Citation Nr: 21066060 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 18-34 236 DATE: October 28, 2021 REMANDED Entitlement to service connection for a left hip condition, including as secondary to service-connected spondylosis and first degree spondylolisthesis of L5-S1, is remanded. Entitlement to service connection for a right hip condition, including as secondary to service-connected spondylosis and first degree spondylolisthesis of L5-S1, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1973 to September 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The Veteran testified before the undersigned Veterans Law Judge (VLJ) via a virtual hearing in July 2021; a transcript is of record. 1. Left Hip Condition 2. Right Hip Condition The Veteran seeks service connection for a bilateral hip disability. The Board acknowledges receipt of an April 2018 VA examination and opinion concluding that the Veteran's bilateral hip conditions were less likely than not caused by his now service-connected lumbar condition. However, the examiner did not discuss whether the Veteran's conditions were aggravated by his lumbar spine disability. El-Amin v. Shinseki, 26 Vet. App. 136 (2012). Accordingly, this opinion is inadequate to determine the etiology of the Veteran's bilateral hip disorder. Furthermore, the Veteran's medical records indicate a relationship between his service-connected back disability and his bilateral hip pain. See July 2017 VA Primary Care Attending Note; December 2017 VA Primary Care Attending Note; March 2018 VA Primary Care Attending Note; March 2018 VA Primary Care Letters; April 2018 VA Primary Care Letters. This evidence was not discussed by the April 2018 examiner. Although this evidence reflects a causal link between the Veteran's service-connected lumbar spine disability and his bilateral hip disorders, there is no rationale provided to explain these conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Thus, the Board cannot rely on this evidence to determine whether the Veteran's service-connected spondylosis and first degree spondylolisthesis of L5-S1 is related to his bilateral hip conditions. Finally, the Board notes that the April 2018 examiner concluded that the Veteran's obesity was a more likely cause of his bilateral hip disabilities. However, this raises the question of whether the Veteran's obesity is an intermediate step between his service-connected spondylosis and first degree spondylolisthesis of L5-S1 and bilateral hip condition. See Marcelino v. Shulkin, 29 Vet. App. 155 (2018); VAOPCGPREC 1-2017 (Jan. 6, 2017). In light of the above, the Board requests an addendum opinion regarding the nature and etiology of the Veteran's bilateral hip disorders. The matters are REMANDED for the following action: Forward the claims file to an appropriate clinician who has not previously provided an opinion in this case to determine the nature and etiology of any and all bilateral hip condition(s) attributable to the Veteran. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. (a) The clinician should identify any and all bilateral hip condition(s) attributable to the Veteran throughout the period on appeal. (b) For each condition so identified, the clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's condition was either (i) caused or (ii) aggravated by his service-connected spondylosis and first degree spondylolisthesis of L5-S1. NOTE: With respect to the question concerning aggravation, the 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 clinician should attempt to identify the baseline level of severity of disability prior to such aggravation. (c) For each condition so identified, the clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that (i) the Veteran's service-connected spondylosis and first degree spondylolisthesis of L5-S1 caused him to become obese; (ii) such obesity was a substantial factor in causing his condition; and (iii) the current condition would not have occurred but for obesity caused by the service-connected spondylosis and first degree spondylolisthesis of L5-S1. In formulating his or her opinions, the clinician should consider and address the competent medical and lay evidence of record, including but not limited to the Veteran's VA medical records and the Veteran's competent lay statements regarding the onset and continuity of his symptomatology. If the clinician determines that the Veteran's bilateral hip condition(s) is/are less likely than not caused and/or aggravated by his service-connected spondylosis and first degree spondylolisthesis of L5-S1, and/or that the Veteran's obesity is less likely than not an intermediate step between his service-connected spondylosis and first degree spondylolisthesis of L5-S1 and current bilateral hip condition(s), the clinician should discuss what other factor(s) caused the disorder(s). In other words, the clinician should ascertain the most likely etiology of the Veteran's bilateral hip condition(s). The clinician must provide a comprehensive report that includes a complete rationale 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.