Citation Nr: 18142127 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 12-22 702 DATE: October 12, 2018 REMANDED Entitlement to an evaluation in excess of 20 percent for dislocation, right shoulder is remanded. Entitlement to an evaluation of 30 percent prior to September 5, 2012, and 50 percent thereafter for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an evaluation of total disability because of individual unemployability (TDIU) is remanded. Entitlement to service connection for a left hip disability is remanded. REASONS FOR REMAND 1. Entitlement to an evaluation in excess of 20 percent for dislocation, right shoulder is remanded. 2. Entitlement to an evaluation of 30 percent prior to September 5, 2012, and 50 percent thereafter for PTSD is remanded. 3. Entitlement to an evaluation of TDIU is remanded. 4. Entitlement to service connection for a left hip disability is remanded. In September 2011, a VA regional office (RO) awarded service connection and a 30 percent disability evaluation for PTSD, and service connection and a 20 percent disability evaluation for dislocation, right shoulder. The RO denied service connection for a bilateral hip condition, citing the lack of a diagnosed disorder. The Veteran appealed, and in September 2016 the Board of Veterans’ Appeals (Board) provided a different effective date for the Veteran’s increased rating of 50 percent for PTSD and continued the 20 percent shoulder rating unchanged. The Board remanded the Veteran’s bilateral hips claim for an additional VA examination. The Veteran appealed the Board’s decisions regarding his PTSD and shoulder disabilities to the Court of Appeals for Veterans Claims. In June 2017 the parties agreed that the Board had failed to make a credibility finding and discuss certain evidence of record potentially favorable to the Veteran, and jointly moved the Court for a remand of those claims. In September 2017 the Board in turn remanded the right shoulder and PTSD claims to the agency of original jurisdiction (AOJ) to provide the Veteran with new VA examinations and medical opinions for his PTSD and his right shoulder. While the PTSD and right shoulder claims were moving to the Court, the AOJ provided the Veteran, in February 2017, with a new bilateral hips examination. X-rays done at that time showed the presence of mild degenerative changes in both hips, thus providing for the first time a diagnosed hip disability. In consideration of the Veteran’s lay testimony as to the origin of his hip problems, in an April 2017 addendum medical opinion the examiner opined that the degenerative changes in the right hip were at least as likely as not connected to trauma the Veteran suffered from jumping out of a helicopter during combat in Vietnam. He also opined, however, in a single sentence without further explanation, that the degenerative changes in the left hip were less likely as not the result of the Veteran’s military service because he had subsequently broken his left hip in a fall in 1984, subsequent to his service. Consistent with this opinion, in May 2017 the AOJ granted service connection for the Veteran’s right hip disability. This decision, however, did not address the left hip. The Board notes that the fall to which the examiner appears to be referring occurred in May 2001. As part of its September 2017 remand of the right shoulder and PTSD issues, the Board also remanded the Veteran’s left hip claim for readjudication in light of all the evidence. Finally, recognizing the Veteran’s assertion that TDIU had been raised by the record, the Board remanded that claim as well. These issues have now returned to the Board. The Board notes, however, that with respect to its September 2017 remand instructions, only the instruction to readjudicate the Veteran’s left hip claim has been completed. In March 2018 the AOJ obtained an independent medical opinion to the effect that the Veteran’s left hip problem was less likely than not the secondary result of either his service-connected right hip disability or his service-connected lumbar spine disability; nor was it permanently aggravated by either of those disorders. Citing these opinions and the single-sentence April 2017 addendum opinion, finding that the Veteran’s left hip disorder was less likely than not a result of his military service, in a May 2018 supplemental statement of the case the AOJ continued the denial of service connection for the Veteran’s left hip degenerative changes. The Board now finds, however, that the single-sentence April 2017 addendum opinion is conclusory and thus inadequate for adjudication purposes. An adequate rationale must be provided for any medical opinion rendered; a conclusory, contradictory or incomplete analysis is not adequate. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Accordingly, the Board will remand for an adequate addendum opinion concerning direct service connection for the Veteran’s left hip disorder. The Board notes that the AOJ remains in the process of developing and readjudicating the PTSD, right shoulder and TDIU claims as directed by the Board in its September 2017 remand. In this regard, the Board notes that a remand by the Court or the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board is obligated by law to ensure that the AOJ complies with its directives; where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Id. Thus, the Board will remand these issues to allow the required development and readjudication to take place. The matters are REMANDED for the following action: 1. Undertake appropriate efforts to obtain any relevant outstanding VA or private medical records, and associate them with the claims file. 2. Thereafter, obtain an addendum opinion from a qualified examiner regarding the nature and etiology of the Veteran’s left hip disorder. The claims file, including this remand, must be made available to the reviewing examiner, and the examiner must indicate in the addendum report that the claims file was reviewed. If the examiner determines that an additional physical examination is required before the requested opinion can be provided, such examination should be scheduled. The examiner should offer comments and an opinion addressing whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s left hip disorder, to include his left hip degenerative changes, began during the Veteran’s service, or is causally or etiologically related to service. The examiner is advised that the Veteran is competent to report history and symptoms and that those reports, specifically including his description of injuring his left hip while jumping out of a helicopter during combat, must be considered in formulating any requested opinion. If the examiner rejects the Veteran’s reports, the examiner must provide a rationale for doing so. A complete rationale must be given for all opinions and conclusions expressed. If it is not possible to provide a requested opinion without resorting to speculation, the examiner should state why speculation would be required (e.g., if the requested determination is beyond the scope of current medical knowledge, actual causation cannot be selected from multiple potential causes, etc.). If there are insufficient facts or data within the claims file, the examiner should identify the relevant testing, specialist’s opinion or other information needed to provide the requested opinion. 4. In conjunction with the above actions, continue to undertake and complete all development and adjudication required by the Board’s September 2017 remand with respect to the Veteran’s PTSD, right shoulder and TDIU claims. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David S. Katz, Associate Counsel