Citation Nr: 19166324 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 18-50 466 DATE: August 27, 2019 ORDER 1. Entitlement to service connection for right hip disability, to include trochanteric pain syndrome, is denied. 2. Entitlement to service connection for left hip disability, to include trochanteric pain syndrome and degenerative arthritis, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that right hip disability, to include trochanteric pain syndrome, began during active service or is otherwise related to an in-service injury or disease. 2. The Veteran’s left hip disability, to include trochanteric pain syndrome and degenerative arthritis, was not shown as chronic in service and did not manifest within one year of service discharge; continuity of symptomatology is not established, and the disability is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for right hip disability, to include trochanteric pain syndrome, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left hip disability, to include trochanteric pain syndrome and degenerative arthritis, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1990 to August 1994. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). 1. Entitlement to service connection for right hip disability, to include trochanteric pain syndrome, is denied. Veteran contends his right hip pain began in service and was aggravated by his fall off a truck in May 1991. Veteran states on his VA Form 9, Appeal to the Board, that he has suffered hip pain for more than 24 years. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for right hip disability, to include trochanteric pain syndrome. The reasons follow. As to evidence of a current disability, in a September 2017 VA examination report, the examiner diagnosed right trochanteric pain syndrome. Thus, the Veteran meets the first element of a service-connection claim. As to evidence of a disease or injury in service, the evidence shows that the Veteran was seen in March 1991 with complaints of right hip pain without trauma. He was diagnosed with trochanteric bursitis. Resolving reasonable doubt in the Veteran’s favor, the Board finds that there is evidence of right hip pain in service. As to evidence of a nexus between the current disability and service, the Board finds the preponderance of the evidence is against such a nexus. For example, the May 1993 Report of Medical Examination listed injuries the Veteran sustained at the time of the May 1991 fall off the truck, which included scalp laceration and concussion, but did not include a right hip injury, which the Board finds is evidence against a finding that the Veteran injured his right hip at the time of the May 1991 fall; otherwise, such would have been documented in the examination report. Clinical evaluation of the Veteran’s lower extremities in May 1993 was normal, which is evidence against a finding that the Veteran developed a right hip disability in service. This finding is supported by the fact that post-service hip complaints are first documented in the record in 2017, which is over 20 years after the Veteran’s discharge from service and approximately 25 years after his in-service right hip pain complaint. The Board notes that the passage of time between the Veteran’s discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the Veteran’s claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (noting that a lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim, just not the only or sole factor). A VA examiner in September 2017 concluded there was no nexus between the Veteran’s motor vehicle accident in May 1991 and his current hip pain due to no medical evidence supporting this claim. A March 2018 VA medical opinion noted similarly that there was a lack of complaint of right hip pain or documentation to establish the issue as a chronic condition. Because of this missing information, the examiner found it less likely than not the right hip pain was incurred in or caused by service. There is no competent evidence of a positive nexus between the post service right hip disability and service to weigh against these negative opinions. The Veteran is not competent to provide such an opinion, as he has not been shown to have expertise in diagnosing a musculoskeletal disability. The Board concludes that, while the Veteran has a right hip disability, to include trochanteric pain syndrome, and evidence of pain in service, the preponderance of the evidence is against a nexus between this disability and an in-service disease or injury, and service connection is denied. There is no reasonable doubt to be resolved. 2. Entitlement to service connection for left hip disability, to include trochanteric pain syndrome and degenerative arthritis, is denied. In this case, the disorder at issue, arthritis, is a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a Veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Veteran contends he began experiencing left hip pain in 1992 after falling from a truck. On his August 2017 Statement in Support of Claim, Veteran states he suffers from limited motion, pain when sitting, standing, or walking for any length of time, and that he was diagnosed with arthritis in his hips. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for left hip disability, to include trochanteric pain syndrome and arthritis. The reasons follow. As to evidence of a current disability, in a September 2017 VA examination report, the examiner diagnosed left trochanteric pain syndrome and degenerative arthritis. Thus, the Veteran meets the first element of a service-connection claim. As to evidence of a disease or injury in service, the evidence shows that the Veteran was seen in September 1992 with complaints of left hip pain after falling off a bike. Thus, there is evidence of an in-service injury to the left hip. As to evidence of a nexus between the current disability and service, the Board finds the preponderance of the evidence is against such a nexus. For example, the May 1993 Report of Medical Examination listed injuries the Veteran sustained at the time of the May 1991 fall off the truck, which included scalp laceration and concussion, but did not include a left hip injury, which the Board finds is evidence against a finding that the Veteran injured his left hip at the time of the May 1991 fall; otherwise, such would have been documented in the examination report. Clinical evaluation of the Veteran’s lower extremities in May 1993 was normal, which is evidence against a finding that the Veteran developed a left hip disability in service. This finding is supported by the fact that post-service hip complaints are first documented in the record in 2017, which is over 20 years after the Veteran’s discharge from service and approximately 25 years after his in-service hip injury, when he fell off the bike. Similarly, medical records show no post-service complaints of left hip pain until 2017. Veteran was diagnosed with degenerative arthritis in September 2017, which is approximately 23 years after his separation from service. A VA examiner in September 2017 concluded there was no nexus between the Veteran’s motor vehicle accident in May 1991 and his current left hip disability due to no medical evidence supporting this claim. A VA examiner in March 2018 determined Veteran’s left hip disability was less likely than not incurred or caused by an in-service injury, event, or illness because it was difficult to link the current left hip condition to service with no complaints of left hip pain after 1992 or documentation to establish the left hip disability as chronic. There is no competent evidence of a positive nexus between the post service left hip disability and service to weigh against these negative opinions. The Veteran is not competent to provide such an opinion, as he has not been shown to have expertise in diagnosing a musculoskeletal disability. The Board concludes that, while the Veteran has a left hip disability, diagnosed as degenerative arthritis, which is a chronic disease under 38 C.F.R. § 3.309(a), it did not manifest in service or within one year after service, and continuity of symptomatology is not established. Thus, presumptive service connection is not warranted. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for a left hip disability, to include trochanteric pain syndrome and degenerative arthritis, and there is no reasonable doubt to be resolved. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. McDaniels, Associate 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.