Citation Nr: 18155039 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 08-38 918 DATE: December 4, 2018 ORDER Entitlement to service connection for a right hip bursitis, secondary to the residuals of a left pelvic stress fracture residuals, is granted. REMANDED Entitlement to total disability due to individual unemployability is remanded. FINDING OF FACT The evidence is at evenly balanced as to whether the Veteran’s right hip bursitis is related to a service connected disability. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, right hip bursitis is secondary to residuals of left pelvic stress fracture residuals. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1998 to July 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. In March 2013, the Veteran testified before the undersigned. A transcript of that proceeding is associated with the record. Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The Veteran contends that her right hip pain and bursitis is due to an altered gait caused by pain associated with left hip stress fracture residuals and leg problems. She reports a history of complaints of bilateral hip pain since service. A March 1998 service treatment record states a bone scan revealed a left pelvic stress fracture. Her May 1998 separation examination notes a left pelvic fracture. Numerous pelvic X rays from 1998 through 2002 show an old fracture of the superior and inferior left pubic rami. The Veteran’s first VA compensation examination in June 1998 notes a left pelvic stress fracture. In June 2007 a VA examiner noted that the Veteran showed evidence of right hip trochanteric bursitis which was first diagnosed in December 2006 at a VA physiatry examination. He concluded that, “given that this was first diagnosed in 2006, eight years after her discharge from active duty, I do not believe this is related to her military service.” This examiner did not address whether or not the right hip bursitis was caused or worsened by the effects of the Veteran’s other service connected disabilities. In November 2017 a VA examiner outlined the Veteran’s history and concluded that there was no evidence that she sustained a right hip stress fracture, as indicated in a January 2007 examination. He continued to note that, the Orthopedics Outpatient Board Report from April 1998 lists a pelvic stress fracture, but that was not specific about the area of the pelvis. Neither examiner addressed whether the Veteran’s right hip bursitis was secondary to her other service connected disorders. The Board requested a medical opinion to address this question in September 2018. In October 2018 an orthopedist reviewed the provided record and noted various different etiological entities which can cause hip pain. He stated that he found no medical evidence to doubt the chronic complaints and history provided by the Veteran. The medical expert noted that a chronic recurrent alteration in gait patterns can contribute, aggravate and cause issues with weightbearing joints. The orthopedist concluded it was at least as likely as not that the Veteran’s other service connected disabilities causing her alteration of gait were the proximal cause and aggravation of the appellant’s current right hip disorder. As outlined above, the two VA examiners only offered opinions addressing whether the Veteran’s right hip disability was directly related to her service. Taking this into consideration the Board assigns the October 2018 medical opinion greater probative value as the opinion considered the Veteran’s other service connected disabilities as the cause of her current right hip disability. The opinion is also through and well supported by a clear rationale. Thus, resolving reasonable doubt in favor of the Veteran, service connection for right hip bursitis, secondary to service connected disabilities is warranted. REASONS FOR REMAND With regard to the claim of entitlement to a total disability evaluation based on individual unemployability, the Veteran met the schedular criteria for that benefit as of November 2006. Further, there arguably is evidence in the file that she has not been able to work due to her service connected disabilities. This includes written statements, testimony and a vocational plan assessment from 2008 categorizing her service connected disabilities as a serious employment handicap. The claim of entitlement to individual unemployability benefits was inferred by the Board in its June 2013 Remand and the informal claim has been pending since the date of her claim for increased rating due to migraine headaches. Rice v. Shinseki, 22 Vet. App. 47 (2009). The Board acknowledges that the appellant has been assigned a 100 percent rating for her service connected psychiatric disorder. That award, however, did not render moot the claim for individual unemployability because the award was effective only from February 17, 2016. In a September 2017 letter, the RO requested that the Veteran provide a completed VA Form 21-8940, which would have included her work history and reasons for unemployment. To date, the Veteran has not provided the completed VA Form 21-8940. The Board finds that the Veteran should be afforded a final opportunity to provide the VA Form 21-8940. The matters are REMANDED for the following action: 1. Provide the Veteran again with VA Form 21-8940 in connection with the claim for entitlement to total disability evaluation based on individual unemployability, and request that she supply the requisite information. 2. Following her response, or even if she fails to respond, adjudicate the issue of entitlement to total disability evaluation based on individual unemployability for the period prior to February 17, 2016 with the information available in the file. If the benefit sought on appeal remains denied, the Veteran and her representative should be furnished a supplemental statement of the case and provided an appropriate opportunity to respond before returning the case to the Board for further appellate action. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joseph Montanye, Associate Counsel