Citation Nr: 21004445 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 15-38 550 DATE: January 27, 2021 ORDER Service connection for bilateral hip disability is denied. FINDING OF FACT The most probative evidence does not demonstrate that the Veteran’s currently diagnosed bilateral hip disability manifested during, or as a result of, active military service. CONCLUSION OF LAW The criteria for service connection for bilateral hip disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran testified at a hearing before a Decision Review Officer in November 2016, and before the undersigned Veterans Law Judge in an October 2018 Travel Board hearing. The Board remanded the matter twice—in November 2018 and August 2020 for additional development. The Board finds that there has been substantial compliance with the remand directives and therefore will proceed with the appeal. Stegall v. West, 11 Vet. App. 268. Service Connection Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Hickson v. West, 12 Vet. App. 247 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). 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 Veteran. 38 U.S.C. § 5107(b). The Veteran served on active duty in the Air Force from December 1971 to January 1976. The Veteran contends that his bilateral hip disability is due to his military service. Specifically, he contends that his hip disability is due to the physically demanding duties performed in service, his in-service injury where he was roughly flipped and landed on his back, and or his service-connected low back disability. The record indicates a current bilateral hip disability. The September 2019 VA hip and thigh conditions disability benefits questionnaire (DBQ) shows a diagnosis of osteoarthritis of the both hips. The diagnosis date for the right hip was listed as 2010 and as 2011 for the left hip. The entrance examination shows that the Veteran was healthy upon entrance. The service treatment records, to include the November 1975 separation examination, do not show complaints of or treatment for a bilateral hip disability, or pain of the hips or other symptoms related to a hip disability. VA operative reports illustrate that the Veteran underwent right total hip arthoplasty in June 2010 and left total hip arthoplasty in April 2011. VA medical treatment records, dated as recently as February 2020, show that the Veteran continues to receive follow up treatment for his bilateral hip disability. A VA examiner provided negative opinions in September 2019. However, for reasons laid out in the August 2020 remand, these opinions are inadequate. As such, the Board places minimal probative value on these opinions. An internal medicine doctor provided a medical opinion in August 2020. The doctor opined that the Veteran’s bilateral hip disability is less likely than not incurred in or caused by an in-service injury, event, or disease. The rationale provided was that after review of the evidence there was no objective evidence of related hip complaints occurring during service or occurring within one year of the Veteran’s January 1976 separation. The doctor opined that it is less likely than not that the Veteran’s bilateral hip disability is proximately due to or the result of the Veteran’s service-connected low back disability. The rationale provided was that the two conditions are not medically related. The examiner stated that the claimed disorder is a separate entity entirely from the service-connected condition and unrelated to it. Further, the examiner noted that the medical literature does not support a medical relationship. The examiner found that a nexus had not been established. The examiner also found that it is not unusual for two joints to share properties in the same person, but one joint’s disease does not “spread” to another or cause damage to it. The condition of the bilateral hips is due to something intrinsic to the bilateral hips and not the low back. The doctor also opined that the Veteran’s bilateral hip disability is not at least as likely as not aggravated beyond its natural progression because of his service-connected low back disability. The rationale provided was that the decreased range of motion (ROM) and normal strength illustrated in the September 2019 Hip DBQ did not necessitate the use of assistive devices. This falls within the projected natural history of the condition and does not represent aggravation (beyond natural progression). The Board finds the August 2020 VA opinions to be of high probative value. The examiner indicated review of the file and provided clear and thorough rationale. There is no competent opinion to the contrary. The Board acknowledges that the rationale provided for the direct theory of entitlement is stated in one sentence. However, finding that the medical doctor is more than competent to provide an opinion and that the one sentence does not misstate any evidence that Board finds it adequate. The opinion is basically stating that there is no evidence to illustrate any treatment was provided or needed for the Veteran’s hips either during service or shortly after service. A review of the record confirms that there is no indication of a hip disability or symptoms related to such until 2010. The Board also acknowledges that although the doctor that provided the August 2020 opinions stated that decreased ROM and normal strength illustrated in the September 2019 VA Hip DBQ did not necessitate the use of assistive devices, this is not an exact read of the report. A read of the September 2019 VA Hip DBQ report does not indicate one way or the other as to whether assistive devices were needed. No response was provided in the section regarding assistive devices. The Board also acknowledges that the July 2017 Back DBQ indicates regular use of a cane for the Veteran’s low back and bilateral hip. All this said, the Board still finds the August 2020 opinions probative as the medical doctor’s interpretation of the September 2019 VA report is credible. He found the decreased ROM reflected in the report along with the normal strength in both hips did not require the use of assistive devices. Additionally, regular use of a cane does not equate to constant use or required use. Given the probative medical evidence of record, the Board finds that service connection is not warranted, as the Veteran’s bilateral hip disability is unrelated to service. The Veteran left service in January 1976. The earliest evidence, post-separation showing any indication of a bilateral hip disability, is dated June 2010—over three decades after separation. The Veteran is certainly competent to report symptoms such as experiencing pain in his hips or any other symptoms of discomfort. However, he is not competent to attribute these symptoms to an event, injury, or disease in service, as he has not demonstrated that he has the requisite medical expertise in determining its etiology and is a layperson in this regard. Additionally, the August 2020 VA medical opinions far outweigh the Veteran’s contentions, and is the only competent evidence of record regarding the nexus element. The preponderance of the evidence establishes that the Veteran does not have a current disability related to service. There is no probative evidence of record to show a connection between an event, injury, or illness in service, or to show a connection to his service-connected disabilities and the Veteran’s bilateral hip disability. As such, the claim must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Talamantes 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.