Citation Nr: 21062324 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 09-32 896 DATE: October 7, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1980 to September 1982. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from August 2009 and September 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In a December 2014 decision, the Board of Veterans' Appeals (Board) denied the Veteran's claim for entitlement to service connection for a back disorder. The Veteran timely appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In an April 2018 Order, the Court granted the parties' Joint Motion for Partial Remand (JMPR), partially vacated the December 2014 Board decision, and remanded the matter to the Board for readjudication consistent with the JMPR. Most recently, in December 2020, the Board remanded the Veteran's service connection claim for a back disorder as well as his service connection claims for bilateral hip disabilities to the agency of original jurisdiction (AOJ) for further development. In April 2021, the AOJ denied entitlement to the Veteran's service connection claims (as reflected in an April 2021 supplemental statement of the case (SSOC)). Pursuant to the Board's remand, VA medical opinions were obtained in March 2021 to determine any medical relationship between the Veteran's service-connected left ankle disability and his back and bilateral hip conditions. Regarding his back disability, the examiner opined that the Veteran's service-connected left ankle disability did not cause or aggravate his back condition. As rationale, she stated that the Veteran's back condition was not diagnosed until many decades after service and if there was a causal relationship between her left ankle disability and back condition "one would expect those diagnosis to be given in the years close to her time of separation. The records are silent for such a back condition." Instead, she surmised that the Veteran's lupus and use of steroids aggravated her back disability. Regarding the Veteran's bilateral hip conditions, the same examiner likewise opined that the Veteran's service-connected left ankle disability did not cause or aggravate her bilateral hip conditions. In providing a negative etiology opinion, the examiner provided a nearly identical rationale as the one contained in the back condition opinion. The Board finds that the examiner's opinions are flawed. First, contrary to her assertions, back pain was noted during the Veteran's military service. See, e.g., February 1981 service treatment records (STRs). More significantly, the absence of a diagnosis of a back or hip condition in close proximity to service does not discount a relationship between the Veteran's service-connected left ankle disability and her back and/or bilateral hip disabilities. In her etiology opinions, the examiner appears to be commenting on the Veteran's service connection claims on a direct basis; however, in the remand, the examiner was directed to opine on the Veteran's service connection claims on a secondary basis. As such, the Board finds that substantial compliance with the December 2020 remand directives has not been achieved. See Stegall v. West, 11 Vet. App. 268, 271 (1998). On remand, VA addendum opinion should be obtained with complete rationale as to whether the Veteran's back and bilateral hip disabilities are caused or aggravated by her service-connected left ankle disability. The matters are REMANDED for the following action: 1. Send the Veteran's claims file to an appropriate medical professional to obtain addendum opinions regarding the etiology of her back and bilateral hips disabilities. The Veteran's entire electronic claims file must be made accessible to the designated professional for review. A detailed rationale for any opinion expressed should be provided. 2. Following the review of the claims file, the examiner is then requested to respond to the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's back disability is proximately due to or caused by her service-connected left ankle disability? (b) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's back disability has been aggravated (made worse beyond its natural progression) by her service-connected left ankle disability? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. (c) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's left and/or right hip disabilities are proximately due to or caused by her service-connected left ankle disability? (d) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's left and/or right hip disabilities have been aggravated (made worse beyond its natural progression) by her service-connected left ankle disability? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. 3. If the requested opinions cannot be provided without a new examination, one should be scheduled. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.