Citation Nr: 21075441 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 15-29 710 DATE: December 20, 2021 ORDER Entitlement to service connection for a right hip bursitis is granted. REMANDED Entitlement to service connection for a bilateral knee condition is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, right hip bursitis is etiologically related to his service-connected lumbar spondylosis and degenerative joint disease. CONCLUSION OF LAW The criteria for entitlement to service connection for right hip bursitis secondary to service-connected lumbar spondylosis and degenerative joint disease are met. 38 U.S.C. §§ 1110, 1131, 5107; 38C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from December 1970 to June 1972, from January 1990 to August 1994, and from March 2005 to December 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in November 2018. A transcript is of record. In November 2020, the Board, in pertinent part, denied service connection for bilateral knee osteoarthritis. The Veteran subsequently appealed to the United States Court of Appeals for Veterans' Claims (Court). In August, the Court granted the parties' Joint Motion for Partial Remand (JMPR) and vacated the November 2020 decision to the extent that it denied service connection for the bilateral knee disability. Service Connection 1. Entitlement to service connection for right hip bursitis. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107;38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67(Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability that is proximately due to or the result of an established service-connected disorder. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability either (a) was caused by or (b) is aggravated by a service-connected disability. See 38 C.F.R. § 3.310 (a); Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran is currently service-connected for lumbar spondylosis and degenerative joint disease (DJD); trochanteric pain syndrome (claimed as left hip condition) associated with lumbar spondylosis and DJD; trochanteric pain syndrome, left hip limitation of flexion associated with lumbar spondylosis and DJD; and trochanteric pain syndrome, left hip impairment of thigh associated with lumbar spondylosis and DJD. The Board remanded the appeal for a right hip condition for further development in November 2020. A supplemental statement of the case (SSOC) was issued in May 2021 after completion of the Board's remand directives. In August 2021, additional relevant evidence- an August 2021 addendum opinion- was associated with the claims file. As the Board is awarding service connection based on this favorable evidence, an SSOC is not necessary. The Veteran has a current diagnosis of mild greater trochanteric bursitis of the right hip as evidenced by the January 2020 evaluation by Dr. W. In a January 2020 nexus opinion Dr. W. opined that it is more likely than not that the Veteran's right hip bursitis is linked to service. A clear rationale was not provided to support that opinion. However, because there was at least an indication that the Veteran's current right hip disability may be related to his active duty service, the Board remanded the appeal for a VA opinion. During a subsequent VA examination in February 2021, an examiner opined that the current right hip condition, diagnosed as trochanteric bursitis, was less likely than not incurred in service. The examiner explained that there are no records of right hip pain in service and the Veteran also has left hip partial thickness hamstring tear. The examiner noted that the Veteran did have a stress fracture of the right lower extremity in 1993 but explained that it is unlikely for this to have caused a unilateral chronic hip condition as it did not cause a permanent altered gait. The examiner further indicated that there are numerous reports of medical exam and history with no mention of hip pain, but had this been a chronic condition caused by the knee strain in 1989 or the stress fracture in 1993, it would be expected to have been apparent by 2005. In August 2021, a different VA examiner provided an addendum opinion. The examiner opined that the Veteran's right hip bursitis is at least as likely as not (5o percent of greater probability) directly related to service or was caused or aggravated by a service-connected to condition to include lumbar spondylosis and degenerative joint disease. The examiner explained that a VA medical opinion dated in June 2021 determined the Veterans left hip condition was secondary to the service-connected spine condition and that particular examiner's rationale noted, amongst other things, that 'chronic lumbar spine problems effect the Veteran's gait and thus put undue stress on the adjacent joint (the hip). If this occurs over a long period of time, it could result in a chronic hip problem (such as chronic bursitis or even degenerative changes).' The examiner further indicated that nonetheless, injury, overuse or conditions causing inflammation involving any of the bones, ligaments or tendons in the hip can cause continued hip condition and place a strain on the hip due to instability in gait. Long-term hip mobility issues can have potentially debilitating effects on the contra-lateral parts of the body, including the hip joints, causing decrease in mobility. With a decrease in hip mobility, the body tries to compensate for the loss of motion by shifting usages to other and/or opposing parts of the body. These compensations can act as contributing factors to more injuries in other parts of the body as the body's usage is unevenly distributed to other areas. Therefore, the Veteran's left hip condition that is secondary to the service-connected spine condition indicates that the right hip condition may also have been related to the service-connected spine condition (lumbar spondylosis and degenerative joint disease) and/or by the left hip condition. The Board finds the two competing medical opinions from the VA examiners to be persuasive and probative. Based on the foregoing competent medical evidence, and after resolving all reasonable doubt in the Veteran favor, service connection for right hip bursitis, as secondary to service-connected lumbar spondylosis and DJD, is warranted. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral knee condition is remanded. In the JMPR, the parties agreed that the 2019 VA medical opinion the Board relied on in denying the claim was inadequate. The examiner concluded the Veteran's in-service injuries were "too remote in time for the pain resulting therefrom to persist this many years." The JMPR reflects the parties' stipulation that the examiner's explanation that the Veteran's in-service bilateral knee strain and right fibula stress fracture diagnosis are old diagnoses that "should have completely healed by this time" appears speculative and ignores the theory of continuity of symptomatology. The JMPR reflects a need for a new medical opinion that considered continuity of symptomatology. A new medical opinion must be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the bilateral knee condition is at least as likely as not related to active duty, to include his bilateral knee strain injury in September 1989. Provide a rationale to support the opinion, to include consideration of the Veteran's reported continuity of bilateral knee symptomatology since active duty. The examiner should review the pertinent evidence of record, to include, but not limited to, the Veteran's September 2021 lay statement discussing post-service treatment for his bilateral knees. In providing the requested opinion and rationale, consider the Veteran's description of his in-service injury and symptoms as well as his post-service bilateral knee symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current bilateral knee disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.