Citation Nr: 21069024 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 10-11 022 DATE: November 17, 2021 REMANDED Entitlement to service connection for a bilateral hip disability, to include as secondary to service-connected degenerative joint and disc disease of the lumbosacral spine, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1983 to February 1987 and from March 1996 to September 1996; and in the United States Air Force from October 1992 to February 1993. In November 2015 and April 2017, the Veteran testified at Board hearings. The transcripts are of record. This is a panel decision as testimony was taken by two judges on the same issue. This matter was most recently before the Board in June 2021, at which time it was remanded for further development. The Board observes that the issue of entitlement to a disability rating in excess of 10 percent for degenerative joint disease of the right knee was remanded for further evidentiary development by a September 2021 Board decision. However, the requested development has not yet been completed. Thus, the issue will be adjudicated in a separate decision at a later time. Entitlement to service connection for a bilateral hip disability Following the Board's June 2021 remand, the Veteran was afforded a new VA examination in August 2021. The examiner opined that it was less likely than not that the Veteran's bilateral hip disability was incurred in or caused by service. In support of the opinion, the examiner explained that osteoarthritis is often referred to as "wear and tear" arthritis, age-related, or degenerative joint disease. Although X-rays from 2017 showed minimal bilateral degenerative changes in both hips, the examiner noted that the service treatment records were negative for evidence of previous hip injury contributing to the current condition. Additionally, there were negative statements on all health assessments with regard to hip pain, musculoskeletal pain, or lower extremity pain, as well as no support for progression or chronicity of hip pain stemming from service. The examiner further opined that it was less likely than not that the Veteran's bilateral hip disability is proximately due to or the result of his service-connected lumbar spine disability. In support of the opinion, the examiner noted that the Veteran was service-connected for a back condition; however, the evidence was negative for an altered gait, which may have led to subsequent hip condition. Unfortunately, the Board finds that this opinion does not substantially comply with the Board's June 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). In this regard, the examiner failed to address the Veteran's lay contentions regarding an in-service fall resulting in injuries. The examiner instead based the opinion on the lack of evidence documented in the service treatment records. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination was inadequate where the examiner did not comment on the Veteran's report of in-service injury but relied on the service medical records to provide a negative opinion). Moreover, as to secondary service connection, the examiner failed to provide an opinion as to whether the Veteran's bilateral hip disability was aggravated beyond its natural progression by his service-connected lumbar spine disability. Accordingly, another remand is necessary to obtain a medical opinion discussing the nature and etiology of the Veteran's bilateral hip condition. The matter is REMANDED for the following action: 1. Obtain a medical opinion from an appropriate medical examiner to determine the nature and etiology of the Veteran's bilateral hip disability. The examiner must review pertinent documents in the Veteran's claims file. It is up the examiner to determine whether an examination is necessary in order to provide the requested opinion. (a.) The examiner should state whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's bilateral hip disability (i) had its onset in service or is otherwise etiologically related to active service; (ii) was caused by his service-connected lumbar spine disability; or (iii) was aggravated beyond its natural progression by his service-connected lumbar spine disability. The term "aggravated" in this context refers to a permanent worsening of the underlying condition beyond the natural progress of the disease, as contrasted to temporary or intermittent flare-ups of symptomatology that resolve with a return to the baseline level of disability. In providing the opinion, the examiner is asked to specifically address the Veteran's contentions regarding an in-service fall resulting in injuries. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. The examiner is reminded that it is not sufficient to cite passages from medical literature without explaining how the medical literature is relevant in the instant case, i.e., the VA examiner must identify the medical literature relied upon and explain how the medical literature supports the underlying opinion by applying the content of the medical literature to the facts, including medical and lay evidence, in instant case. (Continued on the next page) Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 2. The AOJ must review the medical opinion and ensure that it complies with the directives of this remand. If the opinion does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tracy O. Joseph, 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.