HIP IMPAIRMENT OF

Summary

The Veteran served on active duty from March 1988 to June 1996. The Veteran appealed the denial of service connection for five conditions: left hip disorder, right hip disorder, left foot disorder, right foot disorder, and a neck disorder. All five conditions were claimed as secondary to a service-connected low back disorder. The Board noted that current disabilities were established for these conditions. The primary issue was whether these claimed conditions were proximately due to, the result of, or aggravated by the Veteran's service-connected low back disorder. The Board reviewed VA examinations from January and June 2020. The June 2020 opinions consistently found that the hip, foot, and neck disorders were less likely than not proximately due to or the result of the Veteran's lumbar spine disorder. The examiners explained that hip conditions were due to wear and tear and obesity, not the lumbar spine. They also found no biomechanical association between lumbar degenerative disc disease and plantar fasciitis or pes planus, nor for the cervical strain. The January 2020 opinions also found the conditions less likely than not aggravated beyond natural progression. The Board found these VA opinions adequate and persuasive, reflecting understanding of the Veteran's history and the evidence. The Board concluded that the evidence persuasively weighed against the claims, and service connection was denied for all five conditions. The Board considered the benefit of the doubt rule but found it inapplicable as the evidence persuasively favored denial.

Rationale

VA examination found hip condition due to wear and tear and obesity, not lumbar spine disease.; No biomechanical or pathophysiological association between lumbar degenerative disc disease and hip pain.; VA opinion found less likely than not aggravated beyond natural progression.

Full Decision Text

Citation Nr: A24018639
Decision Date: 04/16/24	Archive Date: 04/16/24

DOCKET NO. 200901-106588
DATE: April 16, 2024

ORDER

1. Entitlement to service connection for a left hip disorder, to include as secondary to a service-connected low back disorder, is denied.  

2. Entitlement to service connection for a right hip disorder, to include as secondary to a service-connected low back disorder, is denied.  

3. Entitlement to service connection for a left foot disorder, to include as secondary to a service-connected low back disorder, is denied.  

4. Entitlement to service connection for a right foot disorder, to include as secondary to a service-connected low back disorder, is denied.  

5. Entitlement to service connection for a neck disorder, to include as secondary to a service-connected low back disorder, is denied.  

FINDINGS OF FACT

1. The Veteran's left hip disorder is not caused or aggravated by his service-connected lumbar spine disorder.

2. The Veteran's right hip disorder is not caused or aggravated by his service-connected lumbar spine disorder.

3. The Veteran's left foot disorder is not caused or aggravated by his service-connected lumbar spine disorder.

4. The Veteran's right foot disorder is not caused or aggravated by his service-connected lumbar spine disorder.

5. The Veteran's neck disorder is not caused or aggravated by his service-connected lumbar spine disorder.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left hip disorder, to include as secondary to a lumbar spine disorder, have not been met.  38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.310.

2. The criteria for service connection for a right hip disorder, to include as secondary to a lumbar spine disorder, have not been met.  38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for service connection for a left foot disorder, to include as secondary to a lumbar spine disorder, have not been met.  38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.310.

4. The criteria for service connection for a right foot disorder, to include as secondary to a lumbar spine disorder, have not been met.  38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.310.

5. The criteria for service connection for a neck disorder, to include as secondary to a lumbar spine disorder, have not been met.  38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1988 to June 1996.  This matter comes to the Board of Veterans' Appeals (Board) from a July 2020 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran initially submitted his claims in October 2019.  In January 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the resulting January 2020 decision.  In June 2020, the agency of original jurisdiction (AOJ) found errors in its development of the claims and continued to develop the claims until it issued the July 2020 decision on appeal. 

In the September 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  The Board may only consider the evidence of record at the time of the July 2020 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

On the September 2020 VA Form 10182, the Veteran also appealed the portion of the July 2020 rating decision that denied
 decision on appeal. 

In the September 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  The Board may only consider the evidence of record at the time of the July 2020 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

On the September 2020 VA Form 10182, the Veteran also appealed the portion of the July 2020 rating decision that denied service connection for gastroesophageal reflux disease (GERD).  On a simultaneous submission, he submitted a Supplemental Claim decision review request for this issue.  The AOJ accepted the Supplemental Claim decision review request and granted service connection for GERD in a November 2020 rating decision.  The benefit sought has been granted, and the Board will not address the issue of service connection for GERD in the instant decision.  

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  To establish a right to compensation for a present disability, a Veteran must show:  (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d). 

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability.  38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

1.-5. Entitlement to service connection for left and right hip disorders, left and right foot disorders, and a neck disorder.

The Board will combine its analysis for these five claims given the similarity in the theory of entitlement and disposition.  The Veteran claims he has bilateral hip, bilateral foot, and neck disorders as a result of his service-connected back disorder.  See October 2019 claim.  

First, the July 2020 rating decision made findings that current disabilities are shown, and the Board will not disturb these favorable findings. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d).  The Veteran has bilateral femoral acetabular impingement syndrome, bilateral pes planus, bilateral plantar fasciitis, and a cervical strain.  

The Veteran does not assert, nor does the evidence suggest, that his diagnosed hip, foot, and neck disorders are related to his service.  The Board will therefore address his argument that his claimed conditions are secondarily related to his service-connected back disorder.  

VA provided an examination and opinions for these claims in January and June 2020.  The June 2020 opinions all indicate that the claimed conditions are less likely than not proximately due to or the result of the back disorder.  For the hip disorders, the examiner explained that disease of the lumbar spine is not a known cause of bilateral hip pain.  The hip conditions were primarily due to wear and tear of both hips and chronic obesity, not degenerative disc disease of the lumbar spine.  Regarding plantar fasciitis and pes planus, the examiner explained that there is no biomechanical or pathophysiological association between these conditions and degenerative disc disease of the lumbar spine.  The examiner provided the same reasoning for the cervical strain opinion.  

In the January 2020 opinions, the examiner found that the claimed disorders were less likely than not aggravated beyond their natural progression by the degenerative disc disease.  For the hips, the examiner explained that it was not possible to measure a baseline point for the natural progress of hip femoral acet
 known cause of bilateral hip pain.  The hip conditions were primarily due to wear and tear of both hips and chronic obesity, not degenerative disc disease of the lumbar spine.  Regarding plantar fasciitis and pes planus, the examiner explained that there is no biomechanical or pathophysiological association between these conditions and degenerative disc disease of the lumbar spine.  The examiner provided the same reasoning for the cervical strain opinion.  

In the January 2020 opinions, the examiner found that the claimed disorders were less likely than not aggravated beyond their natural progression by the degenerative disc disease.  For the hips, the examiner explained that it was not possible to measure a baseline point for the natural progress of hip femoral acetabular impingement, and there was also no established progression in general medical guidelines regarding the hip symptoms and lumbar degenerative disc disease.  The examiner provided the same reasoning for the plantar fasciitis, pes planus, and cervical strain opinions.  

The Board finds that the VA opinions are adequate and persuasive.  They reflect an understanding of the Veteran's medical history and consideration of the evidence of record.  Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions).  The opinions persuasively support a finding that the claimed hip, foot, and cervical spine disorders are not proximately due to or the result of, or aggravated by, the Veteran's service-connected back disorder.  

The only evidence that purports to link the claimed conditions to the back disorder on a secondary basis are the Veteran's own statements.  However, the cause of the claimed orthopedic disorders is not susceptible to lay observation and requires medical knowledge as to disease processes and their likely causes, which the Veteran is not shown to possess.  See Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006).  Regardless, the statements are outweighed by the competent medical evidence of record.

Therefore, the Board finds that the evidence persuasively weighs against the Veteran's claims and that service connection is not warranted.  In reaching this decision the Board considered the benefit of the doubt rule; however, as evidence of record is persuasively against the claim, the doctrine is not for application.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc) (providing that only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

 

 

S. CHARLES NEILL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Steve Ginski, Counsel

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.