Citation Nr: 21009552 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 16-19 026A DATE: February 22, 2021 ORDER Entitlement to service connection for frostbite of the feet is denied. Entitlement to service connection for a lower back disorder is denied. REMANDED Entitlement to service connection for a bilateral lower extremity (BLE) disorder, to include restless leg syndrome, neuropathy, and radiculopathy, is remanded. Entitlement to service connection for a bilateral upper extremity (BUE) disorder, to include neuropathy and radiculopathy, is remanded. Entitlement to service connection for a bilateral hip disorder, to include stress reaction of both femoral necks, is remanded. FINDINGS OF FACT 1. Residuals of frostbite of the feet are not demonstrated, and the current bilateral foot disorders are shown to be age-related and not related to service. 2. The evidence does not show that the Veteran’s lower back disorder was incurred in or resulted from service. CONCLUSIONS OF LAW 1. The criteria for service connection for frostbite of the feet are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a lower back disorder are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1978 to August 1980 with subsequent service in the Reserves. This case originally came before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The claims were last before the Board in July 2018. The Veteran did not request a hearing before the Board. See May 2016 VA Form 9. The Board notes that the Veteran submitted a partially completed RAMP Opt-In Election form in January 2019. A May 2019 letter notified the Veteran that her request could not be processed. She has not submitted any subsequent form indicating a desire for a decision under the modernized appeal system. In January 2014, the Veteran noted that she was unemployed and could not work because she could not spend too much time on her feet. Although a claim for a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities can be inferred under Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009), the Board notes that in Rice, the United States Court of Appeals for Veterans Claims (Court) stated that a claim for a TDIU is part and parcel of an increased rating claim when such claim is raised by the record. However, in order for a TDIU to be inferred as part and parcel of a pending claim, there must be a pending appeal from an assigned disability rating. Id. Here, the claims currently on appeal are service connection claims, and none represent an appeal from an assigned disability rating. As such, the Board does not address a TDIU claim herein. Preliminary Matters The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). The Board notes the Veteran’s request for an examination from an “outside medical professional.” See January 2015 statement. The duty to assist includes, when appropriate, the duty to conduct a thorough and contemporaneous examination of the veteran. Green v. Derwinski, 1 Vet. App. 121 (1991). However, it does not require an examination by an “outside medical professional.” The Veteran was provided VA examinations in November 2019 and December 2019, which the Board finds to be adequate as far as the claims decided herein. Therefore, the duty to assist has been met. Should the Veteran obtain a private examination, any evidence related to such may be submitted and would be considered in adjudicating the relevant claim. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires: (1) the existence of a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Furthermore, arthritis is considered a “chronic” disease under 38 C.F.R. § 3.309(a); therefore 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of a “chronic disease” in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Moreover, where a veteran served 90 days or more of active service, and those certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Service connection may be also granted only for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA) or injury incurred or aggravated while performing inactive duty for training (INACDUTRA). See 38 U.S.C. § 101(22), (24); 38 C.F.R. § 3.6. However, the presumption provisions of 38 C.F.R. §§ 3.307 and 3.309, as well as the presumptions of soundness and aggravation, are inapplicable to periods of ACDUTRA and INACDUTRA. Smith v. Shinseki, 24 Vet. App. 40 (2010); Donnellan v. Shinseki, 24 Vet. App. 167 (2010). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 1. Entitlement to service connection for frostbite of the feet The Veteran contends that she developed frostbite in her feet during service and that she has a resultant bilateral foot disorder. In December 2013 and January 2014, she stated that she had frostbite during basic training, which required hospitalization for four nights and five days at Fort Jackson. In her May 2016 VA Form 9, the Veteran provided more details, reporting that during a war game exercise, she was lying down as a member of a blocking force. After almost nine hours, she could not stand up, and felt pain around her neck and low back. She had to be taken to the hospital by ambulance, and was diagnosed with frostbite. Ever since getting frostbite, she had continued to suffer pain and numbness. See January 2015 statement. Evidence Service treatment records (STRs) include an April 1974 enlistment examination report reflecting the Veteran’s denial of foot trouble. In June 1978 and July 1980, she had normal clinical evaluations of the feet and denied foot trouble. The Board notes that STRs from service in the Reserves reflect that callosities on the anterior soles of both feet and left hallux valgus were noted at the July 1983 reserve enlistment examination report, although she denied foot trouble. A July 1986 examination report reflects mild asymptomatic hallux valgus bilaterally. VA treatment records reflect an assessment of bilateral bunions in August 2011. A September 2011 treatment record reflects left foot pain that had progressed over several years. X-rays showed bilateral hallux valgus. She was assessed with marked deviation of the first metatarsal that was compromising her ambulation status due to pain. VA treatment records reflect that she had a left first metatarsal osteotomy with modified McBride in March 202. A July 2012 VA treatment record reflects severe hallux valgus of the left foot. A May 2013 VA treatment record reflects right foot pain of several years’ progression. On examination, she had marked deformity at the first metatarsal joint with no neurologic deficit and full range of motion (ROM) of the first toe and capillary refill in less than two seconds. X-rays showed right hallux valgus. She was assessed with marked deviation of the first metatarsal that compromised her ambulation status due to pain. VA treatment records reflect that the Veteran had a right foot hallux valgus bunionectomy in July 2014, and had a right foot modified McBride and first metatarsal osteotomy performed with diagnosis of severe hallux valgus of the right foot in August 2014. A September 2014 podiatry consultation report reflects that the Veteran was assessed with status-post surgical correction of hallux abductus valgus of the right foot, bilateral onychomycosis, and hammer toe of the right fourth toe. An October 2015 VA podiatry record reflects lateral calcaneal cuboidal and sinus tarsi joint pain bilaterally upon direct pressure, peroneal tenderness along the legs, associated plantar fascia pain, and Morton’s neuroma of the third intermediate head aspect. The Veteran was assessed with plantar fasciitis, peroneal tendinitis, and Morton’s neuroma. A March 2019 VA emergency room note reflects that the Veteran complained of right foot pain and swelling. On examination, she had right foot plantar tenderness as well as the first metatarsal with mild erythema. She was assessed with right foot pain, a history of right bunions and hallux valgus status post screw. She reported an onset of pain after exercising for 60 minutes. X-rays showed soft tissue edema at the metatarsophalangeal (MTP) joint with no fractures or dislocations. A November 2019 VA examination report reflects review of the Veteran’s claims file and diagnoses of bilateral Morton’s neuroma as of 2015, bilateral hallux valgus as of 1983, and bilateral bunion formation as of 2010. The Veteran reported frostbite injuries in her legs with damage in the hips, knees, and feet. She complained of bilateral foot pain as well as numbness in a glove-pattern fashion. The examiner noted that the Veteran had bunion removal osteotomies bilaterally in 2012. X-rays did not document arthritis. The examiner opined that the Veteran’s bilateral foot disorder was less likely than not incurred in or caused by service, explaining that the foot disorders were related to the aging process. The hallux valgus, Morton’s neuromas, and bunion formations had an onset years after service and were not related to the reported in-service frostbite injuries. The numbness in the lower extremities due to peripheral neuropathies was diagnosed years after service and could not be considered related to service or actual bilateral foot disorders. A 2014 nerve conduction velocity study did not show any evidence of any peripheral neuropathies. A December 2019 VA cold injury residuals examination report reflects review of the Veteran’s claims file. The examiner found that the Veteran did not now have or had ever been diagnosed with any cold injury. The Veteran reported a history of cold injury, specifically frostbite, during service and current residuals of a “shooting type pain” at the lateral aspect of the extremities. However, she did not have any signs or symptoms present in either foot at the time of the examination. June 2018 x-rays of the feet did not demonstrate any evidence of osteoarthritis, osteoporosis, or subarticular punched out lesions. Therefore, the examiner found that there was no evidence of frostbite residuals found at this examination. Analysis As indicated, the Veteran reports that she developed frostbite in her legs during basic training and, as a result, has a current bilateral foot disorder. Based on a review of the evidence of record, the Board finds that the evidence weighs against finding in favor of the Veteran’s service connection claim for frostbite of the feet. The competent evidence does not show that the Veteran currently has a cold injury disorder in either foot. The December 2019 VA examiner considered the Veteran’s report of a cold injury and her current symptoms, but found that there was no evidence of frostbite residuals. The Board finds the December 2019 VA opinion that a cold injury disability is not present is both competent and credible as it was rendered by a VA medical examiner who reviewed the Veteran’s file and examined the Veteran’s feet. Moreover, the Veteran’s STRs do not demonstrate any treatment, diagnosis, or complaint related to a cold injury. As a layperson, the Veteran is competent to report matters within her own personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Therefore, the Veteran is competent to report that her feet were exposed to cold weather during service. However, she is not competent to provide a clinical diagnosis of a frostbite disability or its residuals, as such a determination is medical in nature and requires medical expertise to make, and there is no evidence that the Veteran has such medical training. The Board further finds that the Veteran’s currently diagnosed foot disorders (bilateral Morton’s neuroma, hallux valgus, and bunion formation) are not related to a cold injury, as claimed by the Veteran. Indeed, the November and December 2019 VA examiners opined that the Veteran’s current bilateral foot disorders are related to the aging process and not to a cold injury; those disorders had their onset many years after service. As the Veteran has not presented competent and probative evidence showing that she has a cold injury disability of the feet that is related to service, the claim must be denied. See 38 U.S.C. § 5107(a) (“[A] claimant has the responsibility to present and support a claim for benefits.”); Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009) (holding that it is the claimant’s general evidentiary burden to establish all elements of the claim). Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s service connection claim for frostbite of the feet. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. 2. Entitlement to service connection for a lower back disorder The Veteran contends that her lower back disorder is related to service. Specifically, in her May 2016 VA Form 9, she stated that during a war game exercise, she was lying down as a member of a blocking force. After laying down for almost nine hours, she could not stand up, and felt pain around her neck and low back. She had to be taken to the hospital by ambulance, and was diagnosed with frostbite. Evidence STRs reflect the Veteran’s denial of recurrent back pain at enlistment in April 1974 and at examinations in June 1978 and July 1980. She was found to have normal clinical evaluations of the spine at the June 1978 and July 1980 examinations. VA treatment records reflect that the Veteran complained of back pain in July and August 2011. In August 2011, she was found to have myalgias in the lower back. A May 2012 VA treatment record reflects an assessment of hips pain/lumbago. A July 2013 VA treatment record reflects a complaint of right low back pain radiating to the right buttock since the day prior after bending to pick up a heavy piece of wood. On examination, she had right paravertebral pain and reproducible tenderness with tightness of back muscles. July 2012 magnetic resonance imaging (MRI) of the lumbar spine revealed mild degenerative changes of the lumbar spine. She was assessed with lumbago. A March 2015 VA treatment record reflects the Veteran’s complaint of a chronic history of low back pain and exacerbation of pain with pulsatile sensation in the low back. A needle electromyographic study revealed abnormal findings compatible with right low lumbar, high sacral dorsal rami irritation. In July 2015, the Veteran presented at the emergency department with complaints of low back pain on the left side since the day prior. She was assessed with left low back pain and muscle spasm. A December 2019 VA examination report reflects review of the Veteran’s claims file and a diagnosis of mild degenerative changes of the lumbar spine per a 2012 MRI. The Veteran reported a history of low back pain, which limited her activities, specifically handling heavy weights. Imaging studies documented arthritis. The examiner opined that the Veteran’s low back disorder was less likely than not incurred in or caused by service. The examiner noted that imaging studies correlated with the normal atraumatic changes of the aging process. A December 2019 VA cold injury residuals examination report reflects review of the Veteran’s claims file. The examiner found that the Veteran did now have or had ever been diagnosed with any cold injury, and that there was no evidence of frostbite residuals found at this examination. The Veteran reported a history of cold injury, specifically frostbite, during service and current residuals of a “shooting type pain” at the lateral aspect of the extremities. Analysis Based on a review of the evidence of record, the Board finds that the evidence weighs against finding in favor of the Veteran’s service connection claim for a lower back disorder. As an initial matter, the evidence reflects a current lower back disability, specifically arthritis. See December 2019 VA examination report. The Board notes that a July 2012 MRI of the lumbar spine revealed mild degenerative changes of the lumbar spine, and a December 2019 VA examination report reflects that imaging studies documented arthritis. Therefore, the evidence first indicates degenerative changes of the lumbar spine in July 2012, almost 32 years after separation from active duty service. Accordingly, as the evidence does not demonstrate that the Veteran’s arthritis manifested within one year from separation from service, service connection cannot be awarded based on a chronic disease presumption. See 38 C.F.R. §§ 3.307, 3.309. Additionally, although STRs do not demonstrate any treatment, diagnosis, or complaint of a lower back disorder or symptoms during active service, the Veteran reports frostbite during basic training and contends that she sustained injury to her lower back as a result. There is no other evidence or contention of an in-service incurrence besides the reported in-service frostbite injury. However, the evidence does not demonstrate that the Veteran’s current lower back disorder is related to service, specifically frostbite. The December 2019 VA examiner considered the Veteran’s report of a cold injury and her current symptoms, but found that there was no evidence of frostbite residuals. The Board notes that the examiner appears to have focused on the Veteran’s bilateral foot disorder and lower extremities in determining whether the Veteran had any residuals of frostbite. However, after considering the Veteran’s report of frostbite during service, the December 2019 VA examiner opined that the Veteran’s lower back disorder was less likely than not incurred in or caused by service, but was rather related to the normal changes of the aging process, noting that imaging studies correlated with the normal atraumatic changes of the aging process. As stated above, although the Veteran is competent to report observable symptoms and experiences, she is not competent to provide an opinion as to etiology of her lower back disorder, as such determination is medical in nature and goes beyond a simple and immediately observable cause-and-effect relationship. The record does not show, nor does the Veteran contend, that she has specialized education, training, or experience that would qualify her to render a medical opinion on this matter. Under the circumstances of this case, the determination of the nature or etiology of her lower back disorder involves medically complex disease processes because of its multiple possible etiologies, require specialized testing to diagnose, and manifest symptomatology that may overlap with other disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). The Board therefore finds that the Veteran’s lay statements as to etiology are not competent. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s service connection claim for a lower back disorder. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert, supra. REASONS FOR REMAND Issues 1-2: Entitlement to service connection for BLE and BUE disorders is remanded. A remand is required for a new VA examination for the service connection claims of BLE and BUE disorders. The December 2019 VA examination reports reflect that the Veteran did not have radiculopathy, peripheral neuropathy, or a peripheral nerve condition. Rather, the examiner found that the Veteran had normal BUE and BLE nerves with normal muscle strength and normal sensory examination results. However, the examiner did not address the assessments of neuropathy and the treatment of such during the appeal period. See 6/12/13 VA treatment record, 2/14/14 VA treatment record, 3/24/15 VA treatment record, 2/20/19 VA treatment record. Additionally, the Veteran was assessed with fibromyalgia (see 10/10/17 VA letter, 2/20/19 VA treatment record), but the examiner did not clarify whether the BLE and BUE symptoms reported by the Veteran were due to or related to fibromyalgia. As such, a new VA examination should be provided to more completely evaluate the nature and etiology of the Veteran’s BLE and BUE symptoms. 3. Entitlement to service connection for a bilateral hip disorder is remanded. A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). While substantial compliance is required, strict compliance is not. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (citing Dyment v. West, 13 Vet. App. 141, 146-47 (1999)). In July 2018, the Board remanded this issue for a VA examination to determine whether the Veteran’s claimed bilateral hip disorder was related to service. Specifically, it instructed the examiner to provide an opinion as to whether the Veteran’s “current trochanteris pain syndrome and hip pain in general had its onset during active service or is otherwise related to it, to include the Veteran’s February 1978 profile due to stress reaction of both femoral necks and her contention of continuous pain and discomfort since separation.” The Veteran was provided a VA examination in November 2019, at which time he was diagnosed with bilateral trochanteric pain syndrome and bilateral degenerative joint arthritis at the bilateral hip and sacroiliac joints. The examiner also stated that the trochanteric pain syndrome was diagnosed in 2014 and arthritis of the hips was diagnosed in 2016, which were many years after separation from service in 1980 and were compatible with nontraumatic degenerative changes due to the normal progress of the aging process. However, the examiner provided an opinion for trochanteric pain syndrome and did not address the diagnosis of degenerative joint arthritis at the bilateral hip and sacroiliac joints, as well as assessments during the appeal period of hip pain, arthralgias, and lumbago during the appeal period. See November 2019 VA examination report, 7/6/11 VA treatment record, 5/24/12 VA treatment record. Additionally, although the stress reaction of both femoral necks may have resolved, the examiner did not address whether any of these diagnoses could be a residual of or related in any to way to such. Furthermore, the examiner did not discuss the Veteran’s contention of continuous pain and discomfort since separation. As such, an addendum is required in order to more completely address the etiology of Veteran’s claimed bilateral hip disorder. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s claimed BLE and BUE disorders. The claims file, and a copy of this remand, will be available to and reviewed by the examiner. *IF an in-person examination is not feasible given the circumstances surrounding the recent pandemic, refer the case to a VA neurologist for a thorough review of the record and medical opinion. Although a complete review of the record is imperative, attention is called to the following: *A June 2011 VA treatment record reflecting the Veteran’s complaint that her leg had been hurting for two weeks. *A June 2013 VA treatment record reflecting a complaint of increasing bilateral leg pain, a finding of arthritis and myalgias, and an assessment of neuropathies. *The Veteran’s December 2013 statement in which she reported being prescribed medication for leg pain and complained of constant leg pain, especially at night, despite medication. *A January 2014 statement in which the Veteran described constant pain in her legs for almost a year or two. *A February 2014 pharmacy consultation reflecting peripheral neuropathy, which was not relieved with gabapentin; and cervical spondylosis. *A July 2014 VA treatment record reflecting a complaint of throbbing, burning, and paresthesias in the lower legs and a nerve conduction velocity test of the BLE with preliminary results showing no evidence of peripheral neuropathy. *A January 2015 statement in which the Veteran noted that her BLE and BUE disorders included neuropathy and radiculopathy. *A March 2015 VA treatment record reflecting that a needle electromyographic (EMG) study revealed abnormal findings compatible with right low lumbar, high sacral dorsal rami irritation. *An October 2017 VA letter reflecting that the Veteran suffered from fibromyalgia. *A February 2019 VA treatment record reflecting an assessment of BLE neuropathy/fibromyalgia. *A December 2019 VA peripheral nerves examination report reflecting that the Veteran did not have peripheral neuropathy or a peripheral nerve condition. *A December 2019 VA central nervous system and neuromuscular diseases examination report reflecting that the Veteran did not have a diagnosis of restless leg syndrome, but was taking pregabalin for fibromyalgia. *A December 2019 VA cold injury residuals examination report reflecting that the Veteran did not now have or had ever been diagnosed with any cold injury. *A December 2019 VA back examination reflecting that the Veteran did not have radiculopathy. After reviewing the claims file in its entirety and examining the Veteran, if possible, the examiner is asked to address the following with complete rationale: a) Confirm all diagnoses involving the BLE, including fibromyalgia, radiculopathy, and neuropathy, and, if possible, the onset of such. i) For each diagnosis, provide an opinion as to whether it at least as likely as not (50 percent probability or greater) was incurred in or related to service, to include frostbite. b) Confirm all diagnoses involving the BUE, including fibromyalgia, radiculopathy, and neuropathy and, if possible, the onset of such. i) For each diagnosis, provide an opinion as to whether it at least as likely as not (50 percent probability or greater) was incurred in or related to service, to include frostbite. A complete rationale should be provided for any opinion provided. 2. Obtain an addendum by a VA orthopedist to address the nature and etiology of the Veteran’s claimed bilateral hip disorder. If the designated examiner determines that an additional examination is necessary, one should be provided to the Veteran. *IF an in-person examination is determined to be necessary but is not feasible given the circumstances surrounding the recent pandemic, refer the case to a VA orthopedist for a thorough review of the record and medical opinion. After reviewing the claims file in its entirety, the examiner is asked to address the following with complete rationale: a) Confirm all diagnoses involving the bilateral hips, including arthralgias, lumbago, trochanteric pain syndrome and degenerative joint arthritis at hip and sacroiliac joints and, if possible, the onset of each. b) For each diagnosis, provide an opinion as to whether it at least as likely as not (50 percent or greater probability) had its onset during active service or is otherwise related to it. *The examiner should consider and address the Veteran’s complaint and assessment of hip pain since at least July 2011 and her report of continuous pain and discomfort since separation from service.* A complete rationale should be provided for any opinions provided. 3. Thereafter, readjudicate the remanded claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Lee, 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.