Citation Nr: 21023363 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-26 937 DATE: April 20, 2021 ORDER Entitlement to service connection for a left hip disability, to include as secondary to service-connected left knee osteoarthritis (left knee disability) is denied. FINDING OF FACT The Veteran’s left hip disability did not manifest in-service, and is not shown to be causally or etiologically related to an in-service event, injury or disease; or as secondary to a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from October 1981 to November 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). By way of background, in July 2019, December 2019, and April 2020, the Board remanded the issue on appeal for further evidentiary development. That development having been completed, the issue on appeal is returned to the Board. The issues of entitlement to service connection for an acquired psychiatric disability, entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, and entitlement to an increased rating for a right knee disability will be addressed in a different decision. Service Connection Generally, to establish service connection 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.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). 1. Entitlement to service connection for a left hip disability, to include as secondary to service-connected left knee disability. Regarding the first element of service connection (a current disability), in the July 2020 VA examination, the Veteran was diagnosed with Trochanteris pain syndrome of the left hip. See July 2020 C&P Exam. As such, the first element of service connection has been met. Notably, the Veteran is service connected for a left knee disability. A review of the service treatment records (STRs) show that the Veteran had normal lower extremities with no complaints of painful or swollen joints, arthritis, or bursitis in the February/March 1981 enlistment examination. In an October 1985 STR, it was noted that the Veteran’s records were reviewed for separation. It was determined that a physical examination was not required. See March 2015 STR – Medical. The Board finds that the lack of an in-service left hip injury is consistent with the Veteran’s statement that his left hip pain manifested in 2012, more than 25 years after service. See July 2020 C&P Exam. As the Veteran did not claim that he had a left hip injury during service or that he had left hip pain during service. The second element of service connection has not been met. Additionally, the evidence shows that the Veteran did not report left pain or was diagnosed as having a left hip disability until several years after his separation from service. For example, the Veteran initially complained of left hip pain in September 2015, a few months after filing his claim for benefits. See October 2017 Medical Treatment Record – Non-Government Facility. Moreover, the Veteran reported that his left hip pain started around 2012 to 2015 and not during service. See March 2020 C&P Exam and July 2020 C&P Exam. As such, the evidence shows that the Veteran’s left hip disability manifested about 25 to 30 years after service. A review of the post-service medical records shows that the Veteran was afforded VA examinations in March 2020 and July 2020. In the March 2020 examination, the examiner determined that the Veteran does not have a current diagnosis associated with his left hip. The examiner explained that there is no x-ray scan of the left hip. Further, the medical records are void of any diagnosis of a hip condition. The Veteran claimed that his left hip pain started to bother him in 2015. On examination, the Veteran exhibited abnormal range of motion of the left hip. The examiner opined that the Veteran’s claimed condition, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury or illness. The examiner explained that there is no evidence of a left hip condition in the private treatment records. Further, there is no diagnosis of a left hip condition now or in the medical evidence reviewed. There is no medical evidence to support the claim that his claimed left hip condition exists or that it is related to his right or left knee condition. The Veteran’s left hip arthralgia (joint pain) is likely due to age related joint pain and or occupational duties performed as a line man which is rigorous. Notablty, although the examiner opined that the Veteran’s condition clearly and unmistakably existed prior to service, the examiner noted that the records do not reflect a prior existing hip condition. In the July 2020 VA examination, the Veteran reported that his pain started in 2012 and progressively worsened since his second right knee replacement. The Veteran denied having any falls or trauma in service. The examiner diagnosed the Veteran with trochanteric pain syndrome of the left hip and opined that the Veteran’s condition is less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner explained that the STRs do not show any complaints of hip problems. More importantly, the Veteran reported that he did not have any problems with his left hip until he had a second right knee replacement. As such, the examiner concluded that the Veteran’s left hip disability is less likely than not incurred in or caused by his service. The examiner also opined that the Veteran’s left hip disability is less likely than not aggravated beyond its natural progression by the Veteran’s knee disability. The examiner explained that without documenting concomitant left hip injury at the same time of the Veteran’s knee injuries, he is unable to opine any pathophysiologic mechanism by which the Veteran’s knee condition would aggravate his hip condition. The Board gives great probative value to the July 2020 medical opinion as it is consistent with, and well supported by, the records. The Veteran consistently denied having a specific left hip injury in service. The Veteran only claimed that his left hip disability manifested as a result of his knee disability. The VA examiner considered the Veteran’s contentions when providing the opinion but still determined that the Veteran’s left hip disability is less likely than not aggravated beyond the natural progression by the Veteran’s knee disability. Further, the VA and private treatment records predominantly show that from 2015 to 2020 the Veteran had steady and normal gait with 5/5 hip flexion. See January 2020 CAPRI, March 2017 CAPRI, August 2016 CAPRI, and December 2017 Medical Treatment Records – Furnished by SSA. Based on the foregoing, the Board gives great probative value to the July 2020 medical opinion. The Board recognizes the Veteran’s lay statements linking his current left hip disability to his knee disability. The Veteran is competent to report purported symptoms such as left hip pain. 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303 (2007). However, the question of whether the Veteran’s knee disability caused the Veteran’s left hip disability or whether it is due to service is a medical question that requires medical expertise. There is no medical evidence in the record so indicating. The Board finds most probative in this matter the opinion by the July 2020 VA examiner, which is against the claim, and identifies that the Veteran’s left hip disability was not aggravated by his service-connected knee disability. The examiner is a medical professional and is competent to offer an opinion in the matter. The opinion reflects familiarity with the record, and the rationale provided is based on medical principles. It is probative evidence in the matter, and in the absence of competent medical evidence to the contrary, is persuasive. In sum, the criteria for service connection for a left hip disability have not been met. The evidence does not show that the left hip disability had its onset inservice or is directly related to his military service. Further, there is insufficient evidence to support the Veteran’s allegation that his left hip disability was proximately caused by his service-connected left knee disability. Accordingly, service connection for a left hip disability must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Ashley Castillo Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Noh, 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.