Citation Nr: 18158194 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 11-15 729 DATE: December 14, 2018 REMANDED Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for residuals of a pelvic fracture is remanded. Entitlement to service connection for a low back disability, to include as due to pelvic fracture residuals is remanded. REASONS FOR REMAND The Veteran served in the Army National Guard and the Army Reserves, including a period of active duty for training (ACDUTRA) from July 1979 to February 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from July 2009 and December 2009 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. During the course of the appeal, in an October 2018 rating decision, the RO granted service connection for left ankle strain and right ankle strain. As such, the grants of service connection represent the full benefit sought on appeal and the matters are no longer for appellate consideration. The Veteran’s May 2011 VA Form 9 contains a request for a hearing before a Veterans Law Judge (VLJ); however, the Veteran, through her attorney, withdrew the request in a September 2012 written statement. The Board remanded the Veteran’s claims in June 2014 and April 2017 for further development. Unfortunately, for the reasons discussed below, that development was not satisfactorily completed and further development is required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a right hip disability, pelvic fracture residuals, and a low back disability are remanded. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claims so that she is afforded every possible consideration. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017). The Veteran is seeking service connection for a right hip disability, residuals of an in-service pelvic fracture, and a low back disability. Specifically, she contends that she has suffered hip pain and pain from a pelvic fracture since service. The Veteran also asserts that she suffers from a low back disability caused by her right hip and pelvis injuries. Following a June 2014 Board remand, the Veteran was afforded a VA examination in April 2016 to determine whether her hip and pelvic disabilities were related to service. The VA examiner opined that the Veteran’s disabilities were less likely than not incurred in or caused by an in-service injury, event, or illness. He explained that there was no indication that the problems with the Veteran’s hip and pelvis were secondary to active service and current x-rays revealed normal findings. In April 2017, the Board determined that the VA examiner’s rationale was inadequate, as he had impermissibly relied on the absence of evidence in forming his opinion. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002). Furthermore, the examiner had failed to comply with the June 2014 remand directives which had instructed the examiner to consider March 2008 hip and pelvis x-rays that revealed degenerative changes when providing an opinion. The Board again remanded the Veteran’s service connection claims with specific instructions for an addendum opinion that did not rely solely on the absence of treatment records and which considered the Veteran’s March 2008 x-rays. In May 2017, the Veteran’s claims file was returned to the April 2016 VA examiner. The VA examiner opined that the Veteran’s hip and pelvis injuries were less likely than not related to active service, as there were “no records indicating problems of the pelvis or hips in service or that activities in the service resulted in these problems noted approximately 30 years following discharge.” Again, the Board finds the VA addendum opinion inadequate, as the opinion neglects to adhere to the April 2017 Board remand directives. The opinion continues to rely on the lack of treatment records as a rationale and there is no indication that the Veteran’s March 2008 x-rays were taken into consideration when forming the requested opinion. Furthermore, the examiner failed to consider the Veteran’s February 1984 claim of service connection for a pelvic bone fracture as evidence of a noted problem, nor did he address her statements regarding ongoing hip and pelvis pain since separation from service. The Board notes that although a private physician, Dr. G. T., provided a positive nexus opinion for the Veteran’s low back and hip pain in June 2017, this opinion did not include sufficient rationale upon which a decision to grant entitlement to service connection may be based. Lastly, the Board finds that the Veteran’s claim of service connection for a low back disability is inextricably intertwined with the issues of entitlement to service connection for right hip and pelvis disabilities. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1990) (issues are inextricably intertwined when they are so closely tied together that a final Board decision cannot be rendered unless all are adjudicated). Thus, this claim must also be remanded. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from a VA examiner other than the examiner who performed the April 2016 VA examination. The electronic claims file and a copy of this remand must be made available to the examiner and the examiner should note in the examination report that the claims file and the remand have been reviewed. The need for an additional examination of the Veteran is left to the discretion of the examiner selected to write the addendum opinion. Based on prior VA examination results and opinions, and a review of the record, the examiner is asked to respond to the following: a) Whether it is as least as likely as not (50 percent or greater) that the Veteran’s hip and/or pelvic disabilities are related to her qualifying period of active military service (whether on active duty, ACDUTRA, or inactive duty for training (INACDUTRA)). Please render an opinion that does not rely solely on the absence of treatment records since service. In forming his or her opinion, the examiner is asked to address: i. the March 2008 x-rays of the hip and pelvis; and ii. the Veteran’s 1984 claim of service connection for a fractured pelvis and her statements regarding the continuity of her hip and pelvic pain since her separation from service. b) If it is determined that any current hip and/or pelvic disabilities are related to service, provide an opinion on whether it is as least as likely as not (50 percent or greater) that the Veteran’s current low back disability is caused or aggravated by her hip and/or pelvic disabilities. If the examiner finds aggravation, the examiner must identify the baseline of the disability that existed before aggravation by the service-connected disability occurred. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training) (Continued on the next page)   2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and her attorney a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Silverblatt, Associate Counsel