Citation Nr: 0624574 Decision Date: 08/14/06 Archive Date: 08/24/06 DOCKET NO. 03-26 131 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama THE ISSUE Entitlement to service connection for bilateral hip disorders, secondary to service-connected right knee disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and his granddaughter ATTORNEY FOR THE BOARD T. Mainelli, Counsel INTRODUCTION The veteran served on active duty from May 1943 to February 1946. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2002 RO decision which, in pertinent part, denied service connection for low back and bilateral hip pain, secondary to the veteran's service-connected right knee disorder. The veteran timely appealed this decision. In January 2005, the RO issued a rating decision which granted service connection at a 20 percent disability rating for lumbar spondylosis and degenerative disc disease, effective from January 2002. In June 2006, the veteran and his daughter appeared and testified at a Travel Board hearing before the undersigned Acting Veterans Law Judge, who was designated by the Chairman of the Board to conduct that hearing and to render a final determination in this case. 38 U.S.C.A. §§ 7101, 7102(a) (West 2002). FINDINGS OF FACT 1. The veteran manifests pain and functional disability of the right hip due to his service-connected right knee disability. 2. The veteran manifests pain and functional disability of the left hip due to his service-connected lumbar spine disability. CONCLUSIONS OF LAW 1. Right hip disability is proximately due to service- connected right knee disability. 38 U.S.C.A. §§ 1110, 5107(b); 38 C.F.R. § 3.310(a) (2005). 2. Left hip disability is proximately due to service- connected lumbar spine disability. 38 U.S.C.A. §§ 1110, 5107(b); 38 C.F.R. § 3.310(a) (2005). REASONS AND BASES FOR FINDINGS AND CONCLUSION Historically, the veteran served on active duty in Army from May 1943 to February 1946, including service in the Rhineland and Central Europe. The veteran claims entitlement to service connection for bilateral hip pain, secondary to his service-connected right knee disability. During the course of his appeal, the veteran was granted service connection at a 20 percent disability rating for lumbar spondylosis and degenerative disc disease. Medical evidence presented in support of the veteran's claim includes an opinion that he manifests disability of the left hip proximately due to his service-connected lumbar spine disability. The Board may consider this theory of entitlement as part of the current claim on appeal. Schroeder v. West, 212 F.3d 1265 (Fed. Cir. 2000); Ashford v. Brown, 10 Vet. App. 120, 123 (1997). Service connection may be established on a secondary basis for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a) (2005). The language of 38 C.F.R. § 3.310(a) has been construed as entailing "any additional impairment of earning capacity resulting from an already service connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service connected condition." Allen v. Brown, 7 Vet. App. 439, 448 (1995). Establishing service connection on a secondary basis essentially requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service connected disability. Id. The veteran bears the burden of presenting and supporting his claim for benefits. 38 U.S.C.A. § 5107(a) (West 2002). In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C. § 5107(b) (West 2002). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id. The veteran has a well documented history of right knee disability manifested by painful motion, locking, crepitus, laxity, give-way, flexion contracture and varus deformity. See, e.g., clinic records of Milton A. Wallace, Jr., M.D., dated June 1987, August 1988, June 1989 and June 1991; VA clinic record dated May 1989; and VA examination report dated October 1991. He began wearing a hinged elastic knee cage due to instability with stretched collateral ligaments in 1991. See Dr. Wallace clinic record dated April 1991. VA examination in April 1995 demonstrated a significant limp on the right side, slight lateral laxity, mild varus deformity and mild swelling with enlargement of the knee. X-ray examination demonstrated degenerative arthritic changes with loose bodies and probable joint effusion. A diagnosis of severe traumatic arthritis of the right knee with chronic instability secondary to anterior cruciate ligament insufficiency was established at that time. The veteran's right knee disability subsequently progressed with increased varus deformity resulting in a stiff-legged limp. See Dr. Wallace statement dated October 1999 and VA examination report dated January 2000. He has described his right knee pain as 9/10 in severity on a daily basis. See Transcript of personal hearing before the RO dated June 2000. Medical opinion has related his markedly abnormal gait as aggravating degenerative disc disease of the lumbar spine and left sacroiliac joint. See Dr. Wallace statement dated November 2001. Service connection has been established for lumbar spondylosis and degenerative disc disease as secondary to service connected right knee disability. See RO rating decision dated January 2005. The diagnosis and etiology of the veteran's bilateral hip symptoms have not been clearly established. VA examinations have provided opinion that the veteran's alteration in gait pattern could be aggravating his bilateral hip condition, but have indicated the extent of additional disability could not be ascertained with any degree of medical certainty. See VA examination report dated July 2002 with addendum and VA examination report dated October 2004. His left hip pain has been attributed to his lumbar spine disability. See Dr. Wallace statement dated November 2002. His right hip pain has been attributed to his right knee disability. See Dr. Wallace clinic note dated June 2003. X-ray examinations of both hips have been interpreted as normal, and also as having no significant arthritis. See VA examination reports dated July 2002 and October 2004 and clinic note from Robert J. Zarzour, M.D., dated June 2003. Physical findings of the right and left hip are significant for reduced range of motion with pain on extremes of motion. See VA examination report dated July 2002. See generally 38 C.F.R. § 4.71a, Plate II (2005). The veteran has also provided credible testimony that his bilateral hip pain significantly interferes with his activities of daily living, especially upon prolonged use. See 38 C.F.R. §§ 4.40 and 4.45 (2005). He requires the use of a walker that he attributes, in part, to his bilateral hip symptoms. His lay report of symptoms are consistent with the medical findings of record. In Sanchez-Benitiz, the Court held that pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. See Sanchez- Benitez v. West, 13 Vet. App. 282 (1999), appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez- Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). In this case, however, the veteran's bilateral hip disorders are manifested by pain, as well as demonstratable functional limitation, i.e. a reduced range of motion with pain at the extremes. In addition, X-ray examination of the hips, performed in June 2003, revealed at least some arthritis. Moreover, unlike the facts in Sanchez-Benitiz, the medical evidence in this case reveals that the veteran's bilateral hip condition has been aggravated by his service-connected disabilities. The June 2003 treatment report from R. Zarzour, M.D., noted the veteran's post-traumatic arthritis, right knee, secondary to his inservice injury, with subsequent "low back pain and right hip pain with arthritis," secondary to awkward gait. The Board finds that the evidence is in equipoise as to whether the veteran's service connected right knee and lumbar spine disability results in additional disability of both hips. The Board exercises reasonable doubt in favor of the veteran, and the claim of entitlement to service connection for right and left hip disability as secondary to service connected disability is granted. 38 U.S.C.A. § 5107(b) (West 2002). ORDER Service connection for right hip disability is granted. Service connection for left hip disability is granted. ____________________________________________ WILLIAM M. YATES Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs