Citation Nr: 22048632 Decision Date: 08/26/22 Archive Date: 08/25/22 DOCKET NO. 15-11 299 DATE: August 26, 2022 ORDER Service connection for a bilateral hip condition to include secondary to a service-connected lumbar disability is denied. FINDING OF FACT The evidence of record does not support a finding that the Veteran's bilateral hip condition was causally related to his service, or that it was caused or aggravated by his service-connected lumbar spine disability. CONCLUSION OF LAW The criteria for service connection for a bilateral hip condition to include as secondary to a service-connected lumbar disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1967 to October 1969. This matter is on appeal from a February 2014 rating decision. This matter was last remanded by the Board of Veterans' Appeals (Board) in February 2022 for a VA examination and medical opinion. Service connection for bilateral hip condition is denied. Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service. Secondary service connection may also be established for a disability which is caused or aggravated by a service-connected disability. To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran's service treatment records indicate that he fell during service resulting in transient sciatic pain in both legs. The Veteran underwent an x-ray in October 1967. The attending physician indicated that the Veteran had a very slight degree of scoliosis with a slight tilt of the pelvis. The Veteran underwent a VA examination in November 2021 and was diagnosed with residuals of osteoporosis and ankylosed hip joints bilaterally. The Board finds that the November 2021 VA medical opinions contain multiple deficiencies that renders them inadequate. Initially, the examiner's negative direct service connection opinion ignores the Veteran's statements regarding a continuity of hip pain since a documented in-service injury during active duty in October 1967 when the Veteran fell during basic training exercises with a 70-pound pack on his back. Next, the examiner's negative aggravation opinion with respect to secondary service connection was based on the inaccurate factual premise that there were no service treatment records (STRs) available to review when there were STRs. associated with the claims file when this opinion was authored. Moreover, the negative aggravation finding was not supported by any rationale or explanation. In addition, the examiner's negative opinion regarding proximate causation of bilateral hip disabilities by a service-connected lumbar spine disability is conclusory and is not supported by a rationale. Further, the examination report indicates that the Veteran was physically unable to undergo hip x-rays which appears to have been inappropriately weighed as negative evidence in the medical opinion. The mere absence of evidence does not equate to unfavorable evidence. See Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (en banc) (cautioning that negative evidence, meaning actual evidence weighing against a party, must not be equated with the absence of substantive evidence). In February 2022, and as a result of the deficiencies in the November 2021 VA examiner's opinion, the Board remanded the claim to have another VA physician provide an opinion on the direct and secondary theories of the claim. In April 2022, a VA physician submitted a disability benefits questionnaire in which they opined that it was less likely than not that the Veteran's bilateral hip condition was causally related to his service. As a rationale, the physician explained that osteoporosis is a bone resorption process which has its onset around the 6th decade of life when bone remodeling begins to decline from age-related hormonal decline. The physician explained that there is no medical chance or likelihood that the Veteran's bilateral hip condition had its onset during service. The physician further opined that the Veteran's ankylosis of the hips is due to age-related joint proximation and breakdown. The physician explained that there is no record of such a disorder in the Veteran's service treatment records or post-service treatment records for several decades following separation. The physician acknowledged that the Veteran fell during service but explained that falls do not cause bone resorption which occurs in older in older adults in their 50s and 60s and also did not cause arthritis related ankylosis. The physician also acknowledged the October 1967 service treatment record (STR), wherein the examining physician indicated that the Veteran had lumbar scoliosis with a pelvic tilt and clockwise rotation of the 5th lumbar vertebra. However, the physician explained that the Veteran's spina bifida and lumbar scoliosis with tilt are congenital conditions and would not cause bone resorption and lead to osteoporosis, nor would it cause the ankylosis which would result from chronic arthritis. The April 2022 VA physician also opined that it was less likely than not that the Veteran's bilateral hip condition was caused or aggravated beyond its natural progression by his lumbar spine disability. As a rationale, the physician reiterated that that osteoporosis is a bone resorption process which has its onset around the 6th decade of life when bone remodeling begins to decline from age-related hormonal decline and that ankylosis of the hips is due to age-related joint proximation and breakdown. The physician explained that there is no medical chance or likelihood that this process could be caused or aggravated by a back injury. The physician also explained that the Veteran's spina bifida and lumbar scoliosis with tilt are congenital conditions which would not aggravate bone resorption and lead to osteoporosis, nor would it aggravate the ankylosis which would result from chronic arthritis. The record indicates that the Veteran has a current diagnosis of a bilateral hip condition. The Veteran's STRs indicate that he fell and injured his back during service. What remains for consideration is whether the Veteran's bilateral hip condition is causally related to his service, or is secondary to the service-connected lumbar spine disability. The Board assigns probative value to the April 2022 VA physician's opinion that it is less likely than not that the Veteran's bilateral hip condition was causally related to his service. The Board notes that the physician supported their opinion with a rationale and provided an explanation as to the cause of the Veteran's bilateral hip condition. Turning to the theory of secondary service connection, the Board also assigns probative to the April 2022 VA physician's opinion that it is less likely than not that the Veteran's bilateral hip condition was caused or aggravated beyond its natural progression by his service-connected lumbar spine disability because it is supported their opinion with a rationale. The April 2022 VA examiner's opinion is well-reasoned and is against the claim on both the direct and secondary service connection theories of the claim. There is no other opinion that it is supportive of any theory of the claim. Although the Veteran believes that his bilateral hip condition was related to his in-service fall and service-connected lumbar spine disability, he is not competent to make such a determination. As a lay person the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of his bilateral hip condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board finds that the weight of the evidence of record is against a finding that the Veteran's bilateral hip condition was causally related to his service or that it was caused or aggravated by his service-connected lumbar spine disability. As such, service connection for a bilateral hip disability is be denied. Carole R. Kammel Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexander Bahus 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.