HIP IMPAIRMENT OF

Summary

The Veteran, a Marine Corps Veteran who served from September 1996 to April 1998, appeals the denial of service connection for a right hip condition, specifically trochanteric pain syndrome and degenerative arthritis. The Veteran claims this hip condition is secondary to his service-connected right ankle disability, asserting that altered gait and compensatory weight shifting have caused the hip issue. The Board reviewed the evidence, including the Veteran's VA treatment records dating back to April 2018, which consistently noted complaints of right hip pain attributed to compensating for his ankle condition. A private doctor in October 2023 concluded the ankle condition impacted the Veteran's kinetic chain, contributing to hip pain, and recommended treating both conditions concurrently. In contrast, two VA medical opinions concluded the hip condition was less likely than not caused by the ankle condition, attributing it more to overuse and obesity, but failed to adequately address the Veteran's and his providers' consistent assertions of a link. The Board found the Veteran's personal statements and multiple treating provider opinions more persuasive and logical than the negative VA opinions, particularly as the VA opinions did not address the Veteran's explanation of weight shifting or the consistent findings of aggravating factors. Consequently, the Board found the Veteran's right ankle condition to be a but-for cause of his right hip condition. Service connection for the right hip condition is granted.

Rationale

Veteran's VA treatment records consistently noted complaints of right hip pain attributed to compensating for right ankle condition.; Private doctor opined ankle condition impacted kinetic chain, contributing to hip pain.; VA opinions failed to address Veteran's explanation of weight shifting and aggravating factors noted by treating providers.

Full Decision Text

Citation Nr: A26003203
Decision Date: 01/13/26	Archive Date: 01/13/26

DOCKET NO. 250305-523334
DATE: January 13, 2026

ORDER

Entitlement to service connection for right hip condition, including degenerative arthritis and trochanteric pain syndrome, is granted.

FINDING OF FACT

The Veteran's right hip condition was caused by his service-connected right ankle disability.

CONCLUSION OF LAW

The criteria for service connection for right hip condition have been met. 38 U.S.C. 1110, 1112, 1116, 5107; 38 C.F.R. 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the Marine Corps from September 1996 to April 1998. The Board recognizes his service to our country and the sacrifices it necessarily entailed.

In the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the January 2025 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. 

Entitlement to service connection for right hip condition.

The Veteran contends that he is entitled to service connection for a right hip condition, as his service-connected right ankle condition alters his gait and his resulting compensation has caused his hip condition. 

Background

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease 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 be granted on a secondary basis for a disability that has been aggravated by or resulted from a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). 

Notably, when analyzing a claim for secondary service connection, the legal threshold for establishing the causal nexus between the service-connected primary disability and the claimed secondary disability is simple "but for" causation, a broad standard that allows for multiple causes. Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023).  See also, Burrage v. United States, 571 U.S. 204, 211-12, 134 S. Ct. 881, 187 L. Ed. 2d 715 (2014).   

In addition to multiple causes, but-for causation allows for multiple links in the evidentiary chain between the primary and secondary disabilities, otherwise known as "intermediate steps." In other words, if the service-connected primary disability causes a condition that does not rise to the level of a disability, or requires medication or other treatment that in turn leads to the claimed disability, the service-connected primary disability is a but-for cause of the claimed disability. See, e.g., Walsh v. Wilkie, 32 Vet. App. 300, 306 (2020); Spicer, 61 F.4th 1365-1366.

Service connection is granted using this theory when: (1) a service-connected disability caused the veteran to become obese or aggravated the obesity; (2) obesity, resulting from a service-connected condition, was a substantial factor in causing, or aggravating, the disability claimed as secondary; and (3) the claimed disability would not have occurred, or been aggravated to its current degree of severity, but for obesity. See e.g., Garner v. Tran, 33 Vet. App. 241, 247-48 (2021).

In making findings and rendering decisions, unless the evidence is persuasive of one side or the other on the issue at hand, the Board necessarily employs a balancing test of positive and negative evidence, and when they are approximately balanced or nearly equal, the veteran receives the benefit of the doubt, such that the Board finds in the veteran's favor on that issue. 38?U.S.C. §?5107; 38?C.F.R. §?3.102; Ortiz v. Principi, 274 F.3d 131, 136
 aggravated to its current degree of severity, but for obesity. See e.g., Garner v. Tran, 33 Vet. App. 241, 247-48 (2021).

In making findings and rendering decisions, unless the evidence is persuasive of one side or the other on the issue at hand, the Board necessarily employs a balancing test of positive and negative evidence, and when they are approximately balanced or nearly equal, the veteran receives the benefit of the doubt, such that the Board finds in the veteran's favor on that issue. 38?U.S.C. §?5107; 38?C.F.R. §?3.102; Ortiz v. Principi, 274 F.3d 131, 1365 (Fed. Cir. 2001).   

Evidence and Analysis

The rating decision on appeal includes favorable findings that the Veteran has a current disability of right hip trochanteric pain syndrome (although the Board notes that this condition has been described with other diagnoses throughout the record, as in the January 2024 examination that diagnosed degenerative arthritis), and that the primary right ankle disability is service connected. These facts are therefore conceded.

The Veteran's VA treatment records show many complaints from the Veteran for many years that compensating for his right ankle condition has caused him right hip pain. (See CAPRI records from April 2018, June 2018, June 2021, February 2023, November 2024, etc.). In April 2018, a VA nurse's assessment of the Veteran's condition stated, "gait abnormal due to right foot pain, likely causing pain in right knee hip and low back." 

In October 2023, the Veteran's private doctor assessed his right hip condition. He concluded that the Veteran's ankle condition was a factor in the Veteran's hip pain due to the impact of the ankle condition on the Veteran's "kinetic chain." The doctor also recommended assessment for treatment of the Veteran's ankle condition as part of his treatment for his hip condition.

In contrast, two VA medical opinions concluded that the Veteran's right hip condition was less likely than not caused by his ankle condition. Both stated several possible causes of right hip trochanteric pain syndrome, including overuse and repetitive movements. Neither opinion's rationale addressed the fact that the Veteran has claimed that his right ankle causes overuse of the right hip, however, despite the fact that the January 2024 opinion's evidence comments included a quote from the Veteran found in the record, stating that, "due to my service connected right ankle condition, I often have to shift my weight when walking and standing to reduce the strain on my ankle. This has caused me to have labral tearing in my hip."  

Both opinions conclude that obesity is a more likely cause of the Veteran's hip pain. Notably, because only actual cause need be established, this does not actually contradict a conclusion that the Veteran's hip condition was caused by his foot condition if his ankle condition substantially contributed to weight gain, which, on its face, is entirely plausible. Finally, both opinions also fail to discuss the previously discussed instances in the record in which the Veteran's treating doctor and nurse both determined that the Veteran's ankle problems were aggravating the Veteran's hip pain, five years apart and at separate medical facilities. 

The Board finds that the evidence favors the Veteran's claim that his right hip condition would not have developed absent his right ankle condition. The Veteran's personal statements have consistently and competently stated that he feels as though his pain is worsened by walking following the onset of his ankle disability, and multiple treating providers have agreed that this is an aggravating factor in the Veteran's pain. 

(Continued on the next page)

?

The Veteran's personal observations about his pain, as well as these providers' opinions, are more logical and well-reasoned than the negative VA medical opinions, which failed to address both the Veteran and his providers' competent and credible statements. Therefore, the Board finds the Veteran's right ankle condition caused his right hip condition. Service connection for his hip condition is warranted, and the appeal is granted.

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rippel, Chloe 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.