Citation Nr: 21000291 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-50 957 DATE: January 5, 2021 REMANDED Entitlement to service connection for a bilateral hip disability, to include as secondary to service-connected bilateral knee disability, is remanded. Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1983 to March 1989. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. Subsequently, the Board remanded the matter in September 2019 for further development. The Veteran seeks service connection for back and bilateral hip disabilities, to include as secondary to service-connected bilateral knee disability. During the March 2019 Board hearing, the Veteran testified that he began to have back and hip pain in service, which he treated with heating pads and over-the-counter medications. He further testified that he first got treatment for this back and hip from a chiropractor in 1990. Pursuant to the Board’s September 2019 remand directives, the Veteran was afforded a VA examination in November 2019. The examiner opined that the Veteran’s back and bilateral hip disabilities were less likely than not due to or aggravated by his bilateral knee conditions. The examiner reasoned that symmetrical bilateral knee degenerative joint disease does not cause significant gait imbalance and there is no significant gait imbalance noted or documented in the records. The examiner noted that scientific medical literature review does not support the claim that bilateral knee degenerative joint disease causes spine or hip degenerative joint disease. The examiner noted that there was no evidence to support aggravation nor evidence of a chronic back or hip condition documented within one year of separation from service. The examiner reasoned that according to his records, his chiropractor treatment started in January 1992 for pain symptoms and not for degenerative joint disease. The examiner noted that the Veteran was diagnosed with lumbar degenerative joint disease in May 2013 and with bilateral hip degenerative joint disease in July 2013. The examiner indicated that the Veteran’s lumbar and hip degenerative joint disease was most probably due to normal age progression. Addressing the September 2013 letter from the Veteran’s treating physician, the examiner indicated that the physician documented pain, which may have many reasons, and did not provide a rationale regarding the Veteran’s development of degenerative joint disease. The Board finds that remand is required for an addendum VA medical opinion before the matter can be adjudicated. Where VA provides a veteran with an examination in a service connection claim, the examination and medical opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, the November 2019 VA examiner’s opinion is improperly based, in part, on the absence of a diagnosis of degenerative joint disease of the spine and/or hip until 2013. The examiner did not consider the Veteran’s lay statements regarding onset and duration of his symptoms, or whether his back and hip degenerative joint disease are otherwise due to or the result of his painful back and hips in military service. Additionally, the VA examiner opined that the Veteran’s back and bilateral hip disabilities were not secondary to his service-connected bilateral knee disabilities. However, the examiner failed to provide a clear rationale for this opinion. Rather, the examiner vaguely explained, in pertinent part, that the Veteran’s knee conditions were symmetrical and that there was no significant gait imbalance noted in the medical records. No adequate rationale was provided as to whether the Veteran’s disabilities were aggravated by his bilateral knee disabilities. Accordingly, the Board finds that remand is necessary to obtain an addendum medical opinion regarding the etiology of the Veteran’s back and bilateral hip disabilities. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, forward the claims file to an appropriate medical professional to obtain a VA medical opinion to determine the nature and etiology of the Veteran’s back and bilateral hip disabilities. If the examiner determines that another VA physical examination is necessary, such an examination should be scheduled. Following a review of the claims file, the examiner is asked to opine as to the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s back and/or bilateral hip disabilities manifested in or are otherwise etiologically related to active service; b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s back and/or bilateral hip disabilities are proximately due to, the result of, his service-connected bilateral knee disability; c) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s back and/or bilateral hip disabilities have been aggravated beyond normal progression by his service-connected bilateral knee disability? In rendering the requested opinions, the examiner should consider and comment on the September 2013 letter from the Veteran’s treating physician, which indicates that the Veteran’s knees are chronic and debilitating and caused pain in the hips and low back. The examiner is also asked to consider and address the Veteran’s reports that he began having hip and back pain in service and first started seeking hip and back treatment from a chiropractor in 1990. A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Robinson, 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.