Citation Nr: 21075018 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 15-31 961 DATE: December 17, 2021 ORDER Entitlement to service connection for a right hip disability, to include right hip pain and right hip osteoarthritis, is granted. Entitlement to service connection for a left hip disability, to include left hip pain and left hip osteoarthritis, is granted. Service connection for a hemorrhoid disability is granted. FINDINGS OF FACT 1. By resolving all reasonable doubt in the Veteran's favor, his right hip disability is related to in-service duties from his active military service. 2. By resolving all reasonable doubt in the Veteran's favor, his left hip disability is related to in-service duties from active military service. 3. By resolving all reasonable doubt in the Veteran's favor, his hemorrhoid disability is directly incurred in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hip disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left hip disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a hemorrhoid disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 2005 to July 2006, and from April 2008 to June 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office in Wichita, Kansas. In August 2021, the Veteran testified at a Travel Board hearing in Cheyenne, Wyoming before the undersigned Veterans Law Judge. A transcript of this hearing is of record. Service Connection for Right & Left Hip Disabilities (Bilateral Hip Disability) Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Alternatively, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Thus, secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran asserts that his bilateral hip disability is related to his active military service. At his Board hearing, the Veteran testified that his trouble with hip pain likely began in service, around 2009, after he completed a ten mile marathon in Kuwait. He also testified that he underwent a left hip arthroplasty approximately four years after his separation from service, in July 2014. See August 2020 Board Hearing Transcript. Additionally, the Veteran asserts that his bilateral hip disability is secondary to a lower back injury that he sustained during his active military service. See e.g. August 2014 Statement in Support of Claim. Pertinent to his assertions, the Veteran is service-connected for degenerative disc and joint disease of the lumbar spine. See February 2014 VA Examination Report. Further, the medical evidence reflects a current hip disability. See e.g. November 2011 Physical Therapy Consult Note (reflecting the earliest documented evidence of hip pain); see also February 2014 VA Examination Report (reflecting that the Veteran was diagnosed with bilateral hip osteoarthritis in January 2014). In February 2014, he was afforded a VA examination for hip conditions. At this examination, the VA examiner noted that hip pain began in 2013, in which the left hip began first. In describing the functional impairment of his bilateral hip disability, he explained, among other details, that he has groin pain in the left hip, which causes him to guard against the pain by avoiding activities that cause it flare up, such as, for example, slowly climbing stairs one at a time. After this examination, however, a VA examiner opined that the Veteran's bilateral hip condition is less likely than not proximately due to, or the result of his service-connected condition. As the rationale for this opinion, the VA examiner reasoned that it is well known in the medical community that for one joint to affect another joint, there must be some significant change in gait, like a significant limp, "Trendelenburg" walk, and that the Veteran does not have an abnormal gait. Further, the VA examiner also reasoned that having degenerative disc/joint disease of one joint does not mean you will have degenerative disc/joint disease of other joints, and that degenerative joint/disc disease is a condition associated with wear and tear on the skeletal structures and aging. Nonetheless, in support of his claim, the Veteran has submitted a medical opinion from his physical therapist, B.D. In this August 2021 opinion, B.D. opined that there is at least as likely as not a correlation that exists between the Veteran's back injury and his bilateral hip disability. By citing medical literature, B.D. further explained, in pertinent part, that active duty military service members were significantly more likely to experience, among other musculoskeletal conditions, hip osteoarthritis, as well as any osteoarthritis diagnosis, regardless of site, when compared with non-exposed controls; and that military rank and branch of military service appeared to be occupational risk factors associated with osteoarthritis medicine. In reviewing all probative evidence, the Board finds that this August 2021 private opinion is more probative than the February 2014 VA opinion. Specifically, this August 2021 opinion contemplates the Veteran's competent, credible statements about the onset and manifestations of his hip disability; and pertinently, it cites to medical literature to support a finding that the Veteran's bilateral hip disability is related to a series of in-service events as an occupational risk factor, thereby establishing a correlation between the Veteran's bilateral hip disability and his service. Although service treatment records do not expressly reflect any evidence of in-service complaints, treatment, or diagnoses related to a hip condition, the medical evidence reflects evidence of bilateral hip pain as far back as approximately fifteen months after the Veteran separation from service, in November 2011; and that the Veteran underwent a total left hip arthroplasty in July 2014, and more specifically, four years after his separation from service. See November 2011 Physical Therapy Note; see also August 2014 Letter of Medical Necessity, Private Treatment Records. Given that the earliest medical evidence of a post-service hip condition is not too remote in time from the Veteran's separation from service, the Board has also considered the Veteran's lay statements about the onset and continuity of symptoms related to the bilateral hip. In doing so, the Board finds that these lay statements are competent and credible as they are consistent and corroborated by medical evidence. Therefore, the Board also finds that the overall probative evidence is in at least relative equipoise with respect to a positive nexus between the Veteran's active service and his current bilateral hip disability. Thus, by resolving all reasonable doubt in the Veteran's favor, the Board further finds that the Veteran's bilateral hip disability is the result of his active service; and service connection for the right hip and left hip disabilities are granted. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. (Continued on the next page) Hemorrhoid Disability: The Veteran provided credible evidence describing the onset of hemorrhoid while in service that corresponded to flare-ups of irritable bowel syndrome. As noted, service connection is in effect for irritable bowel syndrome and a 30 percent disability rating is assigned. That rating criteria contemplates alternating diarrhea and constipation. Hence, given the credible testimony regarding the onset of the hemorrhoid condition as well as its relationship to his already service-connected irritable bowel syndrome, the Board finds that the hemorrhoid disability is directly due to service. The appeal is granted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V-N. Pratt 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.