HIP IMPAIRMENT OF

Summary

The Veteran served on active duty from October 1988 to June 1992. He appeals the denial of service connection for left hip degenerative arthritis as secondary to his service-connected right hip disability. The Veteran's left hip condition was diagnosed as moderate osteoarthritis and likely a consequence of the right hip disability, according to his private orthopedic surgeon. The Board found the Veteran's claim for secondary service connection to be in equipoise, granting the benefit. The Board found the January 2021 and July 2021 VA medical opinions inadequate. The January 2021 VA examiner's opinion on causation was confusing and contradictory, while the July 2021 opinions on causation and aggravation appeared to be boilerplate and lacked a proper rationale. The Board gave no probative value to these VA opinions. The private orthopedic surgeon's opinion, which found a probable causal link between the right and left hip conditions due to increased stress on the left hip, was deemed the most probative evidence. Consequently, service connection for left hip degenerative arthritis as secondary to his right hip disability was granted.

Rationale

Board found evidence in equipoise; VA opinions inadequate; Private surgeon opinion found most probative

Full Decision Text

Citation Nr: A26040788
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210910-184026
DATE: April 30, 2026

ORDER

Service connection for left hip degenerative arthritis as secondary to right total hip replacement is granted.

FINDING OF FACT

The Veteran's left hip degenerative arthritis was caused by his service-connected right hip disability.

CONCLUSION OF LAW

The criteria for service connection for left hip degenerative arthritis as secondary to right total hip replacement are met.  38 U.S.C. §§ 1101, 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.310 (2025).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1988 to June 1992.

This appeal is before the Board of Veterans' Appeals (Board) from a September 2021 rating decision of the agency of original jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO).

Service connection for a left hip disability was initially denied in a March 2021 rating decision.  In April 2021, the Veteran requested higher-level review (HLR) of the denial.  In a June 2021 HLR decision, the higher-level reviewer determined that there had been a duty to assist error and transferred the claim to the supplemental claim decision review option for additional development.  After the development was completed, the September 2021 rating decision on appeal denied service connection.

In his September 2021 notice of disagreement, the Veteran elected the Hearing docket.  In April 2025, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge via videoconference.  A transcript is included in the claims file.  Therefore, the Board may only consider the evidence of record at the time of the September 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the April 2025 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 September 2021 decision on appeal and prior to the April 2025 Board hearing, or (2) more than 90 days following the April 2025 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, he 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, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a supplemental claim are included with this decision. 

Entitlement to service connection for left hip degenerative arthritis as secondary to right total hip replacement

The Veteran claims service connection for a left hip disability.

As the Board is granting secondary service connection, direct service connection will not be addressed.

Service connection may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury."  See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).  For "aggravation of non-service-connected disabilities" it is enough to show that a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).  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.

In September 2017, the Veteran underwent a VA examination for his right hip disability.  The examiner diagnosed osteoarthritis
 connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).  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.

In September 2017, the Veteran underwent a VA examination for his right hip disability.  The examiner diagnosed osteoarthritis post healed fracture of the femoral neck in the right hip, as well as degenerative arthritis of the left hip.  In the left hip, ranges of motion were normal with no pain noted on examination.

In November 2019, the Veteran underwent another VA examination for his right hip disability.  While no left hip diagnosis was given, his ranges of motion in the left hip were normal with no pain noted on examination.  

VA treatment records reflect that at a January 2020 pain consultation, the Veteran reported a primary complaint of left posterior hip pain radiating to the left thigh, intermittent and aggravated by activity.  He was diagnosed with left side radiculopathy, left sacroiliitis, and post lumbar spinal surgery syndrome.  This consultation occurred one week prior to his right hip replacement surgery.  In February 2020 he requested an orthopedic consultation for left hip issues.  X-rays showed moderate narrowing of the left hip joint.  In March 2020 his primary care physician diagnosed moderate osteoarthritis.

In his December 2020 claim, the Veteran attributed his left hip disability to the change in gait caused by his right hip disability.

The Veteran underwent a VA examination in January 2021.  He reported problems that became noticeable in 2010, but it is unclear if he was referring to his left hip, both hips, or his right hip.  He stated that he had a very noticeable limp which now is not as bad.  He was diagnosed with degenerative arthritis of the left hip.  The examiner opined that the disability was less likely than not caused by his right hip disability.  This opinion was based on the rationale that there was no objective evidence of such a relationship.  The examiner cited literature indicating that an injury in one extremity rarely causes a major problem in the opposite extremity except when damage to the leg results in major displacement of the center of gravity while walking or significant shortening of the injured limb with an abnormal gait pattern present for an extended period of time.  The examiner explained that the evidence did not establish such findings.  The examiner further noted that in certain records the Veteran's gait changes have been attributed to his back disability as well as his resultant sacroiliitis.  No opinion as to aggravation was offered.

Private treatment records reflect that at a March 2021 orthopedic consultation (based on a VA referral), the Veteran reported that his left hip continued to worsen and deteriorate.  He was diagnosed with status post right total hip replacement with severe degenerative joint disease of the left hip and morbid obesity.  The orthopedist stated that the left hip condition was likely a consequence of the right hip condition.  This opinion was based on the rationale that the arthritic change and the stress likely put more stress on the left hip, and it deteriorated at a faster rate.  The orthopedist recommended hip replacement surgery, which the Veteran underwent in May 2021.

The Veteran underwent another VA examination in July 2021.  The examiner opined that the Veteran's left hip disability was less likely than not caused by his right hip disability.  This opinion was based on the rationale that there is no medical relationship between the disabilities, and a review of medical literature failed to demonstrate a causal relationship.  The examiner opined that his left hip disability was at least as likely as not aggravated by his right hip disability.  This opinion was based on the same seemingly irrelevant rationale used to support the denial of aggravation with respect to other service connected disabilities.  

At his April 2025 hearing, the Veteran's representative argued that the VA examiners' opinions failed to consider or answer the opinion of his treating orthopedic surgeon, who had more expertise regarding this specific injury.  He further discussed his history of plane jumps in service and how that contributed to his disabilities.

(Continued on the next page)

?

The Board finds that the evidence is at least in equipoise as to whether the Veteran's left hip disability was caused by his service-connected right hip disability.  The January 2021 and July 2021 VA medical opinions are inadequate. 
.  This opinion was based on the same seemingly irrelevant rationale used to support the denial of aggravation with respect to other service connected disabilities.  

At his April 2025 hearing, the Veteran's representative argued that the VA examiners' opinions failed to consider or answer the opinion of his treating orthopedic surgeon, who had more expertise regarding this specific injury.  He further discussed his history of plane jumps in service and how that contributed to his disabilities.

(Continued on the next page)

?

The Board finds that the evidence is at least in equipoise as to whether the Veteran's left hip disability was caused by his service-connected right hip disability.  The January 2021 and July 2021 VA medical opinions are inadequate.  The January 2021 VA examiner found that the Veteran did not experience a gait change from his right hip disability sufficient to damage his left hip and confusingly added that the apparently nonexistent gait change was attributed to his back disability, which is service connected.  The July 2021 opinions as to causation are based entirely on absence of possibility in medical literature, which seemingly conflicts with the January 2021 VA examiner's explanation of the conditions under which causation existed, and the Veteran's treating orthopedic surgeon's finding that causation was probable.  The July 2021 opinions as to aggravation appear to be copied and pasted from other opinions, as they have no apparent relationship to aggravation.  Even if these opinions were adequate on their own, they would be inadequate for their failure to address the opinion of the Veteran's orthopedic surgeon, who observed unprompted that the left hip disability was probably caused by the strain put on the left hip by the right hip disability.  The Board gives the VA opinions no probative value. The orthopedic surgeon's expertise in the area and familiarity with the Veteran's specific condition render this opinion the most probative evidence on the question.  For these reasons, the Board finds that the evidence is at least in equipoise as to whether the Veteran's left hip disability was caused by his service-connected right hip disability.  Service connection is therefore granted.

 

 

Rebecca N. Poulson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Gallagher, 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.