Citation Nr: 18141420 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 15-41 037A DATE: October 10, 2018 REMANDED Entitlement to service connection for a back disorder, to include as secondary to service-connected bilateral plantar fasciitis and bilateral ankle tendonitis, is remanded. Entitlement to service-connection for a left hip disorder, to include as secondary to service-connected bilateral plantar fasciitis and bilateral ankle tendonitis, is remanded. Entitlement to service connection for a left leg disorder, to include as secondary to service-connected bilateral plantar fasciitis and bilateral ankle tendonitis, is remanded. REASONS FOR REMAND The Veteran served honorably in the U.S. Army from June 1979 until June 1994. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The issues on appeal are remanded to obtain adequate medical opinions. When VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Preliminarily, VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c) (2017). This includes making as many requests as are necessary to obtain relevant records from a Federal department or agency, including, but not limited to, military records. 38 C.F.R. § 3.159(c)(2). The STRs document 2 motor vehicle accidents and the Veteran has reported a third. It thus appears that the Veteran’s STRs may be incomplete. On remand, the Veteran must be given an opportunity to identify any outstanding treatment records related to the third motor vehicle accident. 1. Entitlement to service connection for a back disorder, to include as secondary to service-connected bilateral plantar fasciitis and bilateral ankle tendonitis. A June 2015 VA examination report documents current diagnoses of degenerative disc disease and herniated nucleus pulposus, and opined that the back disorder was not secondary to the service-connected bilateral foot and ankle disorders because those disorders would not significantly contribute to or cause herniated nucleus pulposus. The examiner’s opinion is conclusory and is not supported by an explanation. Additionally, private treatment records from August 2014 document that diagnostic testing showed lower lumbar stenosis, and the etiology of this diagnosis was not addressed by the June 2015 VA examiner. For these reasons, the 2015 opinion is inadequate and remand is required for an adequate one. Also, after the June 2015 examination the Veteran has argued that his back disorders were related to 3 in-service motor vehicle accidents. See October 2015 notice of disagreement. The Veteran’s STRs show that he was involved in at least 2 motor vehicle accidents. Thus, VA must obtain a medical opinion that addresses whether the claimed back disorder is directly due to the Veteran’s period of active service, rather than just as secondary to service-connected disorders. 2. Entitlement to service-connection for a left hip disorder, to include as secondary to service-connected bilateral plantar fasciitis and bilateral ankle tendonitis. A June 2015 VA examination report identifies the Veteran’s left hip disorder as degenerative arthritis. The examiner opined that left hip degenerative joint disease was not secondary to the Veteran’s service connected bilateral foot and ankle disorders because there was no significant gait disturbance that would cause degenerative joint disease. The Veteran has testified that he has used a cane since 2009. Additionally, private treatment reports, VA examination reports, and VA treatment records document an antalgic gait since late 2008 onward. See December 2008 private treatment note; February 2009 VA primary care note; October 2009 VA examination report; March 2011 VA examination report; March 2015 statement. The examiner’s conclusion that there was no evidence of a significant gait disturbance did not adequately consider the treatment records and lay testimony documenting an antalgic gait with cane use since 2009. Also, private treatment records from April 2014 document that diagnostic testing showed os acetabuli with left hip acetabular detachment, and the etiology of this diagnosis was not addressed by the June 2015 VA examiner. For these reasons, remand is required for an adequate medical opinion. In the October 2015 notice of disagreement, the Veteran also argued that his left hip disorder was related to 3 in-service motor vehicle accidents and this theory has yet to be addressed by a VA examiner. Thus, VA must obtain a medical opinion that addresses whether the claimed left hip disorder is directly due to the Veteran’s period of active service   3. Entitlement to service connection for a left leg disorder, to include as secondary to service-connected bilateral plantar fasciitis and bilateral ankle tendonitis. This issue must be remanded because it is inextricably intertwined with an issue on appeal also being remanded. The June 2015 VA examiner diagnosed left sided sciatica, and explained that the sciatica was due to the Veteran’s lumbar spine degenerative disc disease rather than to a currently service-connected disability. Thus, the issue of entitlement to service-connection for a left leg disorder is inextricably intertwined with the claim of entitlement to service-connection for a lower back disorder. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Specifically, request that the Veteran provide information regarding any treatment related to his in-service motor vehicle accidents. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his claimed lower back disorder. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. (a.) Clarify all diagnosed lower back disorders. If degenerative disc disease, herniated nucleus pulposus, or lumbar stenosis are not diagnosed, the examiner must address these prior diagnoses of record. (b.) For each diagnosed back disorder, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the back disorder had onset in, or is otherwise related to, active military service. (c.) For each diagnosed back disorder, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the back disorder was caused or aggravated by the service-connected bilateral plantar fasciitis and bilateral ankle tendonitis. (d.) The examiner must specifically address the following: 1) the Veteran’s assertions of in-service motor vehicle accidents; 2) the STRs showing treatment following two motor vehicle accidents; and 3) the August 2014 private treatment records noting degenerative disc disease and stenosis. 4. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his claimed left hip disorder. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. (a.) Clarify all diagnosed left hip disorders. If left hip degenerative joint disease or left hip acetabular detachment are not diagnosed, the prior diagnoses of record must be addressed. (b.) For each diagnosed left hip disorder, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the disorder had onset in, or is otherwise related to, active military service. (c.) For each diagnosed left hip disorder, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the hip disorder was caused or aggravated by the service-connected bilateral plantar fasciitis and bilateral ankle tendonitis. (d.) The examiner must specifically address the following: 1) Veteran’s assertions of an in-service motor vehicle accidents; 2) the STRs showing treatment following two motor vehicle accidents; 3) the multiple treatment records documenting an antalgic gait, including a December 2008 private treatment note, a February 2009 VA primary care note, and October 2009 and March 2011 VA examination reports; 4) the April 2014 VA MRI report noting os acetabuli with left hip acetabular detachment; and 5) the Veteran’s March 2015 statement that he has used a cane since 2009. 5. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2017). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Smith, Associate Counsel