Citation Nr: A21013609 Decision Date: 08/12/21 Archive Date: 08/12/21 DOCKET NO. 190506-19012 DATE: August 12, 2021 ORDER As new and relevant evidence has been received, the application to readjudicate the previously denied claim of entitlement to service connection for lumbar intervertebral disc syndrome (IVDS) status post discectomy, lumbar strain, and lumbar degenerative joint disease (previously rated as back strain condition, hereinafter referred to as back disability), is granted. As new and relevant evidence has been received, the application to readjudicate the previously denied claim of entitlement to service connection for left hip osteoarthritis (claimed as left hip condition), is granted. As new and relevant evidence has been received, the application to readjudicate the previously denied claim of entitlement to service connection for right hip osteoarthritis (claimed as right hip condition), is granted. Service connection for a back disability is granted. Service connection for left hip osteoarthritis, to include secondary to the service-connected plantar fasciitis is denied. Service connection for right hip osteoarthritis, to include secondary to the service-connected plantar fasciitis is denied. FINDINGS OF FACT 1. New evidence was received after the November 2018 denial that is relevant to the issue of entitlement to service connection for a back disability. 2. New evidence was received after the November 2018 denial that is relevant to the issue of entitlement to service connection for left hip osteoarthritis. 3. New evidence was received after the November 2018 denied that is relevant to the issue of entitlement to service connection for right hip osteoarthritis. 4. The evidence is at least in relative equipoise as to whether the Veteran's back disability had its onset in service. 5. The Veteran's right and left hip osteoarthritis were not first shown during service, did not manifest to a compensable degree within one year of discharge, and are not otherwise causally related to service, to include as secondary to service-connected plantar fasciitis. CONCLUSIONS OF LAW 1. The criteria for readjudicating the claim for entitlement to service connection for a back disability have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156 (d), 3.2501. 2. The criteria for readjudicating the claim for entitlement to service connection for left hip osteoarthritis have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156 (d), 3.2501. 3. The criteria for readjudicating the claim for entitlement to service connection for right hip osteoarthritis have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156 (d), 3.2501. 4. Resolving all reasonable doubt in the Veteran's favor, the criteria for service connection for a back disability have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.301, 3.302, 3.303. 5. The criteria for service connection for left hip osteoarthritis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for right hip osteoarthritis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from June 1979 to September 1979. This matter is before the Board of Veterans' Appeals (the Board) on appeal from February 2019 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. By way of history, a July 2018 rating decision denied service connection for lumbar IVDS, status post discectomy, lumbar strain, and lumbar degenerative joint disease (previously rated as back strain condition). In July 2018, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA) by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the higher-level review (HLR) lane. In an August 2018 rating decision, the RO confirmed and continued prior denials of service connection for right and left hip disabilities. In September 2018, the Veteran elected to opt this claim into RAMP by submitting a RAMP election form and selecting the supplemental claim lane. The agency of original jurisdiction (AOJ) issued a RAMP HLR decision in November 2018 denying all claims. Also in November 2018, the Veteran submitted a VA Form 21-4138, Supplemental Claim, and requested review of the November 2018 rating decision based on new and relevant evidence. In February 2019, the AOJ issued the rating decision on appeal, which found that new and relevant evidence had not been received. In the May 2019 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. In March 2021, the Veteran and his representative appeared before the undersigned Veterans Law Judge (VLJ) for a Board virtual hearing. The transcript is of record. Accordingly, the Board must first determine whether new and relevant evidence has been received based only on the evidence of record at the time of the supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Of note, evidence was added to the claims file during a period of time when new evidence was not allowed. As the instant decision has reopened the claims of service connection for a back disability, left hip arthritis, and right hip arthritis, the evidence submitted outside of the appellate window may not considered in the readjudication. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Whether new and relevant evidence has been received sufficient to warrant readjudication of the previously denied claims for service connection for a back disability, left hip osteoarthritis, and right hip osteoarthritis. The Veteran contends that he submitted new and relevant evidence with his supplemental claim that is sufficient to warrant readjudication of the previously denied claims for service connection for a back disability, left hip osteoarthritis, and right hip osteoarthritis. Under the modernized review system, VA will readjudicate a previously denied claim if new and relevant evidence is present or secured after notice of the prior denial of a veteran's claim(s). 38 C.F.R. §§ 3.156(d), 3.2501. "New evidence" is evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.2501 (a)(1). "Relevant evidence" is evidence that tends to prove or disprove a matter at issue in a claim. Id. As indicated above, the claims for service connection for a back disability, left hip osteoarthritis, and right hip osteoarthritis were denied in a November 2018 rating decision. At the time of the rating decision, the evidence of record included the Veteran's service treatment records (STRs), his VA treatment records dated until September 2017, his private treatment records dated until March 2016, a private medical opinion dated March 2016, his statements dated until March 2017, buddy statements dated January 2017 and February 2017, April 2016 VA examination report for back, December 2016 VA examination report for hips, March 2017 VA examination report for back, January 2018 VA examination report for back, and June 2018 VA medical opinion for back. The evidence received during the appropriate appellate window following the November 2018 rating decision includes the Veteran's VA treatment records dated up to February 2019, the Veteran's March 2021 Board hearing testimony, and the May 2021 private medical opinion. This evidence asserts that the Veteran's disabilities are related to his service-connected plantar fasciitis. In particular, the May 2021 private medical opinion indicates that the Veteran suffered recurrent herniated disc due to a change in gait caused by his plantar fasciitis. The medical opinion also indicates that the Veteran's bilateral hip osteoarthritis is a direct result of his plantar fasciitis. This evidence was not previously of record. This evidence may help prove or disprove presence of a nexus between the Veteran's claimed disabilities and his service-connected plantar fasciitis. As such, new and relevant evidence has been received and readjudication of the claims is warranted. Service Connection. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service occurrence 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Establishing a service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, such chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. It is the Board's responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Then, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. 2. Entitlement to service connection for a back disability. The Veteran contends that his back disability is related to his plantar fasciitis. Specifically, he contends that during service, he was treated for plantar fasciitis, which caused him to use crutches and a cane, in turn causing his abnormal gait to result in back problems. The Veteran's STRs indicate that in June 1979, the Veteran was treated for plantar fasciitis and used a cast and a cane. It was noted that the Veteran also spent approximately 8 weeks using crutches. It was also noted that he underwent physical therapy, injections, and still had increasing symptoms. The Veteran's September 1979 separation examination indicates that he was walking with a cane. There were no back problems noted. A January 1980 VA examination note indicates that the Veteran had low back pain for 6 months, which developed while he was using crutches and a cane while being treated for plantar fasciitis in service. It was noted that the Veteran had full range of motion, tenderness, and spasms. The Veteran was also noted to have knee pain. He was prescribed bed rest and pain medication. A February 1980 VA treatment note indicates that the Veteran complained of back pain. An October 1980 VA treatment note indicates that the Veteran complained of back pain, which radiated to both legs. It was noted that he sprained his back last Thursday, with this sprain being the most recent. A November 1980 VA treatment note indicates that the Veteran complained of sharp needle like pain in his lower back, which initially began one year ago when he was using crutches. There was tenderness to palpation over the L2-L3 area. He was diagnosed with a muscular strain and recurrent myalgia of the low back. An August 2000 private emergency note from Dr. G.M. indicates the Veteran reported injuring his lower back six months ago. It was noted that the Veteran did not have direct trauma, but instead had lower back cramping. The Veteran was prescribed pain medications. An October 2000 private treatment note indicates that the Veteran walked frequently with a cane. A November 2000 private treatment note from Dr. G.M. indicates that the Veteran was being followed in an outpatient setting for back pain when he developed progressive left lower extremity paresis. It was noted that an MRI showed a large disc herniation on the left and that the Veteran underwent hemilaminotomy for discectomy. It was noted that the Veteran was able to ambulate with physical therapy. A January 2012 private treatment note indicates that the Veteran injured his back two weeks ago during Tae-kwondo. His gait was noted to be normal. A February 2016 VA treatment note indicates that the Veteran had normal gait. However, a March 2016 VA treatment note indicates that the Veteran had abducted angle of base gait bilaterally. He also had overpronation of midfoot stance and toe off propulsion. A March 2016 letter from Dr. C.R. indicates that he treated the Veteran throughout 2002 and 2003. Dr. C.R. stated that the Veteran complained of bottom foot pain and had the condition for many years. Dr. C.R. indicated that the Veteran had plantar fasciitis and developed pain in his back from the way that he was walking. They also indicated that the Veteran had multiple back surgeries and that it is reasonable to suggest that the Veteran's plantar fasciitis is directly connected to the reoccurrence of disc herniation. In April 2016, the Veteran underwent a VA examination for his claim. He was diagnosed with a lumbar strain, IVDS, and lumbar degenerative joint disease. The Veteran reported onset of symptoms to be during service when he was treated for plantar fasciitis. He also reported his condition getting progressively worse and requiring two surgeries. Following a review of the records, the VA examiner concluded that it is less likely than not that the Veteran's back disability is related his service-connected plantar fasciitis. The VA examiner indicated that the idea of compensatory biomechanical strain in the lower back due ot a plantar fasciitis condition is unsubstantiated and that the overlap in function of these two anatomical regions is poor. The VA examiner described the function of the back and the feet and indicated that there may be some overlap, but it is not significant enough to establish causality. The VA examiner also noted that plantar fasciitis is of insufficient severity to result in increased biomechanical strain on the back. The VA examiner noted that the Veteran's back surgery records are missing, and that available records show that the Veteran's 2013 back flare up was due to a sports injury. A July 2016 VA treatment note indicates that the Veteran complained of back pain. He reported onset to be 1970's when he was treated for plantar fasciitis and used a walking boot in service. He indicated that this resulted in chronic back pain lasting for 30 years and requiring multiple surgeries. A March 2017 VA addendum medical opinion indicates that the Veteran's back disability was less likely than not caused by or aggravated by his service-connected plantar fasciitis and calcaneal spur. The VA examiner indicated that based on a review of the records, it is likely that the Veteran has lumbar strain, lumbar degenerative joint disease, and IVDS status post diskectomy in 1998 and 2002. The VA examiner noted that the Veteran's discharge examination did not contain complaints of back pain, despite the Veteran's November 1980 reports and his current reports of onset. The VA examiner also noted that no issues of back pain associated with plantar fasciitis or use of crutches were noted at discharge. The VA examiner also indicated that there is insufficient evidence to support a nexus or aggravation between the Veteran's back and his plantar fasciitis. The VA examiner could not determine the exact etiology of the Veteran's back condition. In January 2018, the Veteran underwent a VA examination for his back. He was diagnosed with a lumbar strain, lumbar degenerative joint disease, and lumbar IVDS. The Veteran reported onset of symptoms to be July 1979 when he was being treated for plantar fasciitis. The Veteran reported using a walking cast and having a change in gait. He reported the condition worsening, requiring three surgeries to his back and one to his hip. He reported flare ups, and difficulties with climbing, stooping, kneeling, and crouching. Following a review of the Veteran's records, the VA examiner concluded that it is less likely than not that the Veteran's back disability was incurred in or caused by service. The VA examiner indicated that the idea of a compensatory biomechanical strain in the lower back due to a plantar fasciitis condition is unsubstantiated and that the overall in function of these two anatomical regions is poor. The VA examiner also indicated that the back is responsible for bending, rotating, and bearing weight of the torso, while the feet are responsible for bearing the overall weight of the body and far more prominent role with the gait cycle. The VA examiner indicated that there may be some overlap, however it is not significant enough to establish a causality. The VA examiner also indicated that even if the Veteran had an abnormal gait, the mechanism as to how this would impact the Veteran's back is not clear as the lumbar spine continues to bear the weight of the torso regardless of the foot pathology. The VA examiner noted the Veteran's 2000 back surgery and indicated that it is just as reasonable to believe that the Veteran suffered a direct back injury at this time. With respect to abnormal gait, the VA examiner indicated that there are numerous treatment notes showing normal gait and that the Veteran did not have an abnormal gait during the VA examination. The VA examiner also concluded that it is less likely than not that the Veteran's back condition is aggravated beyond its natural progression by his plantar fasciitis and provided the same rationale for their conclusion. A June 2018 VA addendum opinion indicates that plantar fasciitis and calcaneal spur are not medically known to cause low back strain. The VA examiner indicated that a low back strain is a muscular condition in the lower back and that there is no medical evidence to support a finding that a low back strain is due to or secondary to the service-connected foot condition. The VA examiner also indicated that although the Veteran reported back symptoms since 1979, there was no mention of any back pain or issues during service and no mention of back pain associated with plantar fasciitis or foot pain. A December 2018 VA treatment note indicates that the Veteran had significantly antalgic gait. He was fitted for a walking cane. A May 2021 letter from Dr. C.R. indicates that he treated the Veteran for his plantar fasciitis in 2002. Dr. C.R. indicated that he reviewed all of the Veteran's records, including his STRs, his VA treatment records, and his private treatment records. Dr. C.R. indicated that it is their professional opinion that the Veteran had a significant change in gait due to his plantar fasciitis which caused a reoccurrence of disc herniation in the Veteran's back. Dr. C.R. indicated that at the time that they first treated the Veteran, the Veteran had a significant change in gait due to the pain from his plantar fasciitis, and that upon review of the evidence, the Veteran had complaints for his feet and back in service. Dr. C.R. indicated that this further supports their contention that the Veteran's plantar fasciitis is the cause of his back issues, as well as his knees and hips. Dr. C.R. opined that the Veteran's back and hip disabilities are a result of his plantar fascitis, which began in service. Dr. C.R. stated that this is best explained through the development of the Veteran's plantar fasciitis and kinematics, where the motion of the body can be disrupted when one part of the body suffers a long-term injury. Dr. C.R. stated that the Veteran's gait is severe and is the cause of the change in the points of motion for his legs, hips, and back. Based on the above, the evidence is at least in relative equipoise as to whether the Veteran's back disability had its onset in service. As such, service connection is warranted. The Veteran had a current diagnosis of lumbar strain, lumbar degenerative joint disease, and IVDS. This is most recently confirmed by the January 2018 VA examination report. Accordingly, the first element for establishing service connection, a currently disability, has been met. STRs show that the Veteran was treated for plantar fasciitis during service, requiring him to use a walking cast, crutches, and a cane. The Veteran's discharge examination showed that he was using a cane to walk at discharge. Thus, the second element for establishing service connection, an in-service injury, has been satisfied. The remaining question is whether there is a nexus between the Veteran's back disability and his in-service plantar fasciitis. As previously noted, here the evidence is at least in relative equipoise as to whether the Veteran's back disability had its onset in service. The probative medical evidence of record shows that the Veteran was treated for back pain within 6 months of discharge. A January 1980 VA treatment note indicates that the Veteran has had low back pain for 6 months, following using crutches and a cane in service. A February 1980, October 1980, and November 1980 VA treatment notes contain continued complaints of low back pain. Moreover, the Veteran's treating physician, Dr. C.R. submitted two medical opinions indicating that the Veteran's back disability developed during service as a result of having an abnormal gait due to plantar fasciitis. Dr. C.R. indicated that the Veteran had a severe gait, causing a change in the points of motion for his back. Dr. C.R. personally treated the Veteran, reviewed the Veteran's STRs, and provided a sound rationale for this opinion. Therefore, Dr. C.R.'s opinion is afforded probative value. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Contradictory opinions from April 2016, March 2017, January 2018, and June 2018 VA examiners indicated that the Veteran's back disability is not related to his service or his service-connected plantar fasciitis. The rationale for these opinions is essentially the same. The VA examiners indicated that the idea for compensatory biomechanical strain in the lower back due to a plantar fasciitis condition is unsubstantiated, that the Veteran's discharge examination is silent for back problems, and that even if there was a mechanism for which a foot condition could affect the lower back, the Veteran's plantar fasciitis is of insufficient severity to result in increased biomechanical back strain. Moreover, the VA examiners noted that the Veteran's VA treatment records indicate that he had normal gait. The April 2016, March 2017, January 2018, and June 2018 VA medical opinions are of diminished probative value. First, absence of diagnosis or treatment of a back disability in the Veteran's STRs is not adequate rationale for a negative nexus, because the lack of treatment, alone, cannot serve as the basis for a negative opinion. Particularly here, where the records show the Veteran having complaints of back pain less than 6 months after discharge. Moreover, the VA examiners indicate that there is no mechanism for which plantar fasciitis can cause a back disability, but also indicate that the Veteran's plantar fasciitis is of insufficient severity to cause a biomechanical back strain. This is internally inconsistent, as it is unclear whether it is medically impossible for the Veteran's plantar fasciitis to cause a back strain or that it is possible, and the Veteran's plantar fasciitis is not severe enough. Moreover, the former theory, that there is no mechanism, does not take into consideration Dr. C.R.'s private opinion that the Veteran's gait caused a change in the movement point for his back. In other words, that the Veteran's altered gait was the mechanism through which his back disability developed. The VA examiners indicated that the Veteran's records showed that he had normal gait and an active lifestyle. However, the Veteran's records also clearly indicate that he used crutches and a cane, and that he had an abnormal gait. Additionally, the Veteran reported using crutches and a cane in service, which is confirmed by his STRs. Accordingly, the VA medical opinions are of diminished probative value in this case. Additionally, the Veteran has consistently reported his back pain starting when he used crutches and a cane in service. The Veteran reported this in January 1980, during his VA examinations, throughout his VA treatment records, and during the Board hearing. While he is not competent to provide a diagnosis to which his back pain relates, he is certainly competent to attest to observable symptoms of back pain and there is no reason to doubt the Veteran in this regard. His statements are found to be credible and consistent, further showing that he suffered back pain shortly after discharge. These statements are also afforded probative value. In sum, the evidence is at least in relative equipoise as to whether the Veteran's back pain had its onset during service, regardless of whether it is as a result of the Veteran's altered gait while using crutches and a cane for his plantar fasciitis. The evidence consists of two positive private medical opinions by the Veteran's treating physician, the Veteran's consistent and competent reports of back pain having onset in service, the Veteran's VA treatment records confirming 1980 reports of in-service onset of back pain, and STRs as well as VA treatment records confirming abnormal gait due to plantar fasciitis. In other words, it is as likely as not that the Veteran's back disability had its onset in service. This is based on the Veteran's observable reports of back pain in service, treatments of back pain within 6 months of discharge, and the positive private medical opinions. Resolving all reasonable doubt in the Veteran's favor, his back disability had its onset in service. Accordingly, service connection is warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. Entitlement to service connection for left hip osteoarthritis. 4. Entitlement to service connection for right hip osteoarthritis. The Veteran contends that his bilateral hip osteoarthritis is caused by the altered gait that he had in service while being treated for plantar fasciitis. In addition to the pertinent evidence discussed above, the record contains the following. The Veteran's STRs are silent for any treatments or diagnosis for hip problems. A January 2012 private treatment note from Kaiser Permanente indicates that the Veteran complained of hip pain which had its onset two weeks ago. The pain was noted to start at sacrum and extend down the left leg with neuralgia. He was recommended home stretch exercises and follow up. A March 2014 private treatment note from Kaiser Permanente indicates that the Veteran presented with persistent right hip joint pain. The Veteran was described as a taekwondo martial artis. It was noted that the pain began in January, most notable with taekwondo. Onset was noted to be gradual. Aggravating factors were listed as prolonged sitting, taekwondo roundhouse kicks, FABER position, and walking. It was noted that he had reproducible internal rotation. He was noted to have a potential labral tear. An MRI was taken, showing no significant joint disease and no abnormality. An April 2014 private treatment note from Kaiser Permanente indicates that the Veteran presented with right hip pain due to femoroacetabular impingement with likely labral pathology, mixed type, which he has had for 5 months. It was noted that the Veteran attempted conservative treatment, including rest, physical therapy, and pain medications, all without success. It was also noted that this pain limited his activities significantly, and that given the failure of conservative treatment, the Veteran has elected to proceed with surgery. It was noted that an MRI was pending. A May 2014 private MRI report from Kaiser Permanente indicates that the Veteran had right anterior/superior labral tear, right femoral acetabular impingement, T2 hyperintensity noted laterally in left acetabulum, and small cyst in the center of the left femoral head. A July 2014 private preoperative report from Kaiser Permanente contains diagnosis of right hip impingement syndrome and right hip labral dear. It was noted that the Veteran was undergoing right hip arthroscopy, decompression and labral debridement repair. Postoperative report indicated that the Veteran was doing well with no redness or drainage. A March 2016 VA treatment note indicated that the Veteran's hip rotation was within normal limits. A September 2016 VA treatment note indicates that the Veteran had pain in both hips, worse on the right with prolonged standing. Right hip surgery was noted. It was noted that the Veteran may have early osteoarthritis. Treatment recommendations included low impact exercise, PT, and injections for pain. In December 2016, the Veteran underwent a VA examination for his claim. It was noted that he was diagnosed with bilateral hip osteoarthritis and bilateral hip strain in 2016. The Veteran reported developing hip pain during miliary service due to overuse, secondary to constant running and impact activities. The Veteran also reported his condition getting progressively worse and getting right hip labrum surgery in 2014. X-rays were performed, showing mild bilateral hip osteoarthritis with no evidence of acute fracture of dislocation. The VA examiner summarized the Veteran's records, including his 2014 private treatment records following his taekwondo injury. The VA examiner concluded that it is less likely than not that the Veteran's bilateral hip disability is related to his service-connected plantar fasciitis. For rationale, the VA examiner indicated that the Veteran's private treatment records illustrate that the Veteran's hip disability is related to taekwondo, and not his service-connected disabilities. The VA examiner also concluded that it is less likely than not that the Veteran's bilateral hip disability was aggravated beyond its natural progression by his plantar fasciitis as the evidence shows that the disability is instead related to taekwondo. An April 2017 VA treatment note indicates that the Veteran reported having plantar fasciitis in service with progressive worsening with knee, hip and lower back pain. Based on the above, the preponderance of the evidence is against the finding that the Veteran's bilateral hip osteoarthritis had its onset in service, manifested to a compensable degree within one year of discharge, or is otherwise causally related to the Veteran's service, to include service-connected plantar fasciitis. As such, service connection is not warranted. The Veteran's bilateral hip osteoarthritis did not have its onset in service and did not manifest as arthritis within one year of discharge. The Veteran's STRs, private treatment records, VA treatment records, and December 2016 VA medical opinion indicate that the Veteran's bilateral hip osteoarthritis did not have its onset until approximately 2016. Specifically, specifically, December 2016 x-rays confirm presence of early osteoarthritis. The March 2014 right hip x-ray ruled out arthritis. Moreover, there are no complaints of hip pain recorded until 2012. During the December 2016 VA examination, the Veteran reported having hip problems in service due to overuse secondary to running and impact activities. The Veteran also reported that the condition has gotten progressively worse since. However, the Veteran's records contradict these contentions. As previously noted, the Veteran's STRs are silent with respect to complaints or treatments for a hip disability. Moreover, there are no records of the Veteran having hip pain until January 2012, more than 30 years after discharge. Accordingly, the probative medical evidence of record shows that the Veteran's bilateral hip osteoarthritis did not have its onset in service and did not manifest to a compensable degree as arthritis within one year of discharge. The remaining question is whether there is a nexus between the Veteran's bilateral hip osteoarthritis and service. In this case, the Veteran contends that his bilateral hip osteoarthritis is related to his service-connected plantar fascitis. However, the Veteran's private treatment records from Kaiser Permanente and the December 2016 VA medical opinion show that the Veteran's disabilities are not related to service or his service-connected plantar fasciitis. Specifically, the Veteran's Kaiser Permanente records show that the Veteran's 2012 hip pain was linked to taekwondo. There is no mention of plantar fasciitis or altered gait. The December 2016 VA medical opinion indicates that the Veteran's bilateral hip osteoarthritis is less likely as not the result of bilateral plantar fasciitis and calcaneal spur based on a review of the Veteran's records and available medical literature. The VA examiner also concluded that the Veteran's plantar fasciitis did not aggravate the Veteran's bilateral hip osteoarthritis. The December 2016 VA examiner confirmed that a review of the Veteran's Kaiser Permanent records shows that the Veteran's bilateral hip pain is secondary to injuries related to taekwondo. The examiner also found no evidence establishing a nexus between the Veteran's bilateral hip osteoarthritis and plantar fasciitis. The December 2016 VA examiner reviewed the entire file and provided a full rationale for all conclusions reached. Moreover, these conclusions are supported by the record, particularly the Veteran's Kaiser Permanente records. Accordingly, the December 2016 VA medical opinion is afforded probative value. Of note, the March 2021 private medical opinion submitted by Dr. C.R. indicates that the Veteran's hip disabilities are related to his plantar fasciitis, which began in service. The opinion indicates that the Veteran complained of back and knee problems in service, and that those complaints were due to plantar fasciitis. The opinion also indicates that the Veteran's gait is severe and is due to a change in points of motion of his legs, hips, and back. Essentially, similarly to the back disability, Dr. C.R. concludes that the service-connected plantar fasciitis caused a change in gait, which caused the Veteran's bilateral hip osteoarthritis. In this case, Dr. C.R.'s conclusion is not afforded probative value with respect to the hips. As previously noted, the Veteran's STRs, private treatment records from Kaiser Permanent, and December 2016 VA examination report all show that his bilateral hip osteoarthritis did not have its onset until at least 2012, and that his hip pain was secondary to his taekwondo practice. In other words, while Dr. C.R. concluded that the Veteran's plantar fasciitis caused his hip disabilities, the record shows otherwise. It is recognized that probative value was afforded to Dr. C.R.'s opinion regarding the Veteran's back, but not the Veteran's hips. This is because in the case of the Veteran's back disability, the record supported Dr. C.R.'s conclusions, whereas here, it does not. As previously noted, the Veteran's VA treatment records show that he complained and was treated for back pain within 6 months of service. The Veteran consistently reported his altered gait causing back pain since. This is not the case with respect to the Veteran's claim for bilateral hip ostearthritis. There are no records of hip pain until 2012. Contrary to Dr. C.R.'s contentions, the Veteran's Kaiser Permanent records show that the Veteran's hip problems were associated with his taekwondo practice, not plantar fasciitis. Thus, as the probative medical evidence of record contradicts the Dr. C.R.'s May 2021 conclusion regarding the Veteran's bilateral hip osteoarthritis, the opinion is not afforded probative value. With respect to the Veteran's sincere belief that his current bilateral hip osteoarthritis is related to his plantar fasciitis, the Veteran is not competent to provide a medical nexus opinion as to a relationship between his current disability and service; or, any other service-connected disability. This requires medical expertise and falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). In this regard, any actual diagnosis of a hip disability, causation between service and disability, and causation between plantar fasciitis and hip disability requires objective testing and medical expertise to diagnose. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To the extent that the Veteran believes that his current bilateral hip osteoarthritis is caused or aggravated by his service-connected plantar fasciitis, as a lay person, he is not shown to possess any specialized training in the medical field. The Veteran is not deemed competent to know the cause of bilateral hip arthritis, as this is an internal physiological process that requires medical expertise. Accordingly, the Veteran's opinion as to the nexus in this case is not competent evidence. Id. In sum, the preponderance of the evidence is against a finding that the Veteran's bilateral hip osteoarthritis had its onset in service, manifested as arthritis within one year of discharge, or is otherwise causally related to service, to include service-connected plantar fasciitis. Accordingly, the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application, and service connection is not warranted. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kuksova, Kseniya 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.