Citation Nr: 18150266 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-11 398A DATE: November 14, 2018 ORDER Service connection for coccygeal strain is granted. Service connection for lumbar strain is granted. Service connection for left hip degenerative joint disease (DJD) status post stress fracture is granted. Service connection for acne dermatillomania as secondary to service-connected obsessive compulsive disorder is granted. Service connection for left knee strain, right hip strain, and bilateral hearing loss (BHL) is denied. FINDINGS OF FACT 1. The evidence is at least in equipoise with regard to showing that the Veteran’s coccygeal strain is associated with her service. In July 2014, the Veteran was diagnosed with coccygeal strain by a VA examiner. She has consistently contended since the 1990s that she injured her low back in a fall during basic training and has had pain in the area since that time. No relevant medical conditions were noted on her enlistment examination. Service treatment records (STRs), to include from November 1997, describe a difficult to treat, chronic coccygeal condition not expected to show significant improvement. In connection with her separation from active duty in 2003, but prior to her entrance into the Air Force Reserve/Army National Guard, the Veteran indicated she had recurrent back pain or a back problem on a Report of Medical History form, but it was subsequently crossed out. In contrast to the STR clinician’s opinion that the Veteran incurred a life-long, chronic, unlikely-to-heal coccygeal condition in-service, the September 2014 VA opinion provider stated that the absence of treatment since discharge indicated the condition resolved. However, affording the Veteran the benefit of the doubt, service connection is warranted. 2. The evidence is at least in equipoise with regard to showing that the Veteran’s lumbar strain is associated with her service. In July 2014, the Veteran was diagnosed with lumbar strain by a VA examiner. She has consistently contended since the 1990s that she injured her low back in a fall during basic training. No relevant medical conditions were noted on her enlistment examination. STRs, to include from April 2002, address chronic low back pain in-service. June 1997 STRs contain evidence that her lumbar strain is intertwined with her coccygeal strain, which the Board has already found to be a life-long problem pursuant to competent medical evidence in her STRs. At the same time, the September 2014 VA opinion provider stated that the absence of treatment since discharge indicated the condition resolved. However, affording the Veteran the benefit of the doubt, service connection is warranted. 3. The evidence favors a finding that the Veteran’s left hip DJD status post stress fracture is associated with her service. The Veteran was diagnosed with left hip DJD status post stress fracture by a VA examiner in July 2014 who linked her current DJD to a stress fracture in-service. STRs dated January 2002 document a left hip stress fracture in-service consistent with the Veteran’s contentions in her March 2016 substantive appeal. By contrast, in September 2014 a VA opinion provider stated that the absence of treatment since discharge means that it resolved. However, affording the Veteran the benefit of the doubt, service connection is warranted. 4. The evidence favors a finding that the Veteran’s acne dermatillomania was caused by her 70 percent service-connected obsessive compulsive disorder (OCD). In November 2013, treatment records show the Veteran was diagnosed with skin picking disorder. In April 2006, her VA psychiatrist opined that her skin picking was due to anxiety subsequently attributed to OCD in a VA examination report dated July 2014, which also linked her skin picking to her OCD. Accordingly, service connection is warranted as secondary to service-connected OCD. 5. The preponderance of the competent medical evidence is against a finding that the Veteran’s left knee strain and right hip strain are associated with her service. 6. The preponderance of the competent medical evidence is against a finding that the Veteran has BHL for VA purposes. CONCLUSIONS OF LAW 1. The criteria for service connection for coccygeal strain; lumbar strain; left hip DJD status post stress fracture; and acne dermatillomania as secondary to service-connected obsessive compulsive disorder have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 2. The criteria for service connection for left knee strain; right hip strain; and BHL have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.385 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1992 to October 2003. She served honorably in the United States Army, with additional service in the Air Force Reserve and the Army National Guard. The Board thanks the Veteran for her service to our country. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Decatur, Georgia.   Entitlement to service connection for left knee strain Service connection is warranted where the evidence of record establishes that a particular 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). For the purposes of evaluating lay evidence, to include a veteran’s statements about her health conditions, competent evidence is “limited to that which the witness has actually observed, and is within the realm of his personal knowledge.” Layno v. Brown, 6 Vet. App. 465, 469-470 (1994). For example, although a lay person is competent to report observable symptomatology of an injury or illness (such as pain or the visible flatness of his feet), a lay person is “not competent to opine as to medical etiology or render medical opinions.” Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Here, the Veteran was diagnosed with left knee strain by a VA examiner in July 2014. Pursuant to the examination report, the Veteran contends that onset began in 2002 while running on active duty. However, turning to the question of whether there is a nexus, or link, between left knee strain and service, the Board concludes that the preponderance of the competent medical evidence is against such a finding. The September 2014 VA clinician issued a negative opinion as to nexus that was supported by rationale, to include consideration of the Veteran’s STRs, the full claims file, and her post-service medical history. In addition, a July 2014 VA clinician’s opinion that the Veteran’s left knee strain “could have” developed secondary to a right knee condition in-service is not dispositive because she is not service-connected for a right knee condition, as would be required for a successful secondary service connection claim. Accordingly, service connection for left knee strain is not warranted. Entitlement to service connection for right hip strain Here, the Veteran was diagnosed with right hip strain by a VA examiner in July 2014. In her March 2016 substantive appeal, the Veteran attributed her right hip strain to prolonged standing and running in combat boots in the Army. STRs, to include from July 1997, address a different right hip condition pertaining to small subchondral cystic areas and the September 2014 VA clinician issued a negative opinion as to nexus that was supported by rationale, to include consideration of the Veteran’s STRs, the full claims file, and her post-service medical history. Accordingly, service connection is not warranted. Entitlement to service connection for BHL For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hertz is 40 decibels or greater; or when the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385. Here, the Board concludes that the preponderance of the competent medical evidence is against a finding that the Veteran has BHL for VA purposes. Pursuant to the July 2014 VA examination, auditory thresholds did not exceed 20 decibels   and Maryland CNC Test results showed 100 percent speech recognition scores bilaterally, which is consistent with other medical evidence contained in the claims file. Accordingly, service connection is not warranted. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Fales, Associate Counsel