Citation Nr: 21014970 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 15-17 793 DATE: March 16, 2021 ORDER Service connection for a left hip disability is granted. Eligibility for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only is granted. FINDINGS OF FACT 1. The Veteran’s left hip disability, to include left hip pain, is secondary to his service-connected low back disability. See July 2019 VA Hip Examination. 2. The Veteran’s service-connected left lower extremity neurologic condition results in permanent loss of use of his left foot. See, e.g., VA Examinations dated April 1999, July 1999, February 2001, August 2002, May 2012, October 2012, April 2014, July 2019, August 2019, November 2019. CONCLUSIONS OF LAW 1. The criteria for service connection for a left hip disability are met. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). 2. The criteria for eligibility for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only are met. 38 U.S.C. §§ 3901, 3902, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.808. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from February 1968 to February 1971 and in the Navy from June 1974 to April 1980. This case is before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. 1. Service Connection for a Left Hip Disability Generally, in order to prove service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). In addition, service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that 1) a current disability exists, and 2) the current disability was either a) caused by or b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In the absence of a currently diagnosed condition, pain alone may still constitute a disability as contemplated in 38 U.S.C. § 1110, so long as the pain results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The Veteran contends that his left hip disability is secondary to his service-connected left knee disability. See March 2013 Notice of Disagreement. Specifically, he asserts that “uneven usage” of the left side of the body due to his left knee condition led to “wear and tear” and “pain” in the hip. Id. Notably, the Veteran cited a May 2012 VA medical opinion in support of his contention. That opinion concluded that the Veteran’s “left sided neurologic condition” is related to his cervical spine and left knee disabilities. From the Veteran’s reliance on this opinion to support his left hip claim, the Board infers that the Veteran considers his left hip disability to be part and parcel of his general left side weakness and pain, well attested throughout the record. See, e.g., July 1999 VA Examination; October 2011 VA Treatment Record; May 2017 Board Hearing. VA examinations and the Veteran’s lay statements indicate that this disability results in significant functional impairment, including severely limited ability to walk and poor balance leading to frequent falls. See, e.g., VA Examinations dated April 1999, July 1999, February 2001, October 2012. Therefore, the Board finds that the Veteran’s left hip pain constitutes a disability for VA purposes. The Veteran has been afforded four VA examinations and medical nexus opinions in support of this claim throughout the claim period. An October 2012 VA examination noted a diagnosis of mild osteoarthritis. The examiner opined that this condition was not secondary to the Veteran’s service-connected cervical spine degenerative disc disease and intervertebral disc syndrome. The examiner stated that degeneration in the cervical spine “would not cause a hip derangement.” An October 2014 VA medical nexus opinion (without examination) concluded that the Veteran’s left hip condition was not secondary to his service-connected cervical spine or left knee disability. The opinion author stated that “there is no medical evidence that any given degenerative process of an area of the body has any pathophysiologic or mechanical influence beyond its immediate locality, barring a finding of severe limb length discrepancy.” The author did not note or make a hip diagnosis, but evidently considered the condition in question to be sciatica, and stated that this diagnosis was “in doubt” per a negative electromyographic study from June 2009. An April 2015 medical nexus opinion concluded merely by agreeing with the October 2014 opinion. The opinion author performed an exhaustive review of the record, but provided no independent medical rationale for her conclusion. Finally, a July 2019 VA examination again noted a diagnosis of osteoarthritis of the bilateral hips. The examiner noted that this diagnosis was asymptomatic (Veteran had full range of motion without pain), and opined that it was not related to the Veteran’s cervical spine and left knee disabilities. The examiner stated that because of the lack of symptoms and bilateral presentation of the Veteran’s degenerative changes, they were more likely age-related than secondary to his service-connected disabilities. However, the examiner also noted that when asked where his hip pain was located, the Veteran pointed to “a tender area in the left SI [sacroiliac] joint area” and had no pain in the “trochanter or other hip joint structures.” For this reason, the examiner opined that the Veteran’s hip pain—distinct from his asymptomatic osteoarthritis—was likely caused by his sacroiliac joint and lumbar spine. The Board has the responsibility to interpret VA examinations in light of the entirety of the record, and to reconcile various examinations into a consistent disability picture. 38 C.F.R. § 4.2. Moreover, in order to be adequate for VA purposes, medical examination opinions must support their conclusions with a fully articulated medical analysis or rationale the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). For this reason, the Board finds that the April 2015 VA medical nexus opinion is inadequate for VA purposes, insofar as it did not provide any rationale for its conclusion, and affords it no probative weight. Turning to the remaining examinations, the Board notes that despite the Veteran’s indication that the left hip condition he intended to claim was part and parcel of his general left side weakness and pain, The October 2012 and July 2019 VA examinations focused on his diagnosis of mild osteoarthritis. Both examinations noted that this condition was either mild or without symptoms, and both opined that it was not related to the Veteran’s service-connected cervical spine or left knee conditions. These opinions are competent and well supported, but of limited value insofar as they do not address the Veteran’s reported symptoms of left hip pain as a facet of general left side pain and weakness. On the other hand, although the October 2014 medical nexus opinion did not explicitly name a diagnosis, this opinion does appear to treat the Veteran’s claimed left hip condition as a neurologic rather than an orthopedic condition. The opinion author’s conclusion that any left hip neurologic condition is not related to the Veteran’s cervical spine or left knee disabilities is well supported an entitled to significant weight. Finally, however, the Board notes that the July 2019 VA examiner rendered a positive nexus opinion for the Veteran’s left hip pain as secondary (in part) to his low back. This opinion too is well supported by the examiner’s own examination findings and entitled to significant weight. Moreover, there is no evidence to the contrary. The Veteran is service connected for multi-level degenerative disc disease of the lumbar spine. Altogether, the Board finds that the medical evidence of record indicates that while the Veteran’s mild bilateral hip osteoarthritis is not related to his service-connected conditions, his symptoms of left hip pain are unrelated to this diagnosis and are instead secondary to his service-connected low back disability. To the extent that any reasonable doubt remains as to this conclusion, all such doubt is resolved in the Veteran’s favor. See 38 C.F.R. § 3.102. Therefore, because the Veteran’s left hip disability, to include symptoms of left hip pain, is secondary to his service-connected low back disability, service connection for a left hip disability is warranted. 2. Automobile Allowance Veterans or service members with certain service-connected disabilities may be found eligible to receive financial assistance in acquiring one automobile or other conveyance and adaptive equipment, or adaptive equipment only. 38 U.S.C. § 3901. Eligibility for assistance to purchase a vehicle and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) amyotrophic lateral sclerosis; or, (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38 U.S.C. § 3901; 38 C.F.R. § 3.808. VA regulations provide that permanent loss of use of a hand or foot exists when “no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the elbow or knee with the use of a suitable prosthetic appliance.” See 38 C.F.R. §§ 3.350 (a)(2). As noted in the findings of fact, above, the Board finds that the Veteran’s service-connected left lower extremity neurologic condition results in permanent loss of use of his left foot. Multiple VA examinations throughout the claim period dating back to 1999 indicate that the Veteran’s ability to walk is severely limited by his service-connected left lower extremity condition, even to the point of being able to take no more than a few steps unassisted. See VA Examinations dated April 1999, July 1999, August 2019, September 2019, November 2019. Some other VA examinations seem to reflect less severe impairment. For instance, an April 2014 VA housebound examination noted 5 or 5- out of 5 strength for the bilateral lower extremities, albeit with “some left foot drop.” A July 2019 VA peripheral nerves examination noted that although the Veteran did not use his left lower extremity during the examination, there were no objective signs of nerve paralysis in the extremity. However, these examinations are in the minority, and some of the most recent examinations reflect the most severe impairment: a November 2019 VA housebound examination noted that the Veteran was “barely able to walk a few steps across the room.” Significantly, the relevant standard is not total loss of use, but only such loss of use that amputation and use of a prosthesis would serve the Veteran equally well. See C.F.R. §§ 3.350 (a)(2). In light of the consistent evidence that the Veteran is almost completely restricted from walking and is effectively confined to a wheelchair, the Board finds that his service-connected left lower extremity neurologic condition results in disability approximating permanent loss of use of his left foot. Therefore, eligibility for payment or reimbursement for an automobile or other conveyance and adaptive equipment or adaptive equipment only is warranted. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Timmerman, 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.