HIP IMPAIRMENT OF

Summary

The veteran, who served from March 1969 to April 1969, appeals the denial of service connection for a right hip disorder. The veteran contends the disorder resulted from an in-service hip injection where a piece of the needle allegedly broke off and remained in his hip. The Board reviewed the veteran's claim in light of regulations concerning chronic diseases and the need for continuity of symptomatology. While the veteran has a current diagnosis of degenerative arthritis, the Board found the condition was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and lacked continuity of symptomatology attributable to service. The Board noted that the veteran's first diagnosis of mild osteoarthritis occurred decades after service, outside any presumptive period. The Board also addressed the veteran's assertion of a retained needle fragment, finding no medical basis for this claim due to the absence of any radiographic evidence of such a fragment on multiple post-service imaging studies. A VA physician's opinion from December 2025 was considered, which found the Veteran's current hip condition less likely than not incurred in or caused by service. The examiner noted the temporal proximity of the injection to the onset of symptoms but concluded there was insufficient medical evidence to establish a direct causal relationship, suggesting the flat feet might be an incidental finding or exacerbated by compensatory mechanics rather than directly caused by the injection. The examiner also opined that a retained needle fragment was medically implausible. The Board accorded great probative value to these opinions, finding the evidence weighed against a service connection. The Board also noted that the veteran, while competent to report symptoms, was not competent to provide a medical nexus opinion. Service connection for the right hip disorder was denied.

Rationale

Disability not shown as chronic in service; Did not manifest to a compensable degree within presumptive period; No continuity of symptomatology attributable to service; No medical nexus established between current disorder and service; No radiographic evidence of retained needle fragment; Osteoarthritis diagnosis occurred decades after service

Full Decision Text

Citation Nr: 26005086
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 15-12 869
DATE: April 30, 2026

ORDER

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

FINDING OF FACT

The Veteran's right hip disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for a right hip disorder are not met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active military service from March 1969 to April 1969.  He testified before the undersigned Veterans Law Judge during a September 2018 hearing.  This matter is on appeal from a July 2012 rating decision.

The case was remanded by the Board of Veterans' Appeals (Board) in March 2019, and then denied in a July 2020 decision.  The Veteran thereafter appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court).  In an October 2021 Memorandum Decision, the Court vacated the Board's decision and remanded the case for readjudication in accordance with the Memorandum Decision.  Subsequently, the case was remanded in May 2022, September 2022, May 2023, January 2024, January 2025, June 2025, and December 2025 for further development.  

The Veteran contends that he has a right hip disorder due to getting an injection in the hip during service.  September 2018 Hearing Transcript at 3.  He contends that a piece of the needle broke off and is stuck in his hip.  August 2012 Notice of Disagreement.   

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309.  Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The Veteran has a current diagnosis of degenerative arthritis as evidenced by an October 2019 VA examination.  Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a).

However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology.  Private treatment records show that the Veteran was not diagnosed with mild osteoarthritis until October 2011, decades after separating from service, and decades outside of the applicable presumptive period.  

While the Veteran is competent to report having experienced symptoms of right hip pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis as the Veteran has not demonstrated the necessary medical expertise.  The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  Indeed, arthritis is a disability established by X-ray findings.  38 C.F.R. § 4.71a, Diagnostic Code 5003.

Service connection for a right hip disorder may still be granted on a direct basis; however, the evidence of record persuasively weighs against finding that a medical nexus exists between the Veteran's right hip disorder and an in-service injury, event or disease.  38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. 

A September 2018 VA physician letter showed that the Veteran reported having
 disability established by X-ray findings.  38 C.F.R. § 4.71a, Diagnostic Code 5003.

Service connection for a right hip disorder may still be granted on a direct basis; however, the evidence of record persuasively weighs against finding that a medical nexus exists between the Veteran's right hip disorder and an in-service injury, event or disease.  38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. 

A September 2018 VA physician letter showed that the Veteran reported having pain in his hip since his active duty period.  However, this letter did not provide a medical opinion relating the Veteran's current right hip disorder to his military service.  

In compliance with the October 2021 Memorandum Decision, VA medical opinions were obtained in December 2025.  

With regards to the Veteran's assertion that the finding of bilateral flat foot at discharge, when there was no indication of flat foot at entrance to service, was indicative of adverse effects of the immunization, the examiner opined that the temporal relationship between the onset of the reported pes planus and the adverse reaction to the right hip immunization injection in April 1969 was noteworthy.  The examiner noted that the Veteran's enlistment examination in January 1969 showed normal feet, while service treatment records in April 1969 showed complaints of pain associated with pes planus, and physical examination indicated the presence of flat feet.  The examiner reported that the injection reportedly caused immediate right hip pain and inability to walk.  They reported that while there was no imaging evidence of a retained needle, the Veteran described significant functional impairment immediately following the injection.  The examiner opined that the clinical discovery of pes planus the following day could suggest an exacerbation or functional manifestation secondary to the injection trauma.  They opined that it was plausible that acute pain, altered gait, or compensatory mechanics after the injection could have led to stress on the arches and resulted in either symptomatic manifestation or clinical recognition of flat feet, although a direct causative link could not be definitively established without longitudinal imaging or chronicity data.

The examiner reported that from a pathophysiological perspective, improper administration of intramuscular injections in the hip could lead to immediate local trauma, hematoma formation, nerve irritation, or mechanical injury to surrounding structures.  They reported that short-term adverse effects could include localized pain, swelling, stiffness, and temporary limitation of mobility.  They further reported that reactive or longer-term consequences might include chronic pain, scarring, bursitis, or, in rare cases, disruption of local musculoskeletal function.  They opined that an altered gait due to pain could, in turn, increase stress on the lower extremities, potentially exacerbating underlying structural conditions such as pes planus.  The examiner noted that the absence of continuous care, or chronicity of treatment, did not invalidate the observed clinical findings or the Veteran's reports of functional limitations.  The examiner opined that based on the available evidence, it could not be conclusively determined that the pes planus was an adverse effect of the immunization administered in service.  They concluded that while the temporal proximity raised the possibility of a contributing role, there was insufficient medical evidence to establish a direct causal relationship, and the flat feet might represent either a previously undetected structural variant, an incidental finding, or a manifestation exacerbated by the injection.

Regarding the Veteran's assertion that the needle broke off and was retained in his hip, the examiner opined that there was no medical basis to conclude that a retained needle persisted in the hip or that such a mechanism caused or contributed to the Veteran's current right hip degenerative arthritis.  The examiner reported that bilateral hip X-rays in September 2018, with comparison to prior pelvis/right hip radiographs from January 2018 demonstrated normal alignment, no fracture, and only mild degenerative joint space narrowing and osteophytosis of both hips.  They noted that there was no metallic foreign body, retained needle fragment, or abnormal radiopaque density identified.  The examiner further noted that the October 2019 VA examination explicitly stated that there is no evidence on radiological imaging of a retained needle.  The examiner opined that if a needle fragment had fractured and remained embedded in the right hip in 1969, it would be expected to remain radiopaque and readily visible on plain radiographs obtained decades later.  They reported that metallic foreign bodies did not biologically resorb, and migration sufficient to fully evade detection on repeated modern imaging was medically implausible.  They concluded that the absence of any radiographic evidence of a retained needle on multiple post-service imaging studies obtained approximately 49-50 years after the
 there was no metallic foreign body, retained needle fragment, or abnormal radiopaque density identified.  The examiner further noted that the October 2019 VA examination explicitly stated that there is no evidence on radiological imaging of a retained needle.  The examiner opined that if a needle fragment had fractured and remained embedded in the right hip in 1969, it would be expected to remain radiopaque and readily visible on plain radiographs obtained decades later.  They reported that metallic foreign bodies did not biologically resorb, and migration sufficient to fully evade detection on repeated modern imaging was medically implausible.  They concluded that the absence of any radiographic evidence of a retained needle on multiple post-service imaging studies obtained approximately 49-50 years after the claimed in-service incident established that no retained needle was present.

Additionally, the examiner opined that the Veteran's right hip osteoarthritis and femoroacetabular impingement syndrome was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.  The rationale was that they found no record of chronic or recurrent right hip problems during service.  They reported that no right hip pain, injury, or pathology was noted in the service treatment records or in the immediate post-separation period.  

The examiner opined that a nexus for service connection could not be made at that time due to the missing elements of origin and chronicity of the current condition dating to service.  They reported that no permanent residual or chronic right hip disability was shown by the service medical records or demonstrated by evidence from the period immediately following separation from service.  

The examiner opined that it was medically unfeasible for symptoms and pathology of right hip osteoarthritis or femoroacetabular impingement syndrome to have been as prevalent and chronic as claimed for more than four decades, and yet resulted in no documented evaluation, treatment, or objective findings until many years later.  They noted that there was not simply a lack of documentation during service, but a lack of evidence of any right hip-related complaints or treatment for over 42 years following separation.  They opined that they were unable to objectively connect the Veteran's right hip osteoarthritis and femoroacetabular impingement syndrome to service, as that was not the expected natural course of either condition in the absence of documented chronic symptoms or significant in-service trauma.  

The examiner opined that while the Veteran was competent to report his recollection of an acute painful event following inoculation injections, there was no contemporaneous medical evidence in the service treatment records documenting a right hip injury, retained needle fragment, infection, abscess, neurologic deficit, or musculoskeletal pathology involving the right hip during service.  They further opined that, likewise, there was no objective evidence of continuity of right hip complaints, evaluation, or treatment in the years immediately following separation.  The examiner reported that right hip osteoarthritis was a progressive degenerative condition most commonly associated with age-related wear, genetic predisposition, biomechanical factors, or documented trauma, while femoroacetabular impingement syndrome was a structural condition typically related to congenital or developmental hip morphology rather than an injection-related event.  They opined that a single injection episode, even if acutely painful, would not be medically expected to cause femoroacetabular impingement or degenerative joint disease manifesting decades later without intervening chronic symptoms, repeated treatment, imaging abnormalities, or documented residuals.  The examiner concluded that the prolonged interval of more than four decades between service and the first objective evidence of right hip pathology weighed heavily against a causal nexus.  The examiner reported fully considering the Veteran's lay statements and hearing testimony.   

Lastly, the examiner provided an opinion regarding the pain noted in the September 2018 medical note by a VA physician, and the Veteran's reported complaint of stiffness during his November 2019 VA examination and as noted in an April 1969 clinical note while he was in service.  The examiner also opined regarding any common side effects and adverse reactions, reactive and/or longer term, or the potential impact of administering immunizations improperly. 

In this opinion, the examiner opined that based on the records, the differences among the symptoms documented in April 1969, the September 2018 VA physician letter, and the October 2019 VA examination were primarily related to timing, symptom characterization, and clinical context, rather than representing clearly distinct disease processes.  They noted that in the April 1969 service treatment record, the Veteran complained of tingling in the hands, dizziness, and stiffness after receiving an injection earlier that day.  They opined that, in that setting, "stiffness" was best interpreted as an acute, transient post-injection reaction, which might reflect localized muscle soreness, myofascial tightness, or a short-term systemic response to immunization.  The
 opined that based on the records, the differences among the symptoms documented in April 1969, the September 2018 VA physician letter, and the October 2019 VA examination were primarily related to timing, symptom characterization, and clinical context, rather than representing clearly distinct disease processes.  They noted that in the April 1969 service treatment record, the Veteran complained of tingling in the hands, dizziness, and stiffness after receiving an injection earlier that day.  They opined that, in that setting, "stiffness" was best interpreted as an acute, transient post-injection reaction, which might reflect localized muscle soreness, myofascial tightness, or a short-term systemic response to immunization.  The examiner reported that such symptoms were commonly reported shortly after vaccinations and were generally self-limited, resolving within hours to days.  They reported, importantly, that notation did not describe focal hip pathology, chronic pain, altered gait, or functional limitation, nor did it document follow-up care suggestive of a persistent musculoskeletal condition.

The examiner noted that, by contrast, the September 2018 VA physician's letter referred to chronic hip pain reported since active duty, written decades after service and based on longitudinal care of the Veteran in the VA system.  They opined that that letter reflected a retrospective attribution of ongoing pain rather than contemporaneous clinical documentation from service.  They reported that it did not distinguish stiffness from pain, did not describe objective findings, and did not specify a mechanism of injury.  The examiner opined that, as such, it represented supportive lay history-based medical commentary rather than evidence of continuity documented in service records.

The examiner noted that during the October 2019 VA hip and thigh examination, the Veteran described chronic right hip pain and stiffness with functional limitations such as difficulty walking, squatting, and prolonged standing.  They opined that, in that context, "stiffness" was a chronic degenerative symptom, commonly associated with osteoarthritis, reflecting reduced joint mobility after periods of rest and progressive mechanical pain with use.  The examiner opined that this type of stiffness was qualitatively different from the brief post-injection stiffness noted in 1969, as it implied long-standing structural joint changes rather than an acute inflammatory or muscular response.

The examiner opined that regarding immunizations, common side effects included localized pain, soreness, swelling, induration, and short-term stiffness at or near the injection site, as well as transient systemic symptoms such as dizziness or malaise.  They opined that improper administration (for example, injection too deep, into muscle not intended, or poor technique) might rarely cause localized complications such as hematoma, nerve irritation, bursitis, or myositis.  They reported that those reactions were typically acute or subacute and, when they persisted, usually manifested as soft-tissue injury rather than delayed degenerative joint disease.  They reported that there was no well-established medical evidence that an improperly administered immunization, in the absence of retained foreign material, infection, or documented structural injury, resulted in degenerative arthritis of the hip decades later.

The examiner concluded that, in summary, the April 1969 stiffness reflected an acute post-injection reaction, the September 2018 letter reflected a retrospective report of chronic pain, and the October 2019 stiffness represented a chronic degenerative symptom associated with osteoarthritis.  The examiner opined that, while those symptoms shared overlapping terminology, they differed in clinical meaning, duration, and pathophysiology, and they did not, on their own, demonstrate a continuous disease process originating from the in-service immunization event.

The examiner's opinions are probative, because they are based on an accurate medical history, consider the Veteran's lay evidence, and provides explanations that contains clear conclusions and supporting data.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Therefore, the Board accords great probative value to these opinions showing that the Veteran's right hip disorder is not related to his service.  

While the Veteran believes the claimed right hip disorder is related to an in-service injury, event, or disease, including a hip injection, the Veteran is not competent to provide a nexus opinion in this case because the record does not show that he has the medical training or credentials to make such a determination.  Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24 Vet. App. 428 (2011).  Consequently, the Board gives more probative weight to the competent medical evidence failing to show a relationship to service in denying this claim.

 

 

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. Barstow