Citation Nr: 18149425 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 15-06 042 DATE: November 9, 2018 REMANDED Service connection for a left hip disability, to include as secondary to a lumbar spine disorder, is remanded. Service connection for a right hip disability, to include as secondary to a lumbar spine disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1979 to August 2001. These matters come before the Board of Veterans’ Appeals (Board) from an August 2012 rating decision of the Department of Veterans’ Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied the Veteran’s claims for service connection for his right and left hip disabilities. Entitlement to service connection for right and left hip disabilities are remanded. The Veteran claims that his right and left hip disabilities were due to or aggravated by his service-connected lumbar spine disorder. The Veteran is now in receipt of service connection for a lumbar spine disorder, previously characterized as lumbosacral strain and currently characterized as intervertebral disc disease. According to August 2010 private medical treatment records, the Veteran has right and left hip disabilities, diagnosed as severe degenerative changes. The Veteran underwent right hip replacement surgery in August 2010 and left hip replacement surgery in September 2010. A January 2015 VA examination described the Veteran’s hip conditions as degenerative arthritis in the left and right hip. The primary issue in this case is whether the right hip disability and left hip disabilities were caused by or aggravated by the service-connected lumbar spine disorder. There is also some evidence that the hip disabilities may be associated with service. The record contains an inadequate negative medical opinion dated January 2015. The exam is inadequate because there is evidence of sciatic pain that could indicate hip disability due to the lumbar spine disorder and also because the Veteran’s representative introduced studies that show generally that such a relationship is possible. In the January 2015 medical opinion, the examiner opined that the Veteran’s bilateral hip condition is less likely as not caused by, or a result of, or aggravated by his service connected lumbar spine condition. Moreover, this examination noted that there “are no objective findings in [the Veteran’s] medical record indicating that [his] hip/arthritis surgery is associated with [his] service connected back condition.” This opinion ignores the Veteran’s medical history as the Veteran’s hip pain was described indirectly in conjunction with the Veteran’s lumbar spine condition. For instance, in a June 2001 service treatment record, the doctor found that the Veteran experienced “back pain with sciatica.” The doctor described, that the Veteran “developed acute low back pain radiating down both lower extremities in 1982 after air assault school. Ever since then, he has experienced occasional low back pain with heavy lifting, but notes pain in both sacroiliac areas radiating down both legs whenever he arches his back.” As indicated in the medical literature submitted by the Veteran, the sciatic nerve travels from the lower back through the hip area and down to the legs. The January 2015 examiner opined that the Veteran’s bilateral hip condition was not aggravated by his service-connected lumbar spine disability in a conclusory manner without supporting the finding with reasoning nor explanation. Nor does the opinion take into account the medical evidence suggesting a relationship between the back and hips. In light of the circumstances, the current VA medical opinion is inadequate and an additional VA medical opinion is needed. The Veteran’s representative suggested that the Veteran’s service-connected lumbar spine disorder may have caused the bilateral hip arthritis. The Veteran’s representative submitted an October 2018 informal hearing presentation stating that, “it is not clear whether spinal degeneration leads to hip arthritis, or hip arthritis leads to spinal degeneration” and citing a July 2013 study by Bajwa NS. See Disk Degeneration in Lumbar Spine Precedes Osteoarthritic Changes in Hip, available at https://www.ncbi.nlm.nih.gov/pubmed/24078941. Given this evidence of a possible association between the hip disabilities and the lumbar spine disorder a medical examination and opinion that addresses this medical literature is warranted. Furthermore, reports of sciatic pain throughout the Veteran’s medical history should be considered in determining whether or not the Veteran’s current bilateral hip disability is related to service. In a July 1984 service treatment record, when the Veteran complained about lower back pain, the doctor’s noted under the assessment read “? bilateral sciatica pain.” Later, in the aforementioned June 2001 service treatment record, the Veteran experienced “back pain with sciatica” that radiated down both lower extremities.” This can be read to suggest a potential relationship between the Veteran’s lumbar spine disability and his right and left hip conditions because the sciatic nerve travels through the hip area. In addition, once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Given the above noted inadequacies in the June 2015 examination and the request for a remand by the Veteran’s representative in the October 2018 appellate brief, these matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination as to the etiology of his right and left hip disabilities. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should indicate whether it is as least as likely as not (50 percent probability or more) that the Veteran’s right and left hip disabilities are related to his military service, to include the reported in-service sciatica or anything else in service. The examiner should also indicate whether the right and left hip disabilities are either (a) caused or (b) aggravated by the service connected lumbar spine disorder. If the examiner determines that either the right or left hip was aggravated by the Veteran’s service-connected lumbar spine disorder, the examiner must indicate the baseline level of severity of disability prior to when aggravation occurred. A complete rationale should accompany any opinion provided. (Continued on the next page)   The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The examiner should also address the medical literature submitted by the Veteran. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lopez, Law Clerk