Citation Nr: 18123733 Decision Date: 08/02/18 Archive Date: 08/02/18 DOCKET NO. 15-23 207 DATE: August 2, 2018 REMANDED Entitlement to service connection for left knee condition, as secondary to a service-connected right knee condition, is remanded. Entitlement to service connection for right hip condition, to include as secondary to a service-connected right knee condition, is remanded. Entitlement to service connection for left hip condition, as secondary to a right hip condition or service-connected right knee condition. REMAND The Veteran served on active duty from April 1966 to February 1970. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).   REASONS FOR REMAND 1. Entitlement to service connection for left knee condition, to include as secondary to his service-connected right knee disability. The Veteran contends that his service-connected right knee disability causes him to walk and bend differently, which puts unusual strain on his left knee. See May 2012 Statement in Support of Claim; July 2014 notice of disagreement. The Veteran is service-connected for right knee total knee replacement (previously post-traumatic degenerative arthritis). On review, the Board finds that an addendum opinion is required. The Veteran was afforded a C&P examination in October 2012. The examiner’s rationale as to why the left knee condition was less likely than not proximately due to or result of the Veteran’s right knee condition was that his left knee problems started prior to his total knee replacement. However, the examiner did not appear to have adequately considered his 1987 and 1988 right knee arthroscopic procedures, reports of right knee instability, or considered his contentions as to how his service-connected right knee condition puts unusual strain on his left knee. Moreover, the Veteran was service-connected for right knee post-traumatic degenerative arthritis prior to his total knee replacement. Thus, on remand an addendum is required. 2. Entitlement to service connection for right hip condition, to include as secondary to a service-connected right knee condition is remanded. The Veteran also contends that his service-connected right knee disability causes him to walk and bend differently, which put unusual strain on his left knee. He also contends that his right hip was in pain while at the NCO Academy and was seen at the Maxwell Air Force Base (AFB) in 2004. Specifically, the pain started about two weeks after running on the asphalt. In support of his contention the Veteran submitted a June 2004 Physical Profile Serial Report in August 2015. This report reflects that he was placed on physical training restrictions while at the Maxwell AFB, although it does not identify any specific disabilities for the restrictions. The October 2012 C&P examination report showed that the examiner found the condition is less likely than not proximately due to or the result of the Veteran’s service-connected right knee condition. The rationale was that there is no anatomical connection between the right knee and right hip. In addition, there was no aggravation by the right knee, as the two areas are not anatomically connected or related. The Veteran’s contentions do not appear to have been considered. As such, an addendum opinion is needed. 3. Entitlement to service connection for left hip condition, as secondary to a right hip condition or service-connected right knee condition is remanded. The Veteran asserts that his left hip condition is caused by his right hip condition, as a result of overcompensation. In the alternative, he asserts that his service-connected right knee condition causes him to walk and bend differently, which put unusual strain on his left hip. See May 2012 Statement in Support of Claim; July 2014 notice of disagreement. As the Board is remanding the claim of service connection for the right hip, adjudication of this issue is deferred. In addition, the Board seeks an addendum opinion. At a VA examination in October 2012 X-rays showed arthritis of the left hip; the right hip was normal. The examiner opined that the left hip disability is less likely than not caused or aggravated by his right hip condition. The examiner’s rationale was that there is no anatomical connection between the two hips; one did not cause problems with the other. In a June 2013 addendum opinion, another examiner reviewed the claims file, including the prior October 2012 C&P examination report. The examiner opined the Veteran’s left hip condition is not due to or aggravated by the service-connected right knee condition. The rationale was that the Veteran’s left hip condition (chronic strain and bursitis) is the same diagnosis of the opposite hip and it is thus not “disproportionate.” The examiner also explained that no diagnosis of any degenerative hip disease has been made and symptoms seem to be symmetric, both of which against a right knee causation/aggravation mechanism. The Board finds that this opinion is inadequate as the Veteran was diagnosed with arthritis in the left hip, but not the right, in October 2012. Such indicates the examiner’s addendum opinion was based on a faulty rationale. Finally, updated treatment records should be obtained from the White City VA medical center (VAMC) upon remand. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from the White City VAMC for the period from February 2015 to the present. 2. Return the claims folder and a copy of this Remand to the June 2013 VA examiner for an addendum opinion. If that examiner is no longer available, the opinion should be provided by an appropriate examiner. The examiner must review the entire claims folder and a copy of this Remand. The need for a physical examination is left to the discretion of the examiner. The examiner is asked to answer the following: a) Whether the Veteran’s left knee condition is at least as likely as not (1) proximately due to the service-connected right knee disability, or (2) aggravated beyond its natural progression by the right knee disability. b) Whether the Veteran’s right hip or left hip condition is at least as likely as not related to service, or proximately due to service-connected right knee disability or aggravated beyond its natural progression by the service-connected right knee disability. c) If the examiner determines that the right hip is related to the service-connected right knee disability, the he or she should opine as to whether the left hip disability proximately due to or aggravated beyond its natural progression by the right hip disability. The questions in a)-c) each require two opinions: one for proximate causation and a second for aggravation. In answering these questions, the examiner should specifically address the Veteran’s contentions that his left knee, left hip and right hip are overcompensating due to his right knee disability, including prior to the 2012 right knee replacement surgery. A fully-explained rationale for the requested opinions should be provided. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Tang, Associate Counsel