Citation Nr: 25001985 Decision Date: 02/11/25 Archive Date: 02/11/25 DOCKET NO. 20-15 166 DATE: February 11, 2025 ORDER Service connection for a right hip disorder is denied. Service connection for a left hip disorder is denied. REMANDED Service connection for temporomandibular joint disorder (TMJ). FINDINGS OF FACT 1. The Veteran served on active duty from May 2013 to June 2017. 2. The Veteran had complaints of right and hip pain in service; the symptoms were not shown to be chronic, the current bilateral hip disorders, diagnosed as hip tendonitis, are not causally or etiologically related to service, and were not caused by or permanently worsened in severity by a service-connected disability. CONCLUSIONS OF LAW 1. A right hip disorder was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2024). 2. A left hip disorder was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2024). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In August 2021, the Veteran testified at a hearing held before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In November 2023, the Board denied service connection for TMJ and remanded service connection for a right hip disorder and a left hip disorder. The Veteran appealed to the Veterans Claims Court. In September 2024, the Court Clerk granted a Joint Motion for Partial Remand (JMPR) which vacated the denial for service connection for TMJ and remanded the matter back to the Board for action in compliance with the JMPR. In addition, the development has been completed for the hip disorders. As such, all the claims now return for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F. 3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran contends that right and left hip disorders were incurred in service or in the alternative that they are secondary to service-connected disabilities. Turning to the evidence, a July 2018 VA examiner diagnosed bilateral hip tendonitis. Therefore, the first element of service connection is met. As to in-service incurrence, service treatment records (STRs) reflect complaints of cramps in legs and mild joint/muscle pains in May 2017. On a May 2017 separation Report of Medical Examination, the clinical evaluation of the lower extremities was normal. A May 2017 separation Report of Medical History noted "numbness and tingling interment L leg associated w/ back pain. eval by PCM. no further tx." A May 2017 Report of Medical Assessment reflected that the Veteran suffered from "cramps in legs" on active duty for which she did not seek medical care. Nonetheless, as there were complaints related to the lower extremities in service, the second element of service connection is met. As to nexus, in July 2018, the VA examiner diagnosed bilateral hip tendonitis but did not provide any opinion as to the etiology. On remand, a July 2024 VA examiner opined that the bilateral hip disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner acknowledged that the Veteran's May 2017 separation Report of Medical History noted "numbness and tingling interment L leg associated w/ back pain" and the May 2017 Report of Medical Assessment reflected that the Veteran suffered from "cramps in legs." However, the examiner explained no diagnosis of a hip condition was made and there was no objective evidence of chronic hip pain/condition during service. Additionally, the examiner indicated that symptoms of cramps in the legs were not consistent with tendonitis of the hips and mild joint pain/muscle aches were vague symptoms which did not directly correlate to bilateral hip pain. Further, the examiner noted the Veteran's August 2017 statement that she started experiencing pain in the left thigh, lower back, and knees while on active duty, but the examiner explained that the Veteran did not mention hip pain at the time and there was no formal diagnosis of left thigh pain. Additionally, the examiner noted that the Veteran was diagnosed with bilateral hip tendonitis on the July 2018 VA examination, approximately 11 months after separation from service. However, the examiner explained that symptoms of cramps in the legs were not consistent with tendonitis of the hips and mild joint pain/muscle aches were vague symptoms which did not directly correlate to bilateral hip pain. A September 2024 VA examiner similarly opined that the bilateral hip disorder was less likely than not caused by an in-service complaint of cramps in legs and mild joint/muscle pains in May 2017. The examiner noted that the Veteran's May 2017 separation Report of Medical History noted "numbness and tingling interment L leg associated w/ back pain", a May 2017 Report of Medical Assessment reflected that the Veteran suffered from "cramps in legs" and swollen and painful joints were reported as bilateral knees for two years, aches, and pains without hip pain. The examiner explained that hip tendonitis was caused by inflammation or irritation of the tendon in the hip, which often developed when a person overused the muscles in the hip. They further noted that the STRs did not document any complaints or treatments for bilateral hip pain which was consistent with the post- service diagnosis of hip tendonitis in 2018. The examiner indicated that the May 2017 separation Report of Medical History noting numbness and tingling in the left leg were associated with back pain. Further, she explained that the medical literature did not support cramps in legs as a cause of hip tendonitis. Moreover, they noted that hip tendonitis could happen to anyone but usually occurred in athletes or those that were more active and risk factors included overuse, wear and tear, injury, strain, and too much exercise. T here are no conflicting medical opinions of record related to direct service connection. As such, the medical evidence does not support service connection for a bilateral hip disorder on a direct basis. Next, the Veteran contends that a bilateral hip disorder is related to service-connected bilateral lower extremity sciatic nerve radiculopathy, bilateral metatarsalgia of the feet, degenerative disc disease (DDD) with lumbar facet arthropathy, and bilateral knee chondromalacia patella. Therefore, the Board will address secondary service connection. As noted, the Veteran has been diagnosed with bilateral hip tendonitis. Further, they have been service-connected for bilateral lower extremity sciatic nerve radiculopathy, bilateral metatarsalgia of the feet, DDD with lumbar facet arthropathy, and bilateral knee chondromalacia patella. Therefore, the second element of secondary service connection has also been met. As to a medical nexus between the service-connected disabilities and a bilateral hip disorder, the September 2024 VA examiner opined that the bilateral hip disorder was less likely than not proximately due to or the result of the service-connected disorders. The examiner explained there was no clear evidence from review of the orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5 centimeters (cm.) so that the individual's gait pattern had been altered to the extent that clinically there was an obvious Trendelenburg gait. They noted that this level of severity was not supported based on record review, history or examination and it was not unusual for two joints to share properties in the same person, but one joint's disease did not "spread" to another or cause damage to it. They explained that the medical records were silent for Trendelenburg gait and leg length discrepancy due to the service-connected disabilities. As to aggravation, the September 2024 VA examiner found that the bilateral hip disorders were less likely than not aggravated beyond normal, natural, progression by the service-connected disabilities. They explained that the medical records were silent for aggravation of the bilateral hip disorders beyond the natural progression by the service-connected disabilities and there was no chronic bilateral hip disorder noted in the medical records. There is no contradictory medical evidence of record. Thus, the weight of the medical evidence shows that a bilateral hip disorder was not caused by, aggravated by, or worsened in severity by service-connected disabilities. Therefore, the medical evidence weighs persuasively against the appeals. The Board has considered the Veteran's statements and testimony that the current bilateral hip disorders were caused by service. While she is competent to report symptoms and competent to describe her observations as this requires only personal knowledge as it comes to her through her senses, she is not competent to offer an opinion as to the etiology of the current disorder due to the medical complexity of the matter involved. Specifically, the Veteran's statements about pain in the bilateral hips do not describe symptoms of a particular disorder of the hips or suggest a particular etiology of any such disorder. Such competent evidence concerning the nature and extent of the bilateral hip disorder has been provided by the medical personnel who examined her during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations. These findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disorders are evaluated. The VA medical professionals explained their reasoning based on an accurate characterization of the evidence. Therefore, the Board attaches greater probative weight to the clinical findings than to her lay statements regarding etiology. In sum, after a careful review of the record, the evidence weighs persuasively against the claims for service connection and there is no doubt to be resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND With respect to the appeal for service connection for TMJ, a remand is required for further development. Pursuant to the JMPR, a new medical opinion is required to determine the etiology of the disorder. The matter is REMANDED for the following actions: 1. Identify and obtain any outstanding, pertinent, VA and private treatment records and associate them with the claims file. 2. Direct the claims file to a clinician to address the etiology of TMJ. Applying general medical principles, the clinician's experience, and the Veteran's lay statements, the clinician is asked to address the following: " What is the medical probability (that is, likelihood is at least approximately balanced or nearly equal, or higher) that TMJ diagnosed since at least 2018 was due to or caused by an in-service complaint of pain in the lower jaw after the Veteran bumped her jaw and broke a tooth in February 2016 and/or an in-service complaint of cold sensitivity and a history of head trauma to the lower jaw in a November 2016 Endodontic Evaluation? It would be helpful to the Board if the clinician could explain why the medical evidence is either consistent with or inconsistent with a finding that TMJ is related to an in-service complaint of pain in the lower jaw after she bumped her jaw and broke a tooth and/or an in-service complaint of cold sensitivity and a history of head trauma to the lower jaw, including whether the Veteran's reports about his symptoms align with how TMJ is known to develop. 3. A rationale for all opinions must be provided. 4. An examination need not be scheduled unless the clinician cannot answer the questions presented without one. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Oettle, Teresa I. 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.