Citation Nr: 20006531 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 09-05 397 DATE: January 27, 2020 ORDER Entitlement to service connection for a left hip condition, to include as secondary to service-connected left foot disability, is denied. REMAND The application to reopen a previously denied claim for service connection for a sleep disorder is remanded. FINDING OF FACT The Veteran’s left hip condition was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; it is not secondary to the service-connected left foot disability; and it is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left hip condition are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from October 1990 to August 1991, November 1992 to October 1995, and from January 2005 to February 2006. He also had service in the Army Reserves beginning in January 1984. Service Connection 1. Entitlement to service connection for a left hip condition, to include as secondary to service-connected left foot disability The Veteran contends that he has a left hip condition, including trochanteric bursitis and degenerative joint disease (arthritis) that were caused by an in-service injury, event, or disease. Alternatively, he contends that his left hip arthritis was shown as chronic in service; or, manifested to a compensable degree within one year of separation from service; or, was noted in service with continuity of symptomatology since service. Finally, he asserts that his left hip condition was caused or aggravated beyond its natural progression by his service-connected left foot disability. LAW Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.303 (2019). The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (2019). The questions before the Board, which will be addressed in separate sections below, are: Is the Veteran’s left hip condition related to any in-service injury, event, or disease, to include a claimed 1984 left hip dislocation? Was the Veteran’s left hip arthritis shown as chronic in service; or, manifest to a compensable degree within one year of separation from service; or, noted in service with continuity of symptomatology since service? Did the Veteran’s service-connected left foot disability proximately cause, or aggravate beyond its natural progression, his left hip condition? EVIDENCE The Veteran has a current diagnosis of left hip trochanteric bursitis and arthritis as evidenced by VA examination of August 2008 and subsequent treatment records. The Veteran has stated in numerous medical records and at his October 2011 Board hearing that he dislocated his left hip during Army reserves basic training in July 1984. The Veteran stated that he was taken to a hospital near Fort Benning, GA, where his hip was treated and he was released the same day. He stated he was confined to barracks for three to four days after this, after which he returned to full duty because he did not want to be “recycled.” His limited service treatment records (STRs) do not include any reference to a left hip injury or left hip problems. This includes multiple examinations, continuing through 2006, in which he denied any hip trouble while giving positive responses to other medical concerns, such as injuries to his left foot and left shoulder. The Veteran says that doctors have told him his duties in-service likely caused or aggravated his left hip condition, but there are no statements to this effect in the medical record. A May 2007 orthopedic consult referred to the Veteran’s left hip pain as service-connected, but this appears to be based on the Veteran’s report, as the doctor did not indicate any personal review of STRs. That record, as well as several over the following two years, indicated that the Veteran’s left hip trouble began with his participation in a stomp line dance, which resulted in his left hip being dislocated twice during April 2007. X-rays at the time showed “minimal degenerative changes of both hips with very mild hypertrophic change of the acetabula” as well as a tiny fragment that could have indicated an old fracture. The assessment was “unstable left hip.” The Veteran’s brother provided a June 2007 lay statement mentioning a long list of conditions, including “joint pain,” which began after his return from Operation Desert Storm. He did not specifically discuss the Veteran’s left hip or any particular in-service injury. VA provided several examinations and opinions to address the cause of the Veteran’s left hip condition. An August 2008 VA examiner diagnosed trochanteric bursitis of the left hip and probably early degenerative changes of both hips. The examiner opined that the Veteran’s left hip condition was less likely than not related to service because there was no contemporary medical record confirming his claimed in-service dislocation. An April 2012 VA examiner diagnosed left hip arthritis and opined that it was less likely than not related to the Veteran’s claimed in service left hip dislocation because no symptoms were recorded until the documented double dislocation in April 2007. The April 2012 examiner also opined that the causes of arthritis are often multifactorial, but dislocation is a well-documented contributor to developing arthritis, whereas there is no evidence to show the Veteran’s left foot disability caused left hip arthritis. An August 2013 VA examiner diagnosed trochanteric bursitis and arthritis of the left hip and also opined that the most likely cause of the Veteran’s left hip condition was his documented double dislocation of April 2007. Finally, a June 2018 VA examiner opined that the Veteran’s left hip condition was less likely than not aggravated beyond its natural progression by the Veteran’s left foot disability because there is no medical evidence to support a connection between the two conditions. The Veteran’s wife provided a September 2012 lay statement that she recalled the Veteran stating that his left hip dislocation in the reserves might prevent him from maintaining army fitness standards. DIRECT SERVICE CONNECTION The Board finds that the balance of the evidence is against the Veteran’s claim that his left hip condition is related to any in-service injury, event, or disease. While the Veteran is competent to report that he hurt his left hip in basic training and to report the symptoms he experienced, in this case left hip pain, he is not competent to diagnose the condition as a dislocated hip, which requires specialized medical training that the Veteran is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The statement provided by his wife carries no more probative weight than the Veteran’s own statement, as it is based on what the Veteran told her, not any independent personal knowledge. The record is therefore unclear as to the nature of the Veteran’s left hip injury in basic training. However, it is clear that the decades of STRs after the Veteran’s left hip injury are silent for any complaint of left hip problems, including at times when it would have been natural to report such issues, such as when he reported injury to his left foot and left shoulder. While the Veteran later began to trace his left hip pain back to his injury in basic training, medical records from April 2007 show that his current problems, including chronic left hip pain, did not begin until he dislocated his left hip twice in one month, both during civilian dance routines. All four VA examiners agree that the most likely cause of the Veteran’s current left hip condition is the double dislocation that occurred in April 2007, immediately prior to the onset of the Veteran’s now chronic left hip condition. The only opinion of record linking the Veteran’s current left hip condition to his in-service left hip injury is his own. As noted above, while the Veteran is competent to report his own symptoms, he is not competent to opine as to the cause of his currently diagnosed trochanteric bursitis and arthritis, as this requires specialized medical training which the Veteran is not shown to have. See Jandreau, supra. Consequently, the Board gives more probative weight to the competent medical evidence, specifically the combined opinions of the four VA examiners. The Board therefore finds that the balance of the evidence is against the Veteran’s claim that his current left hip condition is related to any in-service injury, event, or disease. Service connection on a direct basis is therefore not warranted. PRESUMPTIVE SERVICE CONNECTION FOR CHRONIC CONDITION The Veteran has a current diagnosis of left hip trochanteric bursitis and arthritis as evidenced by VA examination of August 2008 and subsequent treatment records. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within the one-year presumptive period following separation, and was not noted in service with attributable continuity of symptomatology. Post-service treatment records show the Veteran was not diagnosed with arthritis until April 2007, more than one year after his separation from service and therefore outside of the applicable presumptive period. While the Veteran is competent to report experiencing symptoms of left hip pain during service and consistently since separation, the Board finds the reports of continuity of symptomatology not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records, which show that he denied experiencing left hip pain for over two decades after the 1984 injury in basic training and initially reported the onset of left hip pain as April 2007, which is outside of the presumptive period. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Service connection on a presumptive basis is therefore not warranted. SECONDARY SERVICE CONNECTION The April 2012 and June 2018 VA examiners opined that the Veteran’s left hip condition less likely than not proximately due to or aggravated beyond its natural progression by his service-connected left foot disability. The rationale was that there is no support in the medical literature to establish any connection between these two distinct conditions. Furthermore, the combined opinion of all four examiners is that it is more likely due to the Veteran’s multiple post-service hip dislocations in April 2007. The Veteran believes his left hip condition is proximately due to or aggravated beyond its natural progression by his service-connected left foot disability. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the collective opinion of the four VA examiners. The Board concludes that, while the Veteran has a current diagnosis of left hip trochanteric bursitis and arthritis, the preponderance of the evidence is against finding that the Veteran’s left hip condition is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). Service connection on a secondary basis is therefore not warranted. REASONS FOR REMAND 1. The application to reopen a previously denied claim for service connection for a sleep disorder is remanded. In a May 2016 VA medical record, as well as several other VA medical records, reference is made to a sleep study performed on April 5, 2016. This sleep study is not in the claims file. A remand is required to allow VA to obtain authorization and request these records. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Wesley Sleep Clinic. Make two requests for the authorized records from Wesley Sleep Clinic, specifically including the April 2016 sleep study, unless it is clear after the first request that a second request would be futile. 2. Readjudicate the Veteran’s claim. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Zimmerman 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.