Citation Nr: 21066209 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 10-07 465 DATE: October 29, 2021 ORDER Entitlement to service connection for a low back disability (other than lumbosacral strain), to include arthritis of the lumbar spine with spina bifida occulta, is denied. Entitlement to service connection for a right hip disability, to include osteoarthritis, is denied. FINDINGS OF FACT 1. The weight of competent and credible evidence is against finding that a low back disability (other than lumbosacral strain), to include arthritis of the lumbar spine with spina bifida occulta, began during active service, or is otherwise related to an in-service injury or disease or was caused or aggravated by a service-connected disability. 2. The weight of competent and credible evidence is against finding that a right hip disability, to include osteoarthritis, began during active service, or is otherwise related to an in-service injury or disease or was caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a low back disability, to include arthritis of the lumbar spine with spina bifida occulta, have not been met. U.S.C. §§ 1110, 1112, 1131 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 (2021). 2. The criteria for entitlement to service connection for a right hip disability, to include osteoarthritis, have not been met. U.S.C. §§ 1110, 1112, 1131 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Army from December 1953 to December 1955. These matters come to the Board of Veterans' Appeals (Board) from a March 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, that declined petitions to reopen the claims of service connection for arthritis of the lumbar spine and right hip. The Veteran testified before the undersigned Veterans Law Judge sitting at the RO in December 2017; a transcript is of record. In January 2018, the Board reopened the claims and remanded the claims for additional development. Thereafter, the Board denied the claims in a July 2019 decision. The Veteran appealed the determination to the United States Court of Appeals for Veterans Claims (Court) and in a February 2021 Order the Court granted a February 2021 Joint Motion for Partial Remand (JMR) recommending that the portion of the July 2019 decision denying the above issues should be vacated and the issues remanded to the Board. In response to the JMR and Order, the Board remanded the issues in July 2021. The issues again are before the Board. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. There is a one-year presumption for arthritis. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. To establish a right to compensation for a present disability, a Veteran must show: (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. 38 C.F.R. § 3.303(a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability, comparing it to the current level of disability, and showing that the secondary condition was not due to the natural progression of a disease. 38 C.F.R. § 3.310(b). 1. Entitlement to service connection for a low back disability, to include arthritis of the lumbar spine with spina bifida occulta The Veteran contends that he has a low back disability (other than lumbosacral strain for which he is service-connected already), specifically to include arthritis, that is the result of a 1955 in-service lifting accident involving a jeep. In the alternative, the Veteran alleges that the arthritis of the lumbosacral spine was caused or aggravated by his service-connected lumbosacral strain. The Veteran's service treatment records include March 1955 treatment for lower back muscle strain after falling on the street. A November 1955 Report of Medical Examination prior to separation from active service included a normal examination of the spine. A December 1957 letter from a private physician indicated that the Veteran had been examined in December 1957 and complained of right hip pain. On examination, there was tenderness in the low back and right hip. There was some pain on range of motion testing. X-rays of the lumbosacral spine showed a mild scoliosis with a convexity to the left with some rotation of the lumbar vertebra. Lateral x-rays of the lumbosacral spine were negative. A December 1957 letter from a fellow service member indicated, "We were in the process of repairing a 14 ton vehicle when he complained he hurt his back. Because of this he had to stay out for about a week. That was about March or April 1955. I do know that he had to go to the doctor for treatments." Another December 1957 letter from another service member noted that the Veteran had injured his back in March 1955, went to the dispensary, and was out from work for about two weeks. No treatment was provided at the time. A December 1957 letter from the Veteran's employer stated that the Veteran had worked for him since July 1956 and at the time he told the employer that he had injured his back while serving in Germany. The employer believed that the Veteran "had been getting along okay until the latter part of November, when he again hurt his back while lifting bales of hay. He was out of work for approximately two weeks. Since then he has complained of his back hurting him when he does any heavy lifting or when he sits in a certain position for a while." A December 1957 letter from a fellow employee of his post-service job discussed the Veteran's problems with his back and associated difficulties with lifting and doing physical work. A January 1958 VA examination report included the Veteran's report of a back injury in March 1955 where he was lifting a corner of a jeep when he felt something give way in the right low back that was followed by pain and stiffness in the right hip. The Veteran stated that the next day a German physician took x-rays and told him "this will never get all right. There have been stretched ligaments." The Veteran reported that over the next several days with heat and local treatment the pain did improve until he left service with no further difficulty. That said, there was a continuing history that when he did any straining, lifting, or following periods of riding a tractor or bulldozer, pain would recur in the same area as in service. Specifically, the Veteran had experienced right hip and low back pain following a November 1957 injury unloading hay. Following examination, the examiner diagnosed congenital defects in the pedicles of L5, especially on the left; spina bifida occulta of S1; lumbosacral strain, chronic, recurrent, moderate; and minimal hypertrophic arthritis of L4 and L5. The examiner opined that the lumbosacral strain was unrelated to the congenital defects of L5 and S1. A February 1958 rating decision granted entitlement to service connection for lumbosacral strain based on the Veteran's in-service back injury. The rating decision also indicated that the x-rays showing minimal arthritis first became manifest at the time of the January 1958 examination and there was no evidence of the condition having been incurred in service. Similarly, the evidence failed to reveal the existence of any superimposed injury or disease during service of sufficient severity to reflect an aggravation of the Veteran's development or constitutional conditions diagnosed as defects in the pedicles of L5 and spina bifida occulta of S1. A December 1958 statement from a co-worker indicated that prior to service the Veteran could do any kind of work, but while working with him for the past 15 months the Veteran had "been troubled with his back and can't do very hard or heavy work." Letters from other co-workers noted the same. A January 1963 VA examination report noted ongoing back pain with any kind of strain or work. The diagnosis was chronic lumbosacral strain. In July 1967, the Veteran reported a 6 to 7-month history of backache. In January 1970, the Veteran was given a corset for his back. The Veteran was afforded another VA examination in July 1979. Following x-rays of the back the diagnosis was severe lumbosacral strain. X-rays also showed spondylosis with spondylolisthesis. June 1982 x-rays showed marked degenerative disc disease at the lumbosacral level with prominent focal hypertrophic spondylosis at L5 without spondylolisthesis and very mild roto scoliosis to the left. A contemporaneous VA examination report included a diagnosis of chronic lumbosacral strain with severe degenerative disc disease. In November 1991, the Veteran complained of a 2 to 3-week history of low back pain that was no longer controlled by Motrin. The assessment as chronic low back syndrome. In February 1992, the Veteran reported that in November 1991 the Veteran had x-rays of his back and the treating physician told him there was old damage between the fourth and fifth vertebrae that was practically bone on bone and showed evidence of arthritis. An October 2008 letter from a private chiropractor indicated that the Veteran had been treated twice in the mid-1980s and once in the mid-1990s. The letter concluded, "Speaking with [the Veteran], his history of low back and hip pain is the direct result of an injury he sustained while serving in the armed forces many years ago. He has suffered intermittent bouts of pain ever since." The Veteran was afforded a VA examination in March 2009. The Veteran reported onset of back pain in 1954 while in Germany upon lifting a vehicle axle with 4 others when the others released the axle and the Veteran was left holding it alone. There was pain in the middle of the back, radiating to the left buttock. The Veteran reported having treated with chiropractors for 30 years without improvement of symptoms. The examiner diagnosed lumbosacral strain with underlying degenerative disc disease and degenerative joint disease. In an August 2009 statement, the Veteran stated that a doctor in Germany during service following his injury told the Veteran that "I would have arthritis in my back and hip and he was right." A March 2013 statement from the Veteran indicated that he had a good job waiting for him after service, but that due to injuries to his back and hip the employer could not put the Veteran on their insurance. It took him an extended period of time to find a job due to the injuries. In a November 2017 statement, the Veteran discussed how he injured his back when a jeep driver placed a jack in an incorrect location and it slipped, fortunately getting caught on the spring. The Veteran went to the dispensary where he was told "my fourth and fifth vertebra[l] disc[s were] crushed." The Veteran thereafter was out of the shop for 2 weeks and "never did any work after that." He stated that he had been trying to get disability benefits for his back "for years after coming out of service," without success. During a December 2017 Board hearing, the Veteran reported back problems as a result of an incident in service where he had to hold up a jeep because there was not a floor jack available and they were forced to use a small jack from the jeep. The Veteran reported ongoing problems from that time with his back. A February 2018 VA examination report is of record. The examiner diagnosed lumbosacral strain (for which the Veteran is service connected), degenerative disc disease of the lumbar spine, and hypertrophic degenerative changes of the lumbar spine. The Veteran reported an injury of the low back in 1955 during service as a result of lifting and pulling. The Veteran reported ongoing pain from that time. Following examination, the examiner concluded that it was less likely than not that the Veteran's low back (other than lumbar strain) disabilities were incurred in or caused by service. The rationale noted that degenerative disc disease and degenerative joint disease were separate from the muscle strain experienced in service. These disabilities were separate disabilities and not a continuation of the lumbar strain from the 1950s. As such, it was less likely than not that the service-connected lumbar strain or associated medication caused or aggravated the degenerative disc disease or degenerative joint disease. As noted above, the JMR found that the February 2018 VA examination report was inadequate with respect to the secondary opinion. As such, the Board obtained an August 2021 VA medical opinion. The medical professional discussed the January 1958 x-ray showing lumbar scoliosis, congenital pars defect of L5 without spondylolisthesis, and spina bifida occulta. July 1979 x-rays showed similar findings, with the addition of spondylolisthesis and moderate hypertrophic degenerative changes. July 2019 x-rays showed early degenerative changes. The medical professional stated, "Individuals with spina bifida occulta and other congenital defects identified on those x-rays in 1958 are at higher risk for developing degenerative disc disease and facet arthritis. Nonetheless, this does not represent aggravation of the condition beyond its natural course as it did not develop until in or around 1979, as identified on x-rays 7/16/79. Degenerative spine disease is considered a naturally occurring condition due to normal wear and tear over a lifetime. It is more likely than not that the congenital changes identified as early as 1958 predispose the veteran to develop degenerative spine disease. However, the lumbar strain would've played no role in its development. This is established medical knowledge and practice (Wheeless' textbook of orthopedics). Therefore, it is less likely than not that veteran's degenerative spine changes are due to are incurred in the veteran's lumbar strain or service in general. It is less likely than not that the degenerative spine change represents aggravation of the congenital condition while in service. The changes identified in 1979 are consistent with the naturally occurring development of those degenerative changes, including spondylolisthesis and spondylosis. It is the spina bifida occult and other congenital changes themselves that predisposed the veteran to develop degenerative spine disease which would have occurred regardless of military service and the service-connected lumbar spine. Furthermore, there is no evidence of progression beyond the natural course due to any cause, including the veteran's lumbar strain. The natural course of degenerative lumbar spine disease tends to progression, often requiring medical intervention, injections and surgical intervention. There is no objective evidence to suggest aggravation beyond the natural course. In summary, it is less likely than not that the veteran's currently diagnosed degenerative spine changes are due to or incurred in service or due to or incurred in the diagnosis of lumbar strain. It is more likely than not that the veteran's lumbar anomalies predisposed the veteran to develop naturally occurring degenerative spine disease and it does not represent aggravation of those conditions beyond their natural course. The veteran, more likely than not, would, have developed degenerative spine disease even in the absence of lumbar strain while in service or due [to] service in general." (Emphasis in original.) The Board recognizes at the outset the August 2021 opinion did not check the correct box, as the opinion concluded "The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness." The opinion itself, however, clearly addressed whether the back arthritis and spina bifida was caused or aggravated by the Veteran's service-connected lumbar strain. As such, the Board finds the opinion adequate. The question for the Board is whether the Veteran has a current low back disability other than lumbosacral strain that began during service, is at least as likely as not related to an in-service injury, event, or disease, or was caused or aggravated by a service-connected disability. As noted above, the Veteran has current diagnoses of degenerative disc disease, degenerative joint disease, and spina bifida occulta, however, the weight of the evidence is against finding that these disabilities began during active service, are otherwise related to an in-service injury, event, or disease, or were caused or aggravated by a service-connected disability. As to granting the claim on a direct basis, the evidence clearly establishes that the Veteran incurred a low back injury during service with a resulting chronic disability. The medical evidence, however, clearly establishes that this disability was lumbosacral strain for which the Veteran already has been granted service connection. The February 2018 VA examiner considered the evidence of record and found that the degenerative disc disease and degenerative joint disease were unrelated to the Veteran's service, as they were separate disabilities from the lumbosacral strain incurred during service. The August 2021 VA medical opinion reached a similar opinion. The other medical evidence of record makes clear that the Veteran's degenerative joint disease and degenerative disc disease of the lumbosacral spine did not manifest until more than one year after separation from service. The Board finds the foregoing evidence the most probative evidence of record as to whether the Veteran's degenerative joint disease or degenerative disc disease was incurred in or is otherwise related to his active service. Multiple medical opinions have discussed how the Veteran's spina bifida occulta was a congenial disorder that preexisted service and that there was no disability superimposed on the spina bifida during service or otherwise as a result of service. There is no lay or medical evidence to the contrary. As to granting the claim on a secondary basis, the VA medical opinions of record have concluded that the degenerative disc disease, degenerative joint disease, and spina bifida are unrelated to the service-connected lumbosacral strain, as they involve separate disabilities and body systems and were not a continuation of the lumbosacral strain. Moreover, the August 2021 medical opinion made clear that the spina bifida occulta was a congenital defect with no additional disability added to it during service. Instead, the degenerative joint disease and degenerative disc disease (or degenerative spine disease as referred to by the August 2021 medical professional) were the normal progression of the spina bifida occulta and not caused by the service-connected lumbar strain. In addition, the August 2021 medical opinion concluded that the degenerative spine changes were not aggravated by the service-connected lumbar strain, as the degenerative changes were most consistent with the natural course of the Veteran's spina bifida causing spondylosis and/or spondylolisthesis and ultimately degenerative changes of the spine. Again, in context it is clear that the opinions found that the lumbosacral strain did not cause or aggravate the degenerative disc disease, degenerative joint disease, or spina bifida occulta. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (a medical report must be read as a whole in the context of the claim and, even an opinion lacking in detail may be provided some probative value based upon the amount of information and analysis contained therein). The Board has considered the Veteran's contentions that at the time of the injury in 1955 a German physician told the Veteran that he would develop arthritis in the spine as the result of the in-service injury. The Board acknowledges that the Veteran is competent to relate a contemporaneous diagnosis rendered by a physician. Even were the Board to accept the accuracy of the Veteran's contentions regarding the German physician's remarks, the Board finds the subsequent medical evidence of greater probative value as these medical professionals had the advantage of reviewing all the subsequent medical and lay evidence and any intervening circumstances in making a determination as to the etiology of any lumbosacral spine arthritis that ultimately developed. In addition, there is no rationale of record from the German physician as to why the Veteran would develop arthritis of the lumbosacral spine multiple years after the 1955 injury. As such, the Board affords greater weight to the other medical evidence of record. The lay evidence of record clearly demonstrates that a low back injury occurred during service and they are competent to report the physically observable symptoms related to the back. These individuals, however, are not competent to link those physically observable symptoms to a specific disability, such as degenerative disc disease or degenerative joint disease, because such a conclusion requires the interpretation of diagnostic testing results and other knowledge beyond that of a layperson. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials 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). 2. Entitlement to service connection for a right hip disability, to include osteoarthritis The Veteran contends that he has a right hip disability that is the result of a 1955 lifting accident involving a jeep. In the alternative, the Veteran alleges that the arthritis of the lumbosacral spine was caused or aggravated by his service-connected lumbosacral strain. The Veteran's service treatment records do not include any complaints, treatment, or diagnoses of a right hip disability. A November 1955 Report of Medical Examination prior to separation from active service included a normal examination of the lower extremities. A December 1957 letter from a private physician indicated that the Veteran had been examined in December 1957 and complained of right hip pain. The Veteran reported that in March 1955 he developed right hip pain after helping to lift a jeep. He went to the dispensary where x-rays were taken. He was told he stretched the tendons behind his hip and that they would never fully heal. The right hip bothered him for 2 to 3 months before gradually improving. Since that time, the Veteran had intermittent right hip problems. In late November 1957, the Veteran was baling hay and riding a tractor when he developed pain behind his hip and the following day it was sore and painful. He had experienced continued pain from that point. On examination, there was tenderness in the low back and right hip. There was some pain on range of motion testing. X-rays of the hips were negative. In December 1957, the Veteran filed a claim for entitlement to service connection for a right hip disability based on an alleged injury to the right hip in March 1955. A January 1958 VA examination report included the Veteran's report of a back injury in March 1955 where he was lifting a corner of a jeep when he felt something give way in the right low back that was followed by pain and stiffness in the right hip. The Veteran stated that the next day a German physician took x-rays and told him "this will never get all right. There have been stretched ligaments." The Veteran reported that over the next several days with heat and local treatment the pain did improve until he left service with no further difficulty. That said, there was a continuing history that when he did any straining, lifting, or following periods of riding a tractor or bulldozer, pain would recur in the same area as in service. Specifically, the Veteran had experienced right hip and low back pain following a November 1957 injury unloading hay. Following examination, the examiner diagnosed congenital defects in the pedicles of L5, especially on the left; spina bifida occulta of S1; lumbosacral strain, chronic, recurrent, moderate; and minimal hypertrophic arthritis of L4 and L5. The examiner opined that the lumbosacral strain was unrelated to the congenital defects of L5 and S1. A February 1958 rating decision denied entitlement to service connection for a right hip disability. The Veteran was afforded another VA examination in July 1979. The Veteran reported that since his injury in service he experienced intermittent severe back pain that radiated into the right hip. The Veteran indicated that he had a dislocation of the right hip due to lifting, but the examiner believed that the Veteran actually meant that he had severe back pain with pain in the right hip but no actual dislocation. Following examination and x-rays the Veteran was diagnosed with a right hip condition due to early degenerative joint disease. An October 2008 letter from a private chiropractor indicated that the Veteran had been treated twice in the mid-1980s and once in the mid-1990s. The letter concluded, "Speaking with [the Veteran], his history of low back and hip pain is the direct result of an injury he sustained while serving in the armed forces many years ago. He has suffered intermittent bouts of pain ever since." The Veteran was afforded a VA examination in March 2009. The Veteran reported low back pain radiating to the right lumbosacral muscles along the iliac crest and into the right hip when stepping wrong or pivoting with his right leg with the foot fixed to the ground. The diagnosis was degenerative joint disease of the bilateral hips. The examiner noted that the Veteran had two types of pain, one radiating from the lumbar spine to the right lumbar muscles along the right iliac crest and the other pain in the hip itself. The examiner concluded that the Veteran's right hip joint degenerative joint disease with pain was not secondary to the service-connected lumbar spine strain or degenerative joint disease. The rationale indicated that degenerative joint disease was expected in an individual of the Veteran's age. In an August 2009 statement, the Veteran stated that a doctor in Germany during service following his injury told the Veteran that "I would have arthritis in my back and hip and he was right." A March 2013 statement from the Veteran indicated that he had a good job waiting for him after service, but that due to injuries to his back and hip the employer could not put the Veteran on their insurance. In a November 2017 statement, the Veteran alleged that as a result of the same in-service incident where he hurt his back he also hurt his right hip. After the injury, he went to the dispensary where he was given drugs and told that his "right hip was pulled out of place." The Veteran thereafter was out of the shop for 2 weeks and "never did any work after that." He stated that he had been trying to get disability benefits for his right hip "for years after coming out of service," without success. A February 2018 VA examination report is of record. The examiner diagnosed right hip osteoarthritis and internal fixation procedure of the intramedullary rod and pin transfixed in the femoral neck. The Veteran reported onset of hip problems in 1955, with a procedure in 2012. The Veteran indicated that he injured the right hip in service due to lifting. There was continued pain from service, with surgery in 2012. Following examination, the examiner concluded that it was less likely than not that the Veteran's right hip disability was incurred in or caused by service. Records did not support right hip arthritis during service. The right hip surgery occurred after service and was unrelated to service. The hip condition occurred after service with procedure in 2012 of internal fixation procedure with intramedullary rod and pin transfixed in the femoral neck from old intertrochanteric fracture. Lumbar strain was a condition of the muscle and not of the joint or ligaments. As such, the Veteran's right hip disability was less likely than not proximately due to or aggravated by the service-connected lumbar strain or associated medication. As noted above, the JMR found that the February 2018 VA examination report was inadequate with respect to the secondary opinion. As such, the Board obtained an August 2021 VA medical opinion. The medical professional stated, "There is no evidence of degenerative hip disease while in service. Early degenerative changes were identified on x-rays 7/16/79. Degenerative changes of the hip are considered a naturally occurring condition due to normal wear and tear over a lifetime. The early changes seen on x-rays in 1979 suggest a recent onset at that time. Therefore, it is less likely than not that the veteran's degenerative hip disease had its onset in service or is due to events in service. It is also less likely than not that the condition is due to or incurred in the veteran's lumbar strain. First, lumbar strain would not cause degenerative changes of the hip. This is established medical knowledge and practice. This includes postural or gait accommodation due to the spinal condition. Furthermore, degenerative disease does not spread from one joint or joint system, such as the spine, to another joint. It is more likely than not that the veteran's right hip conditions developed naturally over time and are unrelated to service and/or the Veteran's hip condition. This includes the veteran's hip fracture, status post-ORIF in 2021. There is no evidence of aggravation [of] the veteran's hip condition beyond its natural course due to any cause, including the veteran's lumbar strain. Lumbar strain would not aggravate the veteran's hip condition. The natural course of degenerative hip disease tends to progression, often requiring medical intervention, injections or surgical intervention, including [total hip arthroplasty]. The Veteran's ORIF was due to hip fracture, which is unrelated to any of the above. The rationale above also applies to aggravation as well as primary and secondary cause (Wheeless' textbook of Orthopedics)." (Emphasis added.) The Board recognizes at the outset the August 2021 opinion did not check the correct box, as the opinion concluded "The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness." The opinion itself, however, clearly addressed whether the right hip disability was caused or aggravated by the Veteran's service-connected lumbar strain. As such, the Board finds the opinion adequate. The question for the Board is whether the Veteran has a current right hip disability that is at least as likely as not related to an in-service injury, event, or disease, or was caused or aggravated by a service-connected disability. As noted above, the Veteran has a current diagnosis of osteoarthritis status post-surgery, however, the preponderance of the evidence is against finding that this disability began during active service, is otherwise related to an in-service injury, event, or disease, or was caused or aggravated by a service-connected disability. As to granting the claim on a direct basis, the evidence clearly establishes that the Veteran incurred an injury to the low back in 1955 and the Veteran has credibly testified that a German physician at that time also determined that the right hip had been displaced. The lay and medical evidence, however, demonstrate that in the aftermath of the injury with rest and treatment the Veteran's right hip improved to the point that it was no longer a problem. It was not until an extended period after service that he began to experience right hip problems. Complicating the issue is the fact that the medical evidence demonstrates that the Veteran experiences two types of right hip pain, one pain the result of radiating from the back and the other stemming directly from the right hip. The Veteran's right hip arthritis did not manifest until more than one year after separation from service. In addition, the August 2021 medical opinion specifically discussed how the 1979 x-rays were consistent with recent onset of arthritis in the right hip and that degenerative changes of the hip were considered a naturally occurring condition due to normal wear and tear over a lifetime. For those reasons, the August 2021 medical professional's opinion was that it was less likely than not that the Veteran's right hip arthritis had its onset in service or otherwise was due to events in service. Given the clear rationale and the medical professional's level of education, training, and experience in this area, the Board finds the August 2021 medical opinion the most probative evidence of record as to whether the right hip disability was incurred in service or otherwise caused by service. The Board has considered the Veteran's contentions that a German physician in 1955 told the Veteran that he would always have problems with the right hip as a result of the in-service injury. The evidence (including the Veteran's own reports), however, demonstrate that the Veteran's right hip improved in the aftermath of the in-service injury to the point that it was not a problem. The foregoing speaks against the opinion of the German physician. As such, the Board affords greater weight to the other medical evidence of record. As to granting the claim on a secondary basis, the VA medical opinions of record have concluded that the right hip arthritis was unrelated to the Veteran's service-connected lumbosacral strain. The August 2021 medical professional discussed how arthritis of the hip was naturally occurring with time as an individual aged and that a lumbar strain would not cause arthritis of the hip, including as due to postural abnormality, gait abnormality, or "spread" of arthritis from one joint to another. Moreover, the lumbar strain did not aggravate the right hip arthritis as the worsening of the arthritis over time was most consistent with the natural progression of arthritis in the hip over time, irrespective of the lumbar strain. The Board has considered the Veteran's contentions that at the time of the injury in 1955 a German physician told the Veteran that he would develop arthritis as the result of the in-service injury. The Board acknowledges that the Veteran is competent to relate a contemporaneous diagnosis rendered by a physician. Even were the Board to accept the accuracy of the Veteran's contentions regarding the German physician's remarks, the Board finds the subsequent medical evidence of greater probative value as these medical professionals had the advantage of reviewing all the subsequent medical and lay evidence and any intervening circumstances in making a determination as to the etiology of any right hip arthritis that ultimately developed. In addition, there is no rationale of record from the German physician as to why the Veteran would develop arthritis of the right hip multiple years after the 1955 injury. The Board finds such a conclusion particularly problematic given the evidence that in the aftermath of the injury the Veteran's right hip improved to the point that it appeared to have fully recovered. As such, the Board affords greater weight to the other medical evidence of record. Affording the Veteran the benefit of the doubt, the Board will presume for the purpose of this opinion that he injured his right hip in 1955 during the incident when he also injured his low back. The Veteran is competent to report the associated symptoms. The Veteran, however, is not competent to link those physically observable symptoms to a specific disability, such as right hip arthritis, because such a conclusion requires the interpretation of diagnostic testing results and other knowledge beyond that of a layperson. The Board finds such a conclusion particularly problematic given the evidence against a continuity of symptoms from service. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials 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). J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.