HIP IMPAIRMENT OF

S. HENEKS · 2026 · Case ID: A26008744

DENIED

Summary

The veteran, who served from July 1978 to August 1980, appeals the denial of service connection for bilateral hip and bilateral knee disabilities. The veteran initially attributed these conditions to his service-connected lumbar spine disability. However, at a February 2024 Board hearing, he also raised theories of direct service connection, attributing the hip and knee issues to in-service parachute jumps and general wear and tear. The Board reviewed VA medical opinions from March and April 2020, which found the bilateral hip osteoarthritis less likely than not to be secondary to or aggravated by the service-connected lumbar spine disability. These opinions cited medical literature supporting alternative etiologies like aging and overuse. The Board found these VA opinions to be competent and probative, noting they were based on thorough reviews of the claims file and medical literature. The Board also found the veteran's lay opinions regarding causation to be incompetent, as these complex medical issues extend beyond observable cause-and-effect relationships. For the knee claims, which were previously denied but reopened, the Board again relied on VA opinions finding the bilateral knee osteoarthritis less likely than not caused by service-connected lumbar spine disability or aggravated by it, citing similar reasoning regarding alternative etiologies and the lack of in-service complaints. The Board found the evidence persuasively weighed against service connection for all claimed conditions. Service connection for bilateral hip and bilateral knee disabilities was denied.

Rationale

No in-service complaints or diagnoses related to hips.; Post-service diagnosis of osteoarthritis attributed to aging/overuse.; VA opinions found less likely than not secondary to/aggravated by lumbar spine disability.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200511-87804

Full Decision Text

Citation Nr: A26008744
Decision Date: 01/29/26 Archive Date: 01/29/26

DOCKET NO. 200511-87804
DATE: January 29, 2026

ORDER

Entitlement to service connection for a right hip disability is denied.

Entitlement to service connection for a left hip disability is denied.

Entitlement to service connection for a right knee disability is denied.

Entitlement to service connection for a left knee disability is denied.

FINDINGS OF FACT

1. The Veteran's right hip disability has not been linked by probative evidence to an in-service event, disease, or injury and has not been shown to be caused or aggravated by a service-connected disability.

2. The Veteran's left hip disability has not been linked by probative evidence to an in-service event, disease, or injury and has not been shown to be caused or aggravated by a service-connected disability.

3. The Veteran's right knee disability has not been linked by probative evidence to an in-service event, disease, or injury and has not been shown to be caused or aggravated by a service-connected disability.

4. The Veteran's left knee disability has not been linked by probative evidence to an in-service event, disease, or injury and has not been shown to be caused or aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

2. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

3. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103(a), 5107; 38 C.F.R. §§?3.102, 3.159, 3.303, 3.310.

4. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103(a), 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 from July 1978 to August 1980.

This matter comes to the Board of Veterans' Appeals on appeal from a rating decision issued in November 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely filed a notice of disagreement, and a statement of the case (SOC) was issued in April 2020. The Veteran opted into the Appeals Modernization Act (AMA) by filing a VA Form 10182 in July 2020 in response to the April 2020 SOC and selected the hearing docket.

In February 2024, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the record.

Under the AMA, the Board may only consider the evidence of record at the time of the April 2020 SOC, as well as any evidence submitted by the Veteran or his representative at the February 2024 Board hearing, or within 90 days of the Board hearing. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the February 2020 SOC or (2) more than 90 days following the date of the Board hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision
20.303. If evidence was submitted either (1) during the period after the AOJ issued the February 2020 SOC or (2) more than 90 days following the date of the Board hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In a July 2024 decision, the Board denied the service connection claims on appeal. In July 2025, the United States Court of Appeals for Veterans Claims (Court) issued a Joint Motion for Remand (JMR) vacating the Board's July 2024 decision and remanded these issues for readjudication. In pertinent part, the Court found that the Board erred by not addressing the Veteran's contentions in a July 2020 statement regarding the March 2020 and April 2020 VA examiner.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection generally requires evidence satisfying three criteria: (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. See Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013); Hickson v. West, 12 Vet. App. 247, 253 (1999).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a),(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability.

As an initial matter, the Board acknowledges the Veteran's contentions regarding the adequacy of the VA examiner who provided the March 2020 and April 2020 addendum nexus opinions. See July 2020 Statement in Support of Claim. Specifically, he contends that this examiner should not have provided these opinions because she is employed at the same VA medical center (VAMC) where he is also employed. However, the Board finds that it is not improper for a VA examiner to provide a medical nexus opinion for a Veteran who is employed at the same medical facility where the examiner practices. In this regard, VA examiners are ethically and professionally obligated to render such opinions based on their clinical expertise, reviews of the medical record, and knowledge of the Veteran's condition, regardless of the employment or practice setting. The fact that an examiner practices within the same facility in which the Veteran works does not, by itself, create a conflict of interest or diminish the credibility of the opinion. Here, the Veteran has not presented any evidence suggesting the existence of a conflict of interest or any reason to question the credibility of the examiner. Thus, the Board finds the March 2020 and April 2020 VA opinions to be competent, probative medical evidence.

Furthermore, to the extent that the Veteran has argued that the March 2020 VA examiner should not have provided a nexus opinion without performing a new examination, the Board finds that an in-person examination is not required in all circumstances for an examiner to render a competent nexus opinion. VA examiners are capable of providing addendum opinions based upon a thorough review of the claims file, post-service medical evidence, and prior examination findings when the existing record contains sufficient information to address the medical question at issue. An addendum opinion based upon a review of the record is particularly appropriate where the purpose is to clarify, expand upon, or reconcile prior medical findings, rather than to assess the current severity of a condition. In this case, the opinions requested were intended to address the etiology of the claimed conditions, as opposed to evaluating their current severity. Thus, the Board finds that the March 2020 and April 2020 VA addendum opinions were sufficient to address the issues of service connection on appeal in this matter.

1. Entitlement to service connection for a right hip disability is denied.

2. Entitlement to service connection for a left hip disability is denied.

The medical evidence of record reflects a diagnosis of osteoarthritis of both hips. The Veteran attributes this to his service-connected lumbar spine disability. Alternatively, at the February 2024 Board hearing, the Veteran attributed this condition to his participation in parachute jumps, a fall from a tree, and general wear and tear during active duty.

Service treatment records reflect no complaints, symptomatology, or diagnoses related to the Veteran's hips. A review of the post-service treatment records shows that the Veteran initially reported pain in his hips beginning in 2017.

In November 2017, the Veteran underwent a VA examination for his bilateral hip disability, at which time he reported that his hips began to hurt after he reinjured his back in June 2017. The VA examiner explained that the pain that the Veteran was experiencing in his hips was primarily due to his service-connected radiculopathy, as opposed to the diagnosed osteoarthritis. She further noted that osteoarthritis in the hips was unrelated to a spine disability, which was supported by medical literature. The examiner stated that literature further indicated that osteoarthritis in the hips was associated with hip dysplasia, advancing age, obesity, and prior injuries.

In a March 2020 VA addendum opinion, a VA examiner opined that it was less likely than not that the bilateral hip disability was aggravated by the lumber spine disability. She noted that medical literature did not support a finding that osteoarthritis in one area of the body caused the development or progression of osteoarthritis in another area of the body. Further, she explained that the Veteran's symptoms were due to the radiculopathy of the lower extremities, as opposed to the diagnosis of osteoarthritis in the hips. Moreover, the VA examiner found relevant that the medical literature documented minimal or mild degenerative joint disease that was asymptomatic.

In April 2020, the March 2020 VA examiner provided a second VA addendum opinion. She concluded that the Veteran's bilateral hip disability was not at least as likely as not aggravated by the service-connected lumbar spine disability. The examiner noted the documentation of reports of general hip pain, which was typically associated with lumbar spine pain. She further noted that the Veteran was first diagnosed with this condition in 2017 and that medical literature documented a normal occurrence of arthritis in the fourth or fifth decade of an individual's life, which would progress over time. Thus, she did not find that the bilateral hip osteoarthritis had been aggravated by the lumbar spine disability.

The Board places great probative weight on the aforementioned VA medical opinions, which found that the Veteran's bilateral hip disability is less likely than not secondary to his service-connected lumbar spine disability. Notably, the VA examiners reviewed the claims file, indicating that they were fully aware of the extent of the Veteran's claimed condition, as well as his military service and medical history. The examiners offered complete discussions analyzing the pertinent evidence of record and explaining the bases for the opinions. Indeed, the November 2017 examiner distinguished the Veteran's osteoarthritis symptomatology from the service-connected radiculopathy symptomatology. Additionally, both examiners attributed the osteoarthritis in the bilateral hips to alternative et
spine disability.

Additionally, although the Veteran believes that his service-connected lumbar spine disability caused or aggravated his bilateral hip disability, he is not competent to offer a medical opinion as to causation. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the etiology of his bilateral hip disability is not competent evidence and, consequently, is afforded no probative weight.

The Board notes that, at the February 2024 Board hearing, the Veteran attributed his hip disability to his in-service parachute jumps and physical activities for the first time. Because the theory of direct service connection was raised for the first time after the SOC on appeal, that theory cannot be the basis to remand for an examination or opinion because there was no pre-decisional duty to assist error. Again, the Veteran is not competent to provide an etiological opinion linking his current bilateral hip disability to his military service, to include such activities, and therefore, his lay statements are afforded no probative value. See Jandreau, 492 F.3d at 1376-77.

Based on the foregoing, the Board finds that the competent evidence persuasively weighs against the claims, and service connection for a right hip disability and left hip disability must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Entitlement to service connection for a right knee disability is denied.

4. Entitlement to service connection for a left knee disability is denied.

As an initial matter, the Board notes that service connection for a right knee disability was previously denied in an April 1985 rating decision. However, the Agency of Original Jurisdiction reopened this claim in the November 2017 rating decision based upon the receipt of new and material evidence. The Board is bound by this favorable finding and finds there is no prejudice in proceeding with appellate adjudication.

The medical evidence of record reflects a diagnosis of osteoarthritis of both knees. He attributes this disability to his service-connected lumbar spine disability. At the February 2024 Board hearing, the Veteran alternatively attributed this condition to his participation in parachute jumps, as well as general wear and tear during active duty.

Service treatment records reflect no complaints, symptomatology, or diagnoses related to the Veteran's knees. A review of the post-service treatment records shows that the Veteran twisted his right knee following service in May 1993, following which he continued to experience pain in September 1993. The record is then silent for any reports of knee symptomatology until 2017.

In November 2017, the Veteran underwent a VA examination for his bilateral knee disability, at which time he reported experiencing knee pain and instability. The VA examiner concluded that it was less likely than not that the bilateral knee disability was caused by his service-connected lumbar spine disability. The examiner explained that the Veteran's knee arthritis was the result of overuse, as opposed to the
no complaints, symptomatology, or diagnoses related to the Veteran's knees. A review of the post-service treatment records shows that the Veteran twisted his right knee following service in May 1993, following which he continued to experience pain in September 1993. The record is then silent for any reports of knee symptomatology until 2017.

In November 2017, the Veteran underwent a VA examination for his bilateral knee disability, at which time he reported experiencing knee pain and instability. The VA examiner concluded that it was less likely than not that the bilateral knee disability was caused by his service-connected lumbar spine disability. The examiner explained that the Veteran's knee arthritis was the result of overuse, as opposed to the arthritis in his lower back. The examiner further noted that the Veteran's bilateral knee arthritis was separate from his lower back and radiculopathy conditions, and that the respective symptoms were unrelated. Indeed, the examiner stated that medical literature did not support a relationship between arthritis in the spine and knees.

In April 2020, a VA examiner provided a VA addendum opinion. The examiner concluded that the Veteran's bilateral knee disability was not at least as likely as not aggravated by the service-connected lumbar spine disability. The examiner explained that the Veteran was first diagnosed with this condition in 2017 and that medical literature documented a normal occurrence of arthritis in the fourth or fifth decade of an individual's life, which would progress over time. The examiner further noted that the Veteran had consistently sought treatment for his service-connected lumbar spine and radiculopathy conditions but did not report any knee pain or other related symptoms for many years. Thus, she did not find that the bilateral knee osteoarthritis had been aggravated by the lumbar spine disability.

The Board places great probative weight on the aforementioned VA medical opinions. Notably, the VA examiners clearly reviewed the claims file, indicating that they were fully aware of the Veteran's military service and medical history. They offered complete discussions analyzing the pertinent evidence of record and explaining the bases for the opinions. Indeed, the November 2017 examiner distinguished the Veteran's osteoarthritis symptomatology from the service-connected radiculopathy symptomatology. Additionally, both examiners attributed the osteoarthritis in the bilateral knees to alternative etiologies, to include the general aging process and overuse, and cited to medical literature in support of their opinions. See Nieves-Rodriguez, supra. As there have been no probative opinions submitted in favor of the Veteran's claim, the VA opinions are the only probative medical opinions of record.

The Board notes that, at the February 2024 Board hearing, the Veteran attributed his knee disability to his in-service parachute jumps and physical activities for the first time. Because the theory of direct service connection was raised for the first time after the SOC on appeal, that theory cannot be the basis to remand for an examination or opinion because there was no pre-decisional duty to assist error.

Further, although the Veteran believes that his service-connected lumbar spine disability caused or aggravated his bilateral knee disability, he is not competent to offer a medical opinion as to causation. Moreover, he is not competent to provide an etiological opinion linking his current bilateral knee disability to his military service, and therefore, his lay statements are afforded no probative value. See Jandreau, 492 F.3d at 1376-77.

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Based on the foregoing, the Board finds that the competent, probative evidence persuasively weighs against the claims on appeal, and service connection for a right knee disability and a left knee disability must be denied.

S. HENEKS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Erin J. Trojanowski, 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.

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