Citation Nr: 21068544 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 15-37 649 DATE: November 10, 2021 REMANDED Entitlement to service connection for a right hip disability, to include avascular necrosis, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February 1983 to February 1987. These matters are before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision. In September 2019 a Board hearing was held before a Veterans Law Judge (VLJ) who is no longer with the Board; a transcript is in the record. In July 2020, the Board remanded this matter for further development. [A November 2020 rating decision granted service connection for a back disability, resolving that matter.] In May 2021, this matter was again remanded for development. The Veteran was offered another hearing before a VLJ who would decide the matter. In May 2021 correspondence, his representative declined another Board hearing. Entitlement to service connection for a right hip disability, to include avascular necrosis, is remanded. The May 2021 Board remand ordered development for a VA examination to ascertain the nature and etiology of the Veteran's current right hip disability. The examiner was to identify each right hip disability found (or shown by the record) and opine regarding each right hip disability diagnosed, whether it was related to the Veteran's service, to include as due to his exposure to jet fuels in service. The examiner was to specifically address the Veteran's lay statements regarding onset of hip disability in service and continuity of symptomatology sinc. The examiner was instructed that if there is a medical basis to support or doubt the history provided by the Veteran, the examiner should explain why that is so. On June 2021 VA examination, the examiner noted right hip diagnoses of degenerative joint disease (DJD) and avascular necrosis. The examiner addressed direct service connection and opined that the right hip disability was less likely than not caused by the claimed in-service injury, event, or illness. The examiner did not address the Veteran's September 2019 Board testimony describing continuity of symptomatology regarding his right hip disability. Notably, DJD is a chronic disease, for which service connection may be established by showing continuity. Accordingly, development for a fully adequate medical opinion in this matter is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Arrange for the Veteran's claims file to be forwarded to an appropriate clinician (in orthopedics) for review and a medical advisory opinion regarding the likely etiology of his right hip disabilities. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] The examiner should provide opinions that respond to the following: (a.) Identify the likely etiology for the Veteran's right hip DJD. Specifically, is it at least as likely as not (a 50% or better probability) that it had its onset/was incurred during the Veteran's active service? The rationale provided must reflect consideration of the onset in service and continuity theories of entitlement raised by the Veteran, specifically addressing his lay statement and sworn hearing testimony reporting continuity of DJD symptoms. (b.) Identify the likely etiology for the Veteran's right hip avascular necrosis (of femoral head). (a) Is it at least as likely as not that the disability was incurred in service, to include as due to his exposure to jet fuels therein? Again, the rationale should specifically address the Veteran's lay statements and September 2019 Board hearing testimony. (b) If not, identify the etiology for the avascular necrosis that is considered to be more likely, and explain why that is so. The rationale should include some discussion of the known etiologies/risk factors for development of avascular necrosis. All opinions must include rationale that cites to supporting factual data and/or medical literature, as deemed appropriate. If an opinion sought cannot be provided without resort to mere speculation, there must be explanation why that is so. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lederman, Michael 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.