Citation Nr: 21029275 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 15-22 830 DATE: May 13, 2021 ORDER Entitlement to service connection for right hip disability is denied. FINDING OF FACT The probative evidence of record indicates that the Veteran's right hip disability, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression due to his period of service. CONCLUSION OF LAW The criteria for service connection for right hip disability have not been met. 38 U.S.C. § 1110, 1111; 38 C.F.R. § 3.102, 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States Marine Corps from July 2006 to July 2010. In July 2018, the Veteran testified before the undersigned Veterans Law Judge at a Video Conference hearing. A copy of the transcript has been associated with the claims file. In January 2019, the Board remanded the appeal for further development. 1. Service connection for right hip disability The Veteran contends that his right hip disability is due to his period of service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board finds that the evidence is insufficient to establish service connection for right hip disability. The Veteran has a current diagnosis of right hip acetabular dysplasia. In an August 2016 VA examination, the examiner stated that the Veteran's right hip acetabular dysplasia is a congenital condition. Moreover, in an October 2018 private medical opinion, the examiner reported that the Veteran's diagnosis of acetabular dysplasia is a congenital shallow and up sloping hip socket that can result in early hip problems. The Veteran's right hip acetabular dysplasia was not noted on his September 2005 entrance examination, and therefore the Veteran was presumed sound on entrance into service. However, the medical evidence of record clearly and unmistakably establishes that the asserted condition existed before acceptance and enrollment. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304. The Board will, therefore, consider whether this congenital condition was aggravated beyond natural progression to determine if the presumption of soundness is rebutted. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004) (holding that if a condition is not noted upon entrance into service, then to rebut the presumption of soundness at service entrance VA must show by clear and unmistakable evidence both that there was a pre-existing condition and that it was not aggravated during or by the Veteran's service). The Board notes that, though the Veteran service treatment records note left hip treatment, the records are silent for treatment of the right hip. In an October 2010 VA medical record, the examiner noted that the Veteran reported bilateral hip pain for that has lasted about a year. The examiner reported an impression of hip pain secondary to acetabular dysplasia bilaterally. In a June 2015 Notice of Disagreement, the Veteran stated that he noticed problems with his hips and knees after deployment in 2008. The Veteran also noted that he elected to have surgery on his right hip in 2011 following his separation. He reported that he elected to do the right hip first as it was worse than the left. The Veteran further reported that after an unsuccessful attempt to complete surgery in 2011, his right hip surgery was completed in June 2012. The Veteran stated that he continues to experience right hip pain. The Veteran asserted that he believed that his time in service exacerbated his congenital condition. In an addendum to the August 2016 VA examination, the examiner stated that there was no interceding evidence in the Veteran's service treatment records or evidence from his orthopedic doctor showing any aggravation of the right hip acetabular dysplasia from military service. The examiner went on to state that there was no evidence that the Veteran's right hip acetabular dysplasia is related to or aggravated by his left hip acetabular dysplasia. The examiner related the Veteran's right hip symptoms solely to his pre-existing right hip congenital condition. The Board notes that in a January 2019 Board decision, the Board found the August 2016 VA examination to be inadequate in that it did not consider the Veteran's 2011 surgery and it did not use the correct standard in determining whether the Veteran's preexisting condition was aggravated by service. At a July 2018 Board hearing, the Veteran reported that as an infantryman, his duties required hiking with heavy machine guns and a heavy pack, which took a toll on his hips. He stated that, at the time, his left hip was more bothersome than his right, but his right hip was still bothersome. He asserted that this played a huge factor in the exacerbation of his hip dysplasia symptoms. In an October 2018 private medical opinion, the examiner stated that he treated the Veteran's hip in 2011; however, the records were not available to review. The examiner stated that it is reasonable to conclude that the Veteran's activities during service may have played a role in his current level of symptoms. The examiner explained that, due to the Veteran's declining of a cost prohibitive examination, his opinion was limited; however, he stated that while some people are able to perform high level activities long term on dysplastic hips, not everyone would be able to do so. The Board previously found this opinion to be inadequate due to its reliance on speculation and inadequate reasons and bases to bolster the opinion. In an October 2019 VA addendum opinion, the examiner opined that the Veteran's right hip disability, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner noted that the Veteran underwent an arthroscopy at which time a labral repair as well as reshaping of the proximal femur was attempted in June 2011. The examiner explained, however, that the Veteran had no chronic or ongoing diagnosis, evaluations, treatments and or complaints of right hip condition while on active duty to indicate chronicity of right hip condition while on active duty. The examiner concluded that a nexus between the Veteran's period of service and the aggravation of his right hip congenital condition has not been established. In a March 2021 Appellate Brief, the Veteran, through his representative, asserted that the Veteran had no hip pain at the time of enlistment. The representative also stated that after his deployment in 2008, the Veteran noticed problems with his hip and sought treatment before discharge, citing November 2009 treatment for hip pain. The Veteran's representative noted an October 2010 VA medical record noting bilateral hip pain for a year and a July 2011 surgery on the right hip. The representative stated that these medical records show aggravated and worsened condition during service and beyond natural progression. The Board notes that the November 2009 service treatment record indicates treatment sought specifically for the left hip. A follow-up visit in April 2010 also indicates complaint of and treatment for the left hip only. The Board also notes that while the October 2010 VA record notes the Veteran's report of bilateral hip pain for about a year, there is no indication of report of hip pain prior to separation from service. The Board further notes that the October 2010 VA record does not indicate aggravation of the Veteran's congenital right hip acetabular dysplasia; rather it cites the condition itself as the cause of the Veteran's pain. After review of the record, the Board finds that the probative evidence of record is insufficient to establish service connection for a right hip disability. The October 2019 VA addendum opinion considers the Veteran's service medical history and his July 2011 surgery in opining that the Veteran's right hip disability was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The Board finds the opinion to be both adequate and highly probative for the purpose of adjudicating the claim. Therefore, service connection for a right hip disability is not warranted. The Board has considered the Veteran's contention that his period of service resulted in aggravation of his preexisting right hip disability. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, determining the etiology of his preexisting right hip disability falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In this regard, while the Veteran can competently report his symptoms, any opinion regarding whether the Veteran's right hip disability is related to his service requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board assigns no probative weight to the Veteran's assertions that his right hip disability is related to his military service. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ford 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.