Citation Nr: 21067898 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 16-14 504 DATE: November 8, 2021 REMANDED Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to December 1970, and from December 1973 to June 1979, with additional service in the Army National Guard. The Veteran testified before a Decision Review Officer (DRO) in August 2018. A copy of the transcript is of record. This case was previously before the Board in August 2019, when the claims listed above were remanded for additional development. An August 2020 supplemental statement of the case was most recently issued, and the claims are once again before the Board. 1. Entitlement to service connection for a left hip disability is remanded. 2. Entitlement to service connection for a right hip disability is remanded. 3. Entitlement to service connection for a left knee disability is remanded. 4. Entitlement to service connection for a right knee disability is remanded. 5. Entitlement to service connection for a cervical spine disability is remanded. The Veteran's claims were remanded in August 2019 so that VA examinations and opinions could be provided to determine if the Veteran has left hip, right hip, left knee, right knee or cervical spine disabilities that are related to service. The Board finds the December 2019 VA medical opinions obtained are inadequate. First, the VA examiner did not address the Veteran's credible statements that he has suffered from bilateral hip and knee issues since service. The Veteran reported, in a June 2013 statement, that while stationed in Germany (during active duty) he did a lot of ruck marching and physical training. He stated that he would do up to ten miles in full combat gear and during this time he started to notice pain in his hips and knees. He reported that because of training he never reported to sick call for his pain. The Veteran further reported that during his second tour of active duty he was involved with firing machine guns mounted on tanks and had to manually load the rounds. He also reported that they would have to work on the tracks of the tank if they came off. He stated that this led to pain in his shoulders. He later testified, at his August 2018 Decision Review Officer (DRO) hearing, that although he thought it was his arm that was injured, he was later told it was his actually his neck that was injured. See DRO Hearing Transcript (T.) at 6. While the December 2019 VA examiner correctly noted that various in-service examinations noted normal clinical evaluations, the examiner failed to consider in her analysis that in a February 1978 report of medical history, completed during his second period of active service, the Veteran reported that he did not know if he has a trick or locked knee. The examiner additionally failed to consider in her analysis that in a March 1979 report of medical history, completed shortly before separation from service, the clinician appears to have written "ortho pain" although the writing is not entirely clear. Additionally, the examiner failed to consider in her analysis that in an August 1979 VA examination, completed a few months following separation from his secondary period of active duty, the Veteran reported pain in his knees, and it was noted that he needed further evaluation for possible rheumatoid arthritis. The Board additionally notes that the Veteran was first documented to have right hip joint osteoarthropathy on February 24, 2009 magnetic resonance testing. Records from the Army National Guard confirm that the Veteran was on active duty, active duty training or active duty for special work during this time frame. This was not acknowledged by the VA examiner. The record contains an extensive list of periods of Active Duty for Training (ACDUTRA) and Inactive Duty for Training (INACDUTRA). See Document Dated November 23, 2010. Once VA undertakes the effort to provide an examination or medical opinion when developing a service connection claim, even if not statutorily obligated to do so, it must provide one that is adequate for the purposes of the determination being made. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As such, remand is required to obtain addendum opinions that properly assess the nature and etiology of the Veteran's bilateral hip, bilateral knee, and cervical spine disabilities, before the Board can render an informed decision on the claims. The matters are REMANDED for the following actions: 1. Request addendum medical opinions by a different examiner than the one that provided the December 2019 opinions, who has the appropriate training and expertise to determine the nature and etiology of the Veteran's left hip, right hip, left knee, right knee, and cervical spine disabilities. Following review of the claims file, the examiner should address the following questions: Left Hip Is it at least as likely as not (50 percent probability or more) that the Veteran's left hip disorder began in service, was caused by service, or is otherwise related to: i. Active duty service spanning March 1969 to December 1970 and from December 1973 to June 1979, to include ruck marching and physical training; ii. A disease or injury incurred or aggravated during a period of ACUDTRA; or iii. An injury incurred or aggravated during a period of INACUDTRA. Right Hip Is it at least as likely as not (50 percent probability or more) that the Veteran's right hip disorder began in service, was caused by service, or is otherwise related to: i. Active duty service spanning March 1969 to December 1970 and from December 1973 to June 1979, to include ruck marching and physical training; ii. A disease or injury incurred or aggravated during a period of ACUDTRA; or iii. An injury incurred or aggravated during a period of INACUDTRA. Left Knee Is it at least as likely as not (50 percent probability or more) that the Veteran's left knee disorder began in service, was caused by service, or is otherwise related to: i. Active duty service spanning March 1969 to December 1970 and from December 1973 to June 1979, to include ruck marching and physical training; ii. A disease or injury incurred or aggravated during a period of ACUDTRA; or iii. An injury incurred or aggravated during a period of INACUDTRA. Right Knee Is it at least as likely as not (50 percent probability or more) that the Veteran's right knee disorder began in service, was caused by service, or is otherwise related to: i. Active duty service spanning March 1969 to December 1970 and from December 1973 to June 1979, to include ruck marching and physical training; ii. A disease or injury incurred or aggravated during a period of ACUDTRA; or iii. An injury incurred or aggravated during a period of INACUDTRA. Cervical Spine Is it at least as likely as not (50 percent probability or more) that the Veteran's cervical spine disorder began in service, was caused by service, or is otherwise related to: i. Active duty service spanning March 1969 to December 1970 and from December 1973 to June 1979, to include manually loading rounds in guns mounted on tanks and fixing tracks on tanks; ii. A disease or injury incurred or aggravated during a period of ACUDTRA; or iii. An injury incurred or aggravated during a period of INACUDTRA. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any part of the requested opinions without resort to pure speculation, he or she should so indicate and provide a rationale as to why such a finding is made. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. M. Clark, 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.