Citation Nr: 18155071 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 16-33 014 DATE: December 4, 2018 ORDER Entitlement to service connection for a bilateral hip condition is granted. FINDING OF FACT The Veteran’s current bilateral hip condition is at least as likely as not the result of an in-service event or injury. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral hip condition have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Army, with periods of active duty for training from March 1979 to September 1979 and from June 5, 1987 to June 9, 1987. Service connection may be granted for a disability resulting from injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of entitlement to service connection, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999). The law also provides a disability may be service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C § 5107(b); 38 C.F.R. § 3.102 . In this case, the Veteran contends service connection is warranted for a bilateral hip condition and alleges the claimed condition is the result of a motor vehicle accident he experienced during active service. For the reasons that follow, the Board finds that service connection is warranted for a bilateral hip condition. As an initial matter, the medical evidence of record establishes a current diagnosis of symmetric early osteoarthritis of the hips, as documented in November 2011 private X-ray results and a diagnosis of early degenerative changes of bilateral hip joints in an April 2016 VA examination. With respect to in-service incurrence of a disease or injury, the Veteran’s service treatment records (STRs) indicate he was involved in a vehicle accident on or about June 5, 1987 in which the vehicle he was driving crashed and overturned, crushing both his thighs and injuring his lower back and left knee. Accordingly, the in-service element is established by the evidence of record. The remaining question for consideration is whether the currently diagnosed early degenerative changes of the bilateral hips is related to the motor vehicle accident in service. On this question, the Board finds that the evidence is at least in equipoise that the Veteran’s bilateral hip condition is causally or etiologically due to the motor vehicle accident in service. The Board notes the negative VA medical opinion from the April 2016 VA examiner. The Veteran reported a history of right hip pain that is local and sharp, as well as an antalgic gait during moderate ambulation distances. Although the April 2016 VA examiner diagnosed the Veteran with early degenerative changes of both hip joints, the examiner opined that the Veteran’s bilateral hip condition is not service related. The examiner reasoned that the Veteran’s STRs were silent for a hip condition during service. The Board affords this opinion minimal probative value given the examiner’s opinion is based solely on the absence of medical evidence. A medical opinion based solely on the absence of documentation in the record is inadequate and a medical opinion is inadequate if it does not take into account the Veteran's reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). The Veteran submitted a positive medical opinion in support of his claim. A November 2018 private nexus opinion reflects that the private examiner reviewed the Veteran’s claims file. The private examiner states that it was “at least as likely as not that this Veteran’s bilateral hip pain and osteoarthritis is a direct result of his in-service MVA injury to his bilateral thighs.” See November 4, 2018 Nexus Medical Opinion from Dr. M.B.S., M.D. The examiner noted that when a patient experiences an injury to the knee more often than not an antalgic gait, postural abnormalities and pain develops, involving all the major lower extremity joints. The examiner reasoned that, “When a patient is forced by virtue of an injury to ambulate in an abnormal manner and to stand and sit in an abnormal manner to compensate for an injury, it is at least as likely as not the injury will cause abnormal motions in both hips.” Id. The private examiner went on to say, “All of the opinions I have provided in this report meet the standard of being at least as likely as not in favor of the Veteran. In fact, my opinions in this matter are actually much higher than that standard as my opinions are within a high degree of certainty.” Id. The private examiner’s conclusions are supported by adequate rationale, and therefore the Board affords the opinion greater probative value than the preceding VA medical opinion. The preponderance of the evidence favors the claim, and therefore service connection must be granted. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. N. Shannon, Associate Counsel