Citation Nr: 18142474 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-23 572 DATE: October 15, 2018 ORDER Entitlement to service connection for right hip degenerative joint disease (DJD) as secondary to service-connected total knee replacement with DJD, right knee, is granted. A 100 percent disability for right total knee replacement with DJD is granted from March 4, 2013 to April 30, 2014 under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5055. REMANDED A rating in excess of 30 percent for right total knee replacement with DJD from May 1, 2014, is remanded. FINDINGS OF FACT 1. The record evidence is at least in relative equipoise as to whether the Veteran’s right hip DJD is secondary to his service-connected total knee replacement with DJD, right knee. 2. The Veteran underwent a revision right total knee arthroplasty with revision of the right femoral component and polyethylene exchange on March 4, 2013. CONCLUSIONS OF LAW 1. The criteria for secondary service connection for right hip DJD are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 2. A 100 percent disability rating for total knee replacement with DJD, right knee, is granted from March 4, 2013 through April 30, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.30, 4.71a, DC 5055. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1977 to June 1980, and from February 1981 to April 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a timely notice of disagreement in September 2014. The RO issued a statement of the case (SOC) in March 2016. The Veteran subsequently perfected his appeal with a VA Form 9 in May 2016 and elected not to undergo an optional Board hearing. 1. Entitlement to service connection for right hip DJD as secondary to service-connected total knee replacement with DJD, right knee The Veteran contends that his right hip DJD is secondary to service-connected total knee replacement with DJD of the right knee. Service connection may be established on a secondary basis for: (1) a disability that is proximately due to or the result of a service-connected disease or injury; or, (2) any increase in the severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease or injury. 38 C.F.R. §§ 3.310(a)-(b); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993) (explaining 38 C.F.R. § 3.310(a)); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (explaining 38 C.F.R. § 3.310(b)). The competence, credibility, and probative (relative) weight of evidence, including lay evidence must be assessed. See generally 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis when a layperson (1) is competent to identify the unique and readily identifiable features of a medical condition; or, (2) is reporting a contemporaneous medical diagnosis; or, (3) describes symptoms at the time which supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994); and 38 C.F.R. § 3.159(a)(2). However, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). See 38 C.F.R. §3.159(a)(1). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F. 3d 1274, 1278 (2010). It is VA policy to administer the laws and regulations governing disability claims under a broad interpretation and consistent with the facts shown in every case. When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not prove or disprove the claim satisfactorily. It is a substantial doubt and one within range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. §3.102. While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on behalf of the Veteran. Gonzalez v. West, 218 F. 3d 1378 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). VA treatment records show that the Veteran was diagnosed with DJD of the right hip in August 2012. The primary care physician noted that it is more likely than not that the Veteran’s right hip condition is due to his right knee condition. The same day, VA treatment records show that an orthopedic surgeon reviewed x-rays and found a questionable crescent sign on the Veteran’s right hip. The orthopedic surgeon explained to the Veteran that his hip problem may be coming from the fact that he has been walking poorly due to his knee. The Veteran understood that there was a possibility of relation due to his gait. In a January 2014 VA hip and thigh conditions examination, a VA examiner opined that the Veteran’s hip condition was less likely than not caused by his service-connected right knee disability. The examiner noted that the Veteran presented 24 years after separation and has x-rays that demonstrate a cam lesion of his right proximal femur which would lead to femoral acetabular impingement, a known cause of hip arthritis. The examiner noted that the cam lesion is a bony abnormality that is congenital and not caused by service as they are present even in the general population. In a March 2016 VA hip and thigh conditions examination, a VA examiner opined that the Veteran’s right hip condition was less likely than not secondary to his service-connected right knee disability because the Veteran has mild bilateral hip DJD which is more likely age related and due to the underlying femoracetabular impingement. The examiner added that there is no medical nexus between compensatory hip DJD due to the right knee DJD. The Board finds that the record evidence is at least in relative equipoise as to whether the Veteran’s currently diagnosed right hip DJD is secondary to his service-connected total knee replacement with DJD of the right knee. Although the VA examinations in January 2014 and March 2016 provided negative secondary nexus opinions, the Board finds that the August 2012 positive nexus opinions in combination are sufficient to establish service connection in this case. The August 2012 examiners thoroughly reviewed the Veteran’s record and provided positive secondary nexus opinions that in combination, were supported by an adequate rationale. In view of that and with the resolution of reasonable doubt in favor of the Veteran, service connection for right hip DJD as secondary to total knee replacement with DJD of the right knee is warranted here. 2. Entitlement to a disability rating in excess of 30 percent from October 1, 2013 for total knee replacement with DJD of the right knee The Veteran is seeking a temporary total disability rating for a period of one year following his revision total knee arthroplasty of the right knee. The Veteran is currently in receipt of a 100 percent rating for his right knee disability from March 4, 2013 to September 30, 2013 under 38 C.F.R. § 4.30. From October 1, 2013, the Veteran has a disability rating of 30 percent under 38 C.F.R. § 4.71a, DC 5055. Under 38 C.F.R. § 4.71a, DC 5055, replacement of either knee joint warrants a 100 percent evaluation for a one-year period following implantation of the prosthesis. Thereafter, a 60 percent evaluation is warranted if there are chronic residuals consisting of severely painful motion or severe weakness in the affected extremity. With intermediate degrees of residual weakness, pain or limitation of motion, the disability will be rated by analogy to DCs 5256, 5261 or 5262. The mandatory minimum rating is 30 percent. The 100-percent rating for one year following implantation of prosthesis will commence after the initial grant of a one-month total rating following hospital discharge to be assigned under 38 C.F.R. § 4.30. The record reflects that the Veteran underwent a revision right total knee arthroplasty with revision of the right femoral component and polyethylene exchange on March 4, 2013. The Board finds that this surgery is essentially a knee replacement surgery that qualifies the Veteran for a disability rating under 38 C.F.R. § 4.71a, DC 5055. As such, the Board finds that the evidence supports the Veteran’s entitlement to a 100 percent schedular rating for 1-year for his revision arthroplasty of the right knee pursuant to 38 C.F.R. § 4.71a, DC 5055 (knee replacement (prosthesis)), subsequent to a one-month period of convalescence following the surgery under 38 C.F.R. § 4.30. See 38 C.F.R. § 4.71a, DC 5055, Note 1. In this case, following a one-month period of a 100 percent convalescent rating under 38 C.F.R. § 4.30 in March 2013, the Board replaces the temporary total rating assigned with the 100 percent schedular rating for a prescribed period of one year under 38 C.F.R. § 4.71a DC 5055 from April 1, 2013 to April 30, 2014. REASONS FOR REMAND 1. Entitlement to a disability rating in excess of 30 percent from May 1, 2014, for total knee replacement with DJD of the right knee As mentioned above, the Veteran underwent a revision right knee arthroplasty in March 2013. A review of the record does not contain sufficient evidence for the Board to determine the severity of the Veteran’s right knee condition following his 100 percent rating under 38 C.F.R. § 4.71a DC 5055, beginning May 1, 2014. Therefore, the Board finds that there are outstanding treatment records that need to be obtained on remand. In addition, the Veteran has not been afforded a VA knee examination since January 2014. Therefore, on remand, the Board finds that a VA examination to assess the current severity of the Veteran’s right knee disability is warranted. The matter is REMANDED for the following action: 1. Obtain and associate with the Veteran’s file any VA treatment records that are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. 2. Contact the Veteran and request authorization to obtain any outstanding records pertinent to his claim, including any private treatment records following proper VA procedures (38 C.F.R. § 3.159 (c)). 3. Afford the Veteran a VA orthopedic examination to assess the severity of his right knee disability, status post revision arthroplasty. A copy of this remand and all relevant medical records should be made available to the examiner. The examiner must review the pertinent evidence, including the Veteran’s lay assertions, and undertake any indicated studies. All testing indicated by the current Disability Benefits Questionnaire format must be addressed. The examiner should report all signs and symptoms necessary for rating the Veteran’s right knee disability under the rating criteria. In particular, the examiner should provide the range of motion in degrees of the knee. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and non- weight-bearing, where possible. If the examiner is unable to conduct the required testing, he or she should clearly explain so in the report. The presence of objective evidence of pain, excess fatigability, incoordination and weakness should also be noted, as should any additional disability (including additional limitation of motion) due to these factors. The examiner shall inquire as to periods of flare-up, and note the frequency and duration of any such flare-ups. Any additional impairment on use or about flare-ups should, to the extent possible, be described in terms of the degree of additional range of motion loss. The examiner should specifically describe the severity, frequency, and duration of flare-ups; name the precipitating and alleviating factors; and estimate, per the Veteran, to what extent, if any, such flare-ups affect functional impairment. If the examiner is unable to conduct the required testing, he or she should clearly explain why that is so. All conclusions reached by the examiner should be thoroughly explained. (Continue on next page) 4. Finally, after completing the above actions, as well as any other development that may be warranted, the RO must readjudicate the Veteran’s claim in light of all the evidence of record. If any benefit on appeal remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Morrad, Associate Counsel