Citation Nr: 18144994 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-55 837 DATE: October 25, 2018 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to service-connected lumbar spine and/or bilateral knee disabilities is remanded. Entitlement to service connection for bilateral lower extremity radiculopathy, claimed as sciatic pain is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Marine Corps from May 1976 to August 1997. Regrettably, a remand is necessary in this case to ensure that due process is followed and that there is a complete record upon which to decide the appellant’s claim so that he is afforded every possible consideration. The Veteran contends that his left hip disability is causally related to active service, to include as associated with his service-connected degenerative disc disease (DDD) of the lumbar spine. He also complaints of lower extremity radiculopathy, described as sciatic pain. Review of service treatment records show complaints of chronic low back pain, however, no complaints of hip pain or lower extremity numbness and tingling were reported at separation in 1997. Post service treatment records show complaints of lower back pain and radicular symptoms in the left leg. Specifically, a March 2014 medical clinic record noted progressive lower back pain with significant radicular symptoms of pain and numbness in the left leg. Magnetic resonance imaging (MRI) conducted in June 2014 revealed spondylotic changes of the lumbar spine. A generalized disc bulging which effaces the anterior thecal sac contacting the S1 nerve roots was shown. In addition, a disc protrusion was noted in the right neural foraminal region. The evaluation reported indicated moderate narrowing of the bilateral neural foramina, with left side greater than right as secondary to congenitally shortened pedicles (also associated degenerative arthritis). Also on the left side, there was evidence of a mass which effaces the spinal canal adjacent to the left facet joint. The mass likely represented a complex synovial cyst. Mixed signal intensity was also shown. The combination of disc bulging, congenitally shortened pedicles, and the facet mass caused a central canal stenosis. Moderate to severe stenosis of the bilateral neural foramina was indicated. In April 2015, the Veteran underwent a VA examination. The examiner acknowledged a current diagnosis of a left hip strain. During the clinical evaluation, the Veteran stated that his left hip condition was causally related to his chronic low back pain which began in service in 1994. His symptoms cause impaired range of motion, a limited ability to engage in physical activities and pain during flare-ups. The examiner acknowledged review of radiologic findings from June 2014 which showed degenerative disc disease (DDD) of the lumbar spine. A MRI of the lumbar spine noted a protruded disc to the right side at L4-L5 and multi-level DDD. Following a review of the record, the examiner opined that it is less likely than not (less than 50 percent probability) that the Veteran’s hip condition is causally related to his service-connected lumbar spine condition. In support of the stated conclusion, the examiner indicated that radiographs did not reveal evidence of degenerative joint disease of the left hip, sacroiliitis or sciatica. It also referenced prior MRI findings which noted a protrusion of the L4-5 disc to the right side, which might cause sciatica in the right leg. On review of the record, the Board finds the April 2015 opinion inadequate. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See 38 U.S.C. § 5103(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Specifically, the examiner’s opinion fails to show a complete analysis of the June 2014 radiologic findings. Although the MRI results referenced a disc protrusion in the right neural foraminal region, it also noted moderate narrowing of the bilateral neural foramina, with left side greater than right as secondary to congenitally shortened pedicles (also associated degenerative arthritis). The appearance of a soft tissue mass which effaced the spinal canal adjacent to the left facet joint was also noted. The evaluation report suggested that the combination of disc bulging, congenitally shortened pedicles, and the left-sided facet mass reportedly caused moderate to severe stenosis of the bilateral neural foramina. The examiner did not discuss these findings or their possible impacts on the Veteran’s claims. The examiner’s opinion failed to comment or specifically address the March 2014 treatment records which referenced the Veteran’s complaints of progressive lower back pain with significant radicular pain and numbness in the left leg. Based upon the forgoing, the Board finds that a new examination is required. Regarding the Veteran’s claim of entitlement to service connection for bilateral lower extremity radiculopathy, claimed as sciatic pain, the Board’s finds that consideration of this issue is inextricably intertwined with the outcome of his claim for service connection for a left hip condition as secondary to lower back DDD. Therefore, that issue is also remanded According, these matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine whether the Veteran has a current diagnosis of a left hip disability and if so, opine as to whether it is at least as likely as not (more than 50 percent probability) that the condition is casually related active service, to include as secondary to his service-connected low back condition. Access to the electronic claims file and this remand should be made available to the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail along with supportive rationale. The examiner is also specifically requested to identify whether the Veteran has a current diagnosis of sciatica and/or radiculopathy of the lower extremities, and if so, opine as to whether it is at least as likely as not (more than 50 percent probability) that the condition is casually related active service, to include as secondary to his service-connected low back condition and/or his claimed left hip condition. Significantly, in making this determination, the examiner should consider the May 2014 treatment records which identify complaints of lower back pain and radicular pain and numbness to the lower extremities. The examiner’s attention is called to the June 2014 MRI which referenced a disc protrusion to right side as well as the reference to the combined impact of disc bulging, congenitally shortened pedicles, and the left-sided facet mass which reportedly caused moderate to severe bilateral stenosis. All lay statements, medical evidence, and prior evaluative findings must be fully considered. The examiner should also address any other pertinent evidence in the claims file, as appropriate. Any apparent conflict in medical findings or opinions must be fully explained, with citations to the record if appropriate. If the reviewer cannot provide any of the requested opinions without resort to speculation, that conclusion also should be explained. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Whitaker, Associate Counsel