Citation Nr: 21064937 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 13-23 394 DATE: October 22, 2021 REMANDED Entitlement to service connection for a right hip condition, including as secondary to service-connected right knee conditions, is remanded. Entitlement to service connection for a left hip condition, including as secondary to service-connected right knee conditions, is remanded. Entitlement to a total disability evaluation based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1977 to March 1977. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. The Board previously remanded this matter in December 2014, September 2017, March 2018, April 2020, and December 2020. 1. Right Hip Condition 2. Left Hip Condition The Board acknowledges receipt of a March 2021 medical opinion addressing the etiology of the Veteran's bilateral hip osteoarthritis and trochanteric bursitis. However, this opinion is internally inconsistent and requires clarification from the March 2021 examiner on remand. Specifically, when discussing whether the Veteran's obesity was an intermediate step between his service-connected right hip disability and his bilateral hip disorders, the examiner found that the Veteran's service-connected right knee disabilities were "causally related" to his bilateral trochanteric bursitis. Nevertheless, the examiner also found that it was less likely than not that the Veteran's bilateral hip arthritis was secondary to his right knee disabilities. Though the examiner explained that the Veteran's right knee condition and total knee replacement impacted his gait and a leg length discrepancy which "can secondarily affect" the hip joints, the examiner still concluded that it was not at least as likely as not that the Veteran's hip conditions were due to his service-connected right knee conditions. These internal inconsistencies call into question the adequacy of the March 2021 opinion. Additionally, when addressing secondary service connection, the examiner did not opine as to whether the Veteran's service-connected right knee disabilities aggravated his bilateral hip disabilities. See El-Amin v. Shinseki, 26 Vet. App. 136 (2012). Therefore, the Board finds the March 2021 medical opinion to be inadequate and for a new opinion regarding the nature and etiology of the Veteran's bilateral hip conditions to be obtained on remand. 3. TDIU As noted in the previous Board decisions of record, the issue of entitlement to a TDIU is inextricably intertwined with the issues of service connection on appeal. See December 2014 Board Decision; September 2017 Board Decision; March 2018 Board Decision; April 2020 Board Decision; December 2020 Board Decision; Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, because the Board is remanding the issues of service connection, the Board must also remand the issue of entitlement to TDIU. The matters are REMANDED for the following action: Return the claims file to the March 2021 examiner, if available, for an addendum opinion clarifying the March 2021 findings. If this examiner is not available, forward the claims file to a clinician with the appropriate expertise. The examiner/clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's bilateral hip osteoarthritis and/or bilateral hip trochanteric bursitis is/are (i) caused or (ii) aggravated by his service-connected right knee disabilities. NOTE: With respect to the question concerning aggravation, the examiner/clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require "permanent worsening" of the nonservice-connected disability. If aggravation is found, the examiner/clinician should attempt to identify the baseline level of severity of disability prior to such aggravation. In formulating his or her opinion(s), the examiner/clinician should consider and address the competent medical and lay evidence of record, including but not limited to: (i) The Veteran's post-service medical records; and (ii) The Veteran's competent lay statements regarding the onset and continuity of his bilateral hip symptomatology. If the examiner/clinician determines that the Veteran's bilateral hip osteoarthritis and/or bilateral hip trochanteric bursitis is/are less likely than not caused and/or aggravated by his service-connected right knee disabilities, the examiner/clinician should discuss what other factor(s) caused the disorders. In other words, the examiner/clinician should ascertain the most likely etiology of the Veteran's bilateral hip osteoarthritis and bilateral hip trochanteric bursitis. A complete rationale must be provided for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoffman 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.