Citation Nr: 21066617 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 19-22 492 DATE: November 1, 2021 REMANDED Entitlement to service connection for osteoarthritis of the bilateral hips is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from April 1982 to August 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2017 by a Department of Veterans Affairs (VA) Regional Office. In March 2021, the Veteran testified before the undersigned at a videoconference hearing. A transcript of that hearing has been associated with the record. This appeal was previously before the Board in June 2021, at which time it was remanded for further development. For the reasons below, the Board finds that there has not been substantial compliance with its previous remand instructions, and regrettably, additional development is necessary. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7107(a)(2). The Veteran seeks service connection for a bilateral hip disability, asserting that he developed such due to an altered gait resulting from his service-connected bilateral pes planus. In June 2021, the Board remanded the claim to obtain a medical opinion which addressed various VA treatment records showing that the Veteran experienced an abnormality in his gait. The selected examiner was asked to address whether the Veteran's bilateral hip disability had its onset in service, whether it developed secondary to his service-connected disabilities or was aggravated by his service-connected disabilities. The Board must find that the resulting July 2021 VA examination report is inadequate. When addressing whether the Veteran's bilateral hip disability developed as a result of his service-connected disabilities, the examiner determined it was less likely than not. However, he did not provide a rationale for this conclusion; rather, he merely noted various treatment records showing symptoms and surgeries. The examiner then concluded that it was less likely than not that the Veteran's bilateral hip disability was aggravated by his service-connected disabilities. As rationale, he again noted various treatment records showing diagnoses related to the hips and indicated that studies showed that osteoarthritis was "potentially" caused by factors such as advanced age, obesity, hip injuries, genetics, bone deformities, and certain metabolic diseases, without explaining how any of these factors would apply to the Veteran. Thus, in addressing secondary causation or aggravation, the examiner did not provide a rationale or explanation for his conclusions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions). In addition, attempts by the examiner to link an osteoarthritis study and the Veteran's hip disability is of no probative value, as such is of a general nature and does not reference the specific facts particular to the Veteran's claim. See Wallin v. West, 11 Vet. App. 509 (1998); see also Sacks v. West, 11 Vet. App. 314, 317 (1998). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). For these reasons, the July 2021 VA examination report is inadequate, and further remand is warranted. The matters are REMANDED for the following action: Obtain an addendum opinion to determine the nature and cause of the Veteran's current left and right hip osteoarthritis. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner is asked to address whether it is at least as likely as not (that is, a 50 percent or greater probability) that the Veteran's diagnosed left and right hip osteoarthritis is proximately due to, or the result of, his service-connected disabilities, including bilateral pes planus valgus, right foot plantar nerve compression, and painful scar on his right foot. If the clinician finds that the Veteran's hip conditions are not proximately due to or the result of his service-connected foot conditions, they are asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's current right or left hip disability is aggravated (any increase in severity beyond natural progression) by his bilateral pes planus valgus, right foot plantar nerve compression, and painful scar on his right foot. The resulting examination report should include discussion of the Veteran's documented medical history and assertions, to include the Veteran's lay testimony during the March 2021 Board hearing, in which he explained that a podiatrist had told him his foot condition caused his ankles to "turn in" and could cause problems with his knees, hip, and back. The clinician should also consider and discuss April 2003 VA treatment records showing that the Veteran had gait difficulty after his 2003 right foot surgery; the Veteran's noted awkward or hobbling gait during his February 2005 VA examination for his feet; and the March 2010 and March 2012 VA treatment evidence that observed the Veteran to have an antalgic gait. A complete and detailed rationale should be provided for all opinions rendered. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeremy J. Olsen, 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.