Citation Nr: 21000727 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 08-31 838 DATE: January 6, 2021 REMANDED Entitlement to service connection for a left hip disorder, to include as secondary to service-connected bilateral knee disabilities, is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected bilateral knee disabilities, is remanded. Entitlement to service connection for a back disorder, to include as secondary to service-connected bilateral knee disabilities, is remanded. Entitlement to service connection or bilateral lower extremity sciatica, to include as secondary to a back disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1959 to July 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2009 by a Department of Veterans Affairs (VA) Regional Office. While the Veteran previously requested a Board hearing in connection with the issues on appeal, he later withdrew his request in July 2010 and April 2015. In April 2012, the Board remanded the case for additional development and, in June 2016, denied the claims on appeal. Subsequently, the Veteran appealed such decision to the United States Court of Appeals for Veterans Claims (Court). In February 2017, the Court granted the Veteran’s and the Secretary of VA’s (the parties’) Joint Motion for Partial Remand (JMPR), which vacated and remanded the Board’s June 2016 decision as to such issues for action consistent with the JMPR. In this regard, the Court did not address, or find fault with, the Board’s denial of service connection of such claims on a direct basis. Accordingly, the Board’s June 2016 decision on such theories of entitlement is final. In July 2017 and December 2018, the Board remanded the claims on appeal for additional development and they now return for further appellate review. 1. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected bilateral knee disabilities. 2. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected bilateral knee disabilities. 3. Entitlement to service connection for a back disorder, to include as secondary to service-connected bilateral knee disabilities. 4. Entitlement to service connection or bilateral lower extremity sciatica, to include as secondary to a back disorder. Pursuant to the December 2018 Remand, the Veteran was afforded a VA examination in September 2019, at which time the examiner noted diagnoses of lumbar spine degenerative disc disease (DDD)/degenerative joint disease (DJD) with sciatica and bilateral hip degenerative arthritis, and opined that that it was not at least as likely as not that such disorders were aggravated by his service-connected bilateral knee disabilities. However, she provided a conclusory rationale as she simply noted that the there was no documentation in the Veteran’s available medical records that his back and bilateral hip disorders were aggravated by his service-connected bilateral knee disabilities, cited to an UptoDate article that discussed the causation of osteoarthritis, and noted that the cause of the Veteran’s bilateral hip disorder was due to his falls and could be a normal aspect of aging. Additionally, in June 2020, an addendum opinion was obtained to address the Veteran’s bilateral lower extremity sciatica. At such time, the examiner opined that it was not at least as likely as not that the Veteran’s currently diagnosed thoracolumbar spine DDD/DJD and bilateral lower extremity sciatica was aggravated by his service-connected bilateral knee disabilities. However, the examiner also provided a conclusory rationale as she simply stated that, based on a review of the medical record, medical literature, and clinical experience, there was no objective evidence of aggravation beyond the natural progression of his claimed disorder. Thus, the Board finds that a remand is necessary to obtain an addendum opinion that includes an adequate rationale explaining the basis of the conclusion. The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to an appropriate examiner to offer an addendum opinion addressing the etiology of the Veteran’s bilateral hip and back disorders, to include bilateral lower extremity sciatica. Following a full review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral hip disorder, diagnosed as bilateral hip DJD, was aggravated by his service-connected bilateral knee disabilities. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s back disorder, diagnosed as DDD/DJD, with bilateral lower extremity sciatica, was aggravated by his service-connected bilateral knee disabilities. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. The examiner should note that aggravation in this context means “any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease.” 38 C.F.R. § 3.310(b) (emphasis added). An opinion on causation is not needed. In rendering his or her opinion, the examiner is advised that a lack of medical records demonstrating aggravation cannot form the sole basis of a negative opinion. A rationale for any opinion offered should be provided. In this regard, the examiner is advised that the basis for his or her opinion should extend beyond mere citation to medical records, medical literature, and clinical experience. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Clark, 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.