Citation Nr: 20007619 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 12-35 803 DATE: January 29, 2020 ORDER Entitlement to service connection for a left hip/groin strain is granted. FINDING OF FACT The Veteran’s left hip/groin strain was caused by his service-connected prostate cancer. CONCLUSION OF LAW A left hip/groin strain is proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION Introduction The Veteran had active service from June 1958 to March 1969. In December 2014 and August 2019, the Veteran attended hearings before two of the undersigned Veterans Law Judges. Transcripts of those proceedings are of record. In July 2015, the Board issued a decision denying service connection for left hip osteoarthritis, to include as secondary to service-connected prostate cancer. The Veteran appealed the July 2015 Board decision that denied service connection for left hip osteoarthritis to the United States Court of Appeals for Veterans Claims (Court). In a Memorandum Decision, dated in March 2017, the Court vacated the July 2015 Board decision, and remanded the issue back to the Board for further proceedings consistent with the Memorandum Decision. Duty to Assist As explained below, the Board has determined that the evidence currently of record is sufficient to grant entitlement to service connection for a left hip/groin strain. Therefore, no further development is required under 38 U.S.C. §§ 5103, 5103A (2012) or 38 C.F.R. § 3.159 (2019). Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2019); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54.   Legal Criteria Service connection may be granted for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (a). Factual Background and Analysis The Veteran seeks service connection for a left hip disorder, which he contends was caused by treatment for his service-connected prostate cancer. In particular, the Veteran contends that his left hip disability was caused by either radiation treatments or the positioning in which he was placed for his lithotomy procedure. The Board has extensively reviewed the Veteran’s post-service medical records. These records confirm the Veteran has been diagnosed with a left hip/groin strain, as well as left hip osteoarthritis. The Veteran testified in December 2014 and August 2019 that he had not experienced any hip pain prior to his September 2006 lithotomy procedure. He has also submitted numerous statements from family, friends, and co-workers, who have acknowledged that following his procedure he struggled to walk and limped noticeably. The Veteran’s private treatment records show that he was diagnosed with prostate cancer in May 2006. He was treated with radiation therapy in June and July 2006. In September 2006, he underwent transperineal prostate brachytherapy with Palladium 103 seeds using transrectal ultrasound and template guidance. Although June 2011 and May 2013 VA examiners found the Veteran’s left hip arthritis was less likely than not caused or aggravated by his radiation treatment or lithotomy procedure, in a March 2008 primary care report, the Veteran’s treating physician found the Veteran’s groin and hip pain may be the result of a muscle strain resulting from his positioning during his prostate surgery. More recently, the Board obtained a medical opinion, and addendum medical opinion from an independent Orthopedic specialist at the Kansas City VAMC. This physician also agreed the Veteran’s left hip arthritis was less likely than not caused or aggravated by his radiation treatment or lithotomy procedure; however, the physician did agree the Veteran’s groin pain may be due to a muscle sprain. In this case, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. The Board also notes that under certain circumstances, lay evidence may be sufficient to establish a nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay evidence has been found to be competent with regard to a disease that has “unique and readily identifiable features” that are “capable of lay observation.” See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007); see also Petitti v. McDonald, 27 Vet. App. 415, 427-28 (2015) (where the Court of Appeals for Veterans Claims found objective evidence of pain need not come from a medical professional; a lay person may provide the requisite confirmation). Here, the Veteran has reported that he experienced pain and gait abnormalities, which have persisted ever since his September 2006 lithotomy procedure. The Board finds the Veteran competent to report his hip and groin area pain. It is generally within the competence of a lay person to identify and observe the effect of a disability under the ordinary conditions of daily life. Many symptoms are readily observable by a lay person. Accordingly, the lay evidence provided by the Veteran is unquestionably competent evidence. In this respect, the Board finds the Veteran’s own reports of experiencing pain to be at least as probative as the above-noted VA examiners’ findings. As previously noted, this appeal turns on whether there is a nexus between the Veteran’s current left hip disability and his September 2006 procedure to treat his service-connected prostate cancer. The Veteran has competently and credibly reported that he experienced hip and groin pain since his September 2006 lithotomy procedure. Further, the March 2008 VA physician and December 2018 VA Orthopedic specialist determined the Veteran’s current left hip/groin pain is likely related to a hip strain caused by his positioning during his prostate cancer surgery. Accordingly, a nexus is established. In sum, the Board is satisfied that the evidence supporting a nexus between the Veteran’s currently diagnosed left hip/groin strain and his September 2006 prostate cancer treatment is at least in equipoise with the evidence against a nexus. Therefore, the Veteran is entitled to service connection for his left hip/groin strain. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Fraser, 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.