Citation Nr: 21006424 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 17-28 178 DATE: February 4, 2021 ORDER Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for a left hip disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. FINDINGS OF FACT 1. The Veteran does not have a right hip disability that is related to his military service or service-connected back disability. 2. The Veteran does not have a left hip disability that is related to his military service or service-connected back disability. 3. The Veteran does not have a left knee disability that is related to his military service or service-connected back disability. 4. The Veteran does not have a right knee disability that is related to his military service or service-connected back disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1963 to October 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision of the Department of Veterans Affairs (VA). The Veteran provided testimony at a Board hearing in March 2018. The transcript of that Board hearing has been associated with the Veteran’s claims file. In May 2019, the case came before the Board. At that time, the Board found the Veteran’s January 2016 VA examination to be inadequate. Accordingly, the Board remanded the Veteran’s claims for entitlement to service connection for a bilateral knee disorder and bilateral hip disorder for an additional examination. In April 2020, the case came before the Board. At that time, the Board found the Veteran’s June 2019 VA examination to be inadequate. Accordingly, the Board remanded the Veteran’s claims for entitlement to service connection for a bilateral knee disorder and bilateral hip disorder for an additional examination. Service Connection The Veteran contends that his disabilities are related to his service-connected lumbar spine disorder. In order to establish service connection for the claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 C.F.R. §§ 3.309. In addition, for secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or the result of service-connected disease or injury, or that service-connected disease or injury has aggravated the nonservice-connected disability for which service connection is sought. See 38 C.F.R. § 3.310. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Although lay persons are competent to provide opinions on some medical issues, some medical issues fall outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the Veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau, supra. Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Lastly, in order to deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for a right hip disability 2. Entitlement to service connection for a left hip disability As to a current diagnosis, the Board notes that the Veteran’s disability has been diagnosed as bilateral osteoarthritis and trochanteris pain syndrome. As to the in-service incurrence, the Board notes that the Veteran’s service treatment records are silent for any treatment or a diagnosis for a hip injury. As to the Veteran’s lay statements, the Board acknowledges that the Veteran reported that he began experiencing hip pain approximately 15 years before he attended his Board hearing. The Board further acknowledges that the Veteran testified that he believes that his bilateral hip disorder is related to his service-connected back disability. Turning to the medical evidence at hand, the Board notes that the Veteran attended a VA examination for these issues in August 2020. Following the examination, the examiner found that the Veteran’s bilateral hip disorders were less likely as not incurred in service. The examiner also found that the Veteran’s bilateral hip disorders were less likely as not proximately due to or aggravated by the Veteran’s service-connected back disability. As to the theory of direct service connection, the examiner stated that he found no records in the claims file pertaining to hip problems or injuries during the Veteran’s active military service. The examiner stated that a medical examination at the time of separation from the Air Force indicated no hip or musculoskeletal problems other than back pain. The examiner then stated based on this information, I conclude that the Veteran’s left and right hip condition was less likely than not incurred in or caused by any claimed in-service injury, event, or illness. As to the theory of secondary service connection, the examiner stated that the Veteran had an orthopedic consultation with a physician assistant in 2016 who felt that his hip pain was referred from his back pain. The examiner stated that after the Veteran had lumbar fusion, hip pains did not change or improve. The examiner stated that the Veteran had a recent orthopedic consultation with Dr. A. M. in 2019 who felt hip pain was due primarily to bursitis rather than his lumbar spinal issues. The examiner stated that examination at this time also confirms that he has localized pain in the hips with his range of motion testing. The examiner stated that this is more consistent with osteoarthritis and bursitis of the hips as his source of pain rather than referred pain from the lumbar spine. The examiner stated that degenerative disc disease of the lumbar spine is a separate condition not related to bursitis of the hip or osteoarthritis of the hip. The examiner found no plausible evidence that the Veteran’s lumbar spine condition is responsible for his hip condition. Based on this information, the examiner concluded that the Veteran’s left and right hip conditions are less likely than not proximately due to or the result of the Veteran’s service-connected back disability or that his left or right hip conditions were aggravated beyond their natural progression by his lumbar spine condition. The Board has also reviewed the Veteran’s post-service medical history. The Board notes that the Veteran’s records are silent for a medical opinion that has attributed the Veteran’s bilateral hip disorder to the Veteran’s military service or his service-connected lumbar spine disability. In sum, the Board finds that entitlement to service connection for a bilateral hip disorder is not warranted. After a review of the record, the Board finds that the record is silent for an in-service event, injury, or disease that has caused the Veteran to develop a bilateral hip disorder. In addition, the Veteran’s lay statements and his post-service medical history contain no evidence that demonstrate a continuity of symptomatology since service or that his present disabilities are related to his military service. Moreover, the Veteran’s post-service medical records do not contain any evidence that the Veteran’s bilateral hip disorder is secondary to his lumbar spine disability. Furthermore, the Board finds that the August 20202 VA examination, which found that the Veteran’s disabilities are not a result of his military service or secondary to his lumbar spine disability, is the most probative evidence of record. The Board has considered the Veteran’s contentions; however, the Veteran’s contentions are outweighed by the findings of the VA examiner because the VA examiner has the medical training to provide an opinion regarding the etiology of the Veteran’s disabilities. For the above stated reasons, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply, and the claim for entitlement to service connection for a bilateral hip disorder, diagnosed as bilateral osteoarthritis and trochanteris pain syndrome, must be denied. 3. Entitlement to service connection for a left knee disability 4. Entitlement to service connection for a right knee disability As to a current diagnosis, the Board notes that the Veteran’s disability has been diagnosed as bilateral knee osteoarthritis. As to the in-service incurrence, the Board notes that the Veteran’s service treatment records are silent for any treatment or a diagnosis for a knee injury. As to the Veteran’s lay statements, the Board acknowledges that the Veteran reported that he began experiencing knee pain approximately 15 years before he attended his Board hearing. The Board further acknowledges that the Veteran testified that he believes that his bilateral knee disorder is related to his service-connected back disability. Turning to the medical evidence at hand, the Board notes that the Veteran attended a VA examination for these issues in August 2020. Following the examination, the examiner found that the Veteran’s bilateral knee disorders were less likely as not incurred in service. The examiner also found that the Veteran’s bilateral knee disorders were less likely as not proximately due to or aggravated by the Veteran’s service-connected back disability. As to the theory of direct service connection, the examiner stated that he found no records in the claims file pertaining to knee problems or injuries during the Veteran’s active military service. The examiner stated that a medical examination at the time of separation from the Air Force indicated no knee or musculoskeletal problems other than back pain. Based on this information, the examiner concluded that the Veteran’s left and right knee disabilities are less likely than not incurred in or caused by any claimed in-service injury, event, or illness. As to the theory of secondary service connection, the examiner stated that the Veteran had an orthopedic consultation with Dr. A. M. in 2018 who felt his pain was due to primary osteoarthritis of the knees and that "it is unlikely that the knee pain is coming from the back." The examiner stated that at a primary care visit in 2011, the Veteran reported a history of knee pains for 6-9 months. The examiner stated noted that the Veteran had an injury to his knee from a motor vehicle accident in 1970 and "tore the ligaments in both of his legs." The examiner stated that the MRI at that time showed a right knee lateral meniscus tear along with chondral defects of the superior patella and a subacute or chronic partial ACL tear. The examiner stated that these conditions are unrelated to back strain or other lumbar conditions. The examiner stated that the examination at this time also is consistent with osteoarthritis of the knee which is a separate and unrelated diagnosis to degenerative disc disease of the lumbar spine. The examiner stated that there is no plausible reason to believe that knee osteoarthritis was aggravated by lumbar disc disease. Based on this information, the examiner concluded that the Veteran’s left and right knee conditions are less likely than not proximately due to or the result of the Veteran’s service-connected back disability or that his left or right knee conditions were aggravated beyond its natural progression by his lumbar spine condition. The Board has also reviewed the Veteran’s post-service medical history. The Board notes that the Veteran’s private doctor addressed the etiology of the Veteran’s bilateral knee disorders. An April 2018 treatment note shows that the Veteran’s doctor stated, “I think it is unlikely that the knee pain is coming from the back.” In sum, the Board finds that entitlement to service connection for a bilateral knee disorder is not warranted. After a review of the record, the Board finds that the record is silent for an in-service event, injury, or disease that has caused the Veteran to develop a bilateral knee disorder. In addition, the Veteran’s lay statements and his post-service medical history contain no evidence that demonstrate a continuity of symptomatology since service or that his present disabilities are related to his military service. Moreover, the Veteran’s post-service medical records do not contain any evidence that the Veteran’s bilateral knee disorder is secondary to his lumbar spine disability. Furthermore, the Board finds that the August 20202 VA examination, which found that the Veteran’s disabilities are not a result of his military service or secondary to his lumbar spine disability, is the most probative evidence of record. The Board has considered the Veteran’s contentions; however, the Veteran’s contentions are outweighed by the findings of the VA examiner because the VA examiner has the medical training to provide an opinion regarding the etiology of the Veteran’s disabilities. For the above stated reasons, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply, and the claim for entitlement to service connection for a bilateral knee disorder, diagnosed as bilateral osteoarthritis, must also be denied. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Rescan, 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.