Citation Nr: 21070478 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 19-22 300A DATE: November 24, 2021 REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. REASONS FOR REMAND The appellant served on active duty in the U.S. Army from May 1994 to March 2001. This matter comes before the Board of Veterans' Appeals (Board) from a November 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, denied entitlement to service connection for a lumbar spine disability, and bilateral hip disabilities. The appellant filed a timely Notice of Disagreement (NOD), received in July 2018. A Statement of the Case (SOC) was issued in July 2019. A timely substantive appeal was received in August 2019. The appellant was afforded a virtual hearing before the undersigned Veterans Law Judge (VLJ) in March 2021. A transcript is of record. 1. Entitlement to service connection for a lumbar spine disability. 2. Entitlement to service connection for a right hip disability. 3. Entitlement to service connection for a left hip disability. The appellant contends that he developed lumbar spine and bilateral hip disabilities as the result of altered gait, caused by his service-connected bilateral knee, bilateral ankle, and bilateral foot disabilities. See e.g. March 2021 hearing transcript. A September 2019 Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act) states that the appellant was referred to physical therapy for eight weeks of gait training following left ankle surgery. A December 2019 VA podiatry note states that the appellant continued to present with significant structural deformity which impacts his gait mechanics, resulting in pain not only to the feet but also the ankles, knees, hips, and back. The negative November 2017 VA medical opinions are based, in part, upon a lack of current right and left hip diagnoses, and a determination that service-connected disabilities would not impose excess stress on the hips and back. However, the December 2019 VA podiatry note suggests that service-connected ankle and foot disabilities did cause or aggravate back and hip disabilities, or functional impairment in earning capacity. See Saunders v. Wilkie, 866 F.3d 1356 (2018). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, the Board finds that a new medical opinion should be obtained regarding the lumbar spine disability and the appellant should be afforded a new examination for his claimed bilateral hip disabilities. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician as to the nature and etiology of the appellant's lumbar spine disability. Access to the claims file should be made available to the examiner for review. After reviewing the claims file, the examiner should opine as to the following: Is it at least as likely as not that the appellant's lumbar spine disability had its onset in service or is otherwise related to the appellant's active service? If not, is it at least as likely as that the appellant's lumbar spine disability is proximately due to or the result of altered gait mechanics due to service-connected bilateral knee, bilateral ankle, and bilateral foot disabilities? If neither, is it at least as likely as not that the appellant's lumbar spine disability was aggravated (made worse) by altered gait mechanics due to service-connected bilateral knee, bilateral ankle, and bilateral foot disabilities? If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation. In providing the requested opinions, the clinician should review the relevant evidence of record, to include: (a) the September 2019 Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act) which states that the appellant was referred to physical therapy for eight weeks of gait training following left ankle surgery, and (b) the December 2019 VA podiatry note which states that the appellant continued to present with significant structural deformity which impacts his gait mechanics, resulting in pain not only to the feet but also the ankles, knees, hips, and back. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the clinician determines that an examination of the appellant is necessary, one should be scheduled. 2. Schedule the appellant for an examination with an appropriate clinician to determine the nature and etiology of any and all right and left hip disabilities. Access to the claims file should be made available to the examiner for review. After reviewing the claims file and examining the appellant, the examiner should delineate all right and left hip disabilities. The examiner should then opine as to the following: Is it at least as likely as not that each identified right and/or left hip disability had its onset in service or is otherwise related to the appellant's active service? If not, is it at least as likely as that each identified right and/or left hip disability was proximately due to or the result of altered gait mechanics due to service-connected bilateral knee, bilateral ankle, and bilateral foot disabilities? If neither, is it at least as likely as not that each identified right and/or left hip disability was aggravated (made worse) by altered gait mechanics due to service-connected bilateral knee, bilateral ankle, and bilateral foot disabilities? If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation. If no diagnosis is rendered for the right or left hip, the examiner should still offer opinions as to the above, with respect to any functional impairment of earning capacity for each hip. In providing the requested opinions, the clinician should review the relevant evidence of record, to include: (a) the September 2019 Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act) which states that the appellant was referred to physical therapy for eight weeks of gait training following left ankle surgery, and (b) the December 2019 VA podiatry note which states that the appellant continued to present with significant structural deformity which impacts his gait mechanics, resulting in pain not only to the feet but also the ankles, knees, hips, and back. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Behlen, 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.