Citation Nr: 21075175 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 16-55 996 DATE: December 17, 2021 REMANDED Entitlement to service connection for a right hip disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 2006 to December 2012. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) Winston-Salem, North Carolina. Jurisdiction of this appeal is currently with the RO in St. Paul, Minnesota. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge of the Board in October 2019. A transcript of the hearing has been associated with the claims file. This case was most recently before the Board in May 2021, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. In addition, in an October 2021 rating decision, the AOJ granted service connection for a left knee benign osteochondroma and assigned an initial rating. As this decision represents a full grant of the benefits sought with respect to this claim for service connection, such issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Service Connection Right Hip Disorder The Veteran seeks entitlement to service connection for a right hip disorder. Specifically, she contends that she developed a right hip disorder due to the physical rigors of her active service, to include running and that she was placed on a permanent walking profile. See Notice of Disagreement, June 3, 2014. Additionally, the Veteran asserts that her right hip disorder is secondary to her heels and knee. See Board hearing transcript, October 29, 2019. As noted above, the claim was most recently before the Board in May 2021 when it was remanded to the AOJ for further development. Specifically, the May 2021 Board found that an additional addendum opinion was required because the February 2020 and January 2021 VA medical opinions incomplete to decide the claim. In this regard, the May 2021 Board found that the February 2020 and January 2021 VA opinions did not address the Veteran's diagnosed bone lesion, as directed by the January 2020 Board remand directives and did not provide adequate rationales. Accordingly, the Veteran was afforded a VA examination for her right hip disorder in August 2021. At that time, the examiner opined the Veteran's right hip disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In this regard, the examiner noted there was no evidence of a right hip condition while in service, and noted that although the Veteran reported the onset in 2007, the service treatment records only documented left hip bursitis. Therefore, no nexus was established in service or proximate to service. Additionally, the August 2021 VA examiner noted the Veteran denied right hip pain at separation and there was a negative x-ray in November 2012. Therefore, the examiner noted that the span of five years from service to the first notations of the right hip condition in March 2017, and thus, there was no continuity established and no objective pathology in 2012. Accordingly, the examiner opined that it was less likely than not that the Veteran's right hip complaints were due to or incurred in active service. The August 2021 VA examiner further opined that it was less likely than not that the Veteran's right hip disorder was due to or incurred nor aggravated secondary to the Veteran's left knee disorder. In this regard, the examiner noted that the condition of one joint does not cause a condition of the contralateral joint or another joint on the contralateral side (i.e., the left knee would not cause a right hip condition). The August 2021 examiner indicated that this is established medical knowledge and practice, with rare exceptions including less than five percent of cases of leg length discrepancy and/or chronic, exaggerated Trendelenburg gait. Significantly, the examiner noted that neither of those rare conditions existed with the Veteran, and therefore it was less likely than not that the Veteran's right hip condition was due to or incurred in service, to include as secondary to the left hip condition documented in service, despite of her claims that the onset was during active service and that she had chronicity since. The examiner also noted and referred to general medical knowledge, namely, that one joint would not cause a condition of the contralateral joint without rare extenuating circumstances, and related the knowledge to the specifics of the Veteran's right hip condition. The examiner also noted the Veteran's complaints of, and treatment for, a left hip condition during active service, and addressed the lack of continuity and/or care thereafter. Additionally, the examiner noted the Veteran's service treatment records were silent for her right hip, to include her August 2012 separation examination, and that she did not have a diagnosis of a right hip disorder in November 2012. The examiner noted the Veteran did not have a diagnosis until many years following separation from active service for her right hip. Thereafter, the August 2021 VA examiner opined that the Veteran's claimed right hip disorder was less likely than not etiologically related to her active service, to include as secondary to her left knee and/or left hip, and addressed the medical evidence demonstrating that there were no correlation between the conditions, and therefore opined a nexus between the two were less likely. Unfortunately, the Board finds the claim must again be remanded and an additional VA addendum opinion must be obtained. In this regard, the August 2021 VA opinion is silent as to the Veteran's contention that her right hip disorder is as a result of her heels and knee, due to abnormal gait and flat feet. See Board hearing transcript, October 29, 2019. The August 2021 VA opinion indicates that it is established medical knowledge and practice, with rare exceptions including less than five percent of cases of leg length discrepancy and/or chronic, exaggerated Trendelenburg gait, and that the condition of the contralateral joint or another joint on the contralateral side. However, the Board notes that service connection is currently in effect for bilateral pes planus, and as this theory of entitlement has not yet been addressed, an additional VA addendum opinion must be obtained. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, forward the claims file to the examiner who previously examined the Veteran to obtain an addendum opinion to determine the etiology of her claimed right hip disorder. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: Is at least as likely as not (50 percent or greater probability) that the Veteran's right hip disorder was caused by, or aggravated by service-connected bilateral pes planus, to include as due to pain, altered gait, and flat feet? In offering such opinions, the examiner should consider the Veteran's statements. The examiner must provide a complete rationale for all opinions and conclusions reached. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.