Citation Nr: 21013644 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 08-09 138 DATE: March 10, 2021 REMANDED Entitlement to service connection for a right hip disorder, to include as secondary to service-connected lumbar strain, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1990 to October 1999. He served honorably in the U.S. Army, including service in Southwest Asia during the Persian Gulf War. The Board thanks the Veteran for his service to our country. The Veteran testified before the undersigned at a Board videoconference hearing in March 2015. A transcript of the hearing is of record. The Board previously remanded this case in December 2010, December 2013, August 2017, and May 2020 for additional development. The case has now returned to the Board for further appellate review. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected lumbar strain, is remanded. A remand is warranted to ensure substantial compliance with the May 2020 Board decision. The Board errs when it fails to ensure substantial compliance with a Board remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the May 2020 Board remand, the Board directed the clinician to render an addendum opinion as to the nature and etiology of all disorders current during the period on appeal. During the period on appeal the Veteran had right hip disorder diagnoses including right hip strain, recurrent dislocation of joint of pelvic region and thigh, internal derangement of the hip, and arthritis; a November 2007 MRI also showed fluid on the right hip joint, though it is unclear whether this represents a disorder. However, a July 2020 addendum opinion only addressed the nature and etiology of osteoarthritis. Further, the July 2020 clinician concluded that the Veteran’s right hip osteoarthritis is less likely than not related to service, based in part on the determination that there were no hip complaints identified until approximately 2011 and that any disorder arising in service leading to arthritis would have manifest well before 2011, which is more likely than not the onset of the Veteran’s hip disorder. While an October 2007 orthopedic surgery record noted pain and clicking with flexion and extension of the right hip, however, the clinician did not explain why the Veteran’s hip disorder more likely than not manifested in 2011. Moreover, the July 2020 VA clinician, referencing Wheeless’ Textbook of Orthopaedics, concluded that the Veteran’s right hip osteoarthritis is less likely than not caused by service-connected lumbar strain as a disorder of one joint (in this case the spine) does not cause osteoarthritis of another joint (in this case the hip). In a February 2021 brief, the Veteran’s representative contended that medical literature does show a relationship between joints, referencing websites which purportedly show that long-term altered gait and stance can affect other joints. Accordingly, a remand is necessary to address this seemingly conflicting evidence. Finally, in the February 2021 brief, the representative also raised the issue of service connection under 38 C.F.R. § 3.317 based on the Veteran’s service in Southwest Asia. As it is unclear whether the Veteran’s diagnosed right hip disorders have understood etiologies and pathophysiologies, an opinion is warranted. Accordingly, the matters are REMANDED for the following action: 1. Please secure for the record (the Veteran’s electronic benefits file) copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disability on appeal. Please ask the Veteran to provide the releases necessary for VA to secure private treatment records. 2. After the action requested in paragraph 1 is complete, please refer the claim to an appropriate clinician for an opinion as to the nature and etiology of the Veteran’s right hip disorders. The Veteran’s claims-file must be made available to and reviewed by the clinician. The clinician is requested to opine as to the following: (a.) For each identified disorder, including right hip strain, recurrent dislocation of joint of pelvic region and thigh, internal derangement of the hip, and arthritis is it at least as likely as not (a 50 percent or greater probability) related to service? Please note that an October 2007 orthopedic surgery record noted pain and clicking with flexion and extension of the right hip. (b.) For each identified disorder, including right hip strain, recurrent dislocation of joint of pelvic region and thigh, internal derangement of the hip, and arthritis is it at least as likely as not (a 50 percent or greater probability) caused by service-connected lumbar strain? The clinician is requested to address the Veteran’s representative’s contention that gait and stance can affect other joints, as well as the cited articles (see February 11, 2021 Appellate Brief pages 4-5). (c.) For each identified disorder except arthritis, including right hip strain, recurrent dislocation of joint of pelvic region and thigh, internal derangement of the hip, and arthritis is it at least as likely as not (a 50 percent or greater probability) aggravated by service-connected lumbar strain? The clinician is requested to address the Veteran’s representative’s contention that gait and stance can affect other joints, as well as the cited articles (see February 11, 2021 Appellate Brief pages 4-5). (d.) For each identified disorder, including right hip strain, recurrent dislocation of joint of pelvic region and thigh, internal derangement of the hip, and arthritis, is it a medically unexplained chronic multi-symptom illness (a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology)? Please explain. In rendering the opinion, the clinician is requested to consider and explain as appropriate the following: • An October 19, 2007 orthopedic surgery record noting right hip pain and clicking with flexion and extension of the right hip when the Veteran does a flutter kick type of motion (see CAPRI file page 380 of 581, associated with the record on September 30, 2015); • A November 14, 2007 MRI report noting fluid on the right hip joint (see Medical Treatment Record - Non-Government Facility file, associated with the record on November 14, 2007); • April 7, 2008 diagnoses of recurrent dislocation of joint of pelvic region and thigh and internal derangement of the hip (see Medical Treatment Record - Government Facility file page 6 of 33, associated with the record on July 27, 2015); and • An August 7, 2008 VA examination report diagnosing right hip strain. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination to determine the nature and etiology of the disorder. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Vashaw, 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.