Citation Nr: 19181069 Decision Date: 10/24/19 Archive Date: 10/24/19 DOCKET NO. 16-29 917 DATE: October 24, 2019 ORDER Entitlement to service connection for a right hip disorder, to include as secondary to his service-connected foot and knee disorders, is denied. Entitlement to service connection for a left hip disorder, to include as secondary to his service-connected foot and knee disorders is denied. FINDINGS OF FACT 1. A right hip disorder is not related to service or a service-connected disability. 2. A left hip disorder is not related to service or a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right hip disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2018). 2. The criteria for entitlement to service connection for a left hip disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a veteran (the Veteran) who had active duty service from November 2, 2006, to June 19, 2008, with additional service in the Reserves. This appeal comes before the Board of Veterans’ Appeals (Board) from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. In April 2019, the Veteran presented testimony at a Board hearing, chaired via videoconference by the undersigned Veterans Law Judge and accepted such hearing in lieu of an in-person hearing before a Member of the Board. See 38 C.F.R. § 20.700(e) (2018). At the Board hearing, the Veteran was informed of the basis for the RO’s denial of her claims and she was informed of the information and evidence necessary to substantiate each claim. 38 C.F.R. § 3.103 (2018). A transcript of the hearing is associated with the claims file. Service Connection—Law and Regulations VA law provides that, for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, or other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation, except if the disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131 (West 2014). Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection on a secondary basis requires (1) evidence of a current nonservice-connected disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability caused or aggravated the current nonservice-connected disability. 38 C.F.R. § 3.310(a), (b); Wallin v. West, 11 Vet. App. 509, 512 (1998). After the evidence has been assembled, it is the Board’s responsibility to evaluate the entire record. 38 U.S.C. § 7104(a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3 (2018). A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996); Gilbert at 54. Entitlement to service connection for a right hip disorder. Entitlement to service connection for a left hip disorder. The Veteran contends that he incurred a bilateral hip disorder secondary to his service-connected foot and knee disorders. She does not assert direct service incurrence either during active duty or during any period of active duty for training or inactive duty training. Service treatment records reveal no complaints, treatments, or diagnoses pertinent to a hip disorder. A report of medical examination performed at service separation, on May 7, 2008, reveals normal findings for the lower extremities (Record 02/18/2014 at 6). The Veteran separated from service on June 19, 2008. The Veteran was diagnosed with trochanteric bursitis in October 2010 (Record 12/18/2013). A VA Examination in July 2014 reveals a diagnosis of greater trochanteric bursitis of the hips (Record 07/01/2014). Addressing the Veteran’s contentions as to secondary service-connected the examiner opined that the condition claimed is less likely than not (less than 50%probability) proximately due to or the result of the Veteran’s service connected condition. The rationale was that current medical literature does not support trochanteric hip bursitis being caused by bilateral patella femoral syndrome and/or bilateral pes planus years later (Record 12/11/2014). The Veteran submitted a private opinion, dated June 2015, which reads simply, “It is highly probable that the Veteran’s current bilateral trochanteric bursitis is related to her service-connected pes plans and patellofemoral syndrome (Record 06/12/2015). Not rationale is given. Records from the Veteran’s private treatment provider—Unity Spine Center indicate that the Veteran’s hip symptoms are due to a nonservice-connected low back disorder (Record 11/20/2015). The Board acknowledges the private medical opinion; however, the Board finds it to be of less probative weight than the VA opinion. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). The Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). The Veteran’s private medical opinion contains no rationale whatsoever. Compounding this deficiency, the opinion seems to ignore significant medical evidence which contradicts the opinion. Essentially, evidence linking the Veteran’s hip pain to radiculopathy was not addressed or even acknowledged. The weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Sklar v. Brown, 5 Vet. App. 140 (1993). The Board has considered The Veteran’s lay statements regarding his claim. It is well established that lay statements are competent evidence with respect to some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Generally, lay evidence is competent with regard to identification of a disease with ‘unique and readily identifiable features’ which are ‘capable of lay observation.’ See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); see 38 C.F.R. § 3.159(a)(2). The Board finds that relating a current hip disorder to temporally remote events of service is not the equivalent of relating a broken bone to a concurrent injury to the same body part (Jandreau, at 1377). Such an opinion requires specialized medical knowledge. These matters are not capable of lay observation. Accordingly, the Veteran’s lay statements are not competent evidence of an etiologic relationship between the claimed hip disorder and service. The Board acknowledges that the July 2015 VA opinion does include an opinion regarding secondary aggravation. However, the Board finds that it is adequate in this regard. The examiner’s rationale is that is essentially that there is no contributory role recognized under generally accepted medical principles between trochanteric bursitis and the Veteran’s knee and foot disabilities. The Board finds that this opinion encompasses any contribution to the hip disorder, including aggravation. In sum, the Board finds that, although the Veteran has knee and foot disorders as service-connected disabilities, and although he has a current diagnosis of trochanteric bursitis, a preponderance of the evidence is against any etiologic relationship between the bursitis and his service-connected disorders. Considering these findings, the Board concludes that service connection for the claimed hip disorders is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against each claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Cramp, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.