Citation Nr: 21005606 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-61 865 DATE: February 2, 2021 ORDER Service connection for a left hip disability is granted. Service connection for a right hip disability is granted. REMANDED Service connection for a right knee disability is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in his favor, the Veteran has experienced continuous left hip symptomatology since service. 2. Resolving all reasonable doubt in his favor, the Veteran has experienced continuous right hip symptomatology since service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left hip disability have been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria for service connection for a right hip disability have been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1975 to February 1977. This case returns to the Board of Veterans’ Appeals (Board) after a remand to the agency of original jurisdiction (AOJ) in November 2019. On remand, the AOJ granted service connection for an acquired psychiatric disorder, a left ankle disability, a cervical spine disability, and a left upper extremity disability. See February 2020 rating decision. These issues are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). Service Connection for a Bilateral Hip Disability The Veteran contends that his service-connected left knee disability has permanently altered his gait, causing or aggravating a bilateral hip disability. He also asserts that he has had hip pain since service. After careful review, the Board finds that service connection is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Secondary service connection may be granted when a disability is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 447-48 (1995). Presumptive service connection may be established for certain chronic diseases, including arthritis, which manifest to a compensable degree within one year of separation from active service, provided the Veteran served continuously for 90 or more days. 38 C.F.R. §§ 3.307, 3.309. When such a disease is not shown to be chronic during service or within the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1338. In this case, service treatment records confirm that the Veteran was treated for a left knee patellar tendon injury after a run in June 1976. However, these records are silent for any complaints of hip problems during service. The available post-service medical records show complaints of hip pain going back to 2014. In January 2015, the Veteran was diagnosed with bilateral coxofemoral degenerative osteoarthritis and calcified tendinosis of the sartorius and iliopsoas muscles by x-ray. These medical records contain no information about the onset or cause of the Veteran’s hip problems. At his May 2019 hearing, the Veteran testified that the left knee injury has affected the way he walks and carries his body weight for the last 45 years. He also stated that he has been unable to play sports since service, due to leg or hip pain. In June 2019, he submitted a nexus statement from “Dr. J.L.T.,” a private physician. Dr. J.L.T. attributed the bilateral hip disability to service, explaining that the initial left knee injury caused “secondary damages [to the hips] through the years.” However, Dr. J.L.T. did not provide a clear medical rationale for this conclusion. As a result, the private opinion is not adequate to decide the claim. See Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012) (medical opinions are adequate when they sufficiently inform the Board of a medical expert’s judgment on a medical question and the essential rationale for that opinion). The Board remanded for a VA examination of the Veteran’s hips. During a February 2020 examination, he reported that his hip pain began in service in 1975. The examiner determined, after reviewing the claims file and medical literature, that there was no direct causal relationship between the hip disability and the service-connected left knee disability. The examiner also opined that the hip disability was less likely than not aggravated by the service-connected disability, reasoning that the 2015 x-ray findings showed “a natural progression of the hips.” The February 2020 examiner’s opinion, like the private opinion, is insufficient. Importantly, it does not reflect consideration of the Veteran’s main contention—that the left knee disability has altered his gait, aggravating his hip pain, for decades. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (VA medical opinions on secondary service connection must sufficiently address theories of aggravation, as well as proximate causation). Nor does it account for his statement that he has had hip pain since service. Even in the absence of a probative nexus opinion, the Board finds that the record reasonably establishes continuity of symptomatology since service. See Walker, 708 F.3d at 1339 (describing the more relaxed evidentiary standard for service connection for chronic diseases). As noted above, the Veteran has been diagnosed with bilateral arthritis of the hips, a chronic disease. He has reported an in-service onset of hip pain. He testified that his symptoms have prevented him from playing sports since service. He has also indicated that he sought treatment for the hip disability within a year of his discharge. See April 2017 notice of disagreement. The Board finds these lay statements about his subjective symptoms and personal history to be both competent and credible. Accordingly, resolving all reasonable doubt in the Veteran’s favor, the Board finds that he has experienced continuous bilateral hip symptomatology since service. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The appeal is granted. REASONS FOR REMAND Service Connection for a Right Knee Disability Similarly, the Veteran asserts that his right knee disability is secondary to the service-connected left knee disability. In 2019, the Board remanded for an examination and opinion on secondary service connection. The Veteran received an examination in November 2020. However, the examiner did not opine on whether the right knee disability is aggravated beyond its natural clinical course by the left knee disability, or complete the relevant portion of the disability benefits questionnaire on aggravation. El Amin, 26 Vet. App. at 140. Another remand is therefore necessary. The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file. The matter is REMANDED for the following action: 1. Obtain an addendum opinion on the etiology of the Veteran’s right knee disability. After reviewing the claims file, including this remand, the examiner must address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s right knee disability was incurred in or is otherwise related to service? (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s right knee disability is proximately due to or the result of his service-connected left knee disability? (c.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s right knee disability is aggravated beyond its natural clinical course by his service-connected left knee disability? In particular, the examiner’s opinion must reflect consideration of the Veteran’s May 2019 testimony and any other relevant lay statements. 2. Review the medical opinion above to ensure substantial compliance with the Board’s directives. Take any necessary corrective action. 3. Readjudicate the Veteran’s claim. If it remains denied, issue a supplemental statement of the case and allow the Veteran and his representative the opportunity to respond. Then return to the Board for further appellate review. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.Z. Wall, 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.