Citation Nr: 18160814 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 16-15 739A DATE: December 27, 2018 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to service connected bi-lateral knee disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1974 to June 1977. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. 1. Entitlement to Service Connection for a Left Hip Disability While the Board regrets the delay, pursuant to the duty to assist, additional development is needed with respect to the Veteran’s claim. In the Veteran’s March 2015 VA examination, the examiner was asked to opine “whether the Veteran’s left hip condition, if found, is at least as likely as not (50 percent or greater probability) proximately due to or the result of his service-connected left knee condition.” The examiner stated that “there is insufficient objective evidence to support a causal relationship between his left knee condition and his left hip condition. To opine that there is a causal relationship would be to provide one based merely on speculation. In other words, it is speculative to opine that his left knee condition supersedes other possible causes for his left hip condition.” The examiner does not provide an adequate basis for resorting to speculation, nor does the record make adequate bases apparent. See Jones v. Shinseki, 23 Vet. App. 382 (2010) (holding that an examiner's conclusion that an opinion would be speculative cannot be relied upon unless the examiner has explained the basis for such an opinion or the basis is otherwise apparent from the evidence of record, and that an opinion must clearly consider "all procurable and assembled data" when determining that a conclusion cannot be reached without resort to speculation). In April 2017, the Veteran was provided a VA addendum medical opinion as to secondary service-connection, wherein a different examiner reviewed the available records and was asked to offer an opinion as to whether “the Veteran’s left hip degenerative joint disease was at least as likely as not aggravated beyond its natural progression by his service-connected bilateral knee osteoarthritis and chondromalacia with bilateral instability?” The examiner’s answer was “no” and the rationale provided was that “no objective medical record evidence to indicate permanent aggravation was found. There is no mechanism of action for permanent aggravation.” The VA examiner did not address whether the Veteran’s left hip disability was aggravated by his service-connected bi-lateral knee disabilities. The Board finds that the March 2015 and April 2017 VA examiner’s opinions are inadequate and do not address whether the Veteran’s left hip disability is secondary to his bi-lateral knee disabilities. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). As the medical examination and opinions are not adequate for decision-making purposes, and to prevent any potential prejudice to the Veteran, the Veteran must be provided with a new examination to address whether the Veteran's left hip disability is as likely as not incurred in or caused by the claimed in-service injury event or illness, or is proximately due to, or chronically aggravated by, his service-connected bi-lateral knee disabilities. The Board finds that further development is necessary before a decision on the merits may be made relating to the issue on appeal of entitlement to service connection for a left hip disability. Accordingly, the case is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any left hip disability. The examiner must review the claims file in conjunction with the examination, and the examiner should note such review. Any and all studies, tests and evaluation deemed necessary by the examiner should be performed. The examiner must address the following: a) Whether it is at least as likely as not (at least a 50 percent probability) that the Veteran’s left hip disability had its clinical onset during any period of service or is related to any incident of service. b) Whether it is at least as likely as not (at least a 50 percent probability) that a left hip disability is proximately due to, the result of, or aggravated by service-connected bilateral knee disabilities, including considered in combination. The examiner should provide a complete rationale for each opinion expressed. If the examiner cannot provide the requested information without resorting to speculation, then the examiner should provide an explanation and rationale for why such information could not be provided. 2. Thereafter, the AOJ should readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided with a supplemental statement of the case and allowed an appropriate period for response. The case should then be returned to the Board for further consideration, if otherwise in order. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.E. Leary, Associate Counsel