Citation Nr: 21065457 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 14-35 468 DATE: October 26, 2021 ORDER Entitlement to service connection for right hip condition is denied. Entitlement to service connection for left hip condition is denied. Entitlement to service connection for left knee condition is denied. FINDINGS OF FACT 1. The probative evidence of record does not show that the Veteran's bilateral hip conditions are due to his active-duty service, to include as due to or aggravated by his service-connected lumbar spine disability. 2. The probative evidence of record does not show that the Veteran's left knee condition is due to or related to his active-duty service, to include as due to or aggravated by his service-connected right knee disability. CONCLUSIONS OF LAW 1. The criteria for service connection for right hip condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for left hip condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for left knee condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Navy from April 1975 to August 1979 with additional Reserves service that includes periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). In February 2018, the Veteran was provided a hearing with the undersigned Veterans Law Judge and a transcript of the proceeding is of record. The claims were brought before the Board in May 2018, June 2020, and April 2021 and were remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). Further, service connection on a secondary basis essentially requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310. When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Entitlement to Service Connection: Bilateral Hip Conditions and Left Knee Condition The Veteran contends that his left hip, right hip, and left knee conditions are related to his active-duty service, to include his hip conditions as due to or aggravated by his service-connected lumbar spine (back) disability and his left knee condition as due to and/or aggravated by his service-connected right knee condition. As an initial matter, the Board acknowledges that the Veteran been diagnosed with osteoarthritis and degenerative joint disease (DJD) of the bilateral hips and left knee. Thus, the issue turns upon whether there is evidence of an in-service event or injury and a nexus between the claimed in-service event or injury and the present disability, to include whether his hip conditions are due to and/or aggravated by his service-connected lumbar spine disability and his left knee condition as due to and/or aggravated by his service-connected right knee disability. See Sheldon v. Principi 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. In June 2014, the Veteran was provided a VA examination for his conditions. The examiner opined that the Veteran's claimed conditions were less likely than not related to or caused by the Veteran's active-duty service, to include his military duties as a Navy diver and parachutist. The examiner rationalized that the Veteran's records do not show evidence that supports service connection. The examiner further explained that there is no chronicity of the bilateral hip condition. Regarding the Veteran's left knee, the June 2014 VA examiner also opined that the condition was less likely as not related to or caused by the Veteran's active duty, to include his duties as a Navy diver and parachutist. The examiner explained that the medical evidence did not show evidence of a left knee condition incurred in or sustained during service. The examiner noted the examination showed the Veteran had full range of his left knee. In January 2020, the Veteran was provided another VA examination. The examiner rationalized that the Veteran's bilateral hip condition is less likely than not proximately due to or the result of his back condition. The examiner rationalized that there was insufficient evidence to support that the Veteran's back conditions are severe to cause chronic change in gait or function that would result in the Veteran's current bilateral hip condition. The examiner explained that the conditions were separate and distinct with separate and distinct etiologies. The examiner further found that the Veteran's bilateral hip degenerative joint disease is more likely the result of repetitive trauma over time and not changes in gait due to his back condition. The examiner found it less likely than not that the Veteran's condition was incurred or caused by injuries sustained during his military service. The examiner noted that the Veteran's service records show no evidence of evaluation or treatment for a hip condition. The examiner further explained that there is insufficient evidence showing the Veteran developed a right and left hip condition during his service that became ongoing. Specifically, the examiner found his medical records were silent for a hip condition until 2013, over 20 years after his service. The examiner also noted that radiographic evaluation revealed no significant posttraumatic degenerative changes. The January 2020 examiner then opined that the Veteran's left knee condition was less likely as not proximately due to or the result of his right knee condition. The examiner rationalized that there was insufficient evidence that the Veteran's right knee condition was severe enough to cause a chronic change in his gait that would result in his left knee condition. The examiner explained that the conditions were separate and distinct with separate and distinct etiologies. The examiner also found that his left knee condition is more likely due to repetitive trauma over time. The examiner lastly noted that the evidence does not show the Veteran had a left knee disability in service that became an ongoing concern as there are no complaints for a left knee until 2013, 20 years after his service, as well as radiographic evaluation revealed no significant posttraumatic degenerative changes. In June 2021, a VA opinion was obtained. The examiner opined that the Veteran's bilateral hip conditions were less likely than not aggravated beyond natural progression by his back condition. The examiner rationalized that medical records show in August 2013 when the Veteran reported lumbar spine disability, his gait was normal. The examiner further noted that the Veteran's January 2020 examination also showed normal gait, which suggests the Veteran's current bilateral hip conditions were not aggravated by his lumbar spine but incurred from his everyday use post service employment as security, which is noted in a clinical note dated in October 2014. Regarding the Veteran's left knee condition, the June 2021 examiner also opined that his condition was less likely than not aggravated by his right knee condition. The examiner rationalized that the examiner in August 2013 noted the Veteran had full range of motion and normal gait and clinical notes in February 2014, March 2015, and March 2017 continued to note normal gait. The examiner further noted that a psychiatry note in October 2012 reported the Veteran worked multiple jobs since discharge, including working as a security guard, which the examiner found suggests the Veteran left knee disability is not due to compensation for the right knee joint but from his post service physically demanding employment. While VA treatment and private medical records note complaints and treatment for his bilateral hip and left knee conditions, none of the records related the Veteran's conditions to his service, to include as due to or aggravated by his back disability or right knee disability. The Board also notes that there is no evidence of a left knee or bilateral hip condition prior to 2013. Therefore, the Board finds the June 2014, January 2020, and June 2021 VA opinions to be of significant probative value in determining that the Veteran's bilateral hip conditions and left knee condition are not related to his period of service, to include as due to and/or aggravated by his service-connected back condition or service-connected right knee condition. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Here, the reviewing physicians' opinions were based on review of the Veteran's lay contentions, his reported medical history, medical literature, and review of the medical evidence of record. Further, complete and thorough rationales were provided for the opinion rendered. The Board acknowledges the Veteran's assertions that his bilateral hip and left conditions are due to his active-duty service. The Board recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any hip and knee disability is related to his military service, to include as due to or aggravated by his back condition or right knee condition, requires medical expertise that the Veteran has not demonstrated since shoulder disabilities can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Further, the Board again notes that the Veteran has provided no evidence showing complaints of these conditions prior to 2013, which is over 30 years after his active-duty service. As the Veteran has diagnoses of arthritis, the Board has also considered presumptive service connection or service connection based on a continuity of symptomatology. However, there is no evidence that the Veteran had a bilateral hip disability or left knee disability that manifested within one year after discharge from service. To the extent that the Veteran asserts that he experienced bilateral hip and left knee disabilities continuously since discharge from service, the Board does not find these statements to be credible as they are inconsistent with the overall evidence of record. The Board notes that the first complaint of bilateral hip and left knee pain were in 2013, over 20 years after his service. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claim and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Negron, 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.