Citation Nr: 18146629 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 11-27 397 DATE: October 31, 2018 REMANDED Entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected right knee disability as well as a service-connected right knee scar is remanded. Entitlement to service connection for a right hip disability, to include as secondary to a service-connected right knee disability as well as a service-connected right knee scar is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from April 1966 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The appeal was previously remanded by the Board in August 2014 and April 2017. The appeal previously included a claim of service connection for a bilateral hip disability. The RO granted service connection for a left hip disability in a September 2017 rating decision. As such, the Board has recharacterized the issue on appeal as entitlement to service connection for a right hip disability. 1. Entitlement to service connection for a lumbar spine disability and a right hip disability, to include as secondary to a service-connected right knee disability as well as a service-connected right knee scar is remanded. A remand is required to obtain substantial compliance with a prior Board remand. Stegall v. West, 11 Vet. App. 268 (1998). The April 2017 remand instructed the RO to schedule the Veteran for a VA examination with an orthopedist or orthopedic surgeon to determine the nature and etiology of any back and hip disorders. Alternatively, if an orthopedist or orthopedic surgeon was not available in the Veteran’s location, the RO was to have the examination conducted by an appropriate clinician, and then send the claims file to an orthopedist or orthopedic surgeon for review and have him or her provide the etiological opinion. In accordance with the April 2017 remand, the Veteran was scheduled for a fee-based VA examination for his back and hips. A May 2017 note in the Veteran’s claims file shows that a specialist was not available. As such, the Veteran’s examination was conducted by an internist. However, the etiological opinion also was provided by the internist, not an orthopedist or orthopedic surgeon. Thus, a remand is required to obtain an opinion from an orthopedist or orthopedic surgeon in order to comply with the Board’s prior remand. Additionally, the April 2017 remand instructed the RO to make an attempt to obtain any records from Dr. G.C. and Dr. T.S. from February 2013 to the present. A review of the record shows that the Veteran submitted a completed Authorization for Release of Information, but the RO never made a request for the records from Dr. G.C. or Dr. T.S, other than asking the Veteran to submit them. Accordingly, a remand is required to complete the requested development. Finally, the record shows that there may be additional outstanding private treatment records. In the Veteran’s April 2011 Statement in Support of Claim, he reported treatment from a chiropractor. An August 2013 VA treatment record also notes that the Veteran receives treatment from a chiropractor for his hips and back. As such, a remand is required to obtain these records. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from May 2018 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. G.C. and Dr. T.S. at Hastings Orthopedics and any chiropractor he has sought treatment with for his back and right hip disability since February 2013. Make two requests for the authorized records from Dr. G.C. and Dr. T.S. at Hastings Orthopedics and any identified chiropractor(s), unless it is clear after the first request that a second request would be futile. All attempts made must be documented in the electronic file, to include the unavailability of any identified records. For any identified records that are not obtained, notify the Veteran of such and provide him with an opportunity to submit those records. 3. Obtain a VA medical opinion from an orthopedist or orthopedic surgeon regarding the etiology of the Veteran’s lumbar spine disability and right hip disability. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file, a copy of the May 2017 VA examination report, and a copy of this Remand. The examiner should address the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s lumbar spine disability had its onset in, or is otherwise related to, active service? b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s right hip disability had its onset in, or is otherwise related to, active service? c) Is it at least as likely as not that the Veteran’s lumbar spine disability is caused or aggravated by his service-connected right knee disability or right knee scar? Please explain why or why not, specifically discussing any alterations in weight-bearing or gait caused by the Veteran’s right knee disability. d) Is it at least as likely as not that the Veteran’s right hip disability is caused or aggravated by his service-connected right knee disability or right knee scar? Please explain why or why not, specifically discussing any alterations in weight-bearing or gait caused by the Veteran’s right knee disability. The term “aggravation” means a chronic worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the lumbar spine disability and/or right hip disability prior to aggravation by the service-connected right knee disability. A complete rationale must be provided for all opinions expressed. A discussion of the underlying reasons for all opinions expressed must be included in the reviewer’s report. If the reviewer is unable to provide an opinion without resorting to speculation, he or she must provide an explanation for the basis of that determination D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mortimer, Associate Counsel