Citation Nr: 18150464 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 11-20 487 DATE: November 15, 2018 REMANDED Entitlement to service connection for a left hip labral tear, to include as secondary to service-connected low back strain and/or left knee retropatellar pain syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1978 to June 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Sioux Falls, South Dakota. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in June 2013. A transcript of the hearing is of record. In May 2014 and March 2017, the Board remanded these matters. Following these remands, the Board denied service connection for the Veteran’s claim in an August 2017 decision. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In a May 2018 Joint Motion for Remand (JMR), the Court set aside the Board’s August 2017 decision, and remanded the matter for additional development and readjudication. Entitlement to service connection for a left hip labral tear, to include as secondary to service-connected low back strain and/or left knee retropatellar pain syndrome is remanded. As noted above, the Court vacated the Board’s August 2017 decision in a May 2018 JMR. The basis for the Court’s decision was that the Board failed to address obesity as an “intermediate step,” pursuant to a January 2017 General Counsel opinion. Specifically, in a March 2017 VA examination, the examiner opined that the Veteran’s left hip pain was less likely than not aggravated by his service-connected lumbar spine strain and left knee strain. The examiner provided several different reasonings as to why there was no nexus; however, notably, the examiner stated that the Veteran was obese with a BMI of 34.66 which contributed to his bilateral hip condition, and that there was no objective medical evidence in any medical literature that a low back strain or left knee patellofemoral pain syndrome would cause a labral tear or coxarthrosis. The Board finds this opinion inadequate as it does not address obesity, raised by the examiner, as an “intermediate step.” The Board notes that obesity is not a disease or disability for which service connection may be granted. Nonetheless, the Board finds that an opinion is needed to clarify whether obesity was an “intermediate step” between the Veteran’s service-connected disabilities and the Veteran’s left hip labral tear. See VAOPGCPREC 1-2017. Specifically, to meet the criteria, the Veteran must demonstrate that a previously service-connected disability caused the Veteran to become obese; that obesity was a substantial factor in causing secondary disability; and the secondary disability would only have occurred but for the obesity. Therefore, on remand, an addendum opinion discussing the Veteran’s obesity as an “intermediate step,” is needed. The matter is REMANDED for the following actions: 1. Obtain any outstanding private or VA treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, schedule the Veteran for a VA examination with an appropriate examiner to determine whether the Veteran’s left hip labral tear is secondary to his service-connected low back strain and/or left knee retropatellar pain syndrome, with obesity serving as an intermediate step. The claims file and a copy of this remand should be made available for review. After review, the examiner is requested to respond to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected low back strain and/or left knee retropatellar pain syndrome caused the Veteran to become obese? (b) If yes, was the obesity a substantial factor in causing or aggravating (worsening beyond its natural progression) the Veteran’s left hip labral tear? (c) If yes, would the left hip labral tear not have occurred but for the obesity caused by the Veteran’s service-connected low back strain and/or left knee retropatellar pain syndrome? All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Saudiee Brown, Associate Counsel