HIP IMPAIRMENT OF

Summary

The Veteran served from September 1965 to August 1967. He appeals the denial of service connection for a left hip disorder and a left ankle disorder. The Veteran sought service connection for both conditions directly and as secondary to his service-connected lumbar spine disability and left lower extremity radiculopathy. The Board reviewed service treatment records, which showed no complaints, diagnoses, or treatment of left hip or ankle injuries during service. Post-service treatment records indicated the onset of left hip pain in April 2017 and left ankle pain in November 2020. VA examinations in May and September 2021 concluded that the Veteran's left hip and ankle conditions were less likely than not related to service or aggravated by service-connected conditions. The examiners noted that the Veteran's current hip and ankle issues appeared to stem from compensation for an abnormal gait following right hip surgery and revisions, an issue not related to service. The Board found no evidence linking the left hip or ankle conditions to service or service-connected disabilities, and the Veteran's own statements were deemed insufficient to establish etiology. Therefore, service connection for both the left hip and left ankle disorders was denied.

Rationale

No in-service complaint, diagnosis, or treatment for left hip disorder.; Post-service onset of left hip disorder over 50 years after service.; VA examinations opined less likely than not related to service or aggravated by service-connected conditions.; Examiners attributed hip disorder to compensation for abnormal gait from right hip surgery, not service.

Full Decision Text

Citation Nr: 22007180
Decision Date: 02/08/22	Archive Date: 02/08/22

DOCKET NO. 16-21 354
DATE: February 8, 2022

ORDER

Service connection for a left hip disorder is denied.

Service connection for a left ankle disorder is denied.

FINDINGS OF FACT

1. The Veteran's left hip disorder is not secondary to his service-connected lumbar spine disability or left lower extremity radiculopathy and is not otherwise related to an in-service injury or disease.

2. The Veteran's left ankle disorder is not secondary to his service-connected lumbar spine disability or left lower extremity radiculopathy and is not otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left hip disorder due to service or service-connected lumbar spine disability or left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for a left ankle disorder due to service or service-connected lumbar spine disability or left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1965 to August 1967.

On appeal is an August 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) that, among other things, denied service connection for a left hip disorder and a left ankle disorder.

When this matter previously appeared before the Board of Veterans' Appeals (Board) in November 2018, October 2020 and September 2021, the Board remanded for additional development.

The matter has now been returned to the Board for adjudication. 

Duty to Notify and Assist

The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board").

The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained.  Also of record are VA examinations conducted in May 2021 and September 2021.

The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002).

Service Connection

To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

Service connection may also be granted on a secondary basis, for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

1. Entitlement to service connection for a left hip disorder.

The Veteran seeks service connection for a left hip disorder, to include as secondary to his service-connected lumbar spine disability and left lower extremity radiculopathy.

Service treatment records are associated with the Veteran's claim file.
 or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

1. Entitlement to service connection for a left hip disorder.

The Veteran seeks service connection for a left hip disorder, to include as secondary to his service-connected lumbar spine disability and left lower extremity radiculopathy.

Service treatment records are associated with the Veteran's claim file. The July 1965 entrance Report of Medical Examination reflects the Veteran had a normal examination, with no defects or diagnoses noted, and was determined to be fit for duty. During service, there was no compliant, diagnosis or treatment of a left hip injury. At separation in August 1967, the Veteran signed a statement indicating he was not suffering from any defect or deformity and that there had been no change in his physical condition since his last exam.

Post service treatment records from the Miami VAMC are associated with the Veteran's claims file. In summary, these records show the Veteran began to complain of left hip pain in April 2017; an October 2017 MRI of the left hip showed degenerative tearing of the superior labrum, and since that time, he has received treatment for complaints of left hip pain. 

The Veteran underwent a VA examination of his left hip in May 2021. The examiner noted a diagnosis of left hip strain with limitation of flexion and extension. On the issue of direct service connection, the examiner opined that it is less likely than not the Veteran's left hip disability began in service. As rationale, the examiner stated there is no evidence of the Veteran complaining of left hip pain during service. On the issue of whether the Veteran's left hip disability manifested within one year of discharge of service, the examiner opined that it is less likely than not. As rationale, the examiner stated there is no medical evidence to support the hip condition manifesting within one year of service. On the issue of secondary service connection, the examiner opined that it is less likely than the Veteran's left hip disability was caused or aggravated by his service-connected lumbar spine disability. As rationale, the examiner stated there is no medical evidence to support the hip condition is related to the Veteran's service-connected back disorder. A hip strain is due to excessive use of the hip joint and not related to the Veteran's back condition.

In the September 2021 Board Remand, the Board noted that the May 2021 VA examiner only addressed whether the Veteran's claimed left hip disability was caused by or related to his service-connected back disability  the examiner did not address whether his left hip disorder was caused or aggravated by his left lower extremity radiculopathy. As such, an addendum opinion was ordered on remand.

In September 2021, an addendum medical opinion was obtained. The examiner opined that it is less likely than not the Veteran's claimed left hip disorder is aggravated beyond its natural progression by his service-connected spine condition with radiculopathy. As rationale, the examiner referenced specific medical records including a singular non-recurring back complaint during service, a February 1972 report of medical examination for disability purposes that reported a completely normal musculoskeletal exam with normal gait, and a March 2005 clinical note that reports the Veteran was seeking worker's compensation for an on-the-job lower back injury that showed normal range of motion of the back with no neurological findings and normal gait. The examiner also discussed multiple post-service records documenting right hip surgery in 2011 and complaints of left hip pain, beginning with an April 2017 clinical note that noted lumbar spine surgery in March 2017 with a new complaint of left hip pain. The examiner stated these medical records suggest the Veteran's current left hip disorder was not aggravated by compensation of the lumbar spine that incurred from an on-the-job injury in 2005, but from compensation for his right hip joint and his prolonged walking and standing as a salesman and manager of a chemical company until retirement in 2009. The examiner stated further that the Veteran's right hip condition surgery with revisions caused his left hip injury from long term compensation of the abnormal gait at work as a salesman and chemical plant manager. In closing, the examiner stated one does not develop a labrum tear overnight after back surgery, but concluded that it was rather incurred from his abnormal gait due to right hip while working at his civilian job. (The Board notes the Veteran is not serviced connected for his right hip).

Although only an aggravation medical opinion was requested, the September 2021 VA examiner also offered a medical opinion on
5, but from compensation for his right hip joint and his prolonged walking and standing as a salesman and manager of a chemical company until retirement in 2009. The examiner stated further that the Veteran's right hip condition surgery with revisions caused his left hip injury from long term compensation of the abnormal gait at work as a salesman and chemical plant manager. In closing, the examiner stated one does not develop a labrum tear overnight after back surgery, but concluded that it was rather incurred from his abnormal gait due to right hip while working at his civilian job. (The Board notes the Veteran is not serviced connected for his right hip).

Although only an aggravation medical opinion was requested, the September 2021 VA examiner also offered a medical opinion on direct service connection. On this question, the examiner opined that it is less likely than not the Veteran's left hip disability began in service. As rationale, the examiner made reference to the same medical records documented above, and stated it was the Veteran's right hip condition surgery with revisions that caused his left hip injury from long term compensation of the abnormal gait, not any incident of service. 

In light of the above, the Board finds that while the evidence shows the existence of a current left hip disability, it does not show that the disability was either caused or aggravated by the Veteran's service-connected lumbar spine disability or his service-connected left lower extremity radiculopathy. Allen, 7 Vet. App. at 448. The May 2021 VA examiner concluded that the Veteran's left hip disorder was not caused or aggravated by his service-connected back disability; and the September 2021 VA examiner opined that the Veteran's left hip condition was not caused or aggravated by his service-connected left lower extremity radiculopathy, specifically noting that the cause of his left hip disorder was overcompensation for an abnormal gait caused by his right hip surgery and revisions. There is no medical evidence to the contrary. 

Further, the Board sees no evidence that the Veteran's left hip disorder arose in service or within a year of discharge. The Veteran's VA treatment records were reviewed, and none of these records provide a nexus or link between the Veteran's military service and his current left hip diagnoses. Moreover, the earliest treatment record that notes a left hip condition is dated in April 2017  more than 50 years after the Veteran's separation from service in 1967.

In this case, the only evidence in favor of the Veteran's claim is his own statements concerning his belief that his left hip disorder, diagnosed over 50 years after service, is due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Although the Veteran is competent to report symptoms of a left hip disorder, such as pain, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id.; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).    

As such, the Board finds that, other than the Veteran's unsupported contentions, there is simply no evidence in the record of any etiological relationship between the Veteran's left hip disorder and his time in service or his service-connected disabilities. 

Thus, the criteria for service connection for a left hip disorder have not been met and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

2. Entitlement to service connection for a left ankle disorder.

The Veteran seeks service connection for a left ankle disorder, to include as secondary to his service-connected lumbar spine disability and left lower extremity radiculopathy. 

Service treatment records are associated with the Veteran's claim file. The July 1965 entrance Report of Medical Examination reflects the Veteran had a normal examination, with no defects or diagnoses noted, and was determined to be fit for duty. During service, there was no compliant, diagnosis or treatment of a left ankle injury. At separation in August 1967, the Veteran signed a statement indicating he was not suffering from any defect or deformity and that there had been no change in his physical condition since his last exam.

Post service treatment records from the Miami VAMC are associated with the Veteran's claims file. In summary, these records show the Veteran began to complain of left ankle pain in November 
 left lower extremity radiculopathy. 

Service treatment records are associated with the Veteran's claim file. The July 1965 entrance Report of Medical Examination reflects the Veteran had a normal examination, with no defects or diagnoses noted, and was determined to be fit for duty. During service, there was no compliant, diagnosis or treatment of a left ankle injury. At separation in August 1967, the Veteran signed a statement indicating he was not suffering from any defect or deformity and that there had been no change in his physical condition since his last exam.

Post service treatment records from the Miami VAMC are associated with the Veteran's claims file. In summary, these records show the Veteran began to complain of left ankle pain in November 2020; since that time, he has received treatment for complaints of left ankle pain. 

Of particular note are podiatry consults dated in December 2012 and January 2013 that were for complaints of right ankle pain, but not the left ankle, for which the Veteran now seeks service connection. A November 2020 podiatry consult reflects the Veteran presented for evaluation of his right ankle pain, as well as compensatory left ankle pain due to being "unable to use his right lower extremity while driving due to nerve damage; he states his left ankle begins to cramp from time to time while driving because of the distance he has to reach."  He was diagnosed with ankle arthritis. 

The Veteran underwent a VA examination for his claimed left ankle disorder in May 2021.  The examiner stated the Veteran did not have a current diagnosis of a left ankle disorder.

In the September 2021 Board remand that followed, the Board found that although the May 2021 VA examiner did not find the Veteran to have a current left ankle disability, a November 2020 record reflects the Veteran was assessed to have ankle arthritis of the left lower extremity, and the examiner did not address this diagnosis. A new VA examination was requested on remand.

The Veteran underwent a VA examination of his left ankle in September 2021. On the issue of direct service connection, the examiner opined that it is less likely than not the Veteran's left ankle disability began in service. As rationale, the examiner referenced specific medical records, including the Veteran's service treatment records, which contain no clinical notes during active service reporting left ankle complaints, and a February 1972 report of medical examination for disability purposes that reported a completely normal musculoskeletal exam with normal gait. The examiner also noted post-service treatment records that first document left ankle complaints in 2020. The examiner stated these medical records suggest the Veteran's current left ankle disorder was not due to active service but incurred from compensation of the right hip with abnormal gait from his prolonged walking and standing as a salesman and manager of a chemical company until retirement in 2009. The examiner stated it was the Veteran's right hip surgery that caused his left ankle injury from long term compensation of the abnormal gait. (The Board notes the Veteran is not serviced connected for his right hip). Thus, on the issue of secondary service connection, the examiner opined that it is less likely than not the Veteran's left ankle disability was caused or aggravated by his service-connected lumbar spine disability with radiculopathy. As rationale, the examiner stated again that the Veteran's right hip condition surgery with revisions caused/worsened his left ankle injury from long term compensation of the abnormal gait.

In light of the above, the Board finds that while the evidence shows the existence of a current left ankle disability, it does not show that the disability was either caused or aggravated by the Veteran's service-connected lumbar spine disability or his service-connected left lower extremity radiculopathy. Allen, 7 Vet. App. at 448. The September 2021 VA examiner concluded that the Veteran's left ankle disorder was not caused or aggravated by his service-connected back disability or his service-connected left lower extremity radiculopathy, specifically noting that the cause of his left ankle disorder was overcompensation for an abnormal gait caused by his right hip surgery and revisions.

Further, the Board sees no evidence that the Veteran's left ankle disorder arose in service or within a year of discharge. The Veteran's VA treatment records were reviewed, and none of these records provide a nexus or link between the Veteran's military service and his current left ankle diagnosis. Moreover, the earliest treatment record that notes a left ankle condition is dated in November 2020  more than 50 years after the Veteran's separation from service in 1967.

In this case, the only evidence in favor of the Veteran's claim is his own statements concerning his belief that his left ankle disorder, diagnosed over 50 years after service, is due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kah
 that the Veteran's left ankle disorder arose in service or within a year of discharge. The Veteran's VA treatment records were reviewed, and none of these records provide a nexus or link between the Veteran's military service and his current left ankle diagnosis. Moreover, the earliest treatment record that notes a left ankle condition is dated in November 2020  more than 50 years after the Veteran's separation from service in 1967.

In this case, the only evidence in favor of the Veteran's claim is his own statements concerning his belief that his left ankle disorder, diagnosed over 50 years after service, is due to service. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Although the Veteran is competent to report symptoms of a left ankle disorder, such as pain, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id,; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).    

As such, the Board finds that, other than the Veteran's unsupported contentions, there is simply no evidence in the record of any etiological relationship between the Veteran's left ankle disorder and his time in service or his service-connected disabilities. 

Thus, the criteria for service connection for a left ankle disorder have not been met and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

 

 

Caroline B. Fleming

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jiggetts, T.

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.