Citation Nr: 20044589 Decision Date: 07/02/20 Archive Date: 07/02/20 DOCKET NO. 15-01 739 DATE: July 2, 2020 ORDER Service connection for a right hip disorder (status-post replacement) is denied. Service connection for a right shoulder disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, is denied. Service connection for a left shoulder disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, is denied. Service connection for a right knee disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, is denied. Service connection for a right wrist disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, is denied. FINDINGS OF FACT 1. The right hip disorder (status post-replacement) is not causally or etiologically related to active military service, to include an incident of cliff diving during service. 2. The Veteran is currently diagnosed with right shoulder, left shoulder, right knee, and right wrist disorders. 3. The currently diagnosed right shoulder, left shoulder, right knee, and right wrist disorders were not caused or worsened in severity by the service-connected bilateral lower extremity radiculopathy. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hip disorder (status-post replacement) have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 2. The criteria for service connection for a right shoulder disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.310. 3. The criteria for service connection for a left shoulder disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.310. 4. The criteria for service connection for a right knee disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.310. 5. The criteria for service connection for a right wrist disorder, as secondary to the service-connected bilateral lower extremity radiculopathy, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from May 1972 to August 1980. In April 2017, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. In June 2018, in pertinent part, the Board remanded the issues on appeal for additional development, including for VA medical opinions. October 2019 and September 2019 VA medical opinions have been associated with the record; therefore, an additional remand to comply with the June 2018 remand directives is not required. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection for Right Hip Disorder Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. The Veteran specifically contends that a right hip replacement is related to an in-service cliff diving accident. See April 2017 Board hearing transcript. Various service treatment records reflect an in-service cliff diving accident. Specifically, an August 1974 service treatment record reflects the Veteran injured the back after diving 20 feet from a cliff into a lake. The August 1974 in-service examiner diagnosed a “severe back strain.” The evidence shows a current disability of a right hip status-post replacement disorder. An October 2019 VA examination report reflects right hip replacements in 2010 and 2019. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding a right hip injury or disease during service. The service treatment records appear complete, and contain no complaints, symptoms, diagnosis, or treatment related to a right hip disorder. As the service treatment records reflect that the Veteran sought extensive treatment in August 1974 and September 1974 for back and neck pain after a cliff diving accident, it is highly likely he would also have sought treatment for any other orthopedic injury or joint pain, including any other injury to hip, or at least mentioned hip symptoms during treatment, had such hip injury or hip symptoms in fact occurred. Moreover, the August 1974 service treatment record reflects the service examiner examined the Veteran, diagnosed a back strain, and did not discern any symptoms of a right hip disorder. In addition, the August 1974 service treatment reflects that the Veteran did not report any right hip orthopedic injury or joint pain. A September 1974 service treatment record reflects the Veteran reported back pain as related to the cliff diving incident but did not report any right hip pain or disorder. The September 1974 service examiner assessed low back pain and did not discern any symptoms of a right hip disorder. Like the August 1974 service treatment record, the September 1974 service treatment reflects that the Veteran did not report any right hip orthopedic injury or joint pain. The August 1980 report of medical history at service separation also reflects that the Veteran did not report any right hip injury, disorder, or past or current symptoms. Contrary to the Veteran's more recent, post-service assertion of having sustained a right hip injury during the August 1974 cliff diving incident, the competent evidence record in the form of the Veteran’s contemporaneous reports shown in service treatment records reflect that the Veteran did not report any right hip injury after cliff diving. The weight of the more contemporaneous lay and medical evidence shows that the Veteran never reported any injury to the right hip or right hip symptoms during service, including at service separation, and for decades after service. The Board also finds that the right hip disorder is are not related to in-service symptoms because the weight of the evidence shows no in-service right hip injury or disease to which a current disability could be related. On the question of nexus of current disability to service, the October 2019 VA examiner opined that the current right hip disorder was less likely than not related to service, to include the August 1974 cliff diving incident. The October 2019 VA examiner reasoned that the service treatment records, to include the treatment records related to the August 1974 cliff diving incident, did not demonstrate treatment for any right hip disorder. The October 2019 VA examiner also reasoned that the post-service treatment records reflect that the Veteran first sought treatment for a right hip disorder in 2010, approximately 30 years after separation from service. The Board finds that the October 2019 VA examiner’s opinion is highly probative as it is based on an accurate history and objective findings as shown by the record, with supporting rationale. Insomuch as the Veteran asserts that the right hip disorder is directly related to the in-service cliff diving incident, the Board finds that, under the specific facts of this case which include no in-service right hip injury or disease, no in-service chronic symptoms or treatment or diagnosis, and no post-service symptoms, treatment, or diagnosis for decades after service, the Veteran is not competent to relate the currently diagnosed right hip replacement to active service. While the Veteran is competent to describe symptoms he experiences at any time, he does not have the requisite medical expertise needed to provide a competent opinion regarding causation of a complex medical condition such as post-service right hip replacements and their relationship to active service decades earlier, which requires specialized medical knowledge of the musculoskeletal and knowledge of various possible etiologies of hip replacements, especially in the context of this case where a hip disorder is first diagnosed approximately 30 years after separation from service. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2009) (holding that it was not erroneous for the Board to find that a lay veteran claiming service connection for a back disorder and his wife lacked the “requisite medical training, expertise, or credentials needed to render a diagnosis” and that their testimony “could not establish medical causation nor was it a competent opinion as to medical causation”); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (holding that ACL injury is “medically complex” for lay diagnosis). For these reasons, the Board finds that the preponderance of the lay and medical evidence that is of record weighs against service connection for right hip disorder; consequently, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Secondary Service Connection for Right Shoulder Disorder Secondary Service Connection for Left Shoulder Disorder Secondary Service Connection for Right Knee Disorder Secondary Service Connection for Right Wrist Disorder Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. The Veteran specifically contends that the claimed right shoulder, left shoulder, right knee, and right wrist disorders are secondary to the service-connected bilateral lower extremity radiculopathy. See September 2014 claim; see also March 2015 notice of disagreement, April 2017 Board hearing transcript. As such, the right knee, right hip, right wrist, and bilateral shoulder disorders on appeal have been limited by the Veteran to a secondary service connection theory under 38 C.F.R. § 3.310. The evidence of record reflects the Veteran is currently diagnosed with right shoulder, left shoulder, right knee, and right wrist disorders. A November 2014 VA examination report reflects the VA examiner diagnosed tendon, rotator cuff, and labral tears of the shoulders, right knee arthritis and meniscal tear, and a right wrist sprain. While the November 2014 VA examiner indicated that the bilateral shoulder, right knee, and right wrist disorders were related to self-reports of frequent falls caused by the service-connected bilateral lower extremity radiculopathy, the November 2014 VA examiners’ opinion is of no probative value because, as discussed below, it based upon an inaccurate medical history reported by the Veteran of frequent falls due to the lower extremity radiculopathy. See Swann v. Brown, 5 Vet. App. 229, 233 (1993); Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The January 2015 and September 2019 VA examiners each opined that the bilateral shoulder, right knee, and right wrist disorders were not caused by the service-connected bilateral lower extremity radiculopathy. The January 2015 VA examiner reasoned the bilateral shoulder disorder was present in 2012, and that the Veteran had not sought treatment for “frequent falls” as suggested by the November 2014 VA examiner. The January 2015 VA examiner also reasoned that bilateral shoulder tendon, rotator cuff, and labral tears were inconsistent with the “biomechanics” of falling. The January 2015 VA examiner also reasoned that while, the August 2014 VA examiner relied on self-reports of falling, the VA and private treatment records did not demonstrate treatment for frequent falls, and that the right knee disorder was due to age. Further, the January 2015 VA examiner reasoned that VA treatment records from 2012, which pre-dated a right wrist sprain, reflect treatment for carpal tunnel and “complaints of wrist pain prior to the series of reported falls.” As to the question of secondary aggravation, the September 2019 VA examiner opined that the bilateral shoulder, right knee, and right wrist disorders were not aggravated by the service-connected bilateral lower extremity radiculopathy. Like the January 2015 VA examiner, the September 2019 VA physician reasoned that the bilateral shoulder, right knee, and right wrist disorders were unrelated to the Veteran’s self-reports of falling caused by the service-connected bilateral lower extremity radiculopathy as the post-service treatment records did not reflect the self-reported falls. Taken together, the January 2015 and September 2019 VA examiners’ opinions are highly probative as they are based on a review of the record, objective findings shown by the record, and the VA examiners provided rationale for the opinions given. The January 2015 and September 2019 VA opinions provide competent, credible, and probative evidence that supports the finding that the currently diagnosed bilateral shoulder, right knee, and right wrist disorders were not caused or aggravated by the service-connected bilateral lower extremity radiculopathy disorder. The Board is also affording no probative value to an April 2017 private treatment record, as well as the August 2018 and November 2018 private examiners’ purported opinions. As to the April 2017 private treatment record, the private examiner indicated that the service-connected bilateral lower extremity radiculopathy caused “multiple fractures, dislocations, tears, etc.” The April 2017 private treatment record does not specify that the service-connected bilateral lower extremity radiculopathy caused or aggravated the claimed right shoulder, left shoulder, right knee, right hip, and right wrist disorders. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). The August 2018 private examiner’s purported opinion is of no probative value because the August 2018 private examiner’s general attribution that the bilateral shoulder disorder “may be” related to service is speculative with no supporting rational. Significantly, that August 2018 private examiner’s purported opinion does not address the secondary service connection theory – the only theory of service connection advanced by the Veteran. See April 2017 Board hearing transcript. Finally, the November 2018 private examiner’s purported opinion is of no probative value because the opinion is based on an inaccurate medical history reported by the Veteran, to include self-reports of post-service falls related to the service-connected bilateral lower extremity radiculopathy. See Reonal, 5 Vet. App. at 461. As discussed above, the January 2015 VA medical opinion, which the Board has found to be highly probative, reflects that the Veteran’s self-reports of post-service falls related to the service-connected bilateral lower extremity radiculopathy are inaccurate facts reported by the Veteran and recorded by the VA examiner in August 2014. As such, the November 2018 private medical opinion is of no probative value. The weight of the evidence shows service connection is not warranted on a secondary basis; therefore, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against secondary service connection for right shoulder, left shoulder, right knee, and right wrist disorders, so the appeal must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Tenney, 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.