Citation Nr: 1319390 Decision Date: 06/14/13 Archive Date: 06/21/13 DOCKET NO. 07-17 957 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUE Entitlement to service connection for left hip disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. Chapman, Associate Counsel INTRODUCTION The Veteran had active duty service from June 1978 to October 1994. This matter is again before the Board of Veterans' Appeals (Board) on appeal from a December 2004 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The case was previously remanded in January 2011 and November 2011. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The case must again be remanded to the RO for failure of the VA examiner to offer an adequate rationale for the opinions requested in the prior remands. The Veteran is seeking service connection for left hip disability. Service connection has already been established for disabilities of the right knee, left knee, and left heel. VA must consider the left hip issue under a secondary service connection theory with regard to the service-connected disabilities. As noted by the Veteran's representative in a May 2013 written brief presentation, the opinions obtained have not been supported by any detailed rationale. Further action is therefore necessary to allow for informed appellate review. . Accordingly, the case is REMANDED for the following actions: 1. The Veteran should be scheduled for an appropriate VA examination (by an examiner who has not already examined the Veteran) to ascertain the nature and etiology of her claimed left hip disability. It is imperative that the claims folder be reviewed in conjunction with the examination. Any medically indicated special tests should be accomplished, and all special tests and clinical findings should be clearly reported. After reviewing the claims file and examining the Veteran, the examiner should offer the following opinions: a) Is it at least as likely as not (i.e., a 50% or higher degree of probability) that the Veteran's claimed left hip disability is causally related to her active duty service or any incident therein? b) Is it at least as likely as not (i.e., a 50% or higher degree of probability) that the Veteran's claimed left hip disability is proximately due to or the result of her service-connected right and/or left knee disabilities? c) Is it at least as likely as not (i.e., a 50% or higher degree of probability) that the Veteran's claimed left hip disability has been aggravated by her service-connected right and/or left knee disabilities? The term 'aggravation' is defined as a worsening of the underlying disability versus a temporary flare-up of symptoms. d) Is it at least as likely as not (i.e., a 50% or higher degree of probability) that the Veteran's claimed left hip disability is proximately due to or the result of her service-connected left heel disability? e) Is it at least as likely as not (i.e., a 50% or higher degree of probability) that the Veteran's claimed left hip disability has been aggravated by her service-connected left heel disability? The term 'aggravation' is defined as a worsening of the underlying disability versus a temporary flare-up of symptoms. All opinions and conclusions expressed must be supported by a complete rationale in the report, to include discussion of relevant medical consideration such as any change in weight-bearing, gait, etc. caused by the service-connected left knee, right knee, and left heel disorders and the impact, if any, on the left hip. 2. In the interest of avoiding further remand, the AMC/RO should review the examination report obtained and ensure that adequate opinions with rationale have been offered. See Jones v. Shinseki, 23 Vet. App. 382, 392-93 (2010) (stating that a VA medical examiner's report was inadequate to resolve the service connection claim where examiner failed to articulate a reasoned explanation of his conclusion that no opinion was possible without resort to mere speculation). If the opinions are not supported by a rationale, the case should be returned to the examiner for an appropriate addendum. 3. After completion of the above and any further development deemed necessary by the AMC/RO, the issue on appeal should be readjudicated under both direct and secondary theories of service connection. If the benefit sought is not granted, the Veteran and her representative should be furnished an appropriate supplemental statement of the case and be afforded an opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).