Citation Nr: 21024111 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 13-04 364 DATE: April 22, 2021 ORDER Entitlement to service connection for a left hip disability is denied. FINDING OF FACT A left hip disability was not incurred in, caused, or aggravated by service, arthritis of the left hip may not be presumed to have been incurred therein, and a left hip disability was not caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a left hip disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the United States Navy from July 1987 to June 1991, in the United States Army from June 2005 to October 2006 (including service in Southwest Asia from September 2005 to September 2006), and the United States Air Force from June 2008 to October 2008, with additional service in the Army National Guard. The issue was remanded by the Board for additional development in February 2017 and January 2020. Entitlement to service connection for a left hip disability Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Certain diseases, to include osteoarthritis, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. As there is no evidence or claim that the Veteran was diagnosed with arthritis of the left hip or within one year of service the above provision is not applicable. Indeed, x-rays from 2010 were negative for left hip arthritis. 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.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the alternative, service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends that he has a left hip disability that began in 2005 during his active service. In the alternative, he alleges that a left hip disability was caused or aggravated by his service-connected low back disability. The Veteran’s service treatment records do not include complaints, treatment, or diagnosis of a left hip disability or related problems. In May 2005, prior to entering that period of active service, the Veteran denied any medical problems. The Veteran’s September 2005 pre-deployment health assessment included the Veteran’s denial of any medical problems and at that time he indicated he was in excellent health. In his September 2006 post-deployment health assessment, the Veteran indicated that his health got worse during the deployment and reported swollen, stiff, or painful joints and muscle aches during his deployment, but there was no specific report of left hip problems. A March 2007 post-deployment health assessment reported swollen, stiff, or painful joints, but the record specifically indicated that the joint problems involved the left knee. Again, there was no mention of the left hip. In a May 2007 Report of Medical History, the Veteran denied current or past swollen or painful joints or impaired use of the legs. A contemporaneous Report of Medical Examination included a normal examination of the lower extremities. In an August 2007 medical prescreen of medical history report, the Veteran denied any limitation of any joint, including the hips. In September 2007 and April 2010, the Veteran indicated that he had no medical problems or symptoms that bothered him. In July 2011, while on his way home from a training exercise the Veteran was involved in a motor vehicle accident. The Veteran reported back and neck pain as a result of the accident, but did not discuss any left hip problems. October 2010 x-rays of the left hip were normal. A January 2011 VA examination considered all the Veteran’s disabilities and whether they represented symptoms of an undiagnosed illness due to service in Southwest Asia. At that time, the Veteran reported onset of left hip problems in 2005 and that since service he had experienced moderate left hip pain, with no known trauma. He experienced the pain when elevating his left lower extremity. Following examination, the examiner concluded that there was no pathology found on physical examination and on x-rays of the left hip, but that the symptoms were not manifestations of an undiagnosed illness. The Veteran underwent a VA examination in July 2018. The examiner diagnosed bilateral hip arthritis. The Veteran reported gradual onset of left hip pain. He did not recall the specific timing of onset, but believed that it had been present for about 2 years. Following examination, the examiner concluded that it was not at least as likely as not that the left hip arthritis was incurred in or caused by service. The rationale noted that there was no evidence of any hip complaints, hip injury, or hip trauma during service. Moreover, the Veteran reported the onset of hip pain was about 2 years previously and gradually worsened. The Veteran did not remember any specific trauma to the hip. X-rays showed degenerative joint disease, which was not uncommon for the Veteran’s age group. As such, the examiner stated, “I opine that his hip condition is at least as likely as not due to his natural process of aging.” The left hip degenerative joint disease was less likely than not related to the 2011 motor vehicle accident. The rationale noted that there was no report of trauma to the hips, no physical examination of problems with the hips, and no complaints of hip pain documented in the medical records in the immediate aftermath of the motor vehicle accident or for years after the accident. The Veteran underwent a VA examination in November 2020. The examiner diagnosed osteoarthritis of the left hip from July 2018. Onset was reported by the Veteran to be from 2005 during basic training without any specific trauma. The course of the condition had generally been the same since onset. Following examination, the examiner concluded that it was less likely than not that the left hip arthritis was incurred in or caused by service. The rationale noted that there were no service treatment records documenting left hip problems and or trauma to the left hip. In addition, the examiner indicated that the history given by the Veteran was compatible with a gradual onset of arthritis and a chronic clinical course. The x-ray evidence of degenerative joint disease or osteoarthritis was of the type usually expected for the Veteran’s age. As such, the examiner concluded that the arthritis “may be related to expected aging process.” A January 2021 addendum opinion also concluded that it was less likely than not that the left hip arthritis was incurred in or caused by service. The rationale again noted that there were no service treatment records documenting left hip problems and or trauma to the left hip. In addition, the examiner indicated that the history given by the Veteran was compatible with a gradual onset of arthritis and a chronic clinical course. The addendum concluded, “The history given by the Vet[eran] is compatible with a gradual onset and chronic clinical course most probably secondary to normal aging process.” As to whether the disability was due to environmental exposures during service in Southwest Asia, the left hip arthritis was not “causally related to any event or circumstance of his service in Southwest Asia. The left hip condition [is] most probably secondary to [the] normal aging process.” As to the Veteran’s secondary claim, the left hip arthritis was less likely than not proximately related to the Veteran’s service-connected back disability. The rationale indicated that it was common to find spine degenerative joint disease in conjunction with peripheral degenerative joint disease (here left hip arthritis), but that there was no direct causation and no aggravation. The examiner again stressed that the Veteran’s left hip arthritis was the result of the natural aging process. As an initial matter, the Board has considered the applicability of 38 C.F.R. § 3.317. In order to obtain a grant of service connection pursuant to 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, a Veteran needs to present some evidence (1) that he or she is a Persian Gulf Veteran; (2) who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (4) that such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a). In this case, the January 2011 examiner specifically indicated that the Veteran’s left hip problems were not due to an undiagnosed illness as a result of his service in Southwest Asia. Moreover, since that time, his left hip problems have been conclusively attributed to his diagnosed left hip arthritis and the January 2021 addendum opinion confirmed that the left hip disability was not due to environmental exposures during service in Southwest Asia. As the Veteran’s left hip arthritis has been attributed to a known clinical diagnosis and, as such, entitlement to service connection under 38 C.F.R. § 3.317 is not warranted. As to otherwise granting the claim as having been incurred in or otherwise caused by service, the Board finds the November 2020 examination report and January 2021 addendum by the same physician of significant probative value. The examiner reviewed the claims file, interviewed the Veteran, and conducted an examination before concluding that it was less likely than not that the left hip arthritis was incurred in or caused by service. The Veteran did not have any documented in service left hip problems and the most likely cause of the arthritis was the normal aging process. As the opinion considered the Veteran’s lay allegations, as well as the other evidence of record, and provided a complete rationale for the opinions stated, the Board finds this the most probative evidence of record as to whether the current left hip arthritis was incurred in or otherwise caused by service. The Board has considered the lay statements from the Veteran. The Veteran is competent to report physically observable symptoms. In this case, however, given the medical complexity of linking any such symptoms to arthritis of the left hip the Board affords the opinions of the medical professionals significantly greater probative weight. The Board also finds it problematic that 2010 x-rays of the left hip failed to show arthritis, which speaks against the Veteran’s allegations that his ongoing left hip pain was a manifestation of arthritis. Cf. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As to granting the claim on a secondary basis, the January 2021 addendum opinion specifically concluded that the left hip arthritis was not caused or aggravated by the Veteran’s service-connected back disability. The physician noted that it was not unusual to have an individual with spine arthritis and arthritis of the lower extremities, but that this Veteran’s the lower extremity arthritis was unrelated to the arthritis of the spine. Instead, the left hip arthritis was the result of the normal aging process. The Board finds this the most probative evidence of record. As with the above contentions, while the Veteran is competent to report left hip pain he experienced, but given the complexity of linking the Veteran’s left hip arthritis to his service-connected low back disability the Board affords far greater probative weight to the January 2021 medical opinion. The physician has greater education, training, and experience with respect to the medical question at issue. In light of the foregoing, the Board finds that the preponderance of the evidence is against the claim, and the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). The appeal must therefore be denied. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. J. Houbeck, 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.