Citation Nr: 21021653 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-12 656 DATE: April 13, 2021 ORDER Service connection for a left hip condition is denied. Service connection for a right hip condition is denied. FINDINGS OF FACT The probative evidence of record (including a November 2020 VA examiner’s opinion) indicates that the functional impairment caused by the Veteran’s bilateral hip problems is less likely than not causally related to his service (including as the result of an altered gait) but rather is caused by his morbid obesity. CONCLUSIONS OF LAW 1. The criteria for service connection for a left hip condition have not been met. 38 C.F.R. §§ 3.102, 3.303, 3.385. 2. The criteria for service connection for a right hip condition have not been met. 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from April 1972 to April 1992. These matters are before the Board of Veterans’ Appeals on appeal from a July 2013 decision of the Department of Veterans Affairs (VA) Regional Office in Phoenix, Arizona. In November 2017, a Board hearing was held before the undersigned and a transcript is associated with the record. These matters were before the Board in December 2018 and were remanded for further development. Service Connection Service connection for a bilateral hip condition is denied. Legal Criteria Generally, to prove service connection, a veteran 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303 (a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303 (d). The requirement that a current disability exist is satisfied if the claimant had a disability at the time his claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Factual Background At a May 2006 orthopedic treatment, the conducting physician indicated that the Veteran had no hip pain with range of motion either internal or external. At a September 2010 medical examination, the Veteran reported that his knees were the only thing bothering him but his back and hips were “good.” At an August 2010 medical appointment, the physician noted that the Veteran had normal gait. At an August 2011 VA examination, the conducting physician indicated that the Veteran’s bilateral hip flexion was 5/5 and noted no significant gait abnormality. At the November 2017 Board hearing, the Veteran testified that both of his hips began to bother him and he believed this was the result of his in-service right knee injury causing him to alter his gait. The Veteran explained that he observed that his knee injury caused him to rock back and forth when he walked which he believed resulted in hip problems. A May 2018 private medical treatment note from the Veteran’s physician indicated that the Veteran had pain all the time in his hips. A separate May 2018 private opinion indicated that, while X-rays in 2016 did not demonstrate subsidence of the components, the Veteran’s total hip arthroplasties had been complicated by functional impairment that was repeatedly observed as a gait pattern change. [There is nothing else in the record suggesting that the Veteran has had arthroplasties of the hips.] In January 2019, the Veteran’s private medical physician explained that the Veteran is receiving active treatment for bilateral hip pain. The physician opined that the Veteran’s bilateral hip condition is causally related to his service. As a rationale, the physician explained that the Veteran’s duties in the military included lifting a radar case weighing more than 500 pounds from the ground to the back of a truck, carrying a backpack weighing more than 100 pounds over half a mile frequently, lifting radar equipment weighing more than 100 pounds onto a tripod and carrying ammunition weighing between 50-75 pounds frequently. The physician opined that due to the frequency and amount of weight carried and lifted, it is at least as likely as not that the Veteran’s bilateral hip condition had an onset in or is otherwise related to his service. The Veteran was afforded a November 2020 VA examination during which the conducting physician opined that it was less likely than not that the Veteran’s bilateral hip condition was causally related to service. As a rationale, the physician indicated that the Veteran had no abnormalities of the hips. The physician explained that X-rays taken of the Veteran’s hips indicated that he had normal and symmetric hip joints with no evidence of joint effusion or arthritic change. The physician explained that the Veteran’s iliac bone, femoral heads and necks, sacroiliac joints, and sacrum all appeared normal. The physician also explained that the coned-down, externally rotated view of the hip showed normal femoral head and neck and proximal femoral diaphysis. The physician did not find any soft tissue abnormalities. The Veteran reported at the examination that he began to have problems with his right hip after injuring his lower back in 1998 which resulted in lower back pain radiating into the right hip and buttock. The Veteran reported that his left hip pain developed gradually which he noticed after his bilateral knee replacement in August 2010. The physician explained there was no evidence of pain on non-weight bearing testing or passive range of motion testing of either hip. The physician also noted that the Veteran had no gait abnormality or disturbances. The physician indicated that the Veteran’s service treatment records are absent for reports or a diagnosis of hip issues, hip trauma or a hip injury. The physician noted that the Veteran has been seeing a chiropractor once or twice monthly on a regular basis since 2000. The physician also noted that the Veteran attends Sierra Vista Chiropractic for pain to the lower back and sacroiliac areas monthly, receives chiropractic adjustments of the lower back, bilateral sacroiliac areas and 15-minute intervals of lumbar spine tractions. The physician reviewed the Veteran’s private treatment records and explained that the orthopedic progress notes state that the Veteran does not have a history of hip pain, difficulty with walking, or gait dysfunction. (See medical treatment records dated April 2019, June 2019, August 2019, and November 2019.) Regarding the Veteran’s reported bilateral hip pain, the physician explained that the medical evidence of record indicates that the Veteran is morbidly obese and that excess weight puts a strain on the joints, especially lower extremity joints such as hips, knees, and ankles. The physician cited several medical articles which suggested a link between obesity and osteoarthritis. Analysis While the November 2020 VA examiner did not diagnose the Veteran with a bilateral hip condition, the record indicates that the Veteran has reported and sought treatment for hip pain. The Veteran is competent to report symptoms of bilateral hip pain. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Symptoms of pain may constitute a disability for VA purposes if the evidence shows functional impairment due to pain. See Saunders v. Wilkie, 886 F.3d 1356, 1367-8 (Fed. Cir. 2018). The Veteran reported functional impairment during the November 2020 VA examination and indicated that he experiences bilateral hip pain after prolonged standing. Accordingly, the remaining question is whether the Veteran’s bilateral hip pain is causally related to his service or to any other service-connected disabilities. The Board assigns significant probative value to the November 2020 VA examiner’s opinion that it is less likely than not that the Veteran’s bilateral hip condition is causally related to service because the examiner supported their findings with a rationale including review of X-ray imaging of the hips which revealed normal and symmetric hip joints with no evidence of joint effusion or arthritic change and the Veteran’s private treatment records which did not suggest a history of hip pain or altered gait. Additionally, the examiner supported their opinion that the Veteran’s hip pain was caused by his morbid obesity with several medical articles. While the January 2019 private physician indicated that the Veteran’s bilateral hip condition was causally related to his service activities, the Board notes that the Veteran’s service treatment records, while containing reports of knee injuries, do not contain any reports of hip injuries or pain. Accordingly, the Board assigns more probative value to the November 2020 VA examiner’s opinion than that of the January 2019 private physician. Regarding the Veteran’s testimony that his altered gait from his service-connected right knee condition resulted in bilateral hip pain, the Board notes that the Veteran did not report any hip pain at the May 2006 and September 2010 medical treatments. Additionally, the August 2010, August 2011 and November 2020 VA physicians reported that the Veteran did not have an abnormal gait. The medical notes corresponding to the private medical treatments on April 2019, June 2019, August 2019, and November 2019 indicated that the Veteran did not have hip pain or abnormal gait. Even if the Veteran does experience an abnormal gait, he is not medically qualified (competent) to provide a medical opinion that his abnormal gait is the cause of his hip problems; this is a complex medical question because there are numerous potential causes for hip pain and these medical processes are not all observable to lay persons. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007) (explaining that lay persons are qualified to report observable symptoms and medical events but not to provide medical opinions about complex medical questions). Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran’s bilateral hip pain is the result of an abnormal gait due to his service-connected knee issues. Therefore, the Veteran’s claim must be denied. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alexander Bahus 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.