HIP IMPAIRMENT OF

Summary

The veteran, who served in the United States Marine Corps from April 1972 to May 1999, appeals the denial of service connection for bilateral hip conditions claimed as secondary to his service-connected lumbar spine degenerative changes. The veteran contended that a helicopter accident during service in 1972 caused his hip and back injuries. However, the Board found that the preponderance of the evidence did not support a service connection for the hip conditions. The veteran's service treatment records did not mention any hip problems, and he did not report hip pain on a January 1999 report of medical history. While later medical records from 2004 onwards documented degenerative changes in his hips, the Board found these were likely related to aging and occupational stresses, not service. The Board gave more weight to a September 2014 VA examination, which opined that the bilateral hip osteoarthritis was less likely than not proximately due to or aggravated by the service-connected lumbar spine condition. The examiner noted no history of hip fracture and stated there was no objective evidence of nexus between the hip arthritis and the back condition. The Board acknowledged the veteran's lay testimony about the 1972 accident but found lay witnesses incompetent to opine on medical etiology. Consequently, service connection for both the left and right hip conditions was denied.

Rationale

No in-service complaints, findings, or treatment for hip condition.; No hip problems reported on separation examination.; VA examiner opined less likely than not proximately due to or aggravated by lumbar spine condition.; Examiner noted primary osteoarthritis likely related to aging/stress, not back condition.

Full Decision Text

Citation Nr: 19102667
Decision Date: 01/10/19	Archive Date: 01/10/19

DOCKET NO. 17-10 134
DATE:	January 10, 2019

ORDER

Entitlement to service connection for a left hip condition as secondary to the service-connected disability of lumbar spine degenerative changes is denied.

Entitlement to service connection for a right hip condition as secondary to the service-connected disability of lumbar spine degenerative changes is denied.

FINDINGS OF FACT

1. The Veteran’s left hip condition as secondary to the service-connected disability of lumbar spine degenerative changes did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease.

2. The Veteran’s right hip condition as secondary to the service-connected disability of lumbar spine degenerative changes did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left hip condition as secondary to the service-connected disability of lumbar spine degenerative changes are not met.  38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.310.

2. The criteria for service connection for a right hip condition as secondary to the service-connected disability of lumbar spine degenerative changes are not met.  38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from April 1972 to January 1981 and from January 1981 to May 1999.  The Veteran is the recipient of the National Defense Service Medal, the Navy/Marine Corps Achievement Medal, the Joint Service Commendation Medal, the Humanitarian Service Medal, the Good Conduct Medal, the Overseas Service Ribbon, and the Sea Service Deployment Ribbon.

This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA), which denied entitlement to service connection for the Veteran’s left hip condition and right hip condition as secondary to the service-connected disability of lumbar spine degenerative changes.

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. § 1131; 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); 38 C.F.R. § 3.303.

Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause.  38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Service connection may also be granted when a claimed disability is found to be proximately due to or the result of a service-connected disability or when any increase in severity (aggravation) of a nonservice-connected disease or injury is found to be proximately due to or the result of a service-connected disability.  However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at
 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Service connection may also be granted when a claimed disability is found to be proximately due to or the result of a service-connected disability or when any increase in severity (aggravation) of a nonservice-connected disease or injury is found to be proximately due to or the result of a service-connected disability.  However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury.  38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). 

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence.  Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to service connection for a left hip condition as secondary to the service-connected disability of lumbar spine degenerative changes is denied.

2. Entitlement to service connection for a right hip condition as secondary to the service-connected disability of lumbar spine degenerative changes is denied.

The Veteran contends that he has a left hip condition and right hip condition as secondary to his service-connected disability of lumbar spine degenerative changes. 

The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by service-connected disability.

The Board concludes that, while the Veteran has a current diagnosis of bilateral hip joint osteoarthritis, the preponderance of the evidence is against finding that the Veteran’s bilateral hip joint osteoarthritis is proximately due to or the result of, or aggravated beyond its natural progression by the Veteran’s service-connected lumbar spine degenerative changes.  38 U.S.C. § 1110; Allen, 7 Vet. App. at 448; 38 C.F.R. § 3.310(a). 

A review of the Veteran’s service treatment records does not reflect any complaints, findings, or treatment for any conditions related to a hip condition.  The Veteran did not report any hip problems on a January 1999 report of medical history.  A January 1999 report of medical examination does not report any problems with the Veteran’s hips.  

A radiology report from May 2000 reported that the Veteran’s hip joints appeared intact.  A June 2004 radiology report showed no significant joint space narrowing or osteophyte formation in the Veteran’s hips.  

A November 2004 medical record reported that the Veteran was injured in a motor vehicle accident on November 13, 2004 and was experiencing hip pain.  

A January 2007 medical record reported bilateral degenerative changes to the Veteran’s hips.  A May 2007 radiology report documented moderate degenerative changes in the Veteran’s right hip.  Radiographic imaging taken in January 2013 and May 2014 showed moderate to severe bilateral degenerative changes of the hips.

The Veteran was afforded a VA examination in September 2014.  The Veteran reported that the pain from his back radiating to his hips began years ago.  He reported back pain radiating into his hips and bilateral groin pain when changing positions or standing up from a sitting position.  The examiner opined that the claimed bilateral hip osteoarthritis was less likely as not (less than 50/50 probability) proximately due to or the result of, or aggravated by degenerative changes of the lumbar spine.  As rationale, the examiner provided the following:  

There is no scientific/medical data to support a claim that back conditions cause primary osteoarthritis of the hip [or any other] joints.  Primary osteoarthritis is different from secondary arthritis which occurs after fracture or other similar major bone violation and generally appears within ~2-3 years of the fracture.  There is no history of hip fracture in this case.  Primary osteoarthritis of hip joints, as in this case, is
 examiner opined that the claimed bilateral hip osteoarthritis was less likely as not (less than 50/50 probability) proximately due to or the result of, or aggravated by degenerative changes of the lumbar spine.  As rationale, the examiner provided the following:  

There is no scientific/medical data to support a claim that back conditions cause primary osteoarthritis of the hip [or any other] joints.  Primary osteoarthritis is different from secondary arthritis which occurs after fracture or other similar major bone violation and generally appears within ~2-3 years of the fracture.  There is no history of hip fracture in this case.  Primary osteoarthritis of hip joints, as in this case, is likely related to aging and daily/occupational stresses/strains, genetic propensity, etc.  Veteran is confusing referred symptoms from his back into his BLE [he is SC for back and BLE radiculopathy] as hip arthritis, but that is completely separate/different from the hip joint arthritis [which usually causes groin pain on weight bearing or when putting increased pressure during change of position from sit to stand].  There is no objective evidence of nexus in terms of cause/aggravation, between claimed bilateral hip arthritis and SC back condition.

In January 2017, the Veteran submitted a VA Form 9 in which he reported that his hips and lower back were severely injured in 1972 during helicopter operations at a landing zone at Camp Lejeune, North Carolina.  According to the Veteran, wind from the rotors of a helicopter blew him off a utility truck, causing a hard landing onto his hips and lower back.  He stated that this accident was how he injured his hips and lower back.  The Veteran indicated that he complained about pain in his hips and lower back until total replacements were required...

As previously described, the Veteran’s service treatment records show no evidence of treatment or diagnosis for a hip injury.  Furthermore, at his discharge in January 1999, the Veteran did not report any hip pain.  The earliest evidence of hip pain was the Veteran’s report of experiencing hip pain after a motor vehicle accident in November 2004, more than five years after the Veteran’s discharge from service.  

The Board acknowledges the Veteran’s contentions that his hip pain is related to service or to his service-connected lumbar spine degenerative changes.  While the Veteran is competent to report symptoms observable to a layperson, such as pain, to the extent that she seeks to establish a nexus between a current disability and service or onset in service, the Board finds lay witnesses are not competent to opine on such medical questions of etiology as this requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  For this purpose, the Board finds the Veteran’s statements are not competent medical evidence.  

Consequently, the Board gives more probative weight to the September 2014 VA examination report.  The examiner opined that the Veteran’s bilateral hip osteoarthritis was less likely as not (less than 50/50 probability) proximately due to or the result of, or aggravated by degenerative changes of the lumbar spine.  Because the examiner found no evidence of a hip fracture, she characterized the Veteran’s osteoarthritis as primary arthritis rather than secondary arthritis, which occurs after a fracture and generally appears within two to three years of the fracture.  The examiner explained that there is no medical data to support a claim that back conditions cause primary osteoarthritis of the hip and that the Veteran’s osteoarthritis of his hip joints is likely related to aging and daily occupational stresses and strains, and genetic propensity.  Moreover, the examiner concluded that there was no objective evidence of nexus in terms of cause or aggravation between the Veteran’s hip arthritis and his service-connected back disability.  Furthermore, the Veteran did not provide any medical evidence indicating a link between the Veteran’s bilateral hip arthritis and his service-connected back disability.  

A preponderance of the evidence indicates that the current disability of bilateral osteoarthritis of the hips is unrelated to an in-service injury, and that the arthritis did not manifest within the first year of discharge from service.   Thus, there is no evidence of the Veteran having met the criteria for a compensable rating for bilateral osteoarthritis of the hips within one year after service.  38 C.F.R. §§ 3.307, 3.309. 

Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for both a left hip condition and a right hip condition on either a direct, secondary or presumptive basis.  In reaching this conclusion, the Board has considered
oarthritis of the hips is unrelated to an in-service injury, and that the arthritis did not manifest within the first year of discharge from service.   Thus, there is no evidence of the Veteran having met the criteria for a compensable rating for bilateral osteoarthritis of the hips within one year after service.  38 C.F.R. §§ 3.307, 3.309. 

Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claims for service connection for both a left hip condition and a right hip condition on either a direct, secondary or presumptive basis.  In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant.  See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).  Service connection has not been established and the Veteran’s claim for a left hip condition and a right hip condition must be denied.

 

 KELLI A. KORDICH

Veterans Law Judge

Board of Veterans’ Appeals

ATTORNEY FOR THE BOARD	T. Moore, Associate Counsel