Citation Nr: 21014341 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 13-22 186A DATE: March 11, 2021 ORDER Service connection for a right hip disorder, to include degenerative joint disease (DJD), is denied. Service connection for headache disorder is denied. FINDINGS OF FACT 1. The Veteran’s right hip disorder to include DJD is not related to an in-service injury, event, or disease. 2. The Veteran’s headache disorder is not related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hip disorder, to include degenerative joint disease (DJD) are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for headache disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the U.S. Air Force from April 1954 to November 1957. In November 2014, the Veteran passed away and his surviving spouse has been substituted as the appellant. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The case was last remanded in July 2020 and has since been returned to the Board for appellate review. As the requested development has been completed, no further action is necessary to comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Right hip disorder and headache disorder Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The appellant contends, and the Veteran contended that the Veteran’s right hip disorder and headache disorder are due to his active duty service to include a September 1957 auto accident. Prior to his death, the Veteran had a current right hip disability and suffered from neck pain. Thus, the remaining question is whether the right hip disorder and the neck pain is related to service. Service treatment records show no complaints, diagnosis, or treatment related to a right hip disability. As the Veteran reported other ailments during service, and hip problems are the type that a reasonable person would report, if the Veteran was experiencing problems with his right hip during service the Board would expect that he would have reported these problems to medical professionals. Notably, the while Veteran contends that the Veteran’s right hip disorder is attributable to the Veteran’s auto accident in September 1957, the treatment note did not find any problems regarding the Veteran’s right hip. During the November 1957 separation examination, evaluation of the lower extremities was normal. In a corresponding report of medical history, the Veteran specifically denied having had bone, joint, or other deformity. If hip disability was present during service, the Board would expect the Veteran would have responded “yes” when asked if he had swollen or painful joints or bone, joint, or other deformity at separation because a reasonable person would have interpreted the question to include symptoms of hip disorder. Moreover, the Veteran responded affirmatively when asked whether he had other conditions at separation and the Board would thus expect the Veteran to have also responded affirmatively to having hip problems. Service treatment records shows that the Veteran complained of headaches in June 1954 and in October 1957 although notes do not indicate these as being related. Notably, the while Veteran contends that the Veteran’s headache disorder is attributable to the Veteran’s auto accident in September 1957, the treatment note did not find any problems regarding the Veteran’s headaches disorder. During the November 1957 separation examination, evaluation of the head, face, neck, and scalp was normal. In a corresponding report of medical history, the Veteran specifically denied having had frequent or severe headache. If headache disorder was present during service, the Board would expect the Veteran would have responded “yes” when asked if he had frequent or severe headache at separation because a reasonable person would have interpreted the question to include symptoms of headache disorder. Moreover, the Veteran responded affirmatively when asked whether he had other conditions at separation and the Board would thus expect the Veteran to have also responded affirmatively to having headaches. A right hip disability is not shown by medical evidence until approximately March 2008, many years after the Veteran’s separation from service. Regarding onset of symptoms related to a right hip disability, post-service the Veteran has reported that he fell in March 2008, although the Veteran also had bone graft removed from his right hip in 1972 as confirmed by the November 2020 correspondence from the Veteran’s doctor. Headache disorder is not shown by medical evidence until approximately 1972, many years after the Veteran’s separation from service. Regarding onset of symptoms related to a right hip disability, post-service the Veteran has reported that he has had headaches shortly after the September 1957 accident which progressively worsened until he began seeking treatment in October 1962. While this record is unavailable, he does have a letter from his doctor confirming the performance of Cloward surgery in 1972. In April 2013, the Veteran reported for a VA headaches examination, at which time the examiner performed an in-person examination, reviewed the pertinent medical records and provided an opinion. The examiner opined that the headache disorder is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner explained that there is 2 decades long period of time between his head trauma and incidental mention of headache while in the military and his current headache condition. Therefore, the examiner opined that it is pure speculation that his current headaches are from the neck trauma during service. On Board remand, VA opinions were requested and obtained in December 2016, October 2019, and November 2020 at which time the examiner reviewed the pertinent medical history and provided an opinion. However, the previous Board decision has deemed the October 2019 opinion inadequate, so it will not be discussed in this decision. The December 2016 examiner opined that it is less likely as not that the right hip disorder and the headache disorder was causally connected to the Veteran’s active service or the September 1957 auto accident. In support of this conclusion, the examiner explained that at the time of the auto accident, the Veteran had reported that the tipping of the car was on its left side in an open air vehicle, and the Veteran only complained of pain at the costo-vertebral angle on the right at initial evaluation. The Veteran did not complain of headache or right hip injury at the time. The examiner opined that the Veteran’s right hip condition was due to a fall in March 2008, and the two headache complaints during service occurred in the context of febrile illnesses. The examiner further explained that the Veteran’s headache disorder as described would be due to axial loading, which is force being hit on top of the head to the toes, and the mechanics of the auto accident had tipping to the left with lateral deceleration, which is incongruent with the medical condition for which the Veteran had the surgery. In the November 2020 VA opinion, the examiner opined that it is less likely than not that the Veteran’s headache disorder and right hip disorder are related to any events in the service to include 1957 or to any of his service connected conditions. The examiner also opined that it is less likely than not that the Veteran’s service connected conditions aggravated his right hip disorder. In support of these conclusions, the examiner explained that there was a significant gap in time between the accident in 1957 until any diagnosis of right hip or headache disorder. Notably, the examiner pointed to the lack of continuous documentation regarding the Veteran’s hips between 1957 and 50 years later and explained that the Veteran’s hip DJD appeared to likely be related to aging. Regarding whether the right hip disorder existed prior to his March 2008 slip, the examiner explained that the right hip disorder does not have evidence of existing for decades since the accident, and therefore would not have a baseline for service connection in the first place. The asserted aggravation does not have a basis on established fact. As for the headache disorder, the examiner explained that there are no continuous complaints of headaches for decades after the accident. There is insufficient medical evidence to create a nexus with the car accident. The examiner also explained that headaches have complex and unknown etiology, especially when they are not continuous from a traumatic brain injury. The potential concussion from the accident did not create a continuous headache conditions based on the available evidence. The Board finds these opinions highly probative as they were made by medical professionals with consideration of the specific facts in this case and after examination of the Veteran. The opinion is also supported by other evidence of record. For example, service treatment records do not show any right hip difficulties after service and until 2008, even after the bone grafting surgery. Although the Veteran reported to having 2 instances of headaches during service, the Veteran also denied having had or having headaches at separation. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. The Board has considered the Veteran’s statements, to include his assertions that these symptoms are related to service. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., hip pain or headaches; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. (Continued on the next page)   To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s report of medical history at separation from service where he denied both headaches and any hip conditions. The Board finds the report of medical history at separation from service to be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. J. Kim, 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.