Citation Nr: 21074347 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 16-36 640 DATE: December 15, 2021 ORDER Entitlement to service connection for a right leg/hip disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's right leg/hip disability began during active service or is otherwise related to service. CONCLUSION OF LAW The criteria for service connection for right leg/hip disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1982 to January 1985. In October 2018, October 2020, February 2021, and July 2021, the Board remanded the claim for further development. Entitlement to service connection for a right leg/hip disability A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for disability shown after service, when all the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. at 54). Analysis The Veteran contends that his right leg/hip condition is due to military service. Specifically, he stated that the condition developed as a result of physical activity/training in bootcamp. He stated that he had to carry the M60 Machine gun which he believes contributed to the condition. The Veteran has been diagnosed with trochanteric pain syndrome (includes trochanteric bursitis), right hip. As such, element one under Shedden is met. The Veteran's service treatment records, (STRs) do not document treatments, complaints, or diagnosis of right leg/hip disability. On his November 1981 Report of Medical History: Enlistment examination, the Veteran's lower extremities were clinically normal. In October 1983 and September 1984, the Veteran was seen for left thigh injury and sore knee, respectively. He stated that he was playing basketball when the pain began. In October, he was diagnosed with minor pulled muscle, and in September, he was diagnosed with pulled muscle. The Board notes that a Separation exam is not of record. However, in January 1985, the Veteran was assigned to U.S. Army Separation Transfer Point. The order stated that after processing, the Veteran was relieved from active duty, not by reason of physical disability. In June 2011, the Veteran saw his private physician regarding a follow up for, among other things, continued episodic discomfort and paresthesias and dysesthesias over the anterior thigh on the right in the distribution of the lateral femoral cutaneous nerve of the right. In November 2020, the Veteran was afforded a VA examination to determine the nature and etiology of his right leg/hip disability. The Veteran stated that he first injured the right hip when he was in basic training. During service, he "looked for treatment in the infirmary." The Veteran stated because he wanted to finish basic training and carry on with his service, he attempted not to show his right hip struggles. The examiner diagnosed the Veteran with right hip strain. The examiner opined that 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 examiner stated that there was no evidence of any in service treatment for a right thigh or hip condition. The examiner also stated that wearing boots and gear is challenging, as the majority of the active duty soldiers do not experience lasting residuals in the right hip. In February 2021, the Board found the November 2020 VA examination to be inadequate because the examiner did not specifically address whether the Veteran's diagnosed right hip strain was due to physical activity and training while wearing boots and carrying a machine gun. As such, the Board remanded the claim for an addendum opinion. In May 2021, the Veteran was afforded a VA examination to determine the nature and etiology of his right leg/hip disability. The examiner noted an insidious onset of right lateral hip pain that seemed to come on at night while the Veteran was lying on his right side. The examiner diagnosed the Veteran with trochanteric pain syndrome (to include trochanteric bursitis), right hip. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated, based on history, the condition began around 2011, long after the Veteran's 1985 discharge from service. Additionally, there are no findings in the STR consistent with trochanteric pain syndrome. If this condition began during service or were secondary to service, it would have manifested itself much earlier. Also, its onset began while the Veteran was lying on his side. In July 2021, the Board found that the May 2021 VA medical opinion did not comply with the February 2021 Board remand. Specifically, the February Board requested an opinion on whether the Veteran's right leg/hip disability was due to his active service physical activity/training in boots and carrying an M-60 Machine gun. However, the May 2021 VA examiner did not address any of the Veteran's contentions and based the opinion on the lack of in-service treatment. The July Board remanded the claim for a new VA examination. In September 2021 and based on the July 2021 Board remand, the Veteran was afforded another VA examination to determine the nature and etiology of his right leg/hip disability. The Veteran stated that about five to six years prior to the exam, he began experiencing the gradual onset of right hip pain. The pain occurred when he tried to sleep on his right side. The examiner was asked to determine if the Veteran has an arthritis diagnosis, whether it is medically feasible that his current right leg/hip disability was caused by his in-service injury from physical activity/training in boots and carrying an M-60 Machine gun, or whether the Veteran's current right leg/hip disability could be related to or caused by the in-service complaints of knee and left thigh pain noted in October 1983 and September 1984. The examiner was also asked to explain the conclusion. The examiner confirmed the Veteran's trochanteric pain syndrome (to include trochanteric bursitis), right hip diagnosis. However, the examiner stated that the September 2021 x-ray revealed no arthritis. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Veteran reported playing a lot of basketball while in the Army. The examiner stated that the Veteran's STRs note that his right hand, left thigh, and knee injuries were attributed to basketball. The examiner stated that the Veteran's in-service injuries were minor and would not be expected to result in right hip pain 30 years after separation from service. Additionally, during the examination, the Veteran clearly stated that his right hip pain began approximately five to six years prior to his VA examination, i.e., roughly 30 years after his separation from military service. The pain occurred while he was lying on his right side. The Veteran denied any hip pain during his military service, and his STRs, although extensive, were negative for any treatment for right hip pain. Furthermore, Dr. G.V. diagnosed the Veteran with right trochanteric pain syndrome on May 12, 2021. The September 2021 VA examiner confirmed the diagnosis which showed localized tenderness over the posterior aspect of the right greater trochanter. Additionally, the examiner was asked to determine if it is possible that the Veteran's current right leg/hip disability could be related to or caused by the in-service injury from physical activity/training in boots and carrying an M-60 Machine gun. The examiner was to discuss the Veteran's lay statements regarding the history, chronicity, and continuity of the symptomology. The examiner opined that it is less likely than not that the Veteran's current right hip pain is due to an in-service injury from training in boots or carrying an M-60 Machine gun. The examiner reiterated that the Veteran clearly stated the right hip pain began approximately five to six years prior to the examination, i.e., roughly 30 years after his separation from military service. The pain occurred when he was lying on his right side. Additionally, the Veteran's STRs, although extensive, were negative for any treatment for right hip pain. Furthermore, Dr. G.V. diagnosed the Veteran with right trochanteric pain syndrome on May 12, 2021, and the diagnosis was confirmed by the September 2021 examiner. Regarding the Veteran's lay statements, the examiner stated regardless of what the Veteran may have said in the past, he clearly stated to the examiner that his right hip pain began approximately five to six years prior to the examination, and it occurred when he was lying on his right side. The Veteran also denied any hip pain during his military service. The examiner was asked to determine if the Veteran's assertions that his current right leg/hip disability was caused by his in-service injury from physical activity/training in boots and carrying an M-60 Machine gun consistent with medical knowledge or implausible. The examiner stated that it is medically implausible that the Veteran's claimed right hip pain is due to an in-service injury. The examiner stated that, as noted above, there is no documentation of a hip injury in the Veteran's STRs to establish a time of onset. Additionally, the Veteran's lay statement to the examiner was that his right hip pain started approximately five to six years prior to the examination, approximately 30 years after separation from service. Furthermore, the Veteran has a clear diagnosis of trochanteric pain syndrome which is a very common but typically a self-limited condition. Juan J. Canoso, MD., Greater Trochanteric Pain Syndrome, UpToDate, (August 2021), https://www.uptodate.com/contents/greater-trochanteric-pain-syndrome-formerly-trochanteric-bursitis. The examiner stated that it is medically implausible that this condition would have lasted 30 years. Lastly, the examiner was asked to determine if the Veteran's reports about his symptoms or his in-service injury from active service physical activity/training in boots and carrying an M-60 Machine gun is compatible with how the Veteran's right leg/hip disability is known to develop. The examiner stated that the Veteran's reports about his symptoms or his in-service injury from active service physical activity/training in boots and carrying an M-60 Machine gun is not compatible with how the Veteran's right leg/hip disability is known to develop. The examiner noted to see above rationale. He also stated that the etiology of Greater Trochanteric Pain Syndrome is not clear but one major risk factor is obesity, and this Veteran is obese. Additionally, according to Greater Trochanteric Pain Syndrome, remote trauma is not listed as a risk factor. Based on the evidence of record, the Board finds that service connection for right leg/hip disability is not warranted. The Veteran's STRs do not document complaints, treatments, or diagnosis for right leg/hip disability. Additionally, the September 2021 VA examiner opined that 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 examiner stated that it is medically implausible that the Veteran's claim of right hip pain is due to an in-service injury and the report of symptoms or his in-service injury is not compatible with how the Veteran's right leg/hip disability is known to develop. The examiner stated that during the examination, the Veteran clearly stated that his right hip pain began approximately five to six years prior to the exam, i.e., approximately 30 years after his separation from military service. The Veteran also stated that the pain began when he was laying on his right side. The Veteran denied any hip pain during his military service, and his STRs, although extensive, were negative for any treatment for right hip pain. The examiner stated that the Veteran's STRs note that his right hand, left thigh, and knee injuries, which were attributed to basketball, were minor and would not be expected to result in right hip pain 30 years after separation from service. The examiner stated that, according to the article in UpToDate, Greater Trochanteric Pain Syndrome, remote trauma is not listed as a risk factor. The examiner attributed the Veteran's right leg/hip disability to his obesity, i.e., one of the major risk factors of trochanteric pain syndrome. The Board also notes that the first medical evidence of possible right leg/hip disability was in 2011, i.e., 26 years after discharge from service. The fact that there were no records of any complaints or treatments involving the Veteran's right leg/hip disability for many years weighs against the claim. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (it was proper to consider the veteran's entire medical history, including a lengthy period of absence of complaints). The Board has considered the Veteran, his representative's, and other lay statements regarding the etiology of the Veteran's right leg/hip disability. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a nexus between the Veteran's right leg/hip disability and service, is outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Although the Veteran has asserted that he injured his right hip/leg in service and sought treatment for the injury, his STRs do not document treatment for such an injury. The Veteran's STRs are replete with other medical documentation, to include knee and left thigh injury, and it is reasonable to find that a right leg/hip injury would have been recorded. As such, the Board finds the contemporary medical evidence to be more reliable and probative than the Veteran's recollections of events from over 25 years after his discharge from service. Therefore, in the absence of a nexus, the claim for service connection for right leg/hip disability is denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Moore, Tara-Deen 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.