Citation Nr: 21000427 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 15-24 376 DATE: January 5, 2021 REMANDED Entitlement to service connection for a lower back condition, to include as secondary to the Veteran's service-connected bilateral knee disabilities is remanded. Entitlement to service connection for a right hip condition to include as secondary to the Veteran's service-connected bilateral knee disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from April 1966 to December 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board for further development in a January 2019 decision. When VA undertakes to provide an examination or opinion, it must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). When there is not substantial compliance with Board remand requests, the Board errs as a matter of law when it does not ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Low Back and Right Hip As part of the January 2019 Board Remand the RO was required to obtain VA examinations regarding the etiology of the Veteran’s claimed lower back and right hip disabilities. The VA examiners were specifically required to offer opinions on whether the Veteran’s back and hip conditions were at least as likely as not caused or aggravated by the Veteran’s service-connected bilateral knee disabilities. While the RO obtained November 2020 VA examinations for the Veteran’s claimed back and hip disabilities, the Board finds them to be inadequate. In proffering their aggravation opinions, the VA examiner did not provide an adequate medical reasoning for the Veteran’s contention that his condition was related to his service connected knee disabilities. In essence, the examiner simply stated that because the Veteran experienced knee pain before he experienced hip or back pain, the Veteran’s knee condition did not aggravate his back and hip disabilities. However, the examiner’s conclusions are not logically supported by his rationale. The examiner does not explain why the fact that the Veteran’s knee pain existed before his back and hip pain means that the back and hip conditions could not be aggravated by his service-connected knee disabilities. Especially since, as the examiner indicated in their hip and thigh conditions opinion, the Veteran’s baseline was experiencing no pain and that the Veteran is now experiencing pain. As the examiner failed to adequately assess whether the Veteran’s claimed conditions were related to his active duty service, to include as secondary to his service-connected bilateral knee disabilities, the Board finds an additional examination is required to determine the etiology of the Veteran’s claimed conditions. The matters are REMANDED for the following action: Afford the Veteran VA examinations by an examiner(s), who have yet to examine the Veteran, with sufficient expertise to address the etiology and onset of the Veteran’s lower back and right hip disabilities. The electronic records should be made available to and reviewed by the examiner(s). All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner(s) must specifically address the following questions: a. Is it at least as likely as not that the Veteran’s right hip and/or back disability was caused by the Veteran’s service-connected bilateral knee disabilities. b. Is it at least as likely as not that the Veteran’s right hip and/or back disability was aggravated by the Veteran’s service-connected bilateral knee disabilities. The examiner(s) must provide a complete rationale for all proffered opinions. In this regard, the examiner(s) must discuss and consider the Veteran’s competent lay statements. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. (Continued on the next page) Further, the examiner(s) must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community at large. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Gresham 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.