Citation Nr: 21028186 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 10-33 855 DATE: May 10, 2021 ORDER Service connection for a right hip disorder is denied. FINDING OF FACT At no time during the pendency of the claim does the Veteran have a current disability of a right hip disorder, separate and distinct from his service-connected chronic back strain and sacroiliac arthralgia and arthropathy, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. CONCLUSION OF LAW The criteria for service connection for a right hip disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1987 to August 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in December 2009 by a Department of Veterans Affairs (VA) Regional Office. In September 2014, the claim was remanded for additional development and, in April 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In June 2015 and November 2016, the Board again remanded the claim for additional development, and in July 2017, denied service connection for a right hip disorder. The Veteran subsequently appealed such decision to the United States Court of Appeals for Veterans Claims (Court), which, in June 2018, on the basis of a Joint Motion for Partial Remand (JMPR), vacated the July 2017 decision and remanded the matter to the Board for further consideration. In January 2019, June 2020, and December 2020, the Board remanded the claim for additional development and it now returns for further appellate review. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected patellofemoral pain syndrome of the right knee and/or chronic back strain and sacroiliac arthralgia and arthropathy. The Veteran contends that he has a right hip disorder that is caused or aggravated by his service-connected right knee and back disabilities, to include as a result of an altered gait. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 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) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). An award of service connection requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen, 7 Vet. App. 439; Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In the instant case, the Board finds that the Veteran's claim for service connection for a right hip disorder must be denied as he does not have a current disability of a right hip disorder, separate and distinct from his service-connected chronic back strain and sacroiliac arthralgia and arthropathy, at any time proximate to the pendency of the claim, which was received in July 2009. In this regard, while the Veteran's treatment records reflect complaints of pain referable to the right sacroiliac joint and right sacroiliac joint arthropathy, they are silent as to a diagnosed right hip disorder. Furthermore, at a November 2009 VA examination, an assessment of right sacroiliac join arthralgia of unknown etiology with a normal X-ray was rendered. Similarly, a March 2015 VA treatment record reflects chronic right lumbar facet pain with new complaints consistent with right sacroiliac joint arthropathy. Moreover, at a September 2015 VA examination, the Veteran reported radiation to the right posterior hip area that later was diagnosed as sacroiliitis and not a hip issue. Further, the VA examiner determined that there were no objective findings to support a diagnosis of the claimed right hip disorder. In reaching such determination, he noted that, while treatment records reflected that the Veteran was seen after service for non-specific right hip pain as a variable issue, he stated at time of the examination that such issue was not the hip, but the sacroiliac joint, and no current issues were noted. Also, examination of the hips was normal except for loss of full flexion due to habitus with a BMI of 40. Therefore, the examiner found that a chronic or diagnosable current condition, to include a compensable condition, was not currently present. In light of the fact that the record included assessments of right sacroiliac joint arthralgia and arthropathy, the Board sought an addendum opinion in December 2016 in to reconcile such findings in light of the September 2015 VA examiner's determination that the Veteran did not have a diagnosed right hip disorder. In December 2016, the VA examiner found that the Veteran does not have a diagnosed right hip disorder, and the diagnoses of right sacroiliac joint arthralgia and arthropathy do not pertain to the hip. Specifically, the sacroiliac joint is a structure of the posterior pelvis, and is more associated with a cause of mechanical back pain. Thus, the Board denied service connection for a right hip disorder in the July 2017 decision based on a lack of a currently diagnosed disability. In the June 2018 JMPR, the parties found that the December 2016 opinion did not adequately address the relationship between the Veteran's right sacroiliac joint arthropathy and his service-connected back disability. Specifically, it was noted that the examiner stated that the sacroiliac condition was "more associated with a cause of mechanical back pain" but did not address whether he was referring to the service-connected back disability, or whether the sacroiliac joint condition was at all associated with the service-connected back disability. The parties also found that the examiner did not adequately explain why the sacroiliac joint did not pertain to the hip as the hips form part of the pelvis. Furthermore, the parties found that the Board failed to address whether the Veteran was entitled to service connection for his diagnosed right sacroiliac joint arthralgia and arthropathy as his symptoms of hip pain appeared distinct from his symptoms of his service-connected back disability, which included back pain and limping. Thus, the Board remanded the case in January 2019 in order to obtain an addendum opinion addressing such matters. Thereafter, the Veteran was afforded a VA examination in October 2019, at which time the examiner found that he did not have a current right hip disability as such was not shown on clinical examination and no functional impairment was associated with his reported symptoms. In a February 2020 addendum opinion, the examiner reported that, with respect to whether the Veteran had a right hip disability at any time since July 2009, such question, although relevant from a layperson's perspective, did not pertain to the key question about his current disability. Here, the examiner noted that, as an example, a patient's knee contusion injury may be etiology for temporary disability during convalescent period then the temporary disability could be removed due to healing of the knee contusion. He further observed that the Veteran's available medical records, as well as September 2015 and October 2019 VA examinations, were silent for a current right hip disability. Further, while he had limited hip range of motion during the October 2019 VA examination, such was attributed to his body habitus and right knee discomfort. However, as the February 2020 VA examiner did not substantially comply with the January 2019 remand directives as he did not reconcile his finding that the Veteran did not have a current right hip disability at any time since July 2009 with the evidence of record showing that he had a current diagnosis of right sacroiliac joint arthralgia and arthropathy, to include explaining why such diagnosis was not considered a right hip disability as the hips formed part of the pelvis, and whether such diagnosis is separate and distinct from the Veteran's service-connected back strain in light of the fact that such is manifested by hip pain. Thus, the claim was again remanded in June 2020 in order to obtain an addendum opinion. Thereafter, such addendum opinion was obtained in October 2020, at which time the examiner found that the Veteran did not have a current right hip disability. In support thereof, she reported that the Veteran was examined in October 2019, and no pain was noted on examination with range of motion or palpation. Here, the examiner noted that the objective examination was normal with the exception of limited range of motion secondary to body habitus. Additionally, she indicated that the record revealed a history of sacroiliac joint pain, which did make up the posterior part of the pelvis. Here, the examiner noted that the sacroiliac joint was where the lower spine and pelvis connected, and sacroiliac joint pain "most commonly occurs in the buttocks and lower back." She further noted that there was no objective evidence to support such joint pain as a cause of the Veteran's claimed right hip disability. However, while the examiner found that the Veteran's current diagnosis of right sacroiliac joint arthralgia and arthropathy is not considered a right hip disability, she did not determine whether such diagnosis is separate and distinct from the Veteran's service-connected back strain in light of the fact that such is manifested by hip pain. Consequently, in December 2020, the Board remanded the case in order to obtain an addendum opinion addressing such inquiry. In February 2021, a VA examiner opined that the Veteran has a current diagnosis of arthralgia and arthropathy of the right sacroiliac junction/joint and, due to the anatomic proximity and chronic nature of his lumbar spine disability, it is at least as likely as not that such disorder is due to or incurred in such disability. Thus, in light of such opinion, service connection for sacroiliac arthralgia and arthropathy was granted in a February 2021 rating decision. However, the examiner also found that the Veteran's limitation of hip range of motion has been attributed to his body habitus and no diagnosis has been rendered. In this regard, he indicated that the perceived hip pain is likely due to the Veteran's sacroiliac joint arthralgia and arthropathy, and the sacroiliac joint is not considered hip-related, but is often mistaken as such by lay persons. The Board affords great probative weight to the foregoing opinions as such considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiners offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's assertions that he has a current right hip disorder, to include his testimony at the April 2015 hearing that he had pain in his sacroiliac joint, which he reported was his hip joint. However, as a lay person, he does do not have the requisite training and experience necessary to diagnose such disability as it is a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis of a hip disorder involves a medical subject concerning an internal process extending beyond an immediately observable cause-and-effect relationship. Specifically, the diagnosis of such a disorder requires the administration of diagnostic tests performed during a clinical evaluation and interpretation of imaging studies. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). As such, the question of diagnosis in this case may not be competently addressed by lay evidence, and the Board accords the Veteran's statements regarding the presence of a diagnosed right hip disorder no probative value as he is not competent to opine on such a complex medical question. Additionally, as discussed at length in the highly probative medical opinions, the sacroiliac joint is not the hip joint; rather, it is part of the back. Furthermore, the entirety of the Veteran's symptomatology, to include his sacroiliac pain, is contemplated in the currently assigned rating for his chronic back strain and sacroiliac arthralgia and arthropathy, and to evaluate the same manifestation of a disability under different diagnostic codes constitutes pyramiding, which is prohibited. 38 C.F.R. § 4.14. Consequently, the Board finds that at no time during the pendency of the claim does the Veteran have a current disability of a right hip disorder, separate and distinct from his service-connected chronic back strain and sacroiliac arthralgia and arthropathy, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. Furthermore, the record does not reflect that his reported symptoms result in functional impairment of earning capacity. Saunders, supra. Therefore, absent evidence of a current disability of a right hip disorder proximate to the pendency of the claim, service connection for such claimed disorder is not warranted. Brammer, supra. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a right hip disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Spielmann, Jill F. 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.