Citation Nr: 21022872 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 10-27 936 DATE: April 19, 2021 ORDER Entitlement to service connection for the residuals of a pelvic injury is denied. FINDING OF FACT The competent and credible evidence of the claims file reveals that the Veteran’s in-service pelvic injury was treated and resolved with no residuals reported at discharge. The Veteran’s pelvic pain reported in-service healed in a few months and would not be the source of the Veteran’s diagnosed hip pain or be directly related to service. No functional residuals of the in-service pelvic injury are currently demonstrated. CONCLUSION OF LAW The criteria for service connection for the residuals of a pelvic injury have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had a period of active duty service from September 1964 to August 1966. He was subsequently a Member of the Reserves and the file contains periodic examinations. The Veteran testified in a May 2016 hearing before the undersigned. A transcript is of record. The matter was denied by a Board decision. That was appealed to the Court of Appeals for Veterans Claims, which remanded to the Board for additional action. In January 2021, the Board remanded the issue for additional development. The Board finds that there was substantial compliance with the January 2021 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a Veteran must show: ‘(1) the existence of a present 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’”—the so-called “nexus requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). For Veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases may be presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Arthritis is on the list of diseases presumed to have been incurred in-service and receives a one-year presumption. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA 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). To deny a claim on its merits, a preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Entitlement to service connection for the residuals of a pelvic injury The Veteran asserts that the residuals of his pelvic injury are related to his time in-service. As the preponderance of the medical evidence of the record is against July 1966 service treatment records (STRs) reveal that the Veteran was diagnosed with a traumatic separation of his pelvis sustained in a vehicle accident. The in-service examiner noted that the Veteran’s pelvis was repaired in May 1965 and he was hospitalized until June 1965. At his separation examination, the examiner noted the separation of the Veteran’s hip at the pubic ligament. The examiner also noted a midline pubis to umbilicus surgical scar. There were no other complications noted relating to the Veteran in-service pelvic injury and his subsequent period of service was negative for complaints of the claimed disability. A VA examination in 1967 found the scrotum to be asymptomatic. In a July 1973 examination, the examiner diagnosed the Veteran’s prior hip injury in-service as a fractured pelvis and noted no sequelae. The examiner also noted that the Veteran was physically fit for service. In a November 1990 examination, the examiner diagnosed the Veteran as being in good health. Addressing to the Veteran’s hip, the examiner noted that the Veteran had a broken bone but noted that it healed with no sequelae. In an April 2010 VA C&P examination, the examiner diagnosed the Veteran with no objective findings to support a diagnosis of pelvic ligament separation. The examiner also noted no residual findings reported from his pelvic ligament separation from the Veteran’s 1965 in-service motor vehicle accident. In an April 2010 pelvis X-ray, the examiner diagnosed the Veteran with No acute fracture or opaque foreign body. The examiner noted a fracture of the left inferior pubic ramus and adjacent symphysis explaining that there may be cysts fusion of the symphysis pubis. He also noted that the remainder pelvic bony structures and hips are unremarkable. In an August 2013 VA C&P hip conditions addendum opinion, the examiner noted that the Veteran’s pelvic condition is most likely age-related and aggravated by the Veteran’s body mass index of thirty-five. He noted that examinations since the Veteran’s discharge are silent for any pelvis condition until approximately thirty-five years after separation. In a January 2013 CT scan of the Veteran’s pelvis, the examiner diagnosed no suspicious bone lesions. He noted post-traumatic changes of the pelvis can be seen with a fused symphysis pubis. In a December 2014 X-ray, the examiner diagnosed the pelvis as skeletally intact with mild marginal productive changes at the super-lateral acetabular rim with an ankylosed symphysis pubis. April 2015 VA outpatient treatment records reveal that the Veteran reported hip pain. The examiner noted the Veteran hip pain may be attributed to osteoarthritis. a May 2016 hearing before the Board, the Veteran asserts that on May 1965, he separated and injured his pelvis in a jeep accident in-service. The Veteran asserts that he was treated with a stabilizing cast around his pelvis and his injuries required approximately a seven month stay. In a March 2018 VA hip conditions examination, the examiner diagnosed the Veteran with hip pain with a history of pubis fracture with ligament separation. The examiner noted that the Veteran’s fracture of the left pubis appears to have been acute only and has resolved prior to discharge. During the examination, the Veteran reported pain that radiates from the lumbar area of his back, around his left hip, down the inguinal anterior side of the left leg, and down to the medial side of the left leg. The examiner noted that the Veteran had no pain during his range of motion testing nor was there pain noted objectively on palpation. The examiner explained that the Veteran’s pain appears to subjective only. The Veteran reported taking Tylenol for pain. He also reported in the negative for surgery or scars to the hip and thigh area, besides scarring due to surgery of his urethra. The examiner noted that the Veteran’s STRs do not report a pelvic fracture, therefore, the pelvic fracture likely occurred after separation from service. In an April 2018 VA addendum opinion, the examiner opined that the Veteran’s pelvis disorder was less likely than not related to his time in-service. The examiner noted that the Veteran’s in-service injury of the left pubis and his STRs do not show a pelvic fracture, only a separation of the ligament from the pelvis. He explained that there is a thirty-year gap between the Veteran’s reported hip pain over the last 20 years and his motor vehicle accident in-service. The examiner noted that Veteran’s symptoms seem more indicative of radiculopathy from the back and that his subjective pain is not likely related to the in-service motor vehicle accident during service. The examiner determined that a nexus between the Veteran’s current pelvic pain and his in-service motor vehicle accident has not been established. In a January 2021 VA addendum opinion, the examiner was asked to review the record and offer an opinion as to whether the Veteran’s traumatic pelvic injury fully resolved in-service, to include his 2002 post-service x-ray findings indicating the fusion of his pubic symphysis. The examiner determined that there is insufficient evidence to warrant or confirm a diagnosis of a bilateral hip disorder. Therefore, there is no identifiable hip disorder related to the residuals of the Veteran’s service connected pelvic injury. The examiner explained that the Veteran’s 1965 pelvic fracture involved the pelvic ligament site near the symphysis pubis but did not involve the hip joint as an August 2013 bilateral hip x-ray showed normal findings. The examiner also reviewed medical literature and determined that the Veteran’s hip pain is more likely the result of his back radiculopathy and not related to his resolved in-service pelvic injury. He explained that radiculopathy of the lumbar spine is known to radiate down to the hip and legs. Lastly, the examiner determined that despite the Veteran’s subjective complaints of hip pain for the past twenty years post service, an examination performed in April 2010 indicated negative x-ray findings for a hip pathology. The examiner determined the Veteran’s reporting of consistent hip pain is likely the result of radiation from his lumbar spine. The examiner opined that the Veteran’s claimed residuals of an in-service pelvic injury is less likely than not related to an in-service injury, event, or illness. The forgoing summary of the treatment records reveal no possibility for service connection for a pelvic disorder. Multiple Reserve examinations did not reveal any pertinent findings. Although the Veteran’s was diagnosed and treated for a pelvic injury in-service, the injury resolved with no residuals reported at discharge. The Board also reviewed the Veteran’s lay statements and hearing testimony that the residuals of his pelvic disorder are connected to events which occurred in-service. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a pelvic disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2018). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the foregoing summary of the treatment record reveals no possibility for service connection for a neck disorder on a direct basis. While the Veteran reports that the residuals from his pelvic injury are related to his time in-service, the most competent and credible evidence of record reveals that in the Veteran’s most recent VA examination, the Veteran’s pelvic pain reported in-service healed in a few months and is not shown to be the source of the Veteran’s diagnosed hip pain. Furthermore, the examiner noted that the Veteran’s symptoms seem more indicative of radiculopathy from the back and that his subjective pain is not likely related to the in-service motor vehicle accident. Lastly, the examiner determined that despite the Veteran’s subjective complaints of hip pain for the past twenty years post service, an examination performed in April 2010 indicated negative x-ray findings for a hip pathology. Based on the evidence of the record the Board has determined that the Veteran’s claimed residuals of an in-service pelvic injury is less likely than not related to an in-service injury, event or illness. As a pathology for the residuals of a pelvic injury has not been shown to be related to the Veteran’s time in-service, the Board concludes that the clinical evidence does not support the Veteran’s contentions for a granting of service connection on a direct basis.   The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 4.3. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Harris, Michael E. 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.