Citation Nr: 21014326 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 11-17 377 DATE: March 11, 2021 REMANDED Entitlement to service connection for a bilateral hip disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from June 1983 to September 1983, from May 1984 to February 1987, and from October 1988 to April 1990. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a January 2009 Department of Veterans Affairs (VA) rating decision. In December 2015, September 2016, and March 2019, the case was remanded for additional development. [A June 2019 rating decision, promulgating the Board’s March 2019 grant of service connection for a low back disability, awarded service connection for degenerative arthritis of the lumbosacral spine and lumbar disc disease (rated 20 percent, effective May 28, 2008), left lower extremity radiculopathy (rated 20 percent, effective March 12, 2018), right lower extremity radiculopathy (rated 10 percent, effective March 12, 2018), and a lumbar spine scar (rated 0 percent, effective May 28, 2008). A November 19, 2020 rating decision awarded service connection for a right knee disability, fully resolving that issue.] The Board is aware this matter was remanded three times before (and regrets the delay in final adjudication inherent with yet another remand). However, the response provided does comply with previous remand instructions, and corrective action remains necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). On March 2018 VA examination, the examiner noted the Veteran has a “markedly antalgic gait” which is most impacted by his radiculopathy and back condition, and that this and several other factors (age, obesity, ect.) contributed to his hip disorder. The March 2019 Board remand ordered a VA examination that addressing whether the Veteran’s bilateral hip disabilities are related to his service-connected disabilities, to include his left knee and low back disabilities. In a November 2020 VA addendum opinion, the examiner opined that the Veteran’s bilateral hip disabilities are not related to his lumbar scar, lumbosacral spine arthritis and lumbar disc disease, or left knee residuals. The examiner stated that there is no evidence to suggest that an injury or disease of one lower extremity or the lumbar spine would have any significant impact on another extremity joint unless the injury to the knee or spine resulted in major muscle or nerve damage causing partial or complete paralysis of the damaged leg, and/or shortening of the injured lower extremity resulting in a limb length discrepancy of more than four or five centimeters so that the individual’s gait pattern has been altered to the extent that clinically there is an obvious lurching type gait (a significant limp). While the examiner opined the Veteran’s left knee and spine condition is not of the severity to result in a right or left hip condition, the examiner does not address the March 2018 examiner’s finding he has a “markedly antalgic gait.” Notably, the Veteran has also established service connection for a right knee disability and bilateral lower extremity radiculopathy, which were not addressed or considered in the November 2020 opinion. The opinion is less than fully responsive to the remand directives, and is inadequate for rating purposes, requiring corrective action. See Stegall, 11 Vet. App. at 271. The matter is REMANDED for the following: 1. Secure for the record updated (to the present, all outstanding) complete clinical records of VA evaluations and treatment the Veteran has received for his knee, back, lower extremity radiculopathy and hip disabilities. 2. Then, arrange for the Veteran’s record to be forwarded to an appropriate clinician (in orthopedics) for review and an advisory medical opinion regarding the etiology of his current right and left hip disabilities. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] Upon review of the record, the consulting provider should: (a.) Identify (by diagnosis) each hip disability entity found or shown by the record during the pendency of this claim. (b.) Identify the likely etiology of each hip disability entity diagnosed. Specifically, is it at least as likely as not (a 50% or greater probability) that the diagnosed entity was caused or aggravated (permanently increased in severity beyond natural progression) by his service-connected disabilities (to include of bilateral knees, the spine, and bilateral lower extremity radiculopathy)? [The opinion must address aggravation.] (c.) If a service-connected disability did not cause, but aggravated, a hip disability, specify, to the extent possible, the degree of disability (symptoms/impairment) that has resulted from such aggravation. (d.) If a diagnosed hip disability is determined to not have been caused or aggravated by a service-connected disability, identify the etiology for the hip disability that is considered to be more likely (and explain why that is so). All opinions must include rationale that cites to supporting factual data and medical principles. The rationale must also include comment on (expression of agreement or disagreement with, including the reasoning for such) the opinions, each, by the March 2018 and November 2020 providers (reconciling the conflict in those opinions). If an opinion cannot be provided without resort to speculation, it must be so noted in the report (with explanation why that is so). GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Naumovich, 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.