Citation Nr: 18155123 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 11-14 563 DATE: December 3, 2018 REMANDED Entitlement to service connection for a left hip disorder is remanded. Entitlement to service connection for a right hip disorder is remanded. Entitlement to service connection for tinnitus, to include as secondary to pain medications for service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served in the Alabama Army National Guard (ARNG) from June 1975 to December 1995, to include a period of active duty for training (ACDUTRA) from October 1975 to February 1976, and periods of annual training from July 28 to August 11, 1990 and June 6 to June 20, 1992. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision for the Department of Veterans Affairs (VA) Regional Office in Montgomery, Alabama. The Veteran testified before the undersigned Veterans Law Judge during a January 2013 videoconference hearing. This case was before the Board and remanded in November 2017 for additional development. 1. Entitlement to service connection for a bilateral hip disorder is remanded. The Veteran contends that his bilateral hip disorder is related to service. Specifically, the Veteran maintains that his currently diagnosed bilateral hip disorders are the result of wear and tear in having performed his duties as an ammunition specialist, such as having to haul heavy machinery, boxes and tires during ACDUTRA in the Alabama National Guard. The Veteran underwent a VA Hip and Thigh Conditions examination in April 2015. The VA examiner opined that the Veteran’s bilateral hip disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. For his rationale, the examiner indicated that the Veteran had hip symptoms and that his surgeries were after age 50 and that these were probably related to degenerative joint disease. Additionally, the examiner reported that the causes of osteoarthritis of the hip are not known but that the factors that may contribute include joint injury, increasing age, and being overweight. The examiner noted that a person may be putting extra stress on his or her joints, either by being overweight or through activities that involve the hip. However, the Board finds that a remand is necessary because the examination and stated opinions are inadequate for the purpose of adjudicating the Veteran’s claim. Specifically, the examiner did not address the Veteran’s duties as an ammunition specialist having to lift heavy projectiles and ammunition during ACDUTRA in the Alabama National Guard. The Board is required to insure compliance with the instructions of it remands. Stegall v. West, 11 Vet. App. 268 (1998). Such compliance has not been accomplished with respect to the April 2015 VA opinion addressing the claims for service connection for bilateral hip disabilities. In this regard, the September 2014 remand requested a medical opinion that included consideration of the Veteran’s duties as an ammunition specialist having to lift heavy projectiles and ammunition during ACDUTRA in the Alabama National Guard. Given the above, an addendum opinion must be obtained from the April 2015 VA clinician that documents meaningful consideration of the Veteran’s duties as an ammunition specialist. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (holding that once VA undertakes the effort to provide an examination, it must provide an adequate one); Stegall, supra. 2. Entitlement to service connection for tinnitus is remanded. The Veteran is seeking entitlement to service connection for tinnitus, to include as secondary to pain medications for his service-connected disabilities. In this regard, the April 2015 VA audiologist concluded that it was highly suspect that some of the medications that the Veteran required for pain management might have been responsible for the on-and-off-tinnitus, but she did not provide an opinion. In September 2016, the Board remanded the tinnitus disability for a medical opinion as to entitlement to service connection for tinnitus as secondary to pain medications for his service-connected disabilities, notably his lumbar strain with degenerative arthritis and sacroiliac weakness and an opinion as to the etiology of any right ear tinnitus. In October 2016 and July 2017 addendum opinions, the VA examiner was asked to provide the opinion requested by the Board. The examiner, an audiologist, stated that such an opinion is a medical assessment and not audiological and suggested a medical professional answer the question. Therefore, a remand is necessary to have a medical professional answer whether the Veteran has tinnitus caused or aggravated by pain medications used to treat his service-connected disabilities, notably Tramadol and Meloxicam for his lumbar spine disability, as opposed to those taken for his non-service-connected left hip disability. The matters are REMANDED for the following action: 1. Copies of pertinent updated treatment records should be obtained and added to the claims file. 2. Following completion of the above, arrange for addendum opinions from the VA clinician, or a suitable substitute if any such clinician is not available, who rendered the April 2015 opinion addressing the claims for service connection for a bilateral hip disability. The electronic record, to include a copy of this remand, should be made available to and reviewed by the clinician, and opinions as follows are requested: The examiner is to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current hip disability is related to the Veteran’s duties as an ammunition specialist having to lift heavy projectiles and ammunition during ACTUDRA in the Alabama ARNG or otherwise related to disease or injury during any period of ACTUDRA or injury during any period of INACDUTRA service in the Alabama ARNG National Guard. The examiner should also address the Veteran’s lay statements regarding symptomatology suffered during his period of Alabama Army National Guard service, as well as any continuous bilateral hip symptomatology since discharge from the Alabama ARNG. 3. Arrange for a physician or other medical professional with the appropriate expertise to review the file and prepare an opinion on the etiology of the Veteran’s tinnitus, to include as secondary to pain medications for his service-connected disabilities. An examination should be scheduled only if the examiner determines that an examination is necessary to offer an opinion. The claims file should be made available to the examiner. The rationale for all opinions should be provided. The examiner is asked to determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tinnitus was (a) caused by or (b) aggravated by pain medications used to treat his service-connected disabilities, notably Tramadol and Meloxicam for his lumbar spine disability, as opposed to medication taken for his non-service-connected left hip disability. The examiner is further advised that aggravation for legal purposes is defined as a worsening of the underlying disability beyond its natural progression versus a temporary flare-up of symptoms. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Grzeczkowicz, Associate Counsel