Citation Nr: 21004725 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 20-04 918 DATE: January 28, 2021 ORDER Service connection for a back disability, secondary to a service-connected left hip disability, is granted. FINDING OF FACT The evidence is at least in relative equipoise as to whether the Veteran’s back disability is related to his service-connected left hip disability. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for a back disability have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1961 to April 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2018 rating decision by the Department of Veterans Affairs (VA). In January 2021, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. The Veteran’s wife testified on the Veteran’s behalf. Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. If the preponderance of the evidence is against the claim, the claim is to be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Lay evidence may be competent evidence to establish that an event or injury occurred during service. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159(a)(2). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (e.g., a broken leg), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. The Veteran contends that his back disability is related to his service-connected left hip disability. He stated that he has been experiencing back pain and limping beginning in 1963 until 1992 when he was able to undergo his first hip replacement. After the hip replacement, he continued to experience pain and problems with his gait. At the Veteran’s Board hearing, the Veteran’s wife testified that the Veteran injured his hip in 1962 and held off on surgery for as long as possible. During that time, the Veteran’s gait was off. The Veteran was limping badly in 2010. In 2017, a screw came out of his hip. The Veteran’s wife believes that the Veteran’s injured hip is related to his back pain and unstable gait. The Veteran’s private physician provided an opinion in September 2017. He noted that the Veteran had unsteady gait, and x-rays of the lumbar spine indicated moderate degenerative disc disease at L3-L4. He stated that the Veteran had a left hip surgery that resulted in him having an altered gait for his lifetime that is more likely than not the result of his original injury in 1962, which also resulted in chronic back pain and further disability. A June 2012 VA examination and March 2017 VA opinion found that the Veteran’s spine disability was less likely than not due to or a result of his hip condition. The June 2012 examiner stated that a March 2012 primary care medical evaluation noted no back or neck complaints and full range of motion, and the Veteran had a normal physical examination of his low back in spite of abnormal imaging. The March 2017 examiner stated that the two conditions are not medically related, and the medical literature does not support a medical relationship. A June 2018 VA opinion found that it was possible that the Veteran’s hip condition aggravated his lumbar spine condition, but it cannot be stated that his left hip condition aggravated his back condition without speculation. The Board finds this opinion to be speculative and accords it little probative weight. While the Veteran and his wife are not competent to make a diagnosis or determine the etiology of his current back disability, they are certainly competent to identify lay observable symptoms such as chronic pain occurring and problems with gait beginning at the time of the Veteran’s hip injury. In addition to being competent, the statements are credible and supported by his private physician’s opinion. Accordingly, the Board finds the competent statements by the Veteran and his wife concerning his ongoing back pain and problems with gait to be credible and ultimately probative. Therefore, the Board finds that the evidence is in equipoise as to whether the Veteran’s back disability is related to his service-connected left hip disability. Because the relevant evidence is in equipoise, the Board resolves all reasonable doubt in the Veteran’s favor and finds that it is at least as likely as not that his back disability is related to his service-connected left hip disability. Service connection is warranted. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. Kerner, Associate 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.