Citation Nr: 21022397 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 17-32 465 DATE: April 15, 2021 ORDER Entitlement to service connection for left hip disability is denied. FINDING OF FACT The Veteran’s current left hip disability, including strain and DJD, is not attributable to injury, disease, or other events in service. CONCLUSION OF LAW The criteria for service connection for left hip disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1961 to November 1964 and from January 1965 to January 1984. In January 2015 he sought service connection for left hip disability. In a July 2015 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for left hip disability. The Veteran appealed that denial to the Board of Veterans’ Appeals (Board). In July 2019 the Veteran had a Board videoconference hearing before the undersigned Veterans Law Judge. In November 2019 the Board remanded the left hip disability issue to the RO for additional action. 1. Service connection for left hip disability The Veteran contends that his current left hip disability began in service. He asserts that his service duties as a mechanic strained his left hip. He states that he had left hip pain in service, took pain pills but did not go to sick call for that pain. Service connection may be established on a direct basis for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for certain chronic diseases, including arthritis, may be established based upon a legal presumption by showing that the disease manifested itself to a degree of 10 percent disabling or more within one year from the date of discharge from service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. The Court of Appeals for Veterans Claims (Court) has indicated that the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran’s service treatment records do not contain any complaints of left hip pain or problems. On examinations in May 1973, November 1978, and July 1982, each examiner marked normal for the conditions of the Veteran’s lower extremities, spine, and other musculoskeletal areas. On examination in October 1983 for separation from service, the Veteran reported having back pain occasionally, about once a year. He also reported occasional morning pain in his left shoulder. The examiner marked normal for the conditions of the Veteran’s lower extremities, spine, and other musculoskeletal areas. The Veteran’s claims file does not contain any information from the year following his 1984 separation from service that addresses the condition of his left hip. The Veteran’s VA treatment records from 2001 to 2021 reflect ongoing treatment for prostate cancer found by 2002. In November 2005, the Veteran reported chronic pains in his left hip and back area. A treating clinician assessed that the back pain was most likely degenerative joint disease (DJD). In July 2007 he reported bilateral hip pain. A bone scan was negative for abnormalities. In August 2012 the Veteran reported doing daily hip exercises instructed by physical therapy. In February 2013 he reported pain in his left shoulder and low back. In December 2013 he related pain in his elbow, shoulder, and lower back. A bone scan showed greater uptake in right trochanter, noted as suspect for skeletal metastasis, as it was not seen in the July 2007 bone scan. The Veteran denied pain in his right hip. In March 2014, the Veteran denied bone pain other than arthritis. A hip MRI failed to reveal evidence of metastasis. In May 2014 MRI of the Veteran’s left hip showed subchondral cystic changes at the femoral head, described as likely due to osteoarthritis. There were diffuse degenerative changes of the labrum. In October 2014 the Veteran reported a long history of arthritic pain. In July, October, and November 2019, the Veteran reported hip pain. In the July 2019 Board hearing the Veteran reported that heavy physical labor and heavy lifting in service caused pain and problems in his left hip. He stated that in service he took pain pills but did not seek medical attention. He reported that presently he had left hip pain with sitting or standing for a long time. On VA examination in December 2020, the Veteran reported that during service he lifted heavy objects and began to experience left hip pain. He stated that presently he had left hip pain and had been found to have left hip arthritis. He reported that his left hip pain caused difficulty sitting or walking for prolonged periods. The examiner found that the Veteran had left hip strain found in 2007 and left hip arthritis found in 2014. On examination his left hip had limitation of motion and pain on motion. The examiner expressed the opinion that current strain and DJD of the Veteran’s left hip was less likely than not caused by injury, illness, or events in service. In explanation the examiner noted that the assembled records do not show complaints of left hip pain earlier than many years after the Veteran’s service. In February 2021 a VA physician reviewed the Veteran’s claims file. The reviewer was asked to consider physical demands during the Veteran’s service and the Veteran’s statements and provide further opinion regarding the likely etiology of the Veteran’s current left hip disability. The reviewer opined that the current left hip disability was less likely than not caused by injury, illness, or other events in service. The reviewer explained that examinations of the Veteran in service in 1982 and for separation in 1983 are expected to have been thorough. The reviewer opined it is unlikely that those examinations would have missed left hip problems if they existed then. The reviewer noted that the earliest post-service indication of left hip problems is from many years after service. He stated that strain in the 1980s and earlier would not have caused the strain and DJD found after 2000. The Veteran recalls experiencing left hip pain during service and self-treating that pain with nonprescription analgesics. In a medical history at separation from service, he reported back pain about once a year. He did not report left hip pain. Examiner at separation and at several earlier intervals did not find any problem with his left hip. In determining the condition of the Veteran’s left hip during service, the history he provided in 1983 and the other records made during service are were recorded closer to the events than the recollections he made years later. The Veteran, as a layperson, does not have the requisite competence to attribute his left hip problems to service. The contemporaneous evidence is persuasive as to the absence of chronic, ongoing left hip problems at the time of separation from service. The VA physician who reviewed the file in February 2021 considered the Veteran’s accounts of pain in service. That consideration added persuasive weight to that physician’s opinion against a connection between symptoms and any strain in service and strain and DJD after 2000. The greater persuasive weight of the evidence is against continuity or other nexus between physical demands and symptoms in service and the left hip strain and DJD found long after service. The Board denies service connection for the current left hip disability. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. J. Kunz, 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.