Citation Nr: 21008348 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 13-13 097 DATE: February 16, 2021 ORDER Entitlement to service connection for left hip disorder is denied. FINDING OF FACT The Veteran’s left hip disorder was not incurred in service and is not otherwise causally or etiologically related to service. CONCLUSION OF LAW The criteria for service connection for a left hip disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty training (ACDUTRA) from October 1976 to November 1976 and in January 2008. The Veteran also had periods of ACDUTRA and inactive duty training (INACDUTRA) with the United States Army Reserves through 2008. This matter is on appeal from an April 2009 rating decision issued by a Department of Veterans (VA) Regional Office (RO). This matter was previously before the Board of Veteran’s Appeals (Board) in April 2015, November 2017, and October 2019. The Board remanded the matter in each of those instances, to allow for additional development, to include obtaining outstanding records and to provide the Veteran with an adequate examination. Additional VA treatment records were added to the Veteran’s file in April 2017 and March 2020 and a VA examination was conducted in January 2020. The Board therefore concludes that there has been substantial compliance with its previous remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that the Veteran’s claimed disability was previously characterized as a left hip/thigh disability. In light of the diagnosis rendered in the January 2020 VA examination, the Board has recharacterized the disability on appeal as a left hip disorder. 1. Entitlement to service connection for left hip disorder is denied. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). Active service also includes authorized travel to or from such duty or service. 38 U.S.C. § 106(d); 38 C.F.R. § 3.6(e). In summary, when a claim for service connection is based only on a period of ACDUTRA or INACDUTRA, there must be evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during that period of ACDUTRA or INACDUTRA. See 38 U.S.C. §§ 101(2), (22), (24); 38 C.F.R. § 3.6(a); Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008) (citing Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995)). In the absence of such evidence, the period of ACDUTRA or INACDUTRA would not qualify as “active military, naval, or air service,” and the appellant would not qualify as a “veteran” for that period of ACDUTRA or INACDUTRA service alone. 38 U.S.C. § 101(2), (24); see Acciola, 22 Vet. App. at 324. Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, a presumption of service connection may be applied for certain chronic diseases, including arthritis, provided that the condition manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307, 3.309(a). However, these provisions are not for application in this matter as the record does not show the Veteran having a period of active service of 90 days or greater. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran generally asserts that she has a left hip or thigh disorder that is related to service. Specific argument in support of this appeal has not been submitted. The Veteran’s service treatment records contact a November 2008 Statement of Medical Examination and Duty Status indicates that the Veteran was on her way home from performing annual training in January 2008 when her vehicle was struck from behind by another vehicle and that she was treated in a civilian hospital for a back muscle strain that was most probably caused by the accident. Private treatment records dated in January 2008 indicate that the Veteran had been a restrained driver in an automobile that was involved in rear end collision, that she was being treated for headaches, neck pain, mid back pain, low back pain, right and left shoulder pain and right and left knee pain. She also reported that her back pain radiated into her thighs at times; however, specific findings or diagnoses related to the hip or thigh were not made. The remaining service records are negative as to any complaints, treatments, or diagnoses pertaining to the left hip or thigh, to include within the Veteran’s active duty dates of October 1976 to November 1976 and January 2008. A January 2020 VA examiner diagnosed the Veteran’s condition as degenerative arthritis of the left hip and opined that it was less likely than not that this condition was incurred during or caused by the Veteran’s service. The examiner reasoned that more than eight years had passed since the Veteran’s line of duty determination in 2008 and her July 2016 diagnosis of a left hip disorder and that the most common type of hip arthritis, namely osteoarthritis or degenerative joint disease, occurred when the joint surface cartilage wears way and leaves the bone exposed to wear and friction. The examiner noted that this condition caused pain and stiffness, which are commonly associated with arthritis, and that the risk factors for osteoarthritis included genetics, childhood hip diseases, obesity and severe trauma. The examiner further reasoned that severe forms of the various types of arthritis required similar forms of treatment, that the Veteran’s claims file did not show any history of trauma during service, that the Veteran’s body mass index was considered to be obese, and that the Veteran was diagnosed with her condition at the age of 68. Therefore, the examiner opined that both age and obesity were more likely the causes of the Veteran’s left hip/thigh disorder rather than military service being the cause. The examiner concluded that a nexus was not established between the Veteran’s condition and her military service. The Board finds the January 2020 VA opinion to be highly probative as the examiner reviewed the claims file, interviewed the Veteran, and provided an opinion supported by a clear rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There is no contrary opinion of record. The Board notes that the Veteran also underwent a VA examination in July 2016; however, the Board found this examination to be based on an inaccurate factual premise in November 2017. In addition, the Veteran underwent a VA examination in May 2019. The Board fount this examination to be inadequate based on the holding in Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Circ. 2018). Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to" and a mere conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran's service and her left hip or thigh disorder to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, the Board accords the statements regarding the etiology of the Veteran's left hip or thigh disorder little probative value as she is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issued. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinion of the Veteran is nonprobative evidence. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a left hip or thigh disorder. As such, that doctrine is not applicable in the instant claim, and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, 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.