Citation Nr: 21064575 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 16-15 739A DATE: October 20, 2021 REMANDED Entitlement to service connection for a left hip disability is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps (USMC) from November 1974 to June 1977. This case comes before the Board of Veterans' Appeals (Board) on appeal of an April 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in December 2018, October 2019, May 2020, and March 2021, at which times the issue on appeal was remanded for further development. This case has been returned to the Board for further appellate action. Service connection Left Hip Disability Although the Board regrets further delay, another remand is warranted to obtain an adequate medical opinion in compliance with the Board's March 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). In the March 2021 Board remand, found that the June 2020 VA medical opinion was inadequate for adjudication purposes. The Board explicitly noted that the June 2020 VA examiner failed to adequately address whether the Veteran's left hip disability was aggravated by his service-connected disabilities. As such, the Board directed the VA examiner to provide two separate opinions, to include one that specifically addressed aggravation of the Veteran's left hip disability. In an April 2021 addendum opinion, a VA examiner opined that it was less likely than not that the Veteran's left hip disability was proximately due to or the result of his service-connected right knee instability. The VA examiner indicated that the orthopedic literature did not provide clear evidence that injury to one joint would have significant impact on another opposite uninjured joint, unless there was muscle or nerve damage, paralysis, shortened limbs, or altered gait patterns. Additionally, the VA examiner opined that the Veteran's left hip osteoarthritis was not aggravated beyond its natural progression by his service-connected condition. The VA examiner reasoned that the Veteran was diagnosed with left hip osteoarthritis 20 years ago and had not required surgical intervention for the condition. In a June 2021 addendum opinion, a VA examiner opined that the Veteran's left hip disability was less likely as not proximately due to or the result of bilateral knee disabilities or his antalgic gait, due to his bilateral knee disabilities. The VA examiner reasoned that there was no medical evidence to suggest that the Veteran's gait modification caused the Veteran's primary left hip osteoarthritis. The VA examiner also reasoned that the Veteran's left hip osteoarthritis was more likely than not a product of a natural aging process and that arthritis in one joint does not cause an arthritis on another joint. The Board finds that the April 2021 VA opinion is inadequate. In this regard, the VA examiner failed to address the Veteran's lay statements pertaining to the onset of his hip pain. Additionally, the VA examiner provided insufficient rationale to support the opinion, as the fact the Veteran had no surgical intervention or had a diagnosis 20 years prior is not relevant in regard to whether his bilateral knee disabilities aggravated his left hip disability. Additionally, the Board finds that the June 2021 VA addendum opinion is also inadequate. In this regard, the VA examiner failed to provide an opinion in regard to aggravation entirely. Based on the foregoing, the Board finds that a remand is warranted to obtain an adequate addendum opinion pertaining to whether the Veteran's left hip disability was aggravated by his service-connected bilateral knee disabilities. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board emphasizes that compliance with a remand is not discretionary and failure to comply with the terms of a remand necessitate a remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Forward the Veteran's claim file, to include a copy of the herein remand, to an orthopedist who has not previously examined the Veteran or provided a medical opinion in this case. The examiner must review the claims file, and note that review in the report. Based on a thorough review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's left hip disability was caused or aggravated (chronically worsened) by a service-connected disability, to include any altered gait and/or body mechanics resulting from such. In forming the opinion, the examiner must consider the Veteran's lay statements regarding the onset and continuity of his left hip disability, and his statements regarding what makes his left hip pain increase in severity. A complete and detailed rationale must be provided for all opinions expressed. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinions. 2. Confirm that all medical opinions comport with this remand, and undertake any other development determined to be warranted. 3. Then, readjudicate the appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Byrd, 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.