HIP IMPAIRMENT OF

Summary

The veteran, who served from June 1983 to June 1985, appeals the denial of service connection for left knee, right hip, and lower back disabilities. The veteran also sought readjudication for a left hip disability due to new and relevant evidence. The veteran testified to an in-service motor vehicle accident where he jumped from a moving vehicle, landing on his left side and sustaining a hip injury. He reported continuous hip pain since the accident, treated with OTC medications. Service treatment records documented an in-service motor vehicle accident resulting in a left clavicular fracture, but were silent regarding left knee, hip, or back injuries. The separation examination also showed no complaints related to these conditions. Private treatment records from 2012 onwards documented left knee and back pain, with a 2019 CT scan showing degenerative changes in the spine and hips. VA examinations in February 2021 diagnosed the veteran with lumbosacral strain, right hip osteoarthritis and degenerative arthritis (post-replacement), and left knee meniscal tear, osteoarthritis, and degenerative arthritis (post-replacement). However, the VA examiners opined that the back, right hip, and left knee disabilities were less likely than not related to service, citing the lack of in-service complaints and the long period of quiescence. The Board found the evidence persuasively against service connection for these conditions, noting the lack of contemporaneous complaints and the Veteran's civilian work as a carpenter contributing to knee pain. The Board found the duty to assist did not require an aggravation opinion for the left knee as it was not service-connected. The left hip claim was remanded due to a pre-decisional duty to assist error, as the VA examiner failed to discuss a September 2019 CT scan showing degenerative arthritis in the left hip. A new VA examination is required for the left hip.

Rationale

New and relevant evidence received; Pre-decisional duty to assist error; Inadequate VA examination

Full Decision Text

Citation Nr: A26040100
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210312-146057
DATE: April 29, 2026

ORDER

New and relevant evidence having been received, the issue of service connection for a left hip disability will be readjudicated.

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

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

Entitlement to service connection for a lower back disability is denied.

REMANDED

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

FINDINGS OF FACT

1. A September 2020 rating decision denied the Veteran's claim for service connection for a left hip disability.

2. Evidence received after the September 2020 rating decision tends to prove or disprove a material fact at issue with respect to the claim for service connection for a left hip disability. 

3. The credible, competent and probative evidence of record does not show the Veteran's left knee disability was incurred in or caused by his military service.

4. The credible, competent and probative evidence of record does not show the Veteran's right hip disability was incurred in or caused by his military service.

5. The credible, competent and probative evidence of record does not show the Veteran's lower back disability was incurred in or caused by his military service.

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim of entitlement to service connection for a left hip condition have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d).

2. The criteria for entitlement to service connection for a left knee injury have not been met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).

3. The criteria for entitlement to service connection for a right hip condition have not been met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).

4. The criteria for entitlement to service connection for a lower back condition have not been met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1983 to June 1985.

In the March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 15, 2024.

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 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. 

New and Relevant Evidence

VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d). "New evidence" is defined as evidence not previously part of the actual record before agency adjudicators. "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501(a)(1). The standard shall not be construed to impose a higher evidentiary threshold than the standard that was in effect prior to the date of the enactment of the Appeals Modernization Act (AMA). See 38 U.S.C. § 5108.

Whether new and relevant evidence has been received to readjudicate the claim for service
 will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d). "New evidence" is defined as evidence not previously part of the actual record before agency adjudicators. "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501(a)(1). The standard shall not be construed to impose a higher evidentiary threshold than the standard that was in effect prior to the date of the enactment of the Appeals Modernization Act (AMA). See 38 U.S.C. § 5108.

Whether new and relevant evidence has been received to readjudicate the claim for service connection for a left hip disability.

The AOJ denied the claim in a September 2020 rating decision because there was no evidence of a currently diagnosed left hip disability. However, with his January 2021 supplemental claim, the Veteran included a written statement that during military service it is "frowned upon for soldiers to go to sick call for every ailment." No additional evidence was submitted that the Veteran had a left hip disability.

The Veteran testified at his November 2024 Board hearing. The Veteran testified that while in service he was involved in a motor vehicle accident (MVA) where he had to jump out of a moving vehicle. The Veteran stated that he landed on his left side with his left arm extended. He also stated that he had a "chunk" of flesh lost from his hip due to the MVA; he did not specify which hip. The Veteran further testified that he did not have any issues with his hips prior to service, but following the MVA he has had continuous hip pain that he treated with over the counter (OTC) medications.

This evidence is new, and also relevant, as it tends to prove or disprove an element at issue in the Veteran's claim. Accordingly, readjudication of the claim of entitlement to service connection for a left hip condition is warranted.

Service Connection

Service connection on a direct basis requires (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d).    

Entitlement to service connection for a left knee condition.

Entitlement to service connection for a right hip condition.

Entitlement to service connection for a lower back condition.

The Veteran contends that his left knee, right hip, and lower back disabilities were the result of a MVA during active military service. 

The Veteran's service treatment records (STRs) discuss an MVA in 1984. A December 1984 STR documented that the Veteran had a left clavicular fracture. During the examination, the examination further documented that his cervical spine, skull, left humerus and left elbow were within normal limits. STRs are silent for left knee, left and right hip, or back injuries. The March 1985 separation examination documented that the Veteran's spine and lower extremities were normal. In the March 1985 Report of Medical History form completed by the Veteran at separation, he answered "NO" as to whether he has or had recurrent back pain, bone, joint or other deformity.

In an April 2012 private treatment record, the Veteran complained of left knee pain. The Veteran reported to his provider that there had been no specific injury, but he worked on his knees a lot as a carpenter, and the pain got worse the more he was on his knees. Private treatment records show that the Veteran complained of back pain in June 2017 without a specific injury. A February 2019 private treatment record documents a gradual onset of back pain that was caused by "lifting." In an August 2019 private treatment record, the Veteran reported that he believed his right hip pain was due to his left knee, and that he will get the left knee replacement when he retired. In September 2019, the Veteran sought private treatment for right lower back pain after he tripped over a rake in his garage and fell on his left side. A September 2019 private treatment record documented a CT scan showing degenerative changes to his spine and both hips.

In a January 2021 written statement, the Veteran noted that during military service it is
 complained of back pain in June 2017 without a specific injury. A February 2019 private treatment record documents a gradual onset of back pain that was caused by "lifting." In an August 2019 private treatment record, the Veteran reported that he believed his right hip pain was due to his left knee, and that he will get the left knee replacement when he retired. In September 2019, the Veteran sought private treatment for right lower back pain after he tripped over a rake in his garage and fell on his left side. A September 2019 private treatment record documented a CT scan showing degenerative changes to his spine and both hips.

In a January 2021 written statement, the Veteran noted that during military service it is "frowned upon for soldiers to go to sick call for every ailment."

In February 2021, the Veteran was given VA examinations for his back, bilateral hips and left knee. The Veteran was diagnosed with a lumbosacral strain; he had a right hip replacement in 2020 for ostearthritis and degenerative arthritis and left knee replacement in 2020 for a left knee meniscal tear, osteoarthritis and degenerative arthritis. There was no diagnosis for his left hip or right knee. 

The February 2021 VA medical opinion for the back concluded that it was less likely than not that the Veteran's back disability was incurred in or caused by his military service. The examiner's rationale was that the Veteran's STRs were silent for complaints or treatment during service. The Veteran did not report continued chronic symptoms from the Veteran's self-reported injury during service in 1984 until his first documented reports of back pain in 2017. Symptoms of a back injury or pain would not be quiescent for 30 years. Thus, a nexus was not established.

The February 2021 VA medical opinion for the right hip stated that it was less likely than not that the Veteran's right hip disability was incurred in or caused by the Veteran's service. The Veteran reported to the examiner that his right hip disability was caused by his left knee disability. The first documented complaints of hip pain with a diagnosis of osteoarthritis are dated in December of 2019. No chronic hip complaints were found in the record during or after service until this time. The examiner further noted that the Veteran's STRs, to include the separation examination are silent for complaints or treatment for a right hip condition or symptoms during service. Thus, a nexus was not established.

The February 2021 VA medical opinion for the left knee held that it was less likely than not that the Veteran's left knee disability was incurred in or caused by his military service. The examiner's rationale was that the Veteran's STRs, to include the separation examination, were silent for complaints or treatment during service. The examiner also noted that a 2012 private orthopedic record complaint of left knee pain "for the last few years" and "there is no specific injury, but he works on his knees a lot as a carpenter, and it gets worse the more he is on his knees." The examiner stated that the Veteran's self-reported left knee injury would not have a period of quiescence from 1984 to 2012. Thus, a nexus was not established.

The Veteran testified at his November 2024 Board hearing that during service, he was forced to jump from a moving vehicle due to a vehicle malfunction. Although the Veteran "landed on his shoulder" he also tumbled which caused a "big chunk of meat" out of his hip and sprained his legs. The Veteran also stated that he believed that the initial providers were more concerned with his left shoulder and did not pay as much attention to his other injuries. The Veteran stated that his conditions had gotten worse due to his injury during service.

After review of the record, the Board finds that competent and probative evidence of record is persuasively against finding the Veteran's lower back, right hip, and left knee conditions were incurred during or are otherwise related to his service. The Board finds the February 2021 VA medical opinions probative in that there is no evidence that the Veteran had complaints of, or sought treatment for his back, right hip and left knee injuries for decades following his service. Detailed reports in the STRs following the inservice MVA pertaining to the Veteran's left clavicle fracture do not show any complaints of symptoms for the back, right hip, or left knee. The December 1984 examination following the MVA documented that the Veteran's cervical spine, skull, left humerus, and left elbow were within normal limits. There was no mention of any pain, injury, or flesh wound to the Veteran's back, right hip or left leg. Additionally, the service records are detailed entries following the MVA, as well as additional STRs for treatment for conditions not involving the MVA. It is
 complaints of, or sought treatment for his back, right hip and left knee injuries for decades following his service. Detailed reports in the STRs following the inservice MVA pertaining to the Veteran's left clavicle fracture do not show any complaints of symptoms for the back, right hip, or left knee. The December 1984 examination following the MVA documented that the Veteran's cervical spine, skull, left humerus, and left elbow were within normal limits. There was no mention of any pain, injury, or flesh wound to the Veteran's back, right hip or left leg. Additionally, the service records are detailed entries following the MVA, as well as additional STRs for treatment for conditions not involving the MVA. It is probative that while the STRs show treatment for other conditions, both related and unrelated to the MVA, that there were no document discussing a complaint of back, right hip or left knee injuries during service to include at separation. Further, both the Veteran's private treating provider and the VA examiner noted that the Veteran was in construction and had complained of knee pain due to his work as a carpenter.

The February 2021 VA medical opinion discusses that the Veteran reported that his right hip disability was caused by his left knee disability. Although an opinion for aggravation was not provided, the Board finds the duty to assist does not require an aggravation opinion in this case because the left knee is not a service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006).

Although lay persons are competent to provide opinions on some medical issues, whether the Veteran's back, right hip or left knee disability is related to his service is outside the realm of common knowledge of a lay person because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).

In summary, the evidence of record persuasively weighs against the claim for service connection for low back, right hip and left knee disabilities. 38 U.S.C. § 5107(b). Thus, the benefit of the doubt doctrine is not for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Entitlement to service connection for a left hip disability.

The claim must be remanded because of a pre-decisional duty to assist error. The February 2021 VA medical examination is inadequate. 

The February 2021 examiner found no diagnosis in the left hip. However, a September 2019 CT scan shows that the Veteran has degenerative arthritis in the left hip. The February 2021 VA examiner did not discuss the September 2019 CT scan results. Remand is required to correct this pre-decisional error. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

Obtain a VA examination from an appropriate provider on the likely etiology of the Veteran's left hip disability. Copies of all pertinent records should be made available to the examiner for review. The examiner should answer the following:

Is it at least as likely as not that the Veteran's left hip disability is related to an in-service injury, event, or disease during his active duty service? Why or why not?

The examiner is asked to discuss (i) the Veteran's lay testimony that he injured his left hip while jumping from a moving vehicle; and (ii) the September 2019 CT scan that diagnoses the Veteran's left hip with degenerative arthritis. 

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?

A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made.

 

 

J. Kirby

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. G. Perkins, 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.