Citation Nr: 21000062 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-03 693 DATE: January 4, 2021 REMANDED Entitlement to service connection for a low back condition is remanded. Entitlement to service connection for a left hip condition, to include as secondary to a low back condition, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1971 to July 1974. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. The Board remanded this matter to the Agency of Original Jurisdiction (AOJ) in April 2019 for additional development, including adequate VA examinations. Although the AOJ obtained VA examinations in November 2019, the Board finds another remand is necessary for addendum opinions because the concerns identified by the Board and the Veteran and his representative were not adequately addressed. Regarding the Veteran’s low back condition, the Board requested the examiner provide the nature and etiology of any associated diagnosis. Further, the Veteran’s contention that his back injury is related to an in-service fall, lifting heavy items, and running with full gear, was noted for the examiner to consider when providing an opinion on the probability that the Veteran’s conditions either began in, or are otherwise related to, military service. The November 2019 examiner provided multiple diagnosis, including back strain, degenerative arthritis, and radiculopathy, but the possible relationship to the noted in-service events was not discussed. The examiner provided a conclusory statement indicating there was no evidence in the service treatment records (STRs) to support the Veteran’s claim and cited a March 2009 physical therapy treatment record, wherein a [post-military, work-related] back injury was documented, as evidence that the back conditions had no nexus to service. See Clayton Knightdale Physical Therapy and Wellness treatment records. Notably, a May 2009 physical therapy treatment note indicates the Veteran reported he still had back pain but not more than before his injury, and VA medical records in the evidentiary record illustrate a history of complaints and treatment for back pain that pre-date 2009. Id. Thus, the examiner did not adequately address the Board’s concerns nor discuss the Veteran's contention that the condition resulted from service-related events. For the Veteran’s left hip condition, the Board also asked the examiner to consider the impact of prolonged sitting, travelling up and down hills in trucks, and running with full gear when determining the etiology and opining on the probability that the condition began in or is related to military service. The November 2019 examiner diagnosed hip strain but provided a conclusory statement to support the determination that the condition is not related to military service. The examiner merely noted a lack of treatment for a hip condition in the STRs and one reference in a July 2017 VAMC treatment record noting back and hip pain had increased. Further, regarding secondary service connection for the left hip, the examiner concluded the Veteran did not have a low back condition due to his military service, and therefore, aggravation of his left hip condition could not be established. As noted above, the examiner did not fully address the nature and etiology of the Veteran’s back condition. The Board finds the issue of entitlement to service connection for the left hip, to include as secondary to the Veteran’s back condition, is inextricably intertwined with the matters being remanded in this case, and as such, it would be inappropriate at this juncture to enter a final determination regarding the left hip condition. Accordingly, the matters are REMANDED for the following action: 1. The AOJ should request assistance from the Veteran and his representative in identifying any outstanding relevant treatment records for the Veteran's back and left hip conditions from private or VA sources. All record requests and responses must be associated with the Veteran's electronic claims file. 2. Then, the AOJ should obtain an addendum opinion from the same provider that conducted the 2019 VA back examination to determine the nature and etiology of the Veteran’s back conditions. If the same examiner is not available, the request should be forwarded to another clinician. If any examiner deems necessary, an in-person examination should be scheduled for the Veteran. The examiner must review the Veteran's claims file and a copy of this REMAND order before the examination and include a notation that a record review was performed. Further, the examiner must provide a complete written rationale for any opinion rendered. (a.) The examiner is asked to determine the nature and etiology of any diagnosed back condition. The examiner is advised that the Veteran is competent to report the onset of his symptoms and history, and such reports, including those of continuity of symptomatology, must be considered and acknowledged in formulating any opinion. See November 2018 Hearing Transcript, at 3-6. (b.) The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any diagnosed back conditions were incurred in, caused, and/or aggravated by active duty, to include an in-service fall while jumping from a moving 18 wheeler fuel truck, routinely lifting wooden crates of heavy items, and frequent runs, often wearing full gear. 3. The AOJ should also obtain an addendum opinion from the same provider that conducted the 2019 VA hip examination to determine the nature and etiology of the Veteran’s left hip condition. If the same examiner is not available, the request should be forwarded to another clinician. If the examiner deems necessary, an in-person examination should be scheduled for the Veteran. The examiner must review the Veteran's claims file and a copy of this REMAND order before the examination and include a notation that a record review was performed. Further, the examiner must provide a complete written rationale for any opinion rendered. (a.) The examiner is asked to determine the nature and etiology of any diagnosed left hip condition. The examiner is advised that the Veteran is competent to report the onset of his symptoms and history, and such reports, including those of continuity of symptomatology, must be considered and acknowledged in formulating any opinion. See November 2018 Hearing Transcript, at 3-6. (b.) The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any diagnosed hip condition was incurred in, caused, and/or aggravated by active duty, to include in-service reports of sitting for prolonged periods of time in an 18 wheeler fuel truck, travelling up and down hills in the truck, and routinely running 3 miles in full military gear. (c.) The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any diagnosed hip condition was caused or aggravated (i.e. permanently worsened beyond the normal progression of that disease) by Veteran’s diagnosed back condition. 4. After completion of the above and any additional development deemed necessary, the issues on appeal must be readjudicated. If the claims remain denied, the Veteran and his representative must be provided a Supplemental Statement of the Case and afforded the opportunity to respond. Thereafter, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Gipson, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.