Citation Nr: 21001884 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 20-09 330 DATE: January 12, 2021 REMANDED Entitlement to service connection for left hip degenerative disease/osteoarthritis is remanded. Entitlement to service connection for right hip degenerative disease/osteoarthritis is remanded. Entitlement to service connection for left wrist tendonitis with osteoarthritis is remanded. Entitlement to service connection for right shoulder degenerative disease/osteoarthritis is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1980 to August 1988, from September 2002 to September 2003, and from March 2006 to November 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision of a regional office (RO) of the Department of Veterans Affairs (VA). This matter was previously before the Board in July 2019 where it was remanded for issuance of a statement of the case (SOC). Manlincon v. West,12 Vet. App. 238 (1999). 1. Entitlement to service connection for left hip disability. 2. Entitlement to service connection for right hip disability. The record reflects an unfavorable March 2018 VA opinion for secondary service connection where the examiner found the claimed bilateral hips less likely than not proximately due to or the result of the Veteran’s service-connected knee or feet conditions. In the rationale the examiner noted that the “medical literature does not support a clear causative mechanism between knee/lumbar/foot pathology and over use type bilateral hip injury.” The examiner added that veteran’s residual knee/lumbar/foot function is still within a functional range and “is unlikely to cause or aggravate a bilateral hip pathologic process.” See VA medical opinion dated March 2018. However, the Veteran, through his attorney, states “it is unclear why the VA medical examiner stated that there was no medical literature to suggest an association when there actually is,” and included a link for an article from Mayo Clinic and a link to a blog, “Orthofeet”, stating that “numerous medical articles do in fact suggest that feet conditions may impact knee and hip pain.” See Statement included with VA Form 9 received March 2020. Given the assertion raised by the Veteran of the examiner’s flawed reasoning, and to seek clarification on what medical literature was in fact reviewed in rendering the opinion, an addendum is necessary. 3. Entitlement to service connection for left wrist disability. 4. Entitlement to service connection for right shoulder disability. A February 2018 VA staff physician rendered an opinion for secondary service connection addressing both left wrist and right shoulder disabilities. In the rationale, the physician indicated that “medical literature does not support a temporal relationship between the wrist and the service connected shoulder/neck conditions. The literature does not support that one shoulder causing degenerative arthritis in the opposite joint/shoulder. Degenerative arthritis from military service is caused by repetitive trauma or by a single high velocity injury.” See February 2018 VA medical opinion. Although an opinion as to secondary service connection was discussed, the February 2018 VA physician did not address aggravation of nonservice-connected disabilities as set out in the regulations under 38 C.F.R. § 3.310 (b). El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). The record also shows that in September 2019, the same VA physician rendered an opinion for direct service connection finding the Veteran’s “left wrist condition is less likely than not caused by or a result of previous military service.” The rationale states that “the degenerative arthritis of the left wrist is most likely a natural progression of aging” and “there is a large gap of treatment for the left wrist between 2007 until 2018.” See September 2019 VA medical opinion. However, the Veteran asserts that the September 2019 VA opinion is inadequate because the examiner relied on “a large gap in treatment from service until when he began treating 2018” as the basis for an unfavorable opinion. The Veteran contends that “where the Veteran treated in service and is complaining again of a similar condition, a more thorough rationale is required.” See Statement included with VA Form 9 received March 2020. Based on the foregoing reasons, remand is necessary to obtain addendum opinions for secondary aggravation and opinions that reflect consideration of the Veteran’s lay statements. The matters are REMANDED for the following action: 1. Hip Disability Arrange for the examiner who conducted the March 2018 VA examination to provide an addendum opinion. If the examiner is not available, the request may be referred to another, equally qualified medical professional, who must independently review the electronic claims folder. If the reviewer determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled. After reviewing the claims file, the examiner is to provide an addendum opinion on the following: a) Is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral hip degenerative disease/osteoarthritis manifested within one year of his service discharge in November 2007 and, if so, describe the manifestations. b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hips were aggravated by his service-connected knee or feet conditions? The examiner should consider medical evidence of record (including review of medical article links provided by the Veteran). See Statement included with VA Form 9 received March 2020 including a link for an article from Mayo Clinic and a link to a blog, “Orthofeet”. A complete rationale for all findings and conclusions is requested. 2. Left Wrist Arrange for the examiner who conducted the February 2018 and September 2019 VA examinations to provide an addendum opinion. If the examiner is not available, the request may be referred to another, equally qualified medical professional, who must independently review the electronic claims folder. If the reviewer determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled. After reviewing the claims file, the examiner is to provide an addendum opinion on the following: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s left wrist tendonitis with osteoarthritis is etiologically related to his active duty service, including complaints of left wrist pain in service? b) Is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left wrist arthritis manifested within one year of his service discharge in November 2007 and, if so, describe the manifestations. c) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s left wrist tendonitis with osteoarthritis caused by his service-connected shoulder and neck conditions? A complete rationale for all findings and conclusions is requested. 3. Right Shoulder Disability Arrange for the examiner who conducted the February 2018 VA examination to provide an addendum opinion. If the examiner is not available, the request may be referred to another, equally qualified medical professional, who must independently review the electronic claims folder. If the reviewer determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled. After reviewing the claims file, the examiner is to provide an addendum opinion on the following: a) Is at least as likely as not (a 50 percent or greater probability) that the Veteran’s right shoulder degenerative disease/osteoarthritis manifested within one year of his service discharge in November 2007 and, if so, describe the manifestations. (Continued on the next page)   b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s right shoulder degenerative disease/osteoarthritis caused by his service-connected shoulder and neck conditions? 4. Upon completion of the requested development and any additional development deemed appropriate, adjudicate the claims on appeal. If the determination remains unfavorable, the Veteran and his representative should be furnished a supplemental statement of the case which addresses all relevant evidence. The Veteran and his representative should be afforded the applicable time period in which to respond. Then, return the case to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. An, 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.