Citation Nr: 9837390 Decision Date: 12/22/98 Archive Date: 12/30/98 DOCKET NO. 96-51 833 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey THE ISSUE Entitlement to service connection for bursitis of the hips. ATTORNEY FOR THE BOARD C. L. Wasser, Associate Counsel INTRODUCTION The veteran served on active duty from August 1975 to February 1996. This case comes to the Board of Veterans’ Appeals (Board) from a July 1996 RO decision which denied service connection for bilateral gluteus medius bursitis. The Board notes that the gluteus medius is one of the muscles of the hip area, and the Board has recharacterized the issue on appeal as service connection for bursitis of the hips (regardless of whether or not the gluteus medius is specifically involved). In June 1998, the Board remanded the case to the RO in order to schedule the veteran for a requested hearing before a member of the Board at the RO (i.e., a Travel Board hearing). Such a hearing was then scheduled, but the veteran failed to report. The case was returned to the Board in October 1998. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that she has bursitis of the hips which is attributable to her military service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), 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 evidence supports service connection for bursitis of the hips. FINDING OF FACT The veteran currently has bursitis of both hips which began during her active service. CONCLUSION OF LAW The veteran's bursitis of both hips was incurred in service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1998). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background The veteran served on active duty in the Army from August 1975 to February 1996. A review of her service medical records shows that on entrance medical examination performed in May 1975, her lower extremities and musculoskeletal system were listed as normal. A June 1980 treatment note shows that she presented with complaints of “sticking pain” in her right hip for the past week with no trauma; on examination, the right bursal area was tender, and there was good range of motion. The diagnostic assessment was questionable bursal pain. Follow-up treatment notes dated in July 1980 reflect continued complaints of right hip pain; the diagnosis was trochanteric bursitis, and she was treated with an injection. In October 1980, the veteran complained of right hip pain which began in June 1980, with no history of injury; the diagnosis was right hip pain of questionable cause, possible bursitis. An X-ray study was negative. In February 1981, the veteran presented with complaints of bursitis of the right hip; the diagnosis was right trochanteric bursitis. In April 1981, she reported intermittent right hip pain for the past week; the diagnostic assessment was trochanteric bursitis. In July 1981, she complained of right hip pain on walking, sitting, and standing. On examination, there was tenderness over the femoral tuberosity; the diagnostic assessment was bursitis of the greater tuberosity. In September 1981, she presented with complaints of bursitis of the right hip; the diagnosis was trochanteric bursitis In July 1982, the veteran presented with complaints of recurring pain and a “rubbing” feeling in her right hip; the diagnosis was trochanteric bursitis. She was referred for follow-up treatment of hip pain in August 1982. In November 1983, the veteran complained of bilateral hip pain; the examiner indicated a diagnostic impression of bursitis, and referred her for physical therapy. In January 1985, the veteran received a steroid injection to the right epitrochanteric bursa with good relief of her complaints of hip bursitis. A March 1985 treatment note shows that the veteran reported a history of bursitis of both hips, with more symptoms on the right currently. On examination, there was full range of motion of the right hip, with obvious pain and hesitation, and considerable snapping and grinding of the joint on full movement. There was some tenderness over the greater trochanter. The diagnosis was probable subtrochanteric bursitis of the right hip. A subsequent March 1985 treatment note shows that the veteran presented with pain in the right inguinal area which came on after she crossed her legs; the diagnostic impression was “hip pointer.” A March 1985 physical therapy note shows that the veteran was referred for ultrasound treatment to the right inguinal area for a five-year history of intermittent right hip pain. On re-enlistment physical examination in May 1985, the veteran's lower extremities and musculoskeletal system were listed as normal. An August 1985 treatment note indicates a diagnosis of chronic bilateral trochanteric bursitis with localized pain and tenderness, with no other abnormalities or misalignment. An April 1986 treatment note shows that the veteran presented with complaints of chronic right hip pain with a history of bursitis. She reported a history of a skiing accident 7 years previously, in which she fell on her right hip, with subsequent chronic intermittent pain, which was worse in damp and cold weather. She reported pain at the greater trochanter radiating around the thigh, and felt crepitus with motion. On examination, the right hip joint was tender to repeated movement of the hip, and crepitus was heard. An X- ray study was negative. The diagnostic assessment was subtrochanteric bursitis. Medication and ultrasound treatments were prescribed. An April 1988 treatment note shows that the veteran presented with complaints of an ongoing problem of bursitis of both hips, with pain for the past four or five days. She reported bilateral hip pain for several years. On examination, range of motion of the hip joints was normal, and the anvil test was negative. On periodic medical examination performed in August 1993, the veteran's lower extremities and musculoskeletal system were listed as normal. In a report of medical history dated in August 1993, the veteran reported a history of arthritis, rheumatism or bursitis; the reviewing examiner noted that the veteran was treated for bursitis of the hips in 1981. On medical examination performed for retirement purposes in January 1996, the veteran's lower extremities and musculoskeletal system were listed as normal. In a report of medical history completed in January 1996 in conjunction with the retirement medical examination, the veteran reported current bursitis. The reviewing examiner noted that the veteran reported bilateral bursitis of the hips for the past 14 years, which was aggravated by cold weather. She said she treated this condition with heat and rest. The examiner noted that she had no permanent profile and the condition had no effect on the activities of daily living. The veteran retired from service at the end of February 1996, having completed more than 20 years of active duty. In April 1996, she submitted a claim for service connection for bilateral hip bursitis, which she said began in 1981. At an April 1996 VA orthopedic examination, the veteran reported that she fell on her right side while skiing during service. She complained of right hip pain which she said persisted since the in-service fall. She reported that she was diagnosed with bursitis in that hip and was treated with injections, and later incurred bursitis in the left hip, and received injections to that hip. She said she was somewhat symptomatic with prolonged ambulation. On examination, the veteran ambulated with a normal alternating gait, there was no evidence of a Trendelenburg gait, and hip range of motion was greater than the normal range. Resisted abduction caused discomfort bilaterally in the region of the gluteus medius bursa, and palpation of the trochanteric bursa was painless bilaterally. Palpation in the region of the gluteus medius bursa was uncomfortable bilaterally. There was full strength about the hips. The pertinent diagnosis was bilateral gluteus medius bursitis. The examiner opined that this was currently symptomatic, and was most likely related to the veteran's hypermobility of the hips, and not specifically related to the in-service fall. By a statement received in September 1996, the veteran stated that a military doctor told her that her 1981 fall caused possible damage to the bursa and led to bursitis, and that she was treated for 15 years for this complaint during service. She asserted that her bursitis was not related to her hip hypermobility. By a statement dated in December 1996, the veteran reiterated many of her assertions, and enclosed medical records of treatment (as a military retiree) at Patterson Army Hospital dated in December 1996. Such records reflect that the veteran presented with complaints of right hip pain which she related began in 1980 after a ski accident. On examination, there was full range of motion, and mild crepitus with range of motion of the right hip. The diagnostic assessment was trochanteric bursitis, right greater than left, and a valgus gait on the right. At a June 1997 VA examination the veteran reported that she fell while skiing in 1981, and developed posterior hip and buttock discomfort with a bruise and point tenderness. She said within a year she had similar discomfort on the left. She reported subsequent intermittent hip flare-ups, and said she was treated with cortisone injections and medication. On examination of her hips, there was no pain in the groin or inguinal area on either side, range of motion was performed rather fluidly, there was no palpable bursa on palpating the greater trochanter, and there was no crepitus or snapping on carrying the hip passively through a flexion, extension, or rotary range of motion. The examiner opined that there was no current evidence of bilateral gluteus medius bursitis, and no evidence of true trochanteric bursitis, although there was evidence that she had trochanteric bursitis in the past. II. Analysis The veteran's claim for service connection for bursitis of the hips is well grounded, meaning plausible. The file shows that the RO has properly developed the evidence, and there is no further VA duty to assist the veteran with her claim. 38 U.S.C.A. § 5107(a). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service medical records from the veteran's 1975-1996 active duty reflect episodic treatment for bilateral hip pain, primarily diagnosed as bilateral trochanteric bursitis. On medical examination performed for retirement purposes in January 1996, the veteran's lower extremities and musculoskeletal system were listed as normal. In a report of medical history completed in January 1996 in conjunction with the retirement medical examination, the reviewing examiner noted that the veteran reported bilateral bursitis of the hips for the past 14 years, which was aggravated by cold weather. The veteran retired from service at the end of February 1996. Shortly thereafter, at an April 1996 VA examination, the veteran was diagnosed with bilateral gluteus medius bursitis (i.e., bursitis of both hips) which was currently symptomatic. Medical records dated in December 1996 from Patterson Army Hospital reflect that the veteran was diagnosed with trochanteric bursitis, right greater than left. At a June 1997 VA examination, the examiner found no evidence of current bilateral gluteus medius bursitis or true trochanteric bursitis, although there was evidence that she had trochanteric bursitis in the past. In sum, there were numerous findings of bursitis of both hips during the veteran’s active duty which ended in 1996, and shortly after service in 1996 there were findings of bursitis of both hips (variously diagnosed as gluteus medius bursitis or trochanteric bursitis) at a VA examination and on treatment at a military facility. Bursitis of the hips was not found at a 1997 VA examination, but, given the historical medical records showing intermittent flare-ups of the condition, it appears the negative findings on this examination merely indicate the chronic condition was then in a state of remission. There appears to be satisfactory evidence of a continuity of symptomatology of bursitis of the hips since service. 38 C.F.R. § 3.303(b). With due regard to the benefit-of-the-doubt rule, 38 U.S.C.A. § 5107(b), the Board finds that bursitis of both hips was incurred in service, warranting service connection. ORDER Service connection for bursitis of both hips is granted. L. W. TOBIN Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), 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, 102 Stat. 4105, 4122 (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. - 2 -