Citation Nr: 18159544 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-61 109 DATE: December 20, 2018 REMANDED Entitlement to service connection for a left hip condition, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from April 2001 to February 2011. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. The Veteran requested reconsideration of the rating decision; however, the Agency of Original Jurisdiction (AOJ) maintained its denial in an April 2016 rating decision. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. The Veteran seeks entitlement to service connection on a direct and secondary basis for his left hip condition. The Board finds that remand is required for an adequate examination. Where VA provides the Veteran with an examination regarding service connection, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, the medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In March 2016, a VA examination addressed both direct and secondary service connection. The examiner stated that the Veteran’s left hip condition was less likely than not related to his other service-connected disabilities, given his relatively excellent ambulation for being 2 months postoperative from his January 2016 hip surgery. No further explanation or rationale was provided by the examiner. In an October 2016 supplemental opinion, the VA examiner concluded that the Veteran’s left hip condition was less likely than not caused by or permanently aggravated by his service-connected knee or back disabilities because his condition was due to congenital narrowing of the hip socket and there was no evidence of gait disturbance before or after the Veteran’s hip surgery. Again, no further explanation or rationale was provided. The Board finds that a new examination and medical opinion must be obtained. Both the March and October 2016 VA examinations are incomplete, as the examiner’s explanations are unclear and do not provide a complete rationale for the opinions expressed therein. Additionally, the examiner failed to consider and address the Veteran’s June 2015, March 2016, and April 2016 medical treatment records, which note gait deviation as well as antalgic gait. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for an examination with an appropriate examiner for an opinion regarding the etiology of the Veteran’s left hip condition. The entire claims file, including a copy of this remand, must be reviewed by the examiner in conjunction with the examination. After reviewing the record and performing any examination of the Veteran deemed necessary, the examiner should then address the following: a. Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left hip condition originated during, or is etiologically related to, active duty service. b. Whether it is at least as likely as not that any currently diagnosed left hip condition was caused or aggravated by the Veteran’s service-connected disabilities, including knee and low back strain with degenerative disc changes. By aggravation, the Board means an increase in the severity of the disability that is beyond natural progression. If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the Veteran’s disability found prior to aggravation; and (2) the increased manifestations which, in the examiner’s opinion, are proximately due to the service-connected disability. (CONTINUED ON NEXT PAGE) The examiner should cite to the medical and lay evidence of record, including the Veteran’s statements, and provide an explanation for all opinions given. If the examiner cannot respond to the inquiries posed without resort to mere speculation, he or she should further explain why it is not feasible to provide a medical opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Robinson, Associate Counsel