Citation Nr: 19190858 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 17-65 706 DATE: December 3, 2019 ORDER Entitlement to service connection for a left hip replacement (“hip condition”) is denied. FINDINGS OF FACT 1. The Veteran was noted to have a preexisting left hip defect upon entry into active duty service. 2. The preexisting hip condition noted at the time of service enlistment was not aggravated by active duty service. CONCLUSIONS OF LAW 1. The Veteran was not presumed sound upon entry into active duty service with respect to his left hip. 38 U.S.C. §§ 1111, 1132; 38 C.F.R. § 3.304 2. The criteria for service connection by aggravation for a left hip condition have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1961 to October 1964. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony at an August 2019 videoconference hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is associated with the claims folder. The Veteran claims his preexisting hip condition was aggravated by his service. Specifically, he alleges the rigors of navy life, to include, running, climbing on aircraft, and carrying heavy parts and equipment led to his osteoarthritis and hip replacement. For the reasons discussed below, the Board finds the evidence weighs against a finding that the Veteran’s current disability is related to service. Therefore, service connection is not warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When determining service connection, a presumption of soundness ordinarily applies. 38 U.S.C. §§ 1111, 1132; 38 C.F.R. § 3.304(b). Pursuant to such presumption, a Veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). Only such conditions as are recorded in examination reports are to be considered as noted. The burden falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the disability was both preexisting and not aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any increase in disability was due to the natural progress of the preexisting condition. 38 U.S.C. § 1153; Wagner, 370 F.3d at 1096. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. See 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304, 3.306(b). A pre-existing disease or injury will be presumed to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. See Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306(a). Furthermore, temporary or intermittent flare-ups of a pre-existing condition during service are not sufficient to be considered aggravation of the condition, unless the underlying condition, as contrasted to symptoms, worsens. See Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993); Hunt v. Derwinski, 1 Vet. App. 292 (1991). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Turning to the evidence, service treatment records (STR’s) reflect a November 1961 enlistment examination listing an old fracture of the left hip as a defect. A conditional waiver was granted. The October 1964 separation examination noted the left hip condition as well. However, there were no documented symptoms, diagnosis, or treatment for the hip while in service. In August 2012 medical records, the Veteran reported he noticed progressive weakness in his left hip about 1 and a half months ago. The physician noted “he lives on a farm and is quite active lifting feed bags for his beef cows and horses.” The physician noted that his left hip has “advanced with arthritis” and that he will need a future total hip replacement. In March 2013 G.S., D.O., noted the Veteran has had progressive arthritic problems for the last 10 to 15 years and he would benefit from hip surgery. In September 2014, the Veteran reported over the last 5 years he has had increasing pain and decreasing function with his left lower extremity secondary to his left hip and groin pain. Radiographs revealed a collapse of the left femoral head protrusion of the blade device which was placed in his hip 64 years prior. In November 2014 the Veteran had left hip arthroplasty and removal of hardware surgery. An April 2015 VA examination report indicated review of the Veteran’s claims file, recounted the Veteran’s history, and recited his complaints. The examiner noted the Veteran had a left side total hip joint replacement when he was 14 years old. He opined there was no aggravation in service. The Veteran had a preexisting fracture of the hip as a child and developed arthritis a year ago. He found the current condition is related to the preexisting condition. A November 2015 examination report from L.L., M.D., provided a positive etiology opinion after review of the claims file, military treatment records, and civilian medical records. A 2012 diagnosis of osteoarthritis and hip joint replacement was noted. The Veteran had total hip replacement in August 2015. The doctor opined the Veteran should not have been admitted to military duty. He found “the excessive marching and physical demands placed on the hip caused advanced arthritis to more of a degree and sooner than if he had a sedentary lifestyle.” The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is not related to service. A preexisting hip condition was “noted” at the time of enlistment, therefore, the presumption of soundness at service entrance did not attach regarding the preexisting hip condition. 38 U.S.C. §§ 1111, 1132; 38 C.F.R. § 3.304(b). Therefore, the question before the Board with regard to the hip condition is whether the preexisting hip condition was aggravated by active service. Initially, the Board notes aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. Davis v. Principi, 276 F.3d 1341, 1342 (Fed. Cir. 2002). There are no records of an in-service arthritis diagnosis, complaints in service, or any indication of an increase in severity of the noted preexisting hip condition. There were no complaints of hip pain in service. In the October 1964 separation examination there were no documented symptoms, diagnosis, or treatment for the hip. While the November 2015 examination report from L.L., M.D., indicated the Veteran’s current diagnosis was aggravated by service, no rationale has been provided. Additionally, the contemporaneous medical records, post service treatment records, and April 2015 VA examination carry more weight. Post service in the August 2012, March 2013, and September 2014 treatment records, the arthritis appears to have progressed in the last 10 to 15 years. The Veteran left service in 1964, 48 years prior to his August 2012 complaints. Additionally, in September 2014, radiographs revealed a collapse of the left femoral head protrusion of the blade device which was placed in his hip 64 years prior. This suggest the Veteran’s current condition is a natural progression which is essentially what the April 2015 VA examiner found. The Board acknowledges the Veteran’s belief that his hip condition is related to or first manifested during his active service. However, his statements alone do not establish a medical nexus. Indeed, while the Veteran is competent to provide evidence regarding matters that can be perceived by the senses, she is not shown to be competent to render medical opinions on questions of etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). (lay testimony is competent to establish the presence of observable symptomatology). As such, as a layperson, he is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis, etiology, or causation of a specific disability. The question of diagnosis and causation, in this case, involves complex medical issues that the Veteran is not competent to address. Such opinions require specialized medical knowledge and are not capable of lay observation. The Veteran served in the Navy Reserves from February 1955 to November 1961. During the August 2019 Board hearing the Veteran discussed his service in the reserves. Specifically, he alleged in 1961 while serving in the reserves, he received a letter requesting he participate in a physical examination. After the examination he was sent to Great Lakes for training which he concludes was very rough. The Board notes the February 1955 enlistment examination, 1957 examination, and November 1961 report of medical history all reflect a notation of the pre-existing hip condition. However, there are no documented complaints or treatment during these periods of service. For these reasons, the claim for service connection for a hip condition must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. [SIGNATURE ON NEXT PAGE] JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.