Citation Nr: 21068571 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-04 735 DATE: November 10, 2021 REMANDED Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran had honorable active service with the United States Marine Corps from September 1969 to November 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claims in January 2019 for a Statement of the Case (SOC), and then in July 2021 for a VA examination. The Veteran was afforded a VA examination in September 2021. After a Supplemental Statement of the Case (SSOC) the claims are back before the Board. 1. Entitlement to service connection for right hip disability is remanded. See Paragraph 2 2. Entitlement to service connection for a right knee disability is remanded. Although further delay is regrettable, a remand is necessary for an adequate VA opinion. The Board finds that the September 2021 VA opinion to be inadequate on its face for VA purposes. When an opinion does not express the right degree of certainty, does not provide a rationale, is conclusory, does not consider all of the relevant evidence of record including lay statements, or does not consider all raised theories of entitlement then the examination is inadequate. Steff v. Nicholson, 21 Vet. App. 120 (2007); Bloom v. West, 12 Vet. App. 185, 187 (1999); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Combee v. Brown, 34 F.3rd1039, 1043-44 (Fed. Cir. 1994). The Veteran alleged that he hurt his right hip and right knee due to an event in service. In particular, the Veteran is service connected for an injury to his right ankle. His records show that he had a chronic right ankle condition. He reported to his VA treatment providers that he hurt his right ankle falling off a truck in service. For example, in June 1989, the Veteran reported continued pain and popping in his right ankle and right knee. He reported he had a ligament tear in his ankle in 1970. See Medical Treatment Record-Government Facility received August 1993. The September 2021 VA opinion did not adequately address the Veteran's contentions that his right knee and right hip disabilities were related to a fall in service. See C&P Exam received September 2021. The opinion also stated that the record was silent for chronicity of care and that a nexus had not been established. There was little discussion of the medical or lay evidence and the rationale was conclusory. Id. Additionally, the Board finds that the VA examiner should consider whether the Veteran's right hip and right knee conditions could be caused by or aggravated by his service-connected right ankle disability. Upon remand an addendum opinion is to be provided which addresses both direct and secondary service connection. The matters are REMANDED for the following action: 1. Update relevant VA and private treatment records. 2. After completing the above development, request a VA medical opinion, by a medical expert with the appropriate training and expertise to determine the nature and etiology of the Veteran's right hip and right knee disabilities. A copy of this remand order should be reviewed by the medical expert. Following review of the complete claims file, the examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's right hip disability is etiologically related to or caused by his service? Please consider and discuss the relevant lay and other evidence, including that the Veteran stated he fell off a truck while in service, injuring his right hip and noting that the Veteran is service connected for a right ankle injury related to a fall in service. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's right knee disability is etiologically related to or caused by his service? Please consider and discuss the relevant lay and other evidence, including that the Veteran stated he fell off a truck while in service, injuring his right knee and noting that the Veteran is service connected for a right ankle injury related to a fall in service. (c.) Then also answer, is it at least as likely as not (50 percent probability or greater) that the Veteran's right hip disability was either: 1. caused by a service-connected right ankle disability, OR; 2. aggravated by (i.e., worsened beyond the normal progression of the disease) the Veteran's service-connected right ankle disability? In addressing whether the Veteran's service-connected ankle disability, was a source of aggravation of the Veteran's right hip disability the examiner must attempt to establish a baseline level of severity of the right hip disability prior to aggravation by the service-connected disability, if any can be determined. (d.) Then also answer, is it at least as likely as not (50 percent probability or greater) that the Veteran's right knee disability was either: 1. caused by a service-connected right ankle disability, OR; 2. aggravated by (i.e., worsened beyond the normal progression of the disease) the Veteran's service-connected right ankle disability? In addressing whether the Veteran's service-connected right ankle disability was a source of aggravation of the Veteran's right knee disability, the examiner must attempt to establish a baseline level of severity of the right knee disability prior to aggravation by the service-connected disability, if any can be determined. 3. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 4. If any benefit sought on appeal is not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is returned to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel, C. Parnell 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.