Citation Nr: 20021111 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 19-06 914 DATE: March 24, 2020 ORDER Entitlement to service connection for right hip disability is granted. Entitlement to service connection for left hip disability is granted. Entitlement to service connection for thoracolumbar degenerative joint disease as secondary to service-connected hip disabilities is granted. Entitlement to service connection for Reynaud’s syndrome is denied. Entitlement to service connection for anemia is denied. REMANDED Entitlement to service connection for neck disability (claimed as cervical sprain) is remanded. Entitlement to service connection for right knee disability (claimed as knee strain), including as secondary to right and left hip disabilities, is remanded. Entitlement to service connection for left knee disability (claimed as knee strain), including as secondary to claimed right and left hip disabilities, is remanded. Entitlement to service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD) and depression is remanded. Entitlement to service connection for sleep apnea, including as secondary to claimed orthopedic and psychiatric disabilities is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, current right hip arthritis is related to active service. 2. Resolving all reasonable doubt in favor of the Veteran, current left hip arthritis is related to active service. 3. Resolving all reasonable doubt in favor of the Veteran, thoracolumbar spine degenerative joint disease is caused or aggravated by service-connected right and left hip disabilities. 4. Reynaud’s syndrome was not shown during service, and the probative evidence of record is against a finding that the Veteran’s Reynaud’s syndrome was incurred in or caused by service. 5. Anemia was not shown during service, and the probative evidence of record is against a finding that the Veteran’s anemia was incurred in or caused by service. CONCLUSIONS OF LAW 1. The criteria for service connection for right hip disability have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for service connection for left hip disability have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 3. The criteria for service connection for thoracolumbar spine degenerative joint disease have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). 4. The criteria for service connection for Reynaud’s syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 5. The criteria for service connection for anemia have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1988 to November 1989 and from August 1996 to March 1998. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection 1. Right and left hip disabilities The Veteran asserts that her right and left hip disabilities are related to active duty. Service treatment records (STRs) reflect that the Veteran complained of pelvic pain in January 1989. An X-ray of the pelvis showed a posterior fusion defect at the S-1 level. A follow-up later that month noted continued pelvic pain. The examiner assessed right inguinal strain. A February 1989 STR noted that the Veteran continued to have trouble and pain with running and stretching. The examiner noted a one-month history of right adductor muscle injury following repeated jumping from trucks. All pain was located in the right thigh adductor groin. In March 1989, the Veteran complained of bilateral hip pain, left greater than right. A bone scan of the hips showed a “mild to moderate stress related phenomena.” The Board notes that the Veteran’s STRs for her second period of active duty have not been located. Following service, October 2005 treatment records noted that the Veteran had degenerative joint disease of the hips. The Veteran was afforded a VA examination in December 2015. The Veteran reported that she developed right hip pain when she conducted road marches and started jumping from trucks during active duty. Her right hip pain continued after service and her hip pain was treated post-service by her primary care provider. The examining physician assistant noted that “civilian records were spare with documents from 2015 showing abnormal labs consistent with inflammatory arthritis.” The examiner rendered a negative etiological opinion, reasoning that, given the lack of documentation to connect her hip pain in 1989 to her diagnosis of arthritis in 2015, it would be speculation to try and say that her symptoms were the onset of an inflammatory arthritis. There is a gap of 26 years that does not support such a connection. In August 2019, a private medical provider provided a medical opinion. The examining physician noted that the Veteran’s military occupational specialty was a driver which required her to jump in and out of trucks. The examiner indicated that, when the Veteran was seen in January 1989 for right hip pain, it was noted that she had an antalgic gait. The examiner stated that since service, the Veteran continued to experience lower region pain, causing limited mobility and significant weight gain. Based on his review of the claims file and relevant medical literature, the examiner opined that it is at least as likely as not that the Veteran’s current hip disorders were the result of her in-service hip and pelvic injuries and altered gait. The examiner reasoned that, while jumping in and out of trucks, the Veteran sustained a repetitive-type traumatic injury to her hips, more pronounced on the right than the left. The injury involved not only her hips but also the pelvis’ bony structures, causing a chronic pain syndrome. The Board finds that service connection for right and left hip disabilities is warranted. The Board acknowledges the contradictory opinions of record and finds the August 2019 opinion to be more probative. The examiner is a physician who reviewed the entire claims file and medical literature in rendering his opinion. Additionally, his discussion of the evidence is more consistent with record. In contrast, the VA examiner has less expertise as a physician assistant. Additionally, she did not address the diagnosis of bilateral hip arthritis in 2005, and based her opinion in part on an inaccurate factual predicate. Consequently, resolving reasonable doubt in favor of the Veteran, service connection for right and left hip disabilities is granted. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 2. Thoracolumbar spine degenerative joint disease (DJD) The Veteran seeks service connection for a back disability. The Board finds that the evidence of record warrants service connection for thoracolumbar spine DJD on a secondary basis. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). As such, the Board need not address direct service connection. Here, the Veteran is currently diagnosed with DJD of the thoracolumbar spine. She is also now service-connected for right and left hip disabilities. Regarding nexus, the only opinion of record is in favor of the claim. The August 2019 private examiner who rendered an opinion regarding her hip disabilities also opined that it is at least as likely as not that the Veteran’s hip and knee disabilities have impacted her low back causing her chronic pain and decreased range of motion. The examiner reasoned that an antalgic gait such as the Veteran’s often causes pain throughout the lower body including the lower back as weight bearing is uneven and joints are asked to bear weight in a manner inconsistent with joint health. This opinion is demonstrative of an etiological relationship between the Veteran’s back and bilateral hip disabilities, and the Board will afford the Veteran the benefit of the doubt in this regard and find a proximate cause relationship between them. Accordingly, secondary service connection for thoracolumbar degenerative DJD is granted. See 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 55-56. 3. Reynaud’s syndrome The Veteran asserts that her Reynaud’s syndrome is related to active duty. Upon review of the record, the Board finds that the probative evidence of record is against a finding that the Veteran’s Reynaud’s syndrome was incurred in or caused by service. STRs reflect that the Veteran presented with a bluish color and coldness in her feet in February 1989. The examiner noted that the Veteran’s boots were too tight, and that color and warmth returned with the boots off. There are no further complaints during the Veteran’s first period of active duty. The Board reiterates that the Veteran’s STRs for her second period of active duty have not been located. Post-service, treatment records note a diagnosis of Reynaud’s disease in December 2008. VA obtained a medical opinion in December 2015. The VA examiner stated that there was no medical evidence that the Veteran’s symptoms in service were the beginning of her Reynaud’s. The examiner noted that the Veteran’s symptoms at that time were attributed to tight boots as they had left an imprint on her legs, and her symptoms were noted to have resolved after removing the boots. The examiner further reasoned that cold hands and feet were a normal physiological response to cold exposure that, to preserve heat, cools the surface skin and causes skin color changes, whereas Reynaud’s is an exaggerated vascular response to cold temperature or emotional stress. Although survey criteria vary, most investigators agreed that a history of at least two-color changes (pallor and cyanosis) after cold exposure was necessary for a definite diagnosis. The Board finds that the December 2015 opinion is adequate because it is based on a review of the claims file and relevant medical literature and provides a thorough rationale for the conclusion reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the opinion is consistent with the evidence of record, and there is no medical opinion of record to the contrary. Although the Veteran believes her Reynaud’s syndrome is related to service, she is not competent to provide an opinion linking her diagnosis to the complaints and treatment provided in service. An opinion of that nature requires medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the preponderance of the evidence is against the claim for service connection for Reynaud’s syndrome. In reaching that conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 55-56. 4. Anemia The Veteran seeks service connection for anemia. Upon review of the record, the Board finds that the probative evidence of record is against a finding that the Veteran’s anemia was incurred in or caused by service. STRs show no diagnosis of or treatment for anemia during service. Post-service, the only notation of anemia is in a February 2015 treatment record. The record states that the Veteran was prescribed Vitamins D3 and B12 for anemia and malabsorption problems status post gastric bypass surgery, which occurred in 2006. Although the Veteran believes that her anemia is related to service, as a lay person, she has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1376-77. In this regard, the diagnosis and etiology of anemia are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of her current anemia is not competent medical evidence. The Board acknowledges that the Veteran has not received a VA examination with respect to her service connection claim for anemia. However, there is no evidence of an in-service event, injury, or disease, and no competent evidence suggesting a possible association between the Veteran’s anemia and service. Therefore, a VA examination or medical opinion is not required. See 38 C.F.R. § 3.159 (c); see also McLendon v. Nicholson, 20 Vet. App. 84 (2006). In sum, the preponderance of the competent, credible, and probative evidence is against the claim. In reaching that conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 55-56. REASONS FOR REMAND The Veteran also seeks service connection for a neck disability, bilateral knee disabilities, sleep apnea, and a psychiatric disability. The August 2019 examiner noted that the Veteran’s medical history included cervical sprain, knee strain, sleep apnea, and depression. However, the treatment records in the VA claims file before the Board does not include any diagnoses pertaining to the Veteran’s neck or knees, sleep apnea, or mental health. Thus, although the examiner rendered positive opinions regarding secondary service connection for the claimed orthopedic disabilities, sleep apnea, and depression, the Board is unable to grant service connection at this time because the August 2019 examiner did not examine the Veteran. Instead, the Board finds that a remand would be helpful in order to obtain any outstanding treatment records that may reflect diagnoses for the remaining claimed disabilities on appeal. The matters are REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have treated her. After securing any necessary releases, VA should request any relevant records identified. In addition, obtain VA treatment records dated since December 2015. If any requested records are unavailable, the Veteran should be notified of such. 2. Conduct any other development determined to be warranted. 3. Then, readjudicate the remaining claims on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Roya Bahrami, 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.