Citation Nr: 21030906 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-22 928 DATE: May 19, 2021 ORDER Service connection for arthritis of the right sacroiliac joint (right hip) is granted on a direct basis. FINDING OF FACT The Veteran's current right sacroiliac joint arthritis is related to service. CONCLUSION OF LAW The criteria for service connection for right sacroiliac joint arthritis has been met. 38 U.S.C. §§ 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from October 1986 to January 1994, April 2007 to March 2008, and September 2009 to January 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge at the RO in January 2020. A transcript of that hearing has been associated with the claims file. The Board remanded the claim for further development in April 2020. That development has been completed, and the case has since been returned to the Board for appellate review. The Board also notes that the Veteran's appeal had originally included the issues of entitlement to service connection for a back disorder and a right shoulder disorder. However, during the pendency of the appeal, the AOJ granted service connection for those disabilities in a March 2021 rating decision. The grant of service connection constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, the matters are no longer in appellate status. See Grantham, 114 F.3d at 1158 (holding that a separate notice of disagreement must be filed to initiate appellate review of "downstream" elements such as the disability rating or effective date assigned). Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. As arthritis is considered to be a chronic disease for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); 38 C.F.R. § 3.310. In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is entitled to service connection for right sacroiliac joint arthritis. Review of the medical records shows that the Veteran was seen several times by Dr. R.G. (initials used to protect privacy) in 2005 for issues including sacroiliitis and somatic dysfunction of the pelvis. A December 2011 post-deployment assessment included reports of muscle aches and painful joints, but the form did not indicate which joints. VA medical records show that the Veteran report right hip pain for 20 years during a July 2017 appointment. X-rays taken at that time revealed degenerative changes of the right L5-S1 facet and the sacroiliac joint. Minor degenerative changes of the right hip were also found. During a VA medical appointment in March 2018, the Veteran reported chronic hip pain, aggravated by her long commute. She reported that she could not tell whether the pain was truly hip pain, or was an issue of the back or sacroiliac joint. In August 2020, the Veteran submitted a statement from W.B., a friend who served with her, as well as treated her for her hip issues during service. W.B. was Chief of physical therapy from 2006 through 2008. He reported that during that time, the Veteran developed right hip issues and demonstrated stiffness to the hip girdle and deep hip complex causing increased back pain. The Veteran was afforded a VA examination in January 2021, and a diagnosis of right hip arthritis was confirmed. Specifically, the VA examiner noted that the July 2017 x-ray revealed degenerative changes of the sacroiliac joint as well as mild degenerative joint disease of the right hip joint. After an evaluation of the Veteran and the medical records in evidence, the examiner opined that complaints of in-service right hip pain were due to the Veteran's sacroiliitis and back disorder. She also opined that the symptom of hip pain secondary to the diagnosis of sacroiliitis began in service. However, she found that the mild degenerative joint disease of the right hip joint was not diagnosed until 2017, and thus, was less likely related to service. With regard to the July 2017 x-ray of the hip, she found that the right hip showed degenerative changes of the sacroiliac (SI) joint with periarticular sclerosis and small osteophytes. She then opined that this degree of degenerative change takes time to develop and likely had been present for years. She specifically noted that it had likely been present as far back as 2012, to have progressed to periarticular sclerosis and osteophyte formation by 2017. She noted that sacroiliitis is an inflammatory change and chronic inflammation can lead to degenerative change in the SI joint. Service connection has already been granted for lumbar thoracic degenerative disc disease with sacroiliitis and scoliosis. However, the Board finds that the findings of the January 2021 VA examiner show that service connection for right sacroiliac joint arthritis is warranted. The VA examiner opined that the disorder developed secondary to the Veteran's service-connected sacroiliitis. Further, the VA examiner found that the right hip degenerative joint disease was not related to service and did not develop within one year of service, the VA examiner's rationale discussed the Veteran's symptoms and conditions and demonstrated that the Veteran's in-service symptoms were related to her sacroiliitis and development of right sacroiliac joint arthritis. Therefore, the Board grants direct service connection, as this is the greater benefit. Based on the foregoing facts, the Board concludes that service connection is warranted for right sacroiliac joint arthritis. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see also Gilbert, 1 Vet. App. at 54. Nathaniel Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Rideout-Davidson, 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.