Citation Nr: 21067086 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-67 233 DATE: November 3, 2021 REMANDED Entitlement to service connection for a right hip disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February 2003 to August 2004 and from March 2009 to August 2010, and had additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision. An August 2018 Board decision denied service connection for a right hip disability, and the Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC), resulting in a March 2019 Joint Motion for Partial Remand (JMPR) by the parties. A March 2019 CAVC Order remanded the matter for compliance with the JMPR instructions. In September 2019, the case was remanded for further development. The Board notes that VA treatment records were added to the Veteran's claims file after the last supplemental statement of the case (SSOC) (which note hip pain on the problem list but do not document additional treatment for a hip disability). As the matter is being remanded, the Veteran is not prejudiced by the Board proceeding because the Regional Office (RO) will have an opportunity to review the additional evidence on remand. The Board regrets further delay, but unfortunately, it finds that the September 2019 remand instructions were not adequately fulfilled. See Stegall v. West, 11 Vet. App. 268 (1998). On August 2021 VA hip examination, bilateral hip strain was diagnosed. The Veteran reported that during physical training in 2015 he experienced right hip pain, continued with training, and one month later he sought treatment for right hip pain. He related that he experienced frequent right hip pain of 8/10, and a shooting sensation related to bending, overuse, and prolonged sitting that was improved with rest and medication. The examiner opined that it was less likely than not that the Veteran's right hip disability was related to his service and/or caused or aggravated by a service-connected left hip disability. He explained that the Veteran's service treatment records (STRs) are silent regarding complaints, diagnoses, and treatment for a right hip disability, and that there was no evidence in the records, literature, or history to support that the right hip disability was caused or aggravated by his left hip strain. The opinion is inadequate because it is cursory and a likely etiology for the right hip disability was not provided. Further, prior to the August 2021 examination, the Veteran had established service-connection for a low back disability, raising an additional secondary service connection theory of entitlement which was not addressed. Therefore, remand for an adequate medical advisory opinion is necessary. The matter is REMANDED for the following: Arrange for the Veteran's record to be forwarded to an appropriate clinician (in orthopedist) for review and an addendum medical advisory opinion. [If the consulting provider determines further examination of the Veteran is deemed necessary, such should be arranged.] Upon review of the record, the consulting provider should determine the nature and likely etiology of his right hip disability, and in particular whether or not it is directly related to (was incurred during) his service, or was caused or aggravated by his service-connected left hip and/or low back disabilities, and provide responses to the following: (a) Identify (by diagnosis) each right hip disability entity found/or shown by the record during the pendency of the instant claim. (b) Identify the likely etiology for each right hip disability entity diagnosed. Specifically, is it at least as likely as not that it was incurred in service? The rationale provided should address the Veteran's lay statements, specifically his report on August 2021 examination of a right hip during training in 2015. (c) If a diagnosed right hip disability is found to not be directly related to the Veteran's service, opine further whether it is at least as likely as not that such disability was caused or aggravated by (increased in severity due to) the Veteran's service-connected left hip and/or low back disabilities. [The opinion must address aggravation.] (d) If the opinion is to the effect that a service-connected disability did not cause, but aggravated, a right hip disability, should specify, to the extent possible, the degree of disability (pathology/impairment) that has resulted from such aggravation. (e) If the opinion is that a right hip disability was not incurred in service or caused or aggravated by a service-connected disability, identify the etiology that is considered to be more likely. The provider must include rationale with all opinions, citing to supporting factual data as deemed appropriate, and should also consider and discuss all lay assertions, to include the Veteran's statements reporting the nature, onset, and continuity of symptoms. The provider is reminded that the lack of in-service or post-service treatment records may not be the sole basis for a negative nexus opinion given. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.