HIP IMPAIRMENT OF

Summary

The veteran, who served from November 2011 to November 2015, March 2018 to June 2019, October 2022 to March 2024, and January 2025 to December 2025, appeals the denial of service connection for left hip, right hip, and right wrist conditions. The Board found that the evidence persuasively weighed against a service connection for these conditions. For the hip claims, the Board noted favorable findings of a current diagnosis of bilateral hip strain and participation in Toxic Exposure Risk Activity (TERA). However, the VA examiner opined that the hip condition was less likely than not related to TERA, attributing it to strenuous physical strain and wear and tear, with no objective evidence or in-service treatment. The Board also found the veteran's lay statement regarding hip injury lacked probative value due to inconsistencies with medical records and the absence of in-service treatment. For the right wrist claim, the Board noted favorable findings of a current diagnosis of chronic right wrist strain and TERA participation. However, the VA examiner opined the condition was less likely than not related to TERA, citing lack of objective evidence and no in-service treatment. The Board found the veteran's lay statement about a Humvee door incident lacked probative value due to the absence of contemporaneous treatment records, weighing against the claim. Service connection for the left hip, right hip, and right wrist conditions were denied. The claim for PTSD was remanded for a new VA examination to determine the nexus between the veteran's claimed in-service stressors and the current PTSD diagnosis.

Rationale

No evidence of in-service injury, disease, or event related to hip condition; VA examiner opined less likely than not related to TERA; No objective evidence or in-service treatment for hip condition

Full Decision Text

Citation Nr: A26037260
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 250623-558410
DATE: April 21, 2026

ORDER

Entitlement to service connection for left hip condition is denied.

Entitlement to service connection for right hip condition is denied.

Entitlement to service connection for right wrist condition is denied.

REMANDED

Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that a left hip disability began during active service or is otherwise related to an in-service event, injury or disease.

2. The evidence of record persuasively weighs against finding that a right hip disability began during active service or is otherwise related to an in-service event, injury or disease.

3. The evidence of record is persuasively against finding that the Veteran's right wrist condition began during active service or is otherwise related to an in-service event, injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for left hip disability are not met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 

2. The criteria for service connection for a right hip disability are not met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for a right wrist condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 2011 to November 2015, from March 2018 to June 2019, from October 2022 to March 2024, and from January 2025 to December 2025.

In the June 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 August 2024 and October 2024 agency of original jurisdiction (AOJ) decisions, which were subsequently subject to higher-level review in March 2025. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claim of post-traumatic stress disorder (PTSD), any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Applicable Law

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (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.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 

Certain chronic disabilities, such as arthritis, are presumed to have been incurred in service, even though there is no evidence of such disease during the period of service, if they manifest to a compensable degree within one year of discharge. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. 
 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.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 

Certain chronic disabilities, such as arthritis, are presumed to have been incurred in service, even though there is no evidence of such disease during the period of service, if they manifest to a compensable degree within one year of discharge. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.  Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

It is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. In other words, if the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. See Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for left hip condition is denied.

2. Entitlement to service connection for right hip condition is denied.

In March 2024, the Veteran filed a Fully Developed Claim seeking entitlement to service connection for bilateral hip condition among other claims.  An October 2024 Rating Decision denied entitlement to service connection for bilateral hip condition.  The AOJ made the favorable findings that the Veteran (1) has current diagnoses of left hip strain and right hip strain, and (2) participated in a toxic exposure risk activity (TERA). The Board is bound by these favorable findings. 38 C.F.R. § 3.104 (c).

Although the Veteran is confirmed to have participated in Toxic Exposure Risk Activities (TERA), there is no evidence of record suggesting a direct or presumptive connection between the Veteran's claimed bilateral hip condition and any in-service toxic exposures. In a September 2024 VA TERA opinion, the examiner opined that the Veteran's hip condition is associated with strenuous physical strain on the hips. That x-rays performed in conjunction with this examination indicate bilateral hip strain. That the condition commonly occurs as a result of wear and tear of the joint. It is less likely than not related to toxic exposure risk activities. As such, service connection based on TERA is not supported.  

In the September 2024 Hip and Thigh Conditions VA disability benefits questionnaire (DBQ), the VA examiner diagnosed the Veteran with bilateral hip strain. The Veteran reported gradual atraumatic onset of bilateral hip pain and that the hip condition was concurrent with the back condition.  For both the right and left hip, the Veteran reported difficulty with running, hiking, recurrent lifting, long sitting and driving, walking and ascending/descending stairs.  The examiner noted that the Veteran had abnormal range of motion. She noted that a bilateral hip X-ray on September 24, 2024, revealed no evidence of acute fracture dislocation or osseous lesion, the hip joint space is preserved, and the femoral head has a normal contour.  The examiner also stated that the adjacent soft tissues appear unremarkable.

The September 2024 VA examiner opined that the Veteran's bilateral hip strain was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness, because the Veteran did not seek medical treatment for his hips during active duty, or any time after service. The examiner stated that his symptoms are completely subjective during the C&P exam. Further that the Veteran only complained of low back pain in July of 2023 with tingling into the right leg, but no mention of pain around the hip. Because the Veteran has never sought treatment for his hip, there is no proof that his hip strains are a result of service. Symptoms are subjective only and without any objective evidence a nexus cannot be considered.

Medical records in March 2024 show that the Veteran was seen for back pain, shoulder pain, foot pain, headache, sleep apnea, knee pain, and bilateral
 injury, event, or illness, because the Veteran did not seek medical treatment for his hips during active duty, or any time after service. The examiner stated that his symptoms are completely subjective during the C&P exam. Further that the Veteran only complained of low back pain in July of 2023 with tingling into the right leg, but no mention of pain around the hip. Because the Veteran has never sought treatment for his hip, there is no proof that his hip strains are a result of service. Symptoms are subjective only and without any objective evidence a nexus cannot be considered.

Medical records in March 2024 show that the Veteran was seen for back pain, shoulder pain, foot pain, headache, sleep apnea, knee pain, and bilateral sciatica. The Veteran did not complain of any hip issues such as pain or loss of range of motion.  See Medical Treatment Records-Non-Government Facility, April 2024.  The Veteran's service treatment records show no complaints of or treatment for right or left hip issues and there are no post-service records of complaints of hip issues. While the Veteran has complained of low back pain with bilateral sciatica, these conditions have been filed under other claims.  The Veteran currently has service connection for a low back disability and for and left lower extremity radiculopathy. 

The Veteran submitted a lay statement regarding his bilateral hip condition stating that he has pain around the sides of his hips due to wearing duty belts and various gear for years including belts and gas masks.  See Correspondence, March 2024.  Although the Veteran is competent to report his recollection of injuring his hips during service and experiencing symptoms since then, the Veteran is not competent to opine on the diagnoses or etiology of his current bilateral hip condition, as he is without the medical training and expertise to address such medically complicated topics.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007).  

Because there is no probative medical or lay evidence regarding an inservice injury, disease, or event related to the Veteran's bilateral hip condition, the second and third elements of service connection are not met. The "benefit of the doubt" doctrine does not apply because the evidence of record persuasively weighs against the claim. Accordingly, entitlement to service connection for bilateral hip condition is not warranted and the appeal must be denied. 

3. Entitlement to service connection for right wrist condition is denied.

In March 2024, the Veteran filed a Fully Developed Claim seeking entitlement to service connection for right wrist condition among other claims.  An October 2024 Rating Decision denied entitlement to service connection for right wrist condition.  The AOJ made the favorable findings that the Veteran (1) has a current diagnosis of chronic right wrist strain, and (2) participated in a toxic exposure risk activity (TERA). The Board is bound by these favorable findings. 38 C.F.R. § 3.104 (c). 

As noted in the previous section, although the Veteran is confirmed to have participated in Toxic Exposure Risk Activities (TERA), there is no evidence of record suggesting a direct or presumptive connection between the Veteran's claimed right wrist condition and any in-service toxic exposures. In a September 2024 VA TERA opinion, the examiner opined that the Veteran's right wrist condition was less likely than not related to TERA. As such, service connection for right wrist condition based on TERA is not supported.  

An October 2024 DBQ diagnosed the Veteran with chronic wrist sprain.  The Veteran reported that during active service, the door of a Humvee was slammed onto his right wrist. The Veteran notes that he hid his injury.  He reported that he was unable to do pushups or open doors during the first month of the injury. He reported gradual improvement of acute symptoms however he indicated that he had lingering pain and fatigability.

The examiner noted normal range of motion.  The VA examiner found that although the Veteran reported right wrist pain related to strenuous activity during service the Veteran did not seek medical treatment for his wrist during active duty or any time after service. The examiner stated that the Veteran's symptoms are completely subjective and that X-rays were negative. The examiner stated that because the Veteran has never sought treatment for his wrist there's no proof that his right wrist strain is a result of service. Indeed, the examiner stated that symptoms are subjective only and without any objective evidence a nexus cannot be considered.

The Veteran submitted a lay statement stating that he had his hand slammed in between a Humvee door and was unable to use it for more than a month. He reported that he was afraid due to the climate of the command to report it. That he was barely able to get by working during that time. Moreover, the Veteran stated that after that incident his right
 during active duty or any time after service. The examiner stated that the Veteran's symptoms are completely subjective and that X-rays were negative. The examiner stated that because the Veteran has never sought treatment for his wrist there's no proof that his right wrist strain is a result of service. Indeed, the examiner stated that symptoms are subjective only and without any objective evidence a nexus cannot be considered.

The Veteran submitted a lay statement stating that he had his hand slammed in between a Humvee door and was unable to use it for more than a month. He reported that he was afraid due to the climate of the command to report it. That he was barely able to get by working during that time. Moreover, the Veteran stated that after that incident his right hand has always been weaker and gives out easier. See Correspondence, March 2024.  There is no other evidence of a right wrist injury in the record other than the Veteran's statement. The Veteran's service treatment records show no complaints of or treatment for a right wrist injury, including any profile for training. There are no post-service records of complaints of a wrist condition until the VA examination set forth above.

Although the Veteran states that he was afraid to report the wrist injury due to the "climate of the command," the Board notes that medical records in March 2024 show that the Veteran was seen for back pain, shoulder pain, foot pain, headache, sleep apnea, knee pain, and bilateral sciatica. See Medical Treatment Records-Non-Government Facility, April 2024.  

The Board acknowledges that the absence of evidence does not automatically constitute substantive negative evidence. Buczynski v. Shinseki,?24 Vet. App. 221, 224?(2011). However, the medical evidence of record shows that the Veteran ordinarily sought treatment as necessary for illness and injury during service.   The absence of any complaints or treatment for an injury resulting in an inability to open doors, perform physical training, or perform his MOS as military police does not comport with the evidence of record showing that the Veteran sought treatment for numerous other medical issues.  In this case, the absence of any record regarding a right wrist injury weighs against the credibility of a claimant's testimony. Id.; See also Horn v. Shinseki,?25 Vet. App. 231, 239 n.7?(2012). The Board affords great probative weight to the contemporaneous treatment records, which provide a more thorough picture of the Veteran's medical conditions throughout the appeal period and are less impacted by bias or self-interest than the Veteran's statements in support of his claims for benefits. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the Veteran). 

Because there is no probative medical or lay evidence regarding an inservice injury, disease, or event related to the Veteran's right wrist strain, the second and third elements of service connection are not met. The "benefit of the doubt" doctrine does not apply because the evidence of record persuasively weighs against the claim. Accordingly, entitlement to service connection for right wrist strain is not warranted and the appeal must be denied.

REASONS FOR REMAND

4. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded.

In March 2024, the Veteran filed a Fully Developed Claim seeking entitlement to service connection for posttraumatic stress disorder (PTSD) among other claims.  An August 2024 Rating Decision denied entitlement to service connection for PTSD.  The AOJ made the favorable findings that the Veteran (1) has a current diagnosis of PTSD, and (2) participated in a toxic exposure risk activity (TERA). The Board is bound by these favorable findings. 38 C.F.R. § 3.104 (c).

The Veteran sought a higher-level review.  A March 2025 HLR Rating Decision determined that there was no inservice event, disease, or injury and denied entitlement to service connection for compensation purposes.  However, because the Veteran has a current diagnosis of PTSD, the AOJ granted service connection for PTSD for treatment only.  This is based on the presumption under 38 USC §1702(b) that any Veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have incurred such disability in the active military, naval, or air service if such Veteran develops such disability-(1) within two years after discharge or release from the active military, naval, or air service; and (2) before the end of the two-year period beginning on the last day of the Persian Gulf War.

Service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. §
, the AOJ granted service connection for PTSD for treatment only.  This is based on the presumption under 38 USC §1702(b) that any Veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have incurred such disability in the active military, naval, or air service if such Veteran develops such disability-(1) within two years after discharge or release from the active military, naval, or air service; and (2) before the end of the two-year period beginning on the last day of the Persian Gulf War.

Service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5); (2) credible supporting evidence that the claimed in service stressor occurred; and (3) medical evidence of a link between current symptomatology and the claimed in service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997).

The Veteran underwent a VA examination in May 2024. The VA examiner diagnosed the Veteran with PTSD and recommended that the Veteran seek follow-up treatment.  The Veteran's PTSD stressors all occurred during service and included severe hazing with personal assault, the deaths of fellow service members, and an event with a firearm in which he feared for his safety.  The examiner found the Veteran to be an accurate historian.  Unfortunately, the VA examiner did not provide a nexus opinion regarding whether the Veteran's inservice stressors are linked to his PTSD.

The May 2024 VA opinion is thus found to be inadequate for adjudicatory purposes, and remand is needed to correct a pre-decisional duty-to-assist error. When VA provides an examination or obtains a medical opinion, it must ensure that the examination or opinion is adequate.  Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  

Accordingly, this matter is REMANDED for the following action:

1. Return the Veteran's claims file and a copy of this remand to the March 2024 VA examiner, if available, or to another qualified examiner with sufficient expertise to determine the nature and etiology of the Veteran's PTSD. A VA examination is left to the discretion of the examiner.

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?

2. Based on a complete review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's PTSD is causally or etiologically related to his claimed in-service stressors. 

A complete rationale for all opinions expressed must be provided.

 

I. CANNADAY

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Newton

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.