Citation Nr: 21002150 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-17 686 DATE: January 12, 2021 ORDER Entitlement to service connection for a left hip disorder, including trochanteric pain syndrome and trochanteric bursitis, also claimed as left lower extremity pain, left hip arthritis, and muscle or joint pain left hip, is denied. FINDING OF FACT The preponderance of the evidence is against finding that a left hip disorder began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left hip disorder due to service or service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2008 to September 2014. This issue comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was before the Board in September 2018, September 2019, and August 2020. The Veteran’s claim was remanded for additional development. The case is now again before the Board for further appellate action. Entitlement to Service Connection for a Left Hip Disorder The Veteran asserts that he has a left hip disability which is due to service, to include as due to an in-service dog bite and due to the weight of his law enforcement belt. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 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). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Alternatively, service connection may be established under 38 C.F.R. § 3.303 (b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. Service connection may be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). Objective indications of a qualifying chronic disability include both signs and symptoms, in the medical sense of objective evidence perceptible to an examining physician, and other non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs and symptoms include, but are not limited to, fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317(b). Non-medical indicators include evidence such as time lost from work, the veteran having sought treatment for his symptoms, and change in the veteran’s appearance, physical abilities, and mental or emotional attitude. 60 Fed. Reg. 6661, 6663 (Feb. 3, 1995). The question for the Board is whether there is a relationship between a left hip disorder and the Veteran’s service. Service treatment records are silent as to hip complaints or injury. Post-deployment health assessments conducted in November 2009, December 2011 and May 2012 include a negative report of swollen, stiff, or painful joints. An October 2013 treatment note reported a dog bite by a dog in the K-9 unit. The Veteran was fond to have an open would puncture of the left thigh. The Veteran’s July 2014 military services physical for separation included the Veteran’s report that he was feeling very good overall, no hip disorder or complaints were noted. The Veteran is shown to have begun treatment at a VA medical facility in October 2014, the record demonstrates that after almost two years of treatment at that facility, in August 2016, the Veteran complained of back and hip pain. Mild degenerative changes of the hip were found on x-ray in September 2016. In a November 2016 VA examination, a VA examiner found that the Veteran’s left hip disorder was a condition with a clear and specific etiology and diagnosis not related to exposure to environmental hazards during service in southwest asia. The examiner further stated that there was no medical literature that supported a link between such hazards and a left hip condition. At a March 2019 VA examination, the Veteran stated that he had occasional left lateral hip pain which got worse when he slept over it. The Veteran stated that he had a left hip disorder due to a dog bite during service and reported that he injured his left hip due to constant use of his law enforcement belt. Following review of the record and examination of the Veteran, the examiner determined that the Veteran’s left hip disorder was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner explained that the Veteran’s dog bite was in the distal lateral left thigh whereas the Veteran’s left condition was on the proximal lateral thigh. The examiner stated that there was no objective evidence in medical literature that supported that a small dog bite in the left thigh distal to the hip could cause a left subtrochanteric bursitis, noting that this was in a different anatomical area. The examiner further stated that the Veteran’s left subtrochanteric bursitis condition was not related to his military service because it was incurred several years after the Veteran’s last day of service. Following remand, the Veteran was afforded a new examination in December 2019. The examiner noted that there were no medical records describing the onset of left lateral hip pain. The examiner noted that there was a dog bite wound in the area that resolved in 2013. The examiner stated that the Veteran’s arthritis was found in 2016, which was after service and that the Veteran’s left hip disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. In October 2020, the Veteran’s claims file was provided for an additional medical opinion. Following review of the record, the examiner concluded that the Veteran’s left hip disability was less likely than not incurred in or caused by service. The examiner explained that left hip arthritis and left hip trochanteric syndrome was found in 2016 which would be two years after service. The examiner noted that service treatment records were silent as to this condition. The examiner further stated that the Veteran’s left hip disorder was less likely than not related to an in-service dog bite, noting that the Veteran’s dog bite was resolved, and the left hip trochanteric pain syndrome and arthritis were separate conditions with unrelated etiologies. The examiner stated that a left hip disorder was not at least as likely as not aggravated beyond its natural progression as the service-connected dog bite was a resolved condition in 2013 and had no correlation with left hip trochanteric pain syndrome or left hip arthritis diagnosed in 2016. The Board concludes that, while the Veteran is shown to have a current left hip disorder, the preponderance of the evidence is against finding that the Veteran’s a left hip disorder is related to service. Initially, while the record shows service in southwest asia, the record shows no correlation between the Veteran’s service and a hip disorder as the disorder is a diagnosed condition and not a qualifying chronic disability. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). Moreover, arthritis or degenerative arthritis is a chronic disease subject to such forms of service connection, here there is no indication that such began during or manifest to a compensable degree within one year of service discharge. Therefore, presumptive service connection or service connection based on continuity of symptomatology is not warranted. While in some circumstances, lay evidence may later be confirmed by medical findings, here the record does not demonstrate continuity of service. Such is demonstrated by the lack of complaints in service, and treatment after service without any hip complaints for almost two years after service. Additionally, while the evidence of record demonstrates an in-service dog bite, the record demonstrates that the Veteran had no residuals of the dog bite and that a left hip disorder is entirely unrelated to such. This is demonstrated by the Veteran’s VA examiners who noted that there was no correlation between the dog bite and the Veteran’s present hip disorder whatsoever. Thus, the in-service dog bite is not shown to have caused or aggravated the Veteran’s left hip disorder. Further, the preponderance of the evidence weighs against finding that a left hip disorder is directly due to service to include as due to carrying a law enforcement belt. The Veteran’s VA examiners, following examination of the Veteran and the record are shown to agree that a left hip disorder is not related to service. Service treatment records are silent as to any complaints of left hip pain or findings of a left hip disorder, the Veteran is shown to report no joint problems on multiple occasions in service, and no hip disorder is shown at the time of separation or for over a year thereafter. Additionally, outside of the Veteran’s claim, the evidence does not demonstrate any relationship between the Veteran’s current left hip disorder and his service. While the Veteran might sincerely believe that he has a left hip disability is related to service to include an in-service dog bite or to his carrying a law enforcement belt, in this case the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, and the Veteran is not shown to have 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). Thus, when taken as a whole, the most probative evidence demonstrates no in-service incurrence of a left hip disorder and no nexus between the Veteran’s service and a current left hip disorder. As such, the evidence of record weighs against a finding that the Veteran’s left hip disorder is related in any way to service and service connection must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Slovick, 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.