Citation Nr: 21004889 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-17 935 DATE: January 28, 2021 REMANDED Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a left ankle disability, to include as secondary to a left hip disability, is remanded. Entitlement to service connection for a low back disability, to include as secondary to a left hip disability, is remanded. REASONS FOR REMAND The Veteran had active service from July 1973 to July 1976. This appeal stems from a December 2012 rating decision denying the Veteran’s claims. He appealed, and the Board of Veterans’ Appeal (Board) issued a January 2016 decision which reopened and remanded the Veteran’s claims for service connection for a left hip and low back conditions, and remanded his claim for service connection for a left ankle condition. In September 2018, the Board denied these three service connection claims, a decision appealed by the Veteran to the U.S. Court of Appeals for Veterans Claims (CAVC/Court). In September 2019, the Court issued an Order granting a Joint Motion for Remand (JMR), in which the parties agreed that the Board had erred in failing to address the Veteran’s July 1997 hearing testimony, an August 2018 Informal Hearing Presentation, and the Veteran’s lay statements. As a result of the granted JMR, in September 2020, the Board issued an additional remand directing that the Veteran be examined by a “physician with sufficient expertise” who had not previously evaluated the nature and etiology of his claimed left hip disability. At that time, the Board also remanded the claims for low back and left ankle disabilities, as they are intertwined with his left hip claim. The case has now returned to the Board for adjudication. Service connection for a left hip disability Regretfully, the Board finds that the development following the September 2020 remand is insufficient and that an additional remand is necessary before this issue can be properly and finally adjudicated. While the Veteran was examined as requested in November 2020, the evaluator was not a physician, as specified in the remand directives. While normally, VA accepts qualified examiners, including nurse practitioners, the September 2020 remand specified that the Veteran was to be examined by a physician of sufficient expertise. It is further noted that the nurse who examined the Veteran was a general practitioner and that there was no indication of any expertise in orthopedic injuries of the Veteran’s sort. Also, the Board finds that the opinion provided in November 2020 failed to address key directives in the September 2020 remand concerning the Veteran’s contentions and a 1995 medical opinion concerning the shortening of the Veteran’s left leg. As such, an additional remand is necessary in order to fully comply with the Board’s September 2020 remand directives. Service connection for a low back disability, to include as secondary to a left hip disability Service connection for a left ankle disability, to include as secondary to a left hip disability As the Veteran’s claims for service connection of low back left ankle disabilities are dependent and inextricably intertwined with the claim for service connection for a left hip disability, these additional service connection claims must be remanded as well. Accordingly, these matters are REMANDED for the following action: Schedule the Veteran for a VA examination by a PHYSICIAN with sufficient expertise, who has not already examined the Veteran, to determine the nature and etiology of the Veteran’s claimed left hip disability. All pertinent evidence of record must be made available to the examiner, including the Veteran’s lay statements of symptoms he experienced during and after his active service. Any indicated studies should be performed. The examiner should answer the following questions with respect to each left hip disorder present during the appeal period. a. Did the Veteran’s current left hip disability clearly and unmistakably exist prior to his entrance into active duty? In answering this question, the examiner should address clinical information regarding a pre-existing left hip condition prior to service. b. If the examiner finds that a current left hip disability pre-existed the Veteran’s active duty, did such left hip condition increase in severity during service? In answering this question, the examiner should address clinical information regarding in-service treatment for a left hip condition. c. If the pre-existing left hip disability increased in severity during service, was the increase clearly and unmistakably due to the natural progression of the disease or injury? An adequate rationale explaining how and why the progression was natural is required. d. With respect to any non pre-existing (but current) left hip disability—and with respect to any currently diagnosed low back and left ankle disability—is it at least as likely as not (50% probability or better) that such condition onset in, or is otherwise etiologically related to, the Veteran’s active service? In answering this question, the examiner must consider and discuss the Veteran’s competent and credible reports indicating that his left hip injury had healed without residuals, his reports of left hip disability since service, and his treating physician’s October 1995 determination that his (the Veteran’s) in-service injury may have caused left leg shortening. A full and complete rationale for any opinion expressed must be provided. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.E. Lee 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.