Citation Nr: 21069360 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 14-08 644 DATE: November 18, 2021 REMANDED Entitlement to service-connection for a right hip condition is remanded. Entitlement to service-connection for a left hip condition is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Navy from July 1965 to September 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) denying service connection for a bilateral hip condition, claimed as bursitis/tendonitis. The Veteran testified before the undersigned at a hearing in January 2017. This case was most recently before the Board in April 2021, when it was remanded for Agency of Original Jurisdiction (AOJ) development. The case has been returned to the Board for further appellate review. Unfortunately, another remand is necessary in this case. In the Board's April 2021 remand, the AOJ was directed to obtain a new VA medical opinion regarding the etiology of the Veteran's claimed bilateral hip condition. It was specifically requested that the selected examiner address the Veteran's contention, made at his January 2017 hearing, that his hips are out of alignment because of his service-connected spine disability and/or that his service-connected spine disability causes him to compensate with his hips when walking, which either caused or aggravated his hip disabilities. The Veteran was afforded a new VA examination in June 2021, where his bilateral hip condition was diagnosed as greater trochanteric pain syndrome (GTPS), which was noted to include trochanteric bursitis. In the accompanying VA medical opinions, dated August 2021, the VA examiner opined that there is no nexus between the Veteran's bilateral hip conditions on neither a direct nor a secondary theory of service connection because there was, broadly, "no pathology" of the hips and therefore nothing for the examiner to provide an opinion on. When asked for further clarification in light of the fact that the Veteran had indeed been diagnosed with bilateral hip conditions, the examiner stated the following: "[T]he question was [whether] his hip pain associated with his back condition and the answer is no... [S]urgical, histological, and imaging studies have shown that GTPS is attributable to tendinopathy of the gluteus medius and/or minimus with or without coexisting bursal pathology. Abnormal hip biomechanics are [hypothesized] to predispose to the development of these gluteal tendinopathies... He claims his hips were out of line and very likely the muscle tendinopathy due to age and other factors are [subjectively] causing pain but unrelated to his back." The rationale proffered by the examiner does not adequately address the Veteran's contentions. The Veteran posited that his lumbar spine condition had caused malalignment or compensation in his hips. The examiner did not in any way explain why GTPS could not have been caused by his back pain; instead, they detailed the mechanics of the condition and concluded, without further rationale, that it was unrelated to the back. Further, the information provided by the examiner could be construed to support the Veteran's claim. The examiner conceded that the Veteran likely had abnormal hip biomechanics due to muscle tendinopathy. The Veteran has a history of hip injuries concurrent with his back injuries, most notably a January 2009 instance of low back strain accompanied by a pulled muscle in the left lateral iliac crest region. Taking these facts into account, there is no adequate explanation for the conclusion that GTPS is wholly unrelated to the Veteran's spinal condition. Because the examiner did not provide a sufficient rationale in response to the Veteran's theories of secondary service connection, the Board finds that the August 2021 VA medical opinions are not in substantial compliance with the April 2021 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Therefore, another remand is necessary to obtain an adequate VA medical opinion addendum addressing these theories of entitlement. The matters are REMANDED for the following action: Forward the Veteran's claims file to an appropriate clinician. If the examiner determines that an additional in-person examination is required, one should be scheduled. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should provide a medical addendum opining whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hip disabilities are (a) caused by; or (b) aggravated by (i.e., worsened beyond the normal progression of the disease) the Veteran's lumbar spine disability. Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner must directly address the theory that the Veteran's service-connected spine condition and/or compensation for pain caused by his service-connected spine condition have affected the alignment of the Veteran's hips. Conclusory statements that the spine is unrelated to the hip, without more, will be deemed inadequate rationale for adjudicative purposes. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Narnor, Harriyah 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.