Citation Nr: 23037490 Decision Date: 07/06/23 Archive Date: 07/06/23 DOCKET NO. 15-10 370A DATE: July 6, 2023 ORDER Entitlement to service connection for scar measuring 10 x 0.5cm across the left shoulder and a 2.0 x 0.1cm scar on the left chest just below the pectoris is granted. FINDING OF FACT The competent and credible evidence weighs in favor of finding that the Veteran's residuals of a scar to the left shoulder and chest are due to an in-service injury. CONCLUSION OF LAW The criteria for entitlement to service connection for scar measuring 10 x 0.5cm across the left shoulder and a 2.0 x 0.1cm scar on the left chest just below the pectoris have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for training from September 8, 1978, to December 21, 1978, and served on active duty from March 1980 to December 1981. This matter comes before the Board on appeal from a June 2013 Regional Office (RO) rating decision. In October 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. In a May 2019 decision, the Board reopened and remanded several issues. In an August 2022 decision, the Board granted service connection for left shoulder disability, low back disability, major depressive disorder, and migraine headaches. The Board notes that, despite extensive efforts to locate the Veteran's service treatment records, the vast majority of these records are unavailable. In such circumstances, when service records are unavailable through no fault of the Veteran, VA has a heightened duty to assist a veteran in developing his or her claim. O'Hare v. Derwinski, 1 Vet. App. 365 (1991). VA has met this duty and has obtained the Veteran's available outstanding service treatment records. It has documented all attempts to obtain the missing records and has notified him of these ultimately unsuccessful attempts to obtain the complete records. It has also given heightened consideration to the Veteran's lay testimony regarding the disabilities that are at issue. 1. Entitlement to service connection for residuals of a scar to the left shoulder and chest is granted. Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). To establish a right to compensation for a present disability, a veteran must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran contends that he suffered a scar to his left shoulder and chest when he was cut by a razor while attempting to break up a fight. (See Board hearing transcript, pages 13-14.) He testified that, "[w]hen the MPs came they thought that I was the aggressor... so he grabbed me and took me down to the MP station." (See Board hearing transcript, page 14.) At the station, the officer realized that the Veteran had been slashed and that he was not the aggressor, so he was taken to the hospital. (See Board hearing transcript, page 14.) In an August 2012 personal statement, he reported that "I have a 36 inch, painful scar across my left shoulder and chest." The Board has been unable to obtain records that were created during service in connection with this incident. The Board notes that a few service treatment records dated in 1986 are available from the Veteran's active duty for training and inactive duty training. The May 1986 Army Reserve enlistment examination report notes that there were no identifying body marks, scars, tattoos on examination. These records otherwise do not document a scar on the Veteran's left shoulder and chest. The Board notes that post-service medical evidence reflects that the Veteran has been stabbed multiple times. For example, an April 1994 VA medical record notes that the Veteran "has been stabbed 5 [times] in drug related incidences." A December 2007 VA medical record reflects that the Veteran "has also been stabbed 6 separate times during fights, dating as far back as the military." A January 2014 VA medical record reflects that the Veteran has a "History of stab wound to the chest, 1988," "History of requiring chest tube secondary to stab wound, 1987," and "History 'being stabbed 8 separate times during fights.'" In a March 2023 statement, the Veteran noted that "all other claims I've made have been found credible. [T]his one is no different please defer to the VET in this matter thank you." The Board does find that the Veteran's claim of having been stabbed in service is credible. Therefore, the Veteran has established the occurrence of an in-service injury. Given that the Veteran has also been stabbed many times outside of service, the Board remanded this claim in August 2022 so that the Veteran could undergo an examination and a medical opinion could be obtained that addresses the question of whether the Veteran has a current scar of the left shoulder and chest that is due to an in-service injury. The Veteran underwent this examination in November 2022. Based on review of the record and interview and examination of the Veteran, the examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In her rationale, the examiner noted the following: Review of available [medical records] reveals the following regarding scars of the left shoulder: - He is noted to sustain an injury to the left shoulder from a domestic dispute with his partner at the time, where he was stabbed in the back to the nose. He sustained stab injuries to the back and to the nose, which were noted in police report 12/2009 as well as treatment note at Penn State Hershey 12/2009. On exam, he presents with scar on the left posterior thorax measuring approximately 4 x 1cm which is consistent with this report as noted on form. - He reports being stabbed in the side of the chest in the 1980s-1990s on the left anterolateral chest, resulting in the need for a chest tube. These are reported to be around 1999, per reports on [medical records] as noted. He presents today with two scars on the anterolateral chest which are consistent with what is described. [He] has a scar on the mid anterolateral chest measuring approximately 3 x 1cm from the stab wound, with a scar measuring 1 x 0.5cm just superior to this scar from the chest tube, placed for treatment of the punctured lung he sustained from stab wound. The final scars present on exam are a scar measuring 10 x 0.5cm across the left shoulder and a 2.0 x 0.1cm scar on the left chest just below the pectoris which the claimant reports are due to the fight he was involved in while in service. Review of available medical record, however, is silent for reports of a fight or treatment of these wounds in service. Similarly, review of physician exams in the years after service are silent for scars over the shoulder, including the Reserve physical in 1986, which was silent for any abnormalities of the skin including scars. For this reason, there is insufficient evidence to establish a nexus between the claimed condition of shoulder and chest scars and the claimant's service time. The Board finds this opinion to be highly probative, as it was authored by a medical professional who possesses the necessary education, training, or experience to provide competent medical evidence under 38 C.F.R. § 3.159 (a)(1). See Cox v. Nicholson, 20 Vet. App. 563 (2007). It presents a thorough review of the record and describes all chest and shoulder scars as well as the circumstances under which each identifiable scar was obtained. With respect to the scars to which she could not pinpoint an etiology, the examiner explained that there was insufficient evidence. As the Board finds that the Veteran's claim of having been stabbed in service is credible, the Board resolves reasonable doubt in favor of the Veteran that he suffers from residual scarring. Accordingly, service connection for scar measuring 10 x 0.5cm across the left shoulder and a 2.0 x 0.1cm scar on the left chest just below the pectoris is warranted. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Elizabeth Jalley, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.