Citation Nr: 18142211 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 07-15 839 DATE: October 15, 2018 REMANDED Entitlement to bilateral hip disability, to include as secondary to service-connected right knee disability is remanded. Entitlement to service connection for disability of the legs, to specifically include the left knee, and to include as secondary to service-connected right knee disability is remanded. Entitlement to service monthly compensation (SMC) based on need for aid and attendance or by reason of being housebound is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1971 to July 1974. In May 2009, the Board remanded the case to obtain outstanding transcripts of a DRO hearing. In November 2015, the Board remanded the case to obtain an addendum opinion as to potential aggravation of the Veteran’s bilateral hip and bilateral leg, to include the left knee, as a result of his service-connected right knee disability. The above the development was not completed, and in August 2017, the Board remanded the case for an additional time, to obtain the requested addendum opinion. Bilateral Hip & Bilateral Leg, to include Left Knee The Board finds that an additional remand is necessary to provide the Veteran with a VA examination to determine the nature and etiology of his bilateral hip and bilateral leg, to specifically include the left knee disabilities. Notably, the Board’s prior remands requested an opinion regarding a possible aggravation of the Veteran’s disabilities by his service-connected right knee disabilities. However, upon careful review of the record, the Board finds that an additional VA examination is necessary. First, while the Veteran in his October 2010 DRO hearing suggested that his claimed disabilities were claimed also on secondary basis; however, an opinion on direct service connection was never obtained. Second, the Board finds that the December 2013 VA examination was not only inadequate due to the lack of opinion on aggravation, but also because the examiner’s rationale as to potential causation was inconclusive. The examiner opined that the bilateral hip disability was less likely than not proximately due to or the result of his right knee disability, and stated that the condition “may be more related to recent injury or Veteran’s body habitus with the Veteran at 68” and 300+ pounds.” A recent injury was not identified during the examination and the examiner’s inconclusive opinion is insufficient to determine any potential causation. The examiner provided the exact same opinion and rationale regarding the Veteran’s left knee strain. Moreover, while the Veteran’s claim specifically was for a bilateral leg condition, it appears that only his left knee was examined, and there is no indication whether any additional right or left leg disabilities were present. The medical record specifically shows that the Veteran complained of bilateral leg pain, especially in the left knee, but not exclusively. Third, in a September 2017 addendum opinion, the examiner indicated that the Veteran’s bilateral hip and left knee disabilities were not aggravated beyond their natural progression by his service-connected right knee disability. The examiner explained that there was insufficient evidence indicating that the disabilities were aggravated beyond their natural progression, that there was limited information with regards to his complaints of left knee and bilateral hips, and limited information with regard to the baseline of the bilateral hip and left knee disabilities. The examiner concluded that a comment on aggravation was not feasible without precise baseline of the bilateral hip and left knee conditions. Accordingly, given the inconclusive opinions, the Board finds that a remand is necessary to provide the Veteran with a VA examination, at which time the examiner can elicit from the Veteran the history and onset of symptoms of his bilateral hip and left knee disabilities, as well as consider any other bilateral leg disabilities not previously diagnosed, to assist the examiner in determining a baseline level of the severity. Entitlement to SMC In light of the above, the issue of entitlement to SMC is inextricably intertwined with the service connection claims that are being remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records since August 2017 are associated with the claims file. 2. Thereafter, provide the Veteran with a VA examination to determine the nature and etiology of his bilateral hip and bilateral leg, to include left knee disabilities. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After a review of the claims file and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify all currently diagnosed bilateral hip, bilateral leg, and left knee disabilities during the pendency of the appeal (since February 2006). (b) For each identified disability, elicit from the Veteran all signs and symptoms to determine their onset as well as whether aggravation due to the Veteran’s right knee disability is shown (c) For each currently diagnosed bilateral hip, bilateral leg, and/or left knee disability, provide an opinion whether it is at least as likely as not (50 percent or greater probability) had its onset during active duty service. (d) For each currently diagnosed bilateral hip, bilateral leg, and/or left knee disability, provide an opinion whether it is at least as likely as not (50 percent or greater probability) was caused OR aggravated by his service-connected right knee disability. The examiner should provide a complete rationale for the opinion, whether favorable or unfavorable, and cite to specific evidence of record, as necessary. If the examiner is unable to provide any opinion without resort to speculation, then the examiner should explain the reasons why an opinion cannot be given without resort to speculation. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Yaffe, Associate Counsel