left shoulder *may have aggravated* these conditions. Despite the examiner stating that causation was 'less likely than not,' the BVA looked closely at the possibility of aggravation. Ultimately, the BVA sided with the veteran, granting secondary service connection for the right shoulder conditions. They concluded that the evidence, especially considering the benefit of the doubt, showed the right shoulder was aggravated by the service-connected left shoulder.

Why the VA Denied It

What Would Have Won

The key to winning this case was successfully arguing for *secondary service connection* based on *aggravation* due to overcompensation, rather than trying to prove direct causation. The veteran already had a service-connected left shoulder disability, which provided the necessary link. When the right shoulder started hurting, the veteran connected the dots: using the right shoulder more to compensate for the bad left shoulder led to the new problems. Even though the VA examiner initially said the right shoulder wasn't 'caused' by the left, the BVA carefully reviewed the examiner's full statement. The examiner *did* acknowledge that 'overcompensation may have aggravated these conditions.' This subtle but crucial distinction between 'causation' and 'aggravation' was vital. The BVA recognized that even if the right shoulder had some wear and tear from other activities, the service-connected left shoulder made it worse through overcompensation. Finally, the BVA applied the 'benefit of the doubt' rule. This rule means if the evidence is roughly equal – not clearly for or against the veteran – the veteran wins. Because the examiner's report, combined with the veteran's statement, created an 'approximate balance' of evidence regarding aggravation, the BVA ruled in favor of the veteran. This shows the power of a strong lay statement combined with a medical opinion that, even if not fully supportive of causation, leaves room for an aggravation argument.

The Rule From This Case

If you have a new condition that developed because you're overusing another part of your body to compensate for a service-connected disability, you may be able to claim secondary service connection based on aggravation, even if a medical examiner doesn't find direct causation.

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