Citation Nr: 21062534 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 15-18 724 DATE: October 7, 2021 REMANDED Entitlement to service connection for a left hip disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a lumbar spine disorder, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served honorably, including active duty service from September 1992 to September 1997 and service in the Army Reserves. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Board remanded the case to cure inadequate VA etiology opinions. As an initial matter, the Board notes that the Veteran's claims for service connection for a right hip disorder and a left knee disorder, which were remanded in the March 2021 Board decision, were granted in a June 2021 rating decision. Because the grant of service connection represented full relief for those claims, the issues are no longer before the Board. See Holland v. Gober, 10 Vet. App. 433, 436 (1997). As to the remaining service connection claims, the Board unfortunately finds that further remand is required in order to ensure the Veteran is provided with adequate medical opinions. Regarding service connection for a left hip disorder, the Board's prior remand directed the clinician to specifically consider and discuss a September 1997 report of medical history in which the Veteran reported problems in her hips, as well as her testimony that she experienced continuous left-hip problems since her active-duty service. The new May 2021 addendum opinion, however, simply remarked that there was "no evidence of chronicity of care," without considering the Veteran's statements. A clinician's sole reliance on objective medical evidence or the absence thereof, to the exclusion of the Veteran's competent lay evidence, fails to consider all of the relevant evidence and therefore is inadequate. Dalton v. Nicholson, 21 Vet. App. 23, 39, 40 (2007). A new opinion must be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Moreover, on remand the Board will direct for consideration, as related by the Veteran at an August 2018 Board hearing, that her doctors told her the hip conditions were due to her "trying to keep pressure off [her service-connected] right groin . . . [a]nd when [she] would try to walk, [she] would compensate." Regarding service connection for a right knee disorder, the Board's prior remand directed the clinician to specifically consider and discuss the Veteran's statement that she had experienced right-knee problems beginning in service and continually since then. The new addendum opinion again only remarked that there was "no evidence of chronicity of care," without any discussion of the Veteran's remark/testimony. Thus, this addendum opinion is inadequate, and a new opinion must be provided. Dalton, 21 Vet. App. at 39, 40. On remand, the Board will likewise direct for consideration of the Veteran's statement at the August 2018 Board hearing that her doctor told her that her knee problems were due to trying to relieve pressure off her service-connected groin disability. Regarding service connection for a lumbar spine disorder, the Board finds that the Veteran has not yet been provided a fully adequate etiology/medical opinion. At the August 2018 Board hearing, the Veteran explained that during service, prior to the right-groin injury which she contends has caused her other musculoskeletal disabilities, she injured her back doing sit-ups during physical training at Fort Hood. After that injury, she was unable to pass the physical fitness test; "[b]efore that, [she] had never failed a PT test." She further testified that she has had back problems ever since then. Though the Veteran was provided an etiology opinion in October 2020 that considered a direct connection to service, the clinician simply stated that there was "[n]o chronic diagnosis ... made for low back on a[ctive] d[uty]" and "no evidence of chronicity of care on a[ctive] d[uty] despite ample visits to report chronic back pain." The Board finds that this opinion, as above, focused exclusively on the objective medical evidence without any consideration of the Veteran's competent testimony, as well as failed to sufficiently reconcile the clinician's finding of "ample visits to report chronic back pain" with the finding that there was no low-back condition present during service. Id.; see Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). A new opinion must therefore be obtained. Accordingly, the matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's left hip condition. If possible, obtain the opinion from the author of the October 2020 and May 2021 opinions. It is left to the discretion of the clinician whether a new examination is appropriate. (a) The clinician must opine whether the Veteran's left hip condition at least as likely as not was incurred in or is otherwise related to her service. In rendering this opinion, the examiner MUST consider and discuss the Veteran's report in September 1997 (at the time of her separation from active duty) that she had problems in both hips, as well as the Veteran's testimony that she has had left hip problems since service. The clinician is made aware that an opinion that relies exclusively on the absence of objective medical evidence (e.g., treatment records) will not be sufficient; the Veteran's own statements must be considered and discussed. (b) The clinician must also opine whether the Veteran's left hip condition at least as likely as not either was proximately caused by or has been aggravated by any service-connected condition, to include her right groin disability. The clinician should discuss that Veteran's doctors told her that her hip problems were due to her compensating for and trying to take pressure off of her right groin injury. 2. Obtain an addendum opinion regarding the etiology of the Veteran's right knee condition. If possible, obtain the opinion from the author of the October 2020 and May 2021 opinions. It is left to the discretion of the clinician whether a new examination is appropriate. (a) The clinician must opine whether the Veteran's right knee condition at least as likely as not was incurred in or is otherwise related to her service. In rendering this opinion, the examiner MUST consider and discuss the Veteran's testimony that she has had right knee problems since service. The clinician is made aware that an opinion that relies exclusively on the absence of objective medical evidence (e.g., treatment records) will not be sufficient; the Veteran's own statements must be considered and discussed. (b) The clinician must also opine whether the Veteran's right knee condition at least as likely as not either was proximately caused by or has been aggravated by any service-connected condition, to include her right groin disability. The clinician should discuss that the Veteran's doctors told her that her knee problems were due to her trying to take pressure off of her right groin injury. 3. Obtain an addendum opinion regarding the etiology of the Veteran's lumbar spine condition. If possible, obtain the opinion from the author of the October 2020 and May 2021 opinions. It is left to the discretion of the clinician whether a new examination is appropriate. The clinician must opine whether the Veteran's lumbar spine condition at least as likely as not was incurred in or is otherwise related to her service. In rendering this opinion, the examiner MUST consider and discuss the Veteran's testimony that she has had low back problems since service, as well as the in-service injury reported by the Veteran in which she hurt her back doing sit-ups, leading to inability to pass that physical fitness test. The clinician is made aware that an opinion that relies exclusively on the absence of objective medical evidence (e.g., treatment records) will not be sufficient; the Veteran's own statements must be considered and discussed. (Continued on the next page) 4. After the above development and any other development deemed necessary is completed, readjudicate the Veteran's claims. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.