Citation Nr: 21000450 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 09-29 215 DATE: January 5, 2021 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to service-connected right hip and/or low back disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1981 to June 2004. These matters come before the Board of Veterans’ Appeals (Board) from a November 2008 rating decisions of a Department of Veterans Affairs (VA) Regional Office. The case was previously before the Board in August 2020 and was remanded for further development. Entitlement to service connection for a left hip disability, to include as secondary to service-connected right hip and/or low back disability, is remanded. The Veteran contends that his service-connected orthopedic disabilities resulted in altered gait, which subsequently caused or aggravated his left hip disability. See November 2020 VA Form 21-4138. He contends the recent VA opinion is inadequate for adjudication purposes. The Board most recently remanded the claim in August 2020 for an addendum opinion and for the Veteran to be provided with the examiner’s qualifications. The Board’s remand instructions in August 2020 also directed that the examiner’s opinions regarding secondary service connection address the Veteran’s statements and evidence that he experiences altered gait due to right hip status post fracture and dislocation and lumbar spine strain disability that has caused or aggravated his claimed left hip disability. While the examiner addressed June 2008 imaging results as directed and found that the Veteran manifests bursitis rather than degenerative joint disease, they did not provide adequate rationale for their conclusions regarding causation and aggravation. The examiner opined the Veteran’s bursitis was not possibly caused by his right hip and low back disabilities “from a pathophysiological standpoint,” but did not provide an explanation of the pathophysiological reasons for this opinion. The examiner also did not specifically address altered gait in determining that medical literature and science did not support bursitis could be aggravated by opposing joint arthritis or lumbar spine strain. Given the examiner’s cursory statements regarding pathophysiological and medical science and literature, the Board cannot find that adequate rationale has been provided addressing the Veteran’s contentions of altered gait that is due to service-connected right hip and lumbar spine disabilities resulting in left hip disability. Therefore, an addendum opinion is necessary to decide this claim. See Stegall v. West, 11 Vet. App. 268 (1998); Barr v. Nicholson, 21 Vet. App. 303 (2007). In light of the manifest failure of the examiner who has provided multiple inadequate opinions, the Board also directs that the RO obtain the needed opinion from another examiner. In a July 2020 IHP, the Veteran challenged the September 2019 examiner’s qualifications to provide an expert opinion on the specific issue of whether one hip condition can result, through malalignment or otherwise, in the development of the opposite hip condition under. The Board directed VA to obtain the examiner’s credentials and provide them to the Veteran in the August 2020 remand. In September 2020, VA obtained the examiner’s curriculum vitae (C.V.) but did not provide a copy to the Veteran as directed in the August 2020 remand. The RO will have the opportunity to remedy this oversight on remand. The matter is REMANDED for the following action: 1. Provide the Veteran information regarding the qualifications of the September 2020 VA examiner, to include the September 2020 curriculum vitae (C.V.). 2. Obtain an addendum medical opinion from an examiner who has not yet provided an opinion in this case regarding the Veteran’s left hip disability. The examiner must review additional evidence received in November 2019. If that examiner is unavailable, the claims file must be made available to another appropriate clinician for review. The examiner is asked to review the additional evidence (to include X-ray images from Crestwood Medical Center, an imaging report, and a medical article entitled “Malalignment Syndrome”) submitted by the Veteran and his representative in July 2020 and provide following addendum opinions: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s currently-diagnosed left hip strain and mild degenerative joint disease (for which there is X-ray evidence from June 2008) was incurred during military service, or was a result of an in-service disease, event, or injury? b) If not, then is it at least as likely as not that his currently-diagnosed left hip strain and mild degenerative joint disease (for which there is X-ray evidence from June 2008) was proximately due to or the result of (caused by) his service-connected orthopedic disabilities, including his low back and right hip disabilities? c) If not, then is it at least as likely as not that his currently diagnosed left hip strain and mild degenerative joint disease (for which there is X-ray evidence from June 2008) is aggravated (permanently made worse) by his service-connected low back and right disabilities? The rationale for the opinions must be provided. The rationale should reflect consideration of the additional evidence received since the September 2019 medical opinion, to include copies of lay statements, X-ray images from Crestwood Medical Center, an imaging report, and a medical article entitled “Malalignment Syndrome.” J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Trickey 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.