HIP IMPAIRMENT OF

Summary

The Veteran, an Army veteran who served from October 1959 to October 1962, appeals the denial of service connection for bilateral hip osteoarthritis, claimed as secondary to his service-connected lumbar spine degenerative arthritis. The Veteran contends that radiating pain from his lumbar spine disability causes his hip pain and mobility issues. The Board acknowledged the Veteran's current diagnoses of mild bilateral hip osteoarthritis and his service connection for lumbar spine degenerative arthritis. However, after reviewing the evidence, the Board found that the Veteran's reported hip pain, weakness, and balance problems were not caused by or aggravated by his service-connected lumbar spine condition. Instead, the Board determined these symptoms were manifestations of the separately service-connected lumbar radiculopathies, which cause radiating pain and impaired mobility. The Board concluded that granting separate service connection for hip osteoarthritis would constitute pyramiding, as the symptoms are duplicative of those already compensated for the radiculopathies. Therefore, the Board denied service connection for the bilateral hip osteoarthritis, finding the preponderance of the evidence against the claim.

Rationale

Current diagnosis of mild left hip osteoarthritis; Service-connected for lumbar spine degenerative arthritis; Symptoms attributed to lumbar radiculopathies, not hip joints; Granting would result in pyramiding

Full Decision Text

Citation Nr: 21019334
Decision Date: 04/01/21	Archive Date: 04/01/21

DOCKET NO. 18-51 207
DATE: April 1, 2021

ORDER

Service connection for left hip osteoarthritis, as secondary to the service-connected degenerative arthritis of the lumbar spine, is denied.

Service connection for right hip osteoarthritis, as secondary to the service-connected degenerative arthritis of the lumbar spine, is denied.

FINDINGS OF FACT

1. The Veteran has a current disability of left hip osteoarthritis.

2. The Veteran is service connected for degenerative arthritis of the lumbar spine.

3. The left hip osteoarthritis is not caused by, or increased in severity beyond the natural progress of the disease by, any service-connected disability, to include the degenerative arthritis of the lumbar spine.

4. The Veteran has a current disability of right hip osteoarthritis.

5. The Veteran is service connected for degenerative arthritis of the lumbar spine.

6. The left hip osteoarthritis is not caused by, or increased in severity beyond the natural progress of the disease by, any service-connected disability, to include the degenerative arthritis of the lumbar spine.

CONCLUSIONS OF LAW

1. The criteria for service connection for left hip osteoarthritis, secondary to degenerative arthritis of the lumbar spine, have not been met. 38 U.S.C. §§ 1131, 1154, 5103, 5013A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

2. The criteria for service connection for right hip osteoarthritis, secondary to degenerative arthritis of the lumbar spine, have not been met. 38 U.S.C. §§ 1131, 1154, 5103, 5013A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Army during Peacetime from October 1959 to October 1962.

1. Secondary service connection for left hip osteoarthritis

2. Secondary service connection for right hip osteoarthritis

Service connection may be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995).

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38
 a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment).

The Veteran contends that he has sharp pains radiating from the (service-connected) lower spine over the lateral hips and into the legs. The Veteran contends this radiating pain, which he refers to as hip pain, is caused by the lumbar spine disability.

First, the Board finds that the evidence shows a current diagnosis of osteoarthritis of the left and right hips. Private treatment records from December 2012 show the results of computed tomography (CT) scans performed on the Veteran’s chest, abdomen, and pelvis. The examining physician noted degenerative changes of the lumbar spine, hips, and SI joints. Private treatment records from May 2020 include another set of CT scans, where the examiner diagnosed mild bilateral hip joint osteoarthritis.

Second, the Veteran is currently service connected for degenerative arthritis of the lumbar spine. VA granted service connection for the degenerative arthritis of the lumbar spine in a January 2021 Rating Decision.

After weighing all the evidence, lay and medical, the Board finds that the current osteoarthritis of the left and right hips are not caused by, or increased in severity beyond the natural progress of the disease by, any service-connected disability, including the degenerative arthritis of the lumbar spine. 

Many of the claimed symptoms are actually due to the separately service-connected and separately rated disabilities of radiculopathies of the right and left lower extremity (granted as secondary to the lumbar spine arthritis), namely, radiating nerve pain stemming from the back and moving down to the legs, and moderate incomplete paralysis. VA treatment records from January and February 2017 show the Veteran was diagnosed with lumbar radiculopathy, causing weakness in the legs. The Veteran first brought a claim for hip pain in July 2018, describing the condition as unsteady gait hip pain. The Veteran reported his legs giving out without warning. October 2018 VA treatment records similarly report that the right leg gave out due to pain, albeit with no muscle weakness in the legs.

During a VA examination for the lumbar spine in December 2019, the examiner noted that the Veteran has weakness in his legs that makes stairs difficult; however, the examiner attributed such symptoms to the radiculopathies in both legs. The radiculopathies manifested as moderate intermittent pain, moderate numbness, and moderate dysesthesias and paresthesias, and caused significantly impaired balance.

In December 2019, the Veteran was also examined for knee and leg disabilities. The Veteran reported sharp pains running from the leg down into the lateral knee. The examiner determined that the pains were caused by the radiculopathies, not by a separate knee disorder.

Similarly, the Veteran was examined at the in December 2019 for the hips. The Veteran reported sharp pains radiating from the low spine or buttock over the lateral hips and into the legs. The examiner noted abnormal range of motion in both hips, due to weakness, and severe balance problems; however, the examiner opined that the pain the Veteran felt was not from the hip joints, but rather from the radiculopathies. Consequently, the examiner provided a negative nexus between any hip condition and the lumbar spine. The examiner noted that the radiculopathies caused loss of strength and impaired mobility of the hips as a consequence of the back pain.

A June 2020 statement from the Veteran’s wife described the symptoms she perceives as an ability to walk due to the Veteran feeling like his legs are about to give out. This is a description of impairment caused by the separately service connected and compensated lower extremity radiculopathies. 

VA granted service connection for radiculopathies of the right and left lower extremity, as secondary to the lumbar spine arthritis, in the January 2021 Rating Decision. Service connection was granted for radiating nerve pain stemming from the back and moving down to the legs, as well as for moderate incomplete paralysis.

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In sum, the
 mobility of the hips as a consequence of the back pain.

A June 2020 statement from the Veteran’s wife described the symptoms she perceives as an ability to walk due to the Veteran feeling like his legs are about to give out. This is a description of impairment caused by the separately service connected and compensated lower extremity radiculopathies. 

VA granted service connection for radiculopathies of the right and left lower extremity, as secondary to the lumbar spine arthritis, in the January 2021 Rating Decision. Service connection was granted for radiating nerve pain stemming from the back and moving down to the legs, as well as for moderate incomplete paralysis.

(Continued on the next page)

 

In sum, the radiculopathies manifest as radiating pain spreading from the lower spine or buttocks over the lateral hips and into the legs, which accounts for the hip pain the Veteran has reported. The radiculopathies are also manifested by numbness, resulting in weakness and loss of balance. The symptoms the Veteran has ascribed to a bilateral hip condition are identical to those resulting from the radiculopathies. To grant service connection for separate bilateral hip disabilities would result in pyramiding – the Veteran would be compensated twice for the same symptoms that include pain and weakness. The rule against pyramiding prohibits compensating a veteran twice for the same symptoms. 38 C.F.R. § 4.14; Lyles v. Shulkin, 29 Vet. App. 107 (2017).

For the reasons described above, the Board finds that a preponderance of the lay and medical evidence is against the appeal for service connection for left and right hip osteoarthritis, to include as secondary to service-connected back disability. For these reasons, the appeal for service connection for hip arthritis must be denied.

 

 

J. PARKER

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Plambeck, Charles

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.