Citation Nr: 21032515 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-09 388 DATE: May 27, 2021 ORDER Service connection for a left ankle disability is granted. Service connection for a left hip disability is granted. Service connection for a right hip disability is granted. Service connection for a low back disability is granted. FINDINGS OF FACT 1. It is at least as likely as not that the Veteran's left ankle degenerative arthritis is related to an in-service injury. 2. The evidence is at the very least in equipoise as to whether the Veteran's right and left hip disabilities are related to service. 3. The Veteran's low back disability is proximately due to his service-connected pes planus. CONCLUSIONS OF LAW 1. The criteria for service connection for left ankle degenerative arthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left hip disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right hip disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a low back disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1974 to November 1997. In February 2020, the Veteran testified before the undersigned at a videoconference hearing. A transcript of the hearing is associated with the claims file. The case was then before the Board in May 2020, at which time the Board granted the claim of service connection for hypertension and remanded the instant claims, which return to the Board for adjudication. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). 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. 1. Left Ankle The Veteran contends that he injured his left ankle in service and has suffered from left ankle pain ever since. See Hearing Transcript at p. 9. The Veteran has a diagnosis of left ankle degenerative arthritis. See January 2021 VA examination. Service treatment records show that the Veteran entered service with a normal clinical evaluation of his lower extremities. In November 1981, he sought treatment after he sprained his left ankle playing basketball; at that time, he was noted to have slight swelling. In December 1993, the Veteran sought treatment for his left ankle. The examiner noted that the Veteran had sprained his ankle many years prior and that he presented with mild swelling, no trauma, and pain. The Veteran was assessed with osteoarthritis of the left foot and ankle. In January 1995, the Veteran sought treatment for left foot pain that he said had originated from his left ankle sprain. Therefore, as the first two elements of service connection are met, the question is whether there is a nexus, or link, between the Veteran's current disability and his in-service injuries. In a January 2021 medical opinion, a VA examiner, after examining the Veteran's ankle, opined that his left ankle degenerative arthritis was at least as likely as not related to his in-service injuries. By way of rationale, the examiner noted that the Veteran's medical records documented an extensive history of complaints to the left foot and ankle to include recurrent ankle sprains, heel spurs, plantar fasciitis, and severe pes planus, which, in the examiner's view, could lead to arthritis of the ankle joints. In February 2021, the Veteran's family physician, Dr. C.G., wrote a letter wherein he indicated that he had been the Veteran's family physician for several years and had treated the Veteran for his left ankle pain. He indicated a review of the Veteran's military treatment records and opined that there was at least a 50 percent probability that the Veteran's left ankle injury was related to his military service, specifically his left ankle sprain that he incurred playing basketball. The Veteran's uncle submitted a statement in February 2021 indicating that the Veteran had no medical problems prior to enlisting in the Army, but when he returned home, he noticed the Veteran complaining about his "feet and ankles hurting all the time." In light of the foregoing, the Board finds that the evidence favors a finding that the Veteran's left ankle injury was incurred in service. The Board acknowledges that a VA examiner opined in January 2014 against a relationship between the Veteran's left ankle and service; however, that opinion was based solely on the Veteran's "normal" separation examination, without consideration of other favorable evidence, and therefore the Board does not afford that opinion any probative value. Rather, the Board finds that the January 2021 and February 2021 opinions establish that it is more likely than not that the Veteran's left ankle degenerative arthritis onset in service. The lay statements submitted in support of the Veteran's claim also tend to support the Veteran's theory as to the onset and continuity of his left ankle disability. For these reasons, the Board finds that entitlement to service connection for left ankle degenerative arthritis is warranted based on in-service onset. 2. Bilateral Hip Disabilities The Veteran contends that he injured his left hip in service when it popped out of place while playing baseball during active service. See January 2014 VA examination report. Specifically, he reports that he complained of the injury in service and was told that it was his groin muscle. He said that his symptoms worsened during and after service, and that he tolerated the left hip pain for years until it became unbearable. He finally had a left hip replacement in September 2013. See June 2014 Notice of Disagreement. He contends that his right hip disability is related either to an in-service injury in service or, alternatively, to his left hip injury. He underwent a total left hip replacement in 2013 and has a diagnosis of status post left hip replacement with residual loss of motion and pain on movement. He also has a diagnosis of right hip degenerative arthritis. In January 2014, the Veteran underwent a VA examination for his hips. The examiner, following a review of the evidence, opined that a hip condition was less likely than not due to service. The rationale was that there were no "pertinent" service treatment records and that there was a lack of treatment between separation in 1997 and the exam in 2014. Therefore, in consideration of the service medical records, temporal relationships, and normal examinations in service, the examiner offered a negative opinion. Conversely, Dr. C.G. wrote a letter in February 2021 wherein he noted that the Veteran had injured his left hip in Germany in June 1984 and was diagnosed with a hamstring pull, but that no X-rays were taken. Dr. C.G. also noted that the Veteran injured his right hip in 1991 and was again diagnosed with a hamstring pull. It was Dr. C.G.'s opinion that the degenerative disc disease in the Veteran's hips was the result of a failure to properly treat the misdiagnosed hamstring injuries in service. Moreover, the additional pressure that the Veteran put on his left hip caused the bones in his hip to deteriorate more quickly. Statements submitted from the Veteran's uncle and brother in February 2021 indicate that they noticed the Veteran limping upon returning home from service and that he complained of a hip injury that had been diagnosed in service as groin pain. Both indicated that the Veteran lived with the pain until the Veteran's wife convinced him to go to the doctor, which resulted in a total left hip replacement; the Veteran's wife recounted the same timeline at the Veteran's Board hearing. The Board adds that in Social Security Administration (SSA) records that were associated with the file in May 2021, a December 2012 private treatment note reflects that the Veteran told his provider that he had injured his left hip during a military softball game and that he had hip strain which had become worse. In light of the foregoing, the Board concludes that the evidence is at the very least in equipoise as to whether the Veteran's right and left hip disabilities are related to in-service injuries. The Board affords higher probative value to the findings of Dr. C.G., who indicated that he had treated the Veteran for many years for his hip conditions, and explained that the injuries in service led to the degenerative disease in the Veteran's hips. The Board affords lesser probative value to the January 2014 VA opinion, as the opinion was primarily based on a lack of treatment between separation and the date of the examination and did not even consider the Veteran's left total hip replacement which took place before the examination in 2013. Therefore, the Board concludes that service connection for left and right hip disabilities are warranted based on in-service onset. 3. Low Back Degenerative Arthritis The Veteran contends that his low back condition stems from an in-service lifting injury. Alternatively, he contends that the condition is related to his service-connected pes planus. For the reasons discussed below, the Board finds that service connection may be granted on the latter theory of entitlement. In a March 2021 opinion, Dr. C.G., the Veteran's family physician, indicated that he had treated the Veteran for his back condition for several years, and that in his opinion, there was more than a 50 percent probability that his back condition was secondary to his service-connected pes planus. The rationale was that the Veteran's severe pes planus and severe foot pain caused the Veteran to walk with an unsteady gait, placing additional pressure onto his spinal discs, which caused the discs to deteriorate quickly and led to degenerative disc disease. As there is no other medical opinion addressing secondary service connection, and as Dr. C.G.'s March 2021 opinion provides a sound medical rationale and indicates a review of the Veteran's records, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current low back degenerative arthritis is proximately due to his service-connected pes planus. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for low back degenerative arthritis is warranted on a secondary basis based on causation. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the benefit sought on appeal is granted. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.