Citation Nr: 21005825 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 15-35 231 DATE: February 2, 2021 REMANDED Entitlement to service connection for a left hip condition, to include as secondary to service-connected intervertebral disc syndrome (IVDS) with lumbar stenosis with degenerative disc disease (DDD) is remanded. Entitlement to service connection for a right hip condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. Entitlement to service connection for a right knee condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. Entitlement to service connection for a left knee condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1977 to November 1981. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in January 2019. A transcript of the hearing is associated with the electronic claims file. The Board issued a prior remand on these claims in May 2019. 1. Entitlement to service connection for a left hip condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. 2. Entitlement to service connection for a right hip condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. 3. Entitlement to service connection for a right knee condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. 4. Entitlement to service connection for a left knee condition, to include as secondary to service-connected IVDS with lumbar stenosis with DDD is remanded. As noted above, the Board issued a prior remand on these claims in May 2019, wherein the RO was instructed to update the record and provide the Veteran with VA examinations to determine the etiology of his lumbar stenosis with DDD, and bilateral hip and knee conditions. The Veteran was given VA examinations in February 2020, wherein he was diagnosed with degenerative joint disease (DJD) of the bilateral hips and DJD of the bilateral knees. Following such, in a May 2020 rating decision the Veteran was granted service connection for IVDS with lumbar stenosis with DDD. Nevertheless, in a September 2020 supplemental statement of the case, the RO continued to deny service connection for his bilateral hip and knee conditions based on the February 2020 VA examiner’s negative nexus opinions. Specifically, the February 2020 VA examiner opined that there was (1) “insufficient medical evidence to confirm a nexus for the Veteran’s present hip condition as being caused by or aggravated beyond its natural progression due to his lower back condition” and (2) “insufficient medical evidence available in VBMS or CRPS to include that the Veteran’s present lumbar spine condition caused and/or aggravated the Veteran’s left and or right knee condition beyond their natural progressions.” The Board finds that these opinions did not consider the Veteran’s lay statements and hearing testimony regarding the relationship between his back condition and his bilateral DJD of the hips and knees, nor was adequate rationale regarding aggravation provided. Accordingly, another remand is warranted to provide the Veteran with an addendum opinion regarding secondary service connection. Moreover, the Board notes the December 2020 representative brief wherein it is noted “The appellant is adamant that his service connected back condition has directly lead [sic] to the development of issues in his hips and knees. The strain his back has placed on the rest of his body, which includes issues with his posture has led the appellant to believe that it has also placed a strain on his hips which has then radiated down to his knees. He feels that had the issue with his back never manifested, that his additional conditions would have never come about.” On remand the examiner will also address these contentions. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran’s DJD of the bilateral hips and knees. The electronic claims file must be reviewed by the examiner, and a note that it was reviewed should be included in the report. 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 DJD of the bilateral hips was caused by his service connected IVDS with lumbar stenosis with DDD? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s DJD of the bilateral hips was aggravated beyond its natural progression by the Veteran’s service connected IVDS with lumbar stenosis with DDD? If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the DJD of the bilateral hips by the service connected IVDS with lumbar stenosis with DDD. (c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s DJD of the bilateral knees was caused by his service connected IVDS with lumbar stenosis with DDD? (d.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s DJD of the bilateral knees was aggravated beyond its natural progression by the Veteran’s service connected IVDS with lumbar stenosis with DDD? If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the DJD of the bilateral knees by the service connected IVDS with lumbar stenosis with DDD. In formulating an opinion, the examiner should specifically consider and address: (1) the Veteran’s January 2019 hearing testimony that his hip and knee problems began during his active service “right after the 1979 incident, I was having problems with hips, with my knees, and that was attributed to the way that I was walking because I was favoring my back, which basically the muscles in the legs take the brunt of that.”; (2) the Veteran’s January 2019 hearing testimony that several of his previous doctors indicated that his knee and hip conditions were because of his back condition stating “Pretty much all of them made mentions. They said that that’s part of the conditions of having a bad back. You favor your knees, you favor your feet, and basically it’s taking the brunt of your back.”; and (3) the December 2020 representative brief noting “The appellant is adamant that his service connected back condition has directly lead [sic] to the development of issues in his hips and knees. The strain his back has placed on the rest of his body, which includes issues with his posture has led the appellant to believe that it has also placed a strain on his hips which has then radiated down to his knees. He feels that had the issue with his back never manifested, that his additional conditions would have never come about.” A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Ruiz, Associate 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.