Citation Nr: 21003274 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 17-15 990 DATE: January 21, 2021 REMANDED Entitlement to service connection for right hip disorder is remanded. REASONS FOR REMAND The Veteran was a member of the United States Army Reserve from approximately 1992 to 2005 and, during such service, he had honorable active military service from January 2003 to November 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Regional Office (RO) July 2016 decision. The Veteran testified at a Board videoconference hearing in January 2020, the transcript of which is associated with the claims file. Entitlement to service connection for right hip disorder is remanded. The Veteran has a diagnosis of avascular necrosis in his right hip and, in May 2016, he underwent a total hip replacement. He is seeking service connection for his right hip disorder and contends it is related to treatment he received while on active duty. His main contention is that the avascular necrosis is due to being treated with high-dose long-term steroids (specifically Prednisone) for sarcoidosis. He has also contended that his chemotherapy treatment for colon cancer either resulted in or contributed to his developing avascular necrosis in the right hip. Unfortunately, the Board does not find the record adequate to adjudicate the Veteran’s claim and remand is necessary to obtain additional development. The Veteran’s service treatment records show he was found to have anemia approximately three months after deploying to Iraq and was transferred for treatment to medical facilities in Kuwait and then Germany. While in Germany, he was diagnosed to have a colorectal adenocarcinoma and was returned to the United States for cancer treatment. Reportedly he was transferred to Walter Reed Army Hospital in Washington, DC, and while there was found to have sarcoidosis and was treated with Prednisone. However, there are no records of such treatment in the Veteran’s service treatment records. The Veteran’s service treatment records show the treatment in Germany in at the beginning of July 2003 but the next available treatment records are from when the Veteran was seen at the VA Medical Center in Brockton, Massachusetts in March 2005 to establish and continue care for his cancer. The only records available from Walter Reed Army Hospital are some laboratory results and imaging reports. As the treatment records from Walter Reed Army Hospital are not available, the records showing the sarcoidosis treatment and chemotherapy are not of record. Those records would show the specific treatment the Veteran had, which the Board notes is highly relevant to his contentions as to the etiology of the avascular necrosis in his right hip. Hence, such records should be obtained on remand. Furthermore, it appears that not all the treatment records related to the Veteran’s right hip disorder are of record. Private hospital records show he was treated on an inpatient basis in February 2016 without an indication that he had a diagnosis of a right hip disorder. An April 2016 note from his private orthopedist is the first record of a diagnosis of avascular necrosis in the right hip. However, this note indicates he was seen for follow up and that the plan was already in place for him to have total hip replacement surgery. Those it appears that somewhere between February 2016 and April 2016 the Veteran was diagnosed with avascular necrosis. Having those initial treatment records could be helpful in determining the etiology of the avascular necrosis and, thus, are relevant records that should be obtained on remand. Finally, a negative medical opinion was obtained from a VA clinician in February 2017. The Board finds that the examiner’s opinion is inadequate because not all the relevant records were available to him, significantly the initial treatment records for the Veteran’s sarcoidosis and colon cancer. Furthermore, private treatment records received after the February 2017 opinion was rendered contain a May 2015 note in which his private physician states the Veteran had a history of colon cancer and sarcoidosis with required use of prednisone and a past history of heavy drinking. The private physician stated that all of these could be all contributing factors to the diagnosis of avascular necrosis. However, the private physician’s statement is not adequate to grant the claim because it is too speculative, and no rationale was provided. The matters are REMANDED for the following action: 1. Obtain records of the Veteran’s treatment at Walter Reed Army Hospital from July 2003 to March 2005. Document all requests for information as well as all responses in the claims file. 2. Ask the Veteran to complete a VA Form 21-4142 for the physician(s) who diagnosed him to have avascular necrosis of the right hip. Make two requests for the authorized records identified unless it is clear after the first request that a second request would be futile. 3. After completion of the above development, obtain an addendum opinion from an appropriate clinician regarding: (a.) Is it at least as likely as not (50% probability or greater) that the Veteran’s avascular necrosis of the right hip, status post total hip replacement, was caused by treatment, including during active duty, for sarcoidosis (i.e., Prednisone)?; and (b.) Is it at least as likely as not (50% probability or greater) that the Veteran’s avascular necrosis of the right hip, status post total hip replacement, was caused by treatment, including during active duty, for colon cancer (i.e., chemotherapy)?; and (c.) Is it at least as likely as not (50% probability or greater) that the Veteran’s avascular necrosis of the right hip, status post total hip replacement, was aggravated (any increase in disability) by treatment, including during active duty, for sarcoidosis (i.e., Prednisone)?; and (d.) Is it at least as likely as not (50% probability or greater) that the Veteran’s avascular necrosis of the right hip, status post total hip replacement, was aggravated (any increase in disability) by treatment, including during active duty, for colon cancer? M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.M. Kreitlow 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.