Citation Nr: A25035364 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 220125-214626 DATE: April 16, 2025 ORDER Entitlement to service connection for a left hip disability is granted. Entitlement to service connection for a right hip disability is granted. FINDINGS OF FACT 1. Affording the Veteran the benefit of the doubt, his left hip disability is related to his in-service hip pain. 2. Affording the Veteran the benefit of the doubt, his right hip disability is related to his in-service hip pain. CONCLUSIONS OF LAW 1. The criteria for service connection for a left hip disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for a right hip disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from September 2010 to June 2015. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A June 2021 rating decision denied entitlement to service connection for left and right hip disabilities. The Veteran requested a higher-level review in June 2021. Although the Veteran initially requested higher-level review, the higher-level adjudicator determined that there had been a duty to assist error and transferred the claim to the supplemental claim decision review option for additional development. After additional evidentiary development, a November 2021 rating decision readjudicated and denied service connection for left and right hip disabilities. In the January 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the November 2021 agency of original jurisdiction (AOJ) supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20303. If evidence was submitted either (1) during the period after the AOJ issued the supplemental claim decision on appeal and prior to receipt of the VA Form 10182, or (2) more than 90 days following receipt of the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) 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. Entitlement to service connection for a left hip disability. 2. Entitlement to service connection for a right hip disability. The Veteran contends that he is entitled to service connection for left and right hip disabilities, either as secondary to his service-connected back disability or as directly related to service. As the Board is granting service connection on a direct basis, secondary service connection will not be addressed in this decision. Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection on a direct basis generally requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. This standard does not require the evidence to be exactly equal; rather, it includes "scenarios where the evidence is not in equipoise but nevertheless is in approximate balance. Put differently, if the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt." Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). As an initial matter, the November 2021 rating decision favorably found the Veteran had current diagnoses of left and right hip trochanteric pain syndrome and that his service treatment records documented in-service bilateral hip pain. The Board is bound by these favorable findings, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable findings. See 38 C.F.R. §§ 3.104 (c), 20.801(a). The Board has found the favorable findings are supported by the medical and lay evidence, as discussed in greater detail below. The remaining issue, therefore, is whether there is a causal connection between the Veteran's current left and right hip trochanteric pain syndrome and his documented in-service hip pain. Beginning with the lay evidence of record, the Veteran detailed the onset, duration, and features of his left and right hip disabilities in a January 2022 statement. He reported he began experiencing hip pain and numbness in early 2015 and that the pain has been constant since then without intervening hip injuries. He explained he did not pursue further medical treatment for his hips after his initial complaints because his treatment providers were more focused on treating and reducing the more severe back pain. He reported he has been attempting to treat his hip difficulties through massage therapy, chiropractic treatment, and acupuncture after he had a major flare-up while at work in 2018. The Board finds significant probative value in the Veteran's credible testimony of the onset and continuity of his symptoms. As a lay person, the Veteran is competent to establish the onset and duration of observable symptomatology, such as pain and numbness. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Additionally, the Board finds the Veteran's statements to be credible. The Veteran's reports of the onset and nature of his symptoms are internally consistent with the medical evidence and his statements to VA medical examiners, discussed in further detail below. His explanation for not pursuing further medical treatment for his hips immediately following service is consistent with the evidence of record. VA treatment records show he sought treatment for his back pain beginning in July 2015, and a July 2015 rating decision granted service connection for a lumbosacral strain, effective the date following his separation from service. Turning to the medical evidence of record, the Veteran's June 2009 entrance examination and report of medical history show he denied a history of swollen or painful joints. The examiner marked the Veteran's lower extremities as normal, with the exception of observed mild genu recurvatum, or knee hyperextension. The Veteran denied joint problems twice more during service, in August 2011 and February 2013. He was medically separated from service for a different service-connected condition in June 2015, but an April 2015 service treatment record notes he told a medical provider that there were multiple complaints, including hip pain, that had not been addressed because he had been too proud to bring them up The Veteran's post-service treatment records do not document hip-specific complaints immediately following service, but a July 2015 VA treatment record notes he had back and leg pain. The Veteran underwent a VA examination in April 2021. The examiner diagnosed left and right trochanteric pain syndrome. The Veteran informed the examiner that he began experiencing hip symptoms during service due to heavy lifting, being confined spaces, and long working hours. He described the symptoms as soreness and tightness with decreased range of motion and painful flareups about twice per week. In a May 2021 opinion, the examiner opined the hip disability was not secondary to the Veteran's service-connected back disability, but did not provide an opinion on whether the bilateral hip disability was directly related to service. In response to the Veteran's request for a higher-level review, the AOJ requested an addendum opinion on whether the diagnosed left and right hip disabilities were directly related to service. In a September 2021 addendum opinion, a different examiner opined the left and right hip disabilities were less likely than not incurred in service or caused by the claimed in-service injury. The examiner explained: Upon review of medical records, service treatment records were silent for complains/issues events, medical evaluation/ diagnosis and treatment for the bilateral hip condition. Veteran only reports knee/hip pain upon separation 4/2015 without further evaluation. Post service records did not show chronic bilateral hip pain. Veteran was seen and examined at the recent VA hip and thigh condition examination and showed physical examination findings of bilateral trochanteric pain syndrome. Over[]all review of medical records showed limited medical objective evidence[] to show onset and chronic bilateral hip condition in relation to service. Hence, a nexus cannot be endorsed at this time. The Board finds that the September 2021 opinion is inadequate, as it relies solely on the lack of contemporaneous medical records showing hip pain during and after service, despite the credible lay evidence described above. See Buchanan v. Nicholson, 451 F.3d 1331, 1336, n.1 (Fed. Cir. 2006). The examiner failed to consider the Veteran's competent and credible statements that his hip pain began during service and continued to the present. See Layno v. Brown, 6 Vet. App. 465, 471 (1994). The examiner also relied on a lack of treatment records after separation from service but failed to address the July 2015 VA treatment record that documented leg pain. In sum, the opinion failed to consider competent and credible evidence that the Veteran's hip pain began during service, was reported just prior to separation, and continued to the present with non-clinical attempts at treatment. Accordingly, the Board finds the opinion to be invalid and assigns it no probative weight. Buchanan, 451 F.3d at 1336, n.1 (stating that an examiner's opinion failed to consider whether the lay statements presented sufficient evidence of the etiology of the Veteran's disability such that his claim for could be proven without contemporaneous medical evidence). The Board could remand the claim for another medical opinion, but a request for another opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304 (c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim"). In the circumstances of this case, the documented report of hip pain prior to separation and the competent and credible lay statements of hip pain beginning during active service and continuing since separation are sufficient to place the evidence in relative equipoise as to whether the Veteran's current left and right hip disabilities are related to service. Buchanan, 451 F.3d at 1335 ("[N]othing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself"). For the reasons set forth above, the evidence is at least evenly balanced as to whether the Veteran's left and right hip disabilities had their onset in service. The Board will, therefore, resolve the benefit of the doubt in the Veteran's favor and award service connection for the Veteran's left and right hip disabilities. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. William Skowronski Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Utter, Margaret M. 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.