Citation Nr: 21028376 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 18-39 956 DATE: May 11, 2021 ORDER Entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected disability, is granted. FINDING OF FACT Resolving all reasonable doubt in the Veteran's favor, it is at least as likely as not that his lumbar spine disability is related to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected disability, have been met. 38 U.S.C. §§ 1111, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from February 1991 to June 1991 and in the Navy from March 2004 to April 2007. The Veteran appeared and testified at a virtual teleconference hearing in February 2021 before the undersigned Veterans Law Judge. A transcript of the testimony is of record. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. 1. Entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected disability The Veteran seeks entitlement to service connection for a lumbar spine disability, which he contends was caused or aggravated by his service-connected bilateral hip disabilities. After considering all the evidence of record, the Board determines that service connection is warranted for a lumbar spine disability. First, an MRI of the Veteran's right hip from January 2013 demonstrated moderate degenerative changes of the lumbar spine at L4-L5. His radiating low back pain has been treated with Celebrex and topical lidocaine patches. The Veteran submitted a July 2018 private physician's opinion stating that the Veteran's degenerative arthritis of the lumbar spine is very likely related to an abnormal gait, which is secondary to the Veteran's service-connected hip conditions. The physician elaborated that the Veteran underwent multiple treatments, including surgeries, for bilateral hip avascular necrosis, which left him with a significant limp, observing that he had a Trendelenburg gait upon examination. The physician examined the Veteran's hips and back and determined that the Veteran's decreased sensation in his right calf and limp are likely secondary to his hip surgery, rather than his lumbar spine disorder. They further noted that the Veteran's low back pain has gradually worsened since he underwent hip surgery and is exacerbated by prolonged ambulation due to his abnormal gait. Consistent with the examiner's opinion, the record contains medical records as far back as December 2005 indicating that the Veteran walks with a limp as a result of his hip disorders. Additionally, the Department Head of OB/GYN of the Naval Hospital where the Veteran worked between July 2004 and October 2007 submitted a statement in June 2007 stating that the Veteran developed a limp in Fall 2005. The Veteran underwent his first hip surgery in 2005 and a second surgery in 2015. The Board acknowledges the negative opinion from the April 2017 VA examiner. The examiner opined that the medical literature does not support that the Veteran's hip disabilities alone could have aggravated the Veteran's low back disability. However, the examiner did not discuss the Veteran's abnormal gait, and improperly opined whether the Veteran's service-connected hip disabilities, alone, in the absence of any other factors, aggravated the Veteran's lumbar spine disability. Therefore, the opinion was inadequate and not probative. Ultimately, affording the Veteran the benefit of the doubt, the weight of the evidence supports service connection for a lumbar spine disability, to include as secondary to a service-connected disability. Thus, service connection should be granted. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Veltri, Associate Counsel