Citation Nr: 21008236 Decision Date: 02/12/21 Archive Date: 02/12/21 DOCKET NO. 14-21 380 DATE: February 12, 2021 ORDER Entitlement to service connection for a left hip disability, to include as secondary to a right hip disability, is denied. FINDING OF FACT The Veteran’s left hip disability was not caused and is not aggravated by her service-connected right hip disability and not otherwise related or attributable to her service. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for a left hip disability – either as directly or presumptively due to service or as secondary to the service-connected right hip disability 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2002 to March 2006. This appeal to the Board of Veterans’ Appeals (Board) is from an April 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified in support of this claim during a hearing before the undersigned Veterans Law Judge (VLJ) of the Board in September 2014. A transcript of the hearing is of record. In October 2018, May 2020, and November 2020, the Board remanded this claim back to the RO (Agency of Original Jurisdiction (AOJ)) for further development and consideration – including to obtain all outstanding treatment records and for medical opinions concerning the etiology of the Veteran’s left hip disability, including especially in terms of whether attributable to her service or her service-connected right hip disability. Those remand instructions (as well as others not pertinent to this appeal) since have been completed as directed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only “substantial” rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to service connection for a left hip disability, including as secondary to the service-connected right hip disability The Veteran asserts that her left hip disability was either caused or is aggravated by her service-connected right hip disability, so her claim is predicated on the notion of secondary service connection. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct or presumptive service connection, the Board’s adjudication of this claim will consider only entitlement to secondary service connection. Service connection on a secondary basis may be granted for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) and (b). However, the Board concludes that, while the Veteran has a current disability of left hip strain, the preponderance of the evidence is against finding that her service-connected right hip disability caused or aggravates her left hip strain. See Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). In January 2014, the Veteran underwent a VA examination for her left hip. The examiner noted that the Veteran had a diagnosis of a left hip sprain that had onset in 2015, so 9 years after her separation from service. Unfortunately, this examiner incorrectly provided an opinion on direct service connection for the Veteran’s left hip disability, and for secondary service connection for her already service-connected right hip disability. During the later September 2014 hearing before this Board, the Veteran’s attorney clarified that the correct claim was for secondary service connection for the Veteran’s left hip disability. Thus, the January 2014 VA opinion is inadequate since it did not address this claimed basis of entitlement, i.e., whether the service-connected right hip disability caused or is aggravating the left hip disability. During her September 2014 hearing, the Veteran testified that she believes the pain in her left hip is related to the pain in her right hip because, as soon as the pain starts on her right side, she overcompensates on her left hip, worsening her pain. In June 2016, the Veteran submitted private treatment records from July 2015 showing that she had presented complaining of pain shooting down her left leg, starting in her groin and radiating down her inner thigh. These records do not mention her hip, specifically, but do state that the etiology of her pain was likely musculoskeletal. Because of the inadequacy of the January 2014 VA medical opinion, the Board remanded this claim in October 2018. In December 2019, the Veteran underwent an additional VA examination. This additional examiner confirmed the diagnosis of left hip strain and noted the Veteran’s reported onset in 2004, so during her time in service. But this examiner stated that it was less likely than not the Veteran’s left hip disability was directly related to her service, specifically, to the right hip incident during her service, because imaging from 2014 (so since her service) showed no evidence of fracture or other significant bone, joint, or soft tissue abnormality. Thus, any condition during her service was acute and resolved. Concerning secondary service connection, the examiner opined that it also was less likely than not the Veteran’s left hip disability was either proximately due to or aggravated by her service-connected right hip disability. The rationale was that “the new diagnosis of a left hip strain is a new development since the last C & P exam [in January 2014].” He further opined that it was more likely that the Veteran’s left hip disability was “most likely due to genetic predisposition and cumulative labor occupation present.” Concerning aggravation, the examiner explained that the Veteran’s right hip, because of the severity of that disability, does not warrant overcompensation or overuse of the left hip leading to or aggravating the strain. Since, however, that December 2019 VA examiner had opined that the Veteran’s left hip disability may be due to genetic predisposition, the Board again remanded this claim in May 2020 for still more development – including as specifically concerning that statement of the VA examiner. To this end, in July 2020, a VA examiner provided an addendum opinion. Concerning any direct service connection claim, the examiner opined that it was less likely than not the Veteran’s left hip disability was directly related to her service. The rationale was that her left hip condition “is neither congenital or disease. The opinion citing genetic predisposition is a broad generalization. It is essentially saying Veteran’s particular physical makeup may have made the Veteran more susceptible to this type of injury. There is no congenital condition or disease identified, and strain is not in that category.” Further, the examiner explained that the above is a medical fact, not opinion and as such, “all questions regarding congenital conditions and/or aggravation of congenital conditions are moot.”   In further addressing service connection, the examiner explained that there is no evidence of any left hip disability during the Veteran’s service, no care proximate to her service, and the first notations of a left hip disability were in late 2013 or early 2014. Finally, the examiner clarified that there is no preexisting congenital condition or disease or a left hip condition arising during service. Concerning secondary service connection, the July 2020 VA examiner provided an addendum opinion in August 2020. He opined that it is less likely than not the Veteran’s left hip disability was caused or is aggravated by her right hip disability because there is no anatomic or physiologic mechanism by which right hip bursitis can cause a condition of the contralateral hip. The examiner explained that, in general, conditions of one joint do not cause a condition of the contralateral joint, and simple gait accommodation does not cause a condition of a contralateral joint, which his accepted medical knowledge and practice and is supported by medical literature. Even further, the examiner stated that “[w]ith respect to aggravation specifically, the same rationale applies. Exceptions may include leg-length discrepancies and/or chronic severe Trendelenburg gait. The Veteran has no evidence of such. Additionally, there is no evidence of aggravation of the Veteran’s left hip strain beyond its natural course, due to any cause. Therefore, it is less likely than not that the Veteran’s left hip strain is caused by or due to the Veteran’s right hip bursitis. Furthermore, it is less likely than not that the Veteran’s left hip strain has been aggravated beyond its natural course, due to any cause, and specifically, right hip bursitis.” Ultimately, the Board finds the July 2020 and August 2020 VA examiner’s opinions to be the most probative evidence of record, as they are based on a full and thorough review of the Veteran’s relevant medical history and provide clear opinions with adequate supporting rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Since a lay person, the Veteran is not competent to attribute her left hip disability to her service-connected right hip disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).   Consequently, the Board gives more probative weight to the several VA medical opinions addressing this determinative issue – all ultimately concluding that her left hip disability is not directly due to her service and not secondary to (meaning caused or aggravated by) her service-connected right hip disability. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). For these reasons and bases, the Board finds that service connection for the left hip disability is not warranted, either on the premise it is a direct or presumptive result of the Veteran’s service or, as is being specifically alleged, secondary to her service-connected right hip disability. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Pak 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.