Citation Nr: 21031518 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 11-31 912 DATE: May 24, 2021 ORDER Entitlement to service connection for a left hip disability, claimed as secondary to service-connected disabilities, is denied. FINDING OF FACT The Veteran's left hip disability is not shown to have been caused or aggravated by a service-connected disability, or shown to otherwise be etiologically related to an injury or disease in service. CONCLUSION OF LAW Service connection for a left hip disability (claimed as due to a service-connected disability) is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from February 1977 to February 1981. This case is before the Board of Veterans' Appeals (Board) on appeal from an August 2010 Department of Veterans Affairs (VA) rating decision. In August 2019, a videoconference hearing was held before the undersigned. In September 2019, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) for additional development. At the time of the Board remand, there was an additional claim of service connection for a right leg/knee disability on appeal, but after further development, the AOJ granted that claim and it is no on appeal. Moreover, the Veteran has an appeal before the Board (arising from a July 2017 rating decision) for an earlier effective date for the award of a 30 percent rating for a left knee disability. He requested a Board videoconference hearing on the matter, which is pending, so it will not be addressed in this decision. Entitlement to service connection for a left hip disability, claimed as secondary to service-connected disabilities The Veteran contends that his left hip disability is attributable to his service-connected disabilities, including his bilateral lower extremity disabilities, which he asserts have resulted in an "unnatural walk" and falls that have led to hip problems. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will focus on entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by, service-connected disability. The Board concludes that, while the Veteran has a current disability of osteoarthritis of the left hip, the preponderance of the evidence is against finding that his osteoarthritis is proximately due to or the result of, or aggravated beyond its natural progression by, a service-connected disability. 38 U.S.C. § 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The record contains various VA opinions pertaining to the matter at hand. On February 2010 VA examination to address whether his left leg condition was due to or proximately the result of service-connected ankle problems, the examiner opined that the Veteran's "left leg problems" directly resulted from his bilateral (service-connected) ankle problems "due to physical compensation." In an April 2010 addendum opinion, the VA examiner clarified that the left leg condition was "left knee and hip arthralgia" which was "directly related to his service-connected ankle problems" because the "abnormal ankle joint can cause compensatory stresses altered muscular movement and subtle, yet painful conditions." [At that time, symptoms such as pain, numbness, or weakness, without a diagnosed or identifiable underlying malady, were not sufficient to establish a present disability for VA compensation purposes. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (Sanchez-Benitez I). However, in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the United States Court of Appeals for the Federal Circuit rejected such a theory, holding that pain (and other symptoms) can constitute a current disability under [the relevant statute], so long as it results in functional impairment of earning capacity.] An April 2013 VA examiner diagnosed bilateral hip strain and mild degenerative joint disease, concluding that the diagnosis was less likely than not proximately due to or the result of service-connected disability because the Veteran lacked a "significant enough of a stimulus or injury" beyond an old right ankle issue and X-rays did not reveal "significant pathology other than mild sclerosis of joint space in hips." A July 2017 VA examiner opined that the Veteran's diagnosed mild osteoarthritis of both hips was less likely than not proximately due to or the result of, or aggravated by, his service-connected bilateral ankle disabilities. She noted that each ankle condition was different and would not have produced the Veteran's "equally impact[ed] hip conditions." Regarding the adequacy of the opinions, the 2013 examiner did not address the aggravation question; the 2017 examiner did not consider service connection on a secondary basis as to any of the Veteran's other service-connected disabilities including left knee osteoarthritis, bilateral lower extremity radiculopathy, and lumbosacral degenerative arthritis; and neither of the 2013 and 2017 examiners addressed the 2010 opinion. In September 2019 the Board remanded the case for a new examination and opinion to address deficiencies in the VA opinions. The December 2019 VA examiner diagnosed bilateral osteoarthritis of the hips and opined that the diagnosis was less likely than not proximately due to or the result of, or aggravated by, the Veteran's service-connected disabilities. She opined that the hip diagnosis was instead more likely due to, or aggravated by, other conditions. The examiner explained that the left hip pain described by the Veteran (pain radiating down the lower extremities that was essentially symmetrical) was more consistent with lumbar radicular symptoms and not pain from his hip, which most commonly manifested as groin pain. She stated that if the left hip was negatively impacted by an abnormal gait secondary to service-connected lower extremity disabilities, he would not be expected to have bilateral/equal/symmetric hip pain. She added that the Veteran had bilateral, equal, and mild degenerative changes on imaging, which was a finding that was more consistent with aging and did not suggest evidence of trauma or micro-injuries. She stated that the Veteran's advanced age (62) and obesity were factors that put him at risk for developing degenerative changes in the hips. Regarding the aggravation question, she indicated the objective findings of mild or minimal degenerative changes that were bilateral and symmetrical suggested that the left hip had not been aggravated more than the right hip. She reiterated that the "hip" complaints may be related to a complex interaction between multiple variables, with a major component being symptoms related to the service-connected bilateral lumbar radiculopathies. She signaled her review of the prior VA opinions, noting that the 2013 opinion (with which she was in clear disagreement) did not provide a specific diagnosis other than arthralgia, which was a symptom. The Board finds the December 2019 opinion to be more probative than the favorable April 2010 opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Barr v. Nicholson, 21 Vet. App. 303 (2007), Stefl v. Nicholson, 21 Vet. App. 120 (2007), Prejean v. West, 13 Vet. App. 444 (2000). Essentially, the 2010 opinion holds that the Veteran's left hip condition was the direct result of his compensating behavior due to altered movements brought about by his service-connected bilateral ankle disabilities. The examiner, however, did not appear to consider any other factors such as those that were addressed by the 2019 examiner, to include age, obesity, minimal degenerative changes on imaging that were symmetrical/equal to those on the corresponding right hip, and the type of pain described by the Veteran. In contrast, the 2019 examiner was more thorough and comprehensive, contained additional detail, offered clear conclusions based on accurate medical history, and was supported by factual data. Due to the shortcomings of the 2010 opinion, the Board finds that the 2019 opinion outweighs the 2010 opinion in terms of the probative value in answering the questions presented in this case. The Veteran believes his left hip disability is the result of service-connected disability. He is not competent to provide a nexus opinion regarding this issue, which is medically complex because it requires knowledge of the interpretation of diagnostic testing (imaging), the pathology of osteoarthritis, and anatomical relationships. Therefore, it is outside his competence because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the December 2019 VA examiner's opinion which is unfavorable to the Veteran's claim. Considering the foregoing, the Board finds that the preponderance of the evidence is against this claim and that the appeal in the matter must be denied. George R. Senyk Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Debbie Breitbeil, 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.