HIP IMPAIRMENT OF

Summary

The Veteran served from July 1997 to August 2002. This case involves an appeal concerning service connection for bilateral hip osteoarthritis, claimed as secondary to service-connected right knee residuals. The Veteran also appeals the denial of Total Disability based on Individual Unemployability (TDIU), which has been remanded for further development. The Board reviewed a January 2021 VA examination report, which found the hip conditions less likely than not related to service, citing obesity as a primary risk factor. However, the Board found this opinion inadequate because it was internally inconsistent, noting the possibility of the knee condition contributing to hip arthritis, and it failed to address aggravation. The Board then considered a February 2025 private medical opinion from a non-VA provider, which found the bilateral hip osteoarthritis at least as likely as not due to the service-connected right knee residuals. This opinion cited the "knee-hip-spine syndrome" and explained how an issue in the knee chain affects the hips, influencing the contralateral hip and leading to excess load and tissue damage. The Board found this private opinion adequate and persuasive, granting service connection for both left and right hip osteoarthritis as secondary to the right knee residuals. The TDIU claim was remanded because the Veteran's hip conditions, now service-connected, along with existing service-connected anxiety and right knee disabilities, may impact his employability.

Rationale

Private opinion found hip osteoarthritis at least as likely as not due to service-connected knee residuals.; Private opinion cited "knee-hip-spine syndrome" and multi-causal links.; VA opinion found inadequate due to internal inconsistency and failure to address aggravation.

Full Decision Text

Citation Nr: A26037367
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 210423-155014
DATE: April 21, 2026

ORDER

Entitlement to service connection for left hip osteoarthritis as secondary to service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis is granted.

Entitlement to service connection for right hip osteoarthritis as secondary to service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis is granted.

REMANDED

Entitlement to a total disability evaluation based on individual unemployability (TDIU) as due to the Veteran's service-connected disabilities is remanded.

FINDINGS OF FACT

1. The probative evidence of record attributes the Veteran's left hip osteoarthritis to his service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis.

2. The probative evidence of record attributes the Veteran's right hip osteoarthritis to his service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left hip osteoarthritis as secondary to service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for entitlement to service connection for right hip osteoarthritis as secondary to service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1997 to August 2002.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the April 23, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 5, 2024, during which the Veteran testified before the undersigned Veterans Law Judge (VLJ); a transcript is of record.

Therefore, the Board may only consider the evidence of record at the time of the February 2021 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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(s), 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 entitlement to a TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection - Left Hip Osteoarthritis

Service Connection - Right Hip Osteoarthritis

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires competent medical or lay evidence of three things: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (i.e., a nexus) between the current disability and the disease or injury incurred in or aggravated by service. Shedden v. Principi, 
103(c)(2)(ii).

Service Connection - Left Hip Osteoarthritis

Service Connection - Right Hip Osteoarthritis

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires competent medical or lay evidence of three things: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (i.e., a nexus) between the current disability and the disease or injury incurred in or aggravated by service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Alternatively, a disability which is due to, or the result of, a service-connected disease or injury or aggravated beyond its natural progression by a service-connected disease or injury may be service connected. 38 C.F.R. § 3.310. Secondary service connection requires competent medical or lay evidence of: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and (3) a nexus between the current disability and the service-connected disability, showing that the current disability was either due to or the result of the service-connected disability or that the current disability was aggravated by the service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995); Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (establishing "but-for" causation standard broader than proximate cause, which is not limited to a single cause and effect, but rather contemplates multi-causal links).

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

The Veteran's January 2021 VA examination report indicates that he was diagnosed with bilateral hip osteoarthritis. See January 2021 VA Hip and Thigh Conditions Compensation and Pension (C&P) Examination (received in February 2021). The Veteran and his representative assert that his bilateral hip condition is the result of his above-noted service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis.

Therefore, the sole question on appeal is whether there is a link between the Veteran's service-connected right knee disability and his bilateral hip osteoarthritis. The Board acknowledges receipt of two opinions, which will be addressed in turn.

The first opinion, authored by the January 2021 VA examiner, concludes that the Veteran's hip conditions are less likely than not due to his service-connected right knee condition. The examiner reasoned that the Veteran had numerous risk factors, primarily obesity, for the development of his bilateral hip osteoarthritis. See January 2021 VA Bilateral Hips Medical Opinion (received in February 2021). However, the examiner noted that the Veteran's "right knee problem . . . can contribute to the development of hip arthritis," thereby generating an internal inconsistency in the opinion, causing the Board to question its adequacy.

Additionally, the examiner solely addressed the question of whether the Veteran's service-connected right knee condition caused his bilateral hip osteoarthritis, rather than also addressing whether the Veteran's service-connected right knee condition aggravated his bilateral hip osteoarthritis. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). As such, the Board cannot find that the January 2021 VA opinion is adequate to determine the Veteran's claim.

The second opinion, received in February 2025, within 90 days of the December 2024 hearing, was authored by a non-VA provider, who found that the Veteran's bilateral hip osteoarthritis was at least as likely as not due to his right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis. See November 2023 Opinion by M.M., DNP, CNP (received in February 2025). In supporting this conclusion, the provider reasoned that the human body is "like a chain" connecting the knee to the femur to the hips, including a description of links between the hip joint and the knee joint, indicating that "[i]f one of the chains in the link is out of position, this affects the rest of the chain, traveling both up and down," as known as knee-hip-spine syndrome. See id. Citing to information from an orthopedic study, the provider found that the Veteran's right knee affected his right
 residuals of meniscus tear, status post arthroscopy with traumatic arthritis. See November 2023 Opinion by M.M., DNP, CNP (received in February 2025). In supporting this conclusion, the provider reasoned that the human body is "like a chain" connecting the knee to the femur to the hips, including a description of links between the hip joint and the knee joint, indicating that "[i]f one of the chains in the link is out of position, this affects the rest of the chain, traveling both up and down," as known as knee-hip-spine syndrome. See id. Citing to information from an orthopedic study, the provider found that the Veteran's right knee affected his right hip, which in turn affected his left hip, indicating that "[d]ue to pain and a feeling of instability and fear of twisting the injured body part, the person will favor the contralateral body part . . . [t]his invariably causes excess load on the non-injured body part and damage to the tissues." Id.

The Board finds that the above-noted private opinion which was authored by a medical professional and contains an adequate rationale in support of the conclusion is adequate.

Because the VA medical opinion is inadequate, and the private medical opinion is adequate, the Board finds that the evidence of record persuasively weighs in the Veteran's favor. Service connection for left hip osteoarthritis and right hip osteoarthritis as secondary to the Veteran's service-connected right knee residuals of meniscus tear, status post arthroscopy with traumatic arthritis is herein granted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS FOR REMAND

TDIU

The Board acknowledges that, during the December 2024 hearing, the Veteran testified that his bilateral hip osteoarthritis affected his ability to work. Specifically, he stated that in his position as a law enforcement officer, he rides in a patrol car, and it "usually takes [him] several minutes to get loosened up to walking" when exiting his vehicle. See December 2024 Hearing Transcript. Additionally, the Veteran stated that "by the halfway point" of his twelve-hour shifts, his hips would feel sore. Id. The United States Court of Appeals for Veterans Claims (Court) ruled that TDIU is a "rating option available whenever a claimant attempts to get service connection or a higher rating from VA and the record includes evidence of unemployability." Phillips v. McDonough, 37 Vet. App. 394, 396 (2024) (citing Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009)).

Here, not only did the Veteran indicate that his bilateral hip osteoarthritis affects his work, but medical evidence in the claims file indicates that the Veteran's other service-connected disabilities negatively impact his ability to work. Specifically, an April 2017 VA psychiatric examination report indicates that the Veteran's service-connected other specified anxiety disorder caused occupational and social impairment "due to . . . symptoms which decrease work efficiency and ability to perform occupational tasks . . . during periods of significant stress." See April 2017 VA Mental Disorders (Other than PTSD and Eating Disorders) C&P Examination. Further, a June 2017 VA examiner found that the Veteran's service-connected right knee disabilities rendered him unable to run, stand, or walk for prolonged periods. See June 2017 VA Knee and Lower Leg Conditions C&P Examination.

Because the Board is awarding service connection for left hip osteoarthritis and right hip osteoarthritis, the AOJ is now tasked with assigning ratings and effective dates for these conditions. Thus, at this time, the Board cannot determine whether TDIU is warranted based on the Veteran's service-connected disabilities.

The AMA provides that the Board may issue remands to satisfy a statutory or regulatory duty, if such remands would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a). Therefore, because the AOJ is now tasked with assigning disability evaluations for the Veteran's left hip osteoarthritis and right hip osteoarthritis, the Board finds that remand is warranted to assist the Veteran in his claim for entitlement to a TDIU.

The matter is REMANDED for the following action:

1. The AOJ should assign ratings for the Veteran's service-connected left hip osteoarthritis and right hip osteoarthritis.

2. After the AOJ completes this task, and conducts any additional appropriate development, the AOJ should determine whether entitlement to a TDIU is warranted.

 

 

DELYVONNE M. WHITEHEAD

Veterans Law Judge

Board of Veterans' Appeals


(a). Therefore, because the AOJ is now tasked with assigning disability evaluations for the Veteran's left hip osteoarthritis and right hip osteoarthritis, the Board finds that remand is warranted to assist the Veteran in his claim for entitlement to a TDIU.

The matter is REMANDED for the following action:

1. The AOJ should assign ratings for the Veteran's service-connected left hip osteoarthritis and right hip osteoarthritis.

2. After the AOJ completes this task, and conducts any additional appropriate development, the AOJ should determine whether entitlement to a TDIU is warranted.

 

 

DELYVONNE M. WHITEHEAD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Hoffman

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.