OSTEOARTHRITIS

BETHANY L. BUCK · 2026 · Case ID: A26035366

DENIED

Summary

The Veteran served on active duty from September 1983 to September 2004. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision concerning entitlement to service connection for bilateral hip osteoarthritis. The Veteran claims this condition is secondary to his service-connected bilateral knee disability, citing progressive pain and compensation for the right knee leading to increased pain in the left knee and subsequent hip pain. The Board found that the Veteran has a current diagnosis of bilateral hip osteoarthritis, satisfying the first element for service connection. However, the Veteran's service treatment records (STRs) showed no documentation of bilateral hip complaints during service, nor did lay statements reference an in-service injury or symptoms. The Board noted the Veteran marked yes to a history of arthritis at his retirement examination, but this was related to his knees, not hips. Therefore, direct service connection was denied. For secondary service connection, a January 2025 VA clinician provided a negative nexus opinion, stating that knee arthroplasty does not directly increase the risk of hip arthritis, though other risk factors exist. The clinician's opinion, which reviewed all relevant records and cited medical literature, was afforded probative weight. The Board found the persuasive evidence weighed against entitlement on any theory, and as the evidence was not in relative equipoise, the benefit of the doubt doctrine was not applicable. Service connection for bilateral hip osteoarthritis was denied.

Rationale

No in-service complaints or documentation of bilateral hip issues in STRs.; Lay statements did not reference in-service hip problems.; VA clinician provided negative nexus opinion for secondary connection to knees.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250319-532605

Full Decision Text

Citation Nr: A26035366
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 250319-532605
DATE: April 16, 2026

ORDER

Entitlement to service connection for bilateral hip osteoarthritis is denied.

FINDING OF FACT

The Veteran's bilateral hip osteoarthritis first manifested many years after service and has not otherwise been found to be related to his service; nor is it caused or aggravated by service-connected disabilities.

CONCLUSION OF LAW

The criteria for service connection for bilateral hip osteoarthritis, to include as secondary to his service-connected disabilities, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASON AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1983 to September 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision from a Department of Veteran Affairs (VA) Regional Office (RO) under the modernized appeals system known as the Appeals Modernization Act (AMA).

In March 2025, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal, and requested the AMA direct docket review. Under the rules of the AMA, the Board's review is limited to the evidence associated with the claims file as of the date of the February 2025 rating decision on appeal. 38 C.F.R. § 20.301.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. Generally, service connection requires three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Sheddon v. Principi, 381 F.3d. 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic disease, such as arthritis, 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 with a presumptive period following separation from service (typically one year); 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).

Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). 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) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b).

In deciding the Veteran's claim, the VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or whether the persuasive evidence is against the claim, in which case the claim is denied. 38 U.S.S. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

Entitlement to service connection for bilateral hip osteoarthritis
current level of disability. 38 C.F.R. § 3.310(b).

Entitlement to service connection for bilateral hip osteoarthritis.

In September 2024 and October 2024 claim forms, the Veteran contends his bilateral hip disability is secondary to his bilateral knee disability.

Direct Service Connection

The March 2025 rating decision made the favorable finding that the Veteran has been diagnosed with a disability, and that a January 2025 VA medical examination diagnosed the Veteran with bilateral hip osteoarthritis. The Board is bound by this favorable finding. As such, the first element required for service connection has been met.

Turning to the second element for direct service connection, upon review of the Veteran's service treatment records (STRs), there is no documentation of complaints involving the Veteran's bilateral hips. Specifically, there are Reports of Medical History, which were completed by the Veteran, and Reports of Medical Examination, which were completed by a military doctor, that note many other medical issues, but there is no documentation regarding the bilateral hip. See VBMS, document labeled STR- Medical, receipt date 9/19/2014, pages 3, 30, 132, 142, 144, 146, 148, 152 of 154 (October 12, 1988 Report of Medical History and Report of Medical Examination; June 28, 1993 Report of Medical History (oversees screening); July 21, 1994 Report of Medical History (re-enlistment); July 21, 1994 Report of Medical Examination (re-enlistment); August 24, 1999 Report of Medical history (5 years); August 24, 1999 Report of Medical History (5 years); March 6, 2002 Report of Medical History (overseas screening); July 19, 2004 Report of Medical Examination (retirement), and; July 19, 2004 Report of Medical History (retirement).

Importantly, at the time of the Veteran's retirement examination, although the Veteran marked yes, to a history of arthritis. Notably, arthritis of the knees was previously noted on earlier examinations.

The Veteran has submitted lay statements (as described below) regarding his hips; however, they do not reference an in-service injury or symptoms of hip problems in service. As such, the Board finds that direct service connection is not warranted.

Secondary Service Connection

The Board notes the Veteran submitted a statement in January 2025, where he explained that he continued to experience pain in his right knee post total knee replacement (TKR) that was performed on August 16, 2024. He explained that his left knee has been progressively getting worse and the pain has been increasing due to compensation for the right knee. This is making his walking even more difficult since both knees are causing him to limp and the increased pain due to moving. Important to this case, he also explained that he is feeling the pain in his right hip, since that has shown to be "bone on bone," and will need to be replaced soon, and that he is trying to resolve the issues with his right knee, to include the increased pain in his left knee.

In January 2025, a VA clinician provided a negative medical nexus opinion as to whether the Veteran's bilateral hip disability is proximately due to his service-connected bilateral knee. The clinician explained they reviewed the Veteran's STRs. The clinician added undergoing knee arthroplasty does not directly increase the risk of developing hip arthritis. However, patients who undergo total knee arthroplasty often have osteoarthritis that affects multiple joints. Studies have shown that individuals with osteoarthritis in one joint are at a higher risk of developing osteoarthritis in other joints due to shared risk factors, such as age, obesity, and genetic predisposition. For example, Santana et al. found that patients who underwent TKA had a cumulative incidence at 13 percent for subsequent total hip arthroplasty within 8 years. The clinician specifically referred to a medical journal article on the National Institute of Health website, a nationally recognized peer-reviewed medical resource. Consequently, the clinician opined a nexus is
increase the risk of developing hip arthritis. However, patients who undergo total knee arthroplasty often have osteoarthritis that affects multiple joints. Studies have shown that individuals with osteoarthritis in one joint are at a higher risk of developing osteoarthritis in other joints due to shared risk factors, such as age, obesity, and genetic predisposition. For example, Santana et al. found that patients who underwent TKA had a cumulative incidence at 13 percent for subsequent total hip arthroplasty within 8 years. The clinician specifically referred to a medical journal article on the National Institute of Health website, a nationally recognized peer-reviewed medical resource. Consequently, the clinician opined a nexus is not established. As the clinician reviewed the Veteran's military medical treatment records, post-military medical treatment records, took into consideration the Veteran's lay statements and reconciled their rationale with substantiated reasoning with supported medical facts from the Veteran's claims file, the Board affords this opinion probative weight.

Although the opinion does not address secondary service connection by aggravation, the Veteran has not contended that he had bilateral hip disabilities that were aggravated by his knee disabilities. Rather, he expressly argued that his knee disabilities caused his hip disabilities. As the theory of aggravation was not raised by the record, no opinion is necessary on that topic.

To the extent that the Veteran asserts, without supporting evidence, a relationship between his bilateral hip osteoarthritis and his service-connected disabilities, this is precisely the type of complex medical issue relating to an internal medical process which extends beyond an immediately observable cause-and-effect relationship as to which lay evidence is not competent. Jandreau v. Nicholson, 492 F.3d 1372 at 1376, n. 4 (Fed. Cir. 2007) ("sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer").

Presumptive Service Connection

The Board notes that although the Veteran has contended that he is experiencing pain in his right hip, that he believes is due to his right knee, there is no explicit statement and/or implication that he has been experiencing a continuity of symptoms of his bilateral hips in service.

The Veteran's VA medical treatment record begin documentation in 2015, more than one decade after the Veteran left military service. During that time, there is no documentation in his medical treatment records of bilateral hip issues. The earliest medical documentation in the Veteran's treatment records for his bilateral hip are from July 2024, shortly before he submitted his claim forms for entitlement to service connection. Specifically, a July 24, 2024 primary care notes the Veteran's report of increasing pain to his lower back and hips; that he wanted to find out if the pain is due to changes in his walking post-operation or if he also has arthritis to his hips and back. See VBMS, document labeled CAPRI, receipt date 1/15/2025, page 236 of 332. There is also a July 26, 2024 letter to the Veteran notifying him of the results of the x-rays of the hips and lower back were abnormal; x-rays do show changes that could lead to impingement symptoms of the hip, and; this may need to get evaluated by an orthopedist in the future if hip pain continues. See VBMS, document labeled CAPRI, receipt date 1/15/2025, page 234 of 332.

As such, with regard to granting service connection on a presumptive basis, there is no evidence of record reflecting that the Veteran developed osteoarthritis of his bilateral hip during service and/or to a compensable degree within one year of discharge from active duty, or has otherwise experienced a continuity of symptomatology, such that the presumption for chronic diseases could be applied.

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In summary, the Board finds that the persuasive evidence weighs against entitlement to service connection on any theory of entitlement. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the persuasiveness of the evidence is against the claim, the doctrine is not applicable. 38 C.F.R. § 3.102 (2015), Gilbert v. Derwinski, 1 Vet. App. 39, 54-56 (1990). The evidence is not in relative equipoise for service connection for a bilateral hip disability under any reasonably raised theory, to include secondary service connection. There is no reasonable doubt to resolve in the Veteran's favor, and the appeal is denied.

Bethany L. Buck

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R
has considered the applicability of the benefit-of-the-doubt doctrine. However, as the persuasiveness of the evidence is against the claim, the doctrine is not applicable. 38 C.F.R. § 3.102 (2015), Gilbert v. Derwinski, 1 Vet. App. 39, 54-56 (1990). The evidence is not in relative equipoise for service connection for a bilateral hip disability under any reasonably raised theory, to include secondary service connection. There is no reasonable doubt to resolve in the Veteran's favor, and the appeal is denied.

Bethany L. Buck

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Smith, Associate 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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