Citation Nr: 21020833 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 19-00 401A DATE: April 8, 2021 REMANDED Entitlement to service connection for right hip replacement, to include as secondary to multiple service-connected left lower extremity disabilities, is remanded Entitlement to a compensable disability rating for left hip scars is remanded. REASONS FOR REMAND The Veteran had active duty in the United States Army from December 1965 to January 1968. These matters come before the Board of Veterans’ Appeals (Board) from an appeal of an October 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The Veteran’s claims file contains a transcript of that proceeding. Discussion The Veteran asserts that his right hip disability, post total hip replacement, was proximately due to, or aggravated by, his service-connected left lower extremity disabilities. Right hip replacement The Veteran has the following service-connected left lower extremity disabilities: residuals of a total left knee replacement, residuals of a left femoral neck fracture, left foot drop, residuals of a left thigh vastus lateralis, and scars of the left hip. In an October 2017 notice of disagreement and during the February 2021 Board hearing, the Veteran wrote that his left leg was shorter than the right which caused an out of balance gait and testified that at a time when his left hip and left knee were “terribly arthritic,” he experienced “very sharp pain unexpectedly” and his leg gave way. The Veteran testified that he fell down a flight of stairs and broke his “good right hip.” See February 9, 2021 Hearing Transcript, p. 3. There are undated internal records in the file posted in September 2018 and again in November 2018 that indicate the RO requested a right hip examination and requested a medical opinion on the secondary causation theory. The RO notified the Veteran in correspondence in November 2018 that it would work with the Veteran to schedule an examination. An internal document posted in December 2018 indicated that the examination was canceled with no reason shown. An RO employee noted in December 2018 that he or she was unable to reach the Veteran at the telephone number of record. Thus, the examination of the right hip did not take place. See December 19, 2018 SOC, p. 34. The record of the Veteran’s address is consistent before and after the scheduled examination, but there is no copy of a written notice of the examination to confirm receipt by the Veteran. While the duty to assist is not a one-way street (see Wood v. Derwinski, 1 Vet. App. 190, 193 (1991)), the Board recognizes that this is an original claim and affords the Veteran the benefit-of-the-doubt in this instance. However, the Veteran must realize the he must make himself accessible and available for both the scheduling and appearance at the subsequent right hip examination. Id. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: (1) contains competent evidence of a current diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that an event, injury, or disease occurred in service or certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) indicates that the disability or symptoms may be associated with the established event, injury or disease in service or with another service-connected disability. McClendon v. Nicholson, 20 Vet. App. 79 (2006). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, is a low threshold. Id. Clearly, the Veteran’s competent testimony noted above indicates that his right hip replacement (and preceding right hip fracture) may be associated with established disabilities and diseases. As such, a VA examination on the right hip is necessary to decide the claim. Left hip scars The Veteran also asserts that a noncompensable disability does not adequately contemplate the severity of his left hip scars. At the Board hearing, the Veteran provided extensive testimony concerning his left hip scars and, what he contends are associated symptoms of underlying broken and rusted left hip appliances, pain, and oozing infections. See February 9, 2021 Hearing Transcript, p. 4. The Veteran’s competent and consistent lay testimony (which reiterates contentions advanced in the Veteran’s October NOD, see October 25, 2017 Correspondence, p. 2) indicates that the disability on appeal extends to more than assessment of the scars. The matters are REMANDED for the following actions: 1. Afford the Veteran the opportunity to identify or submit any additional relevant evidence and argument in support of his claims on appeal. If there are any outstanding private medical records that are pertinent to the issues on appeal. prepare releases, obtain the records, and associate them with the claims file. All attempts to secure these records must be documented in the record. If any requested records are unavailable, the Veteran should be notified of such in accordance with 38 C.F.R. § 3.159(e). 2. Consider whether additional ratings are warranted under Diagnostic Codes other than Diagnostic Code 7805 that contemplate the Veteran’s reports of underlying broken and rusted left hip appliances, pain, and oozing infections such as, but not limited to, Diagnostic Codes 7828 and 7829. 3. Arrange for a VA examination of the right hip with an appropriate clinician. The clinician must review the Veteran’s claims file and indicate such a review in the body of the examination report. All necessary clinical testing and interviewing must take place. Upon completion of the tasks above, the clinician should respond to the following inquiries. a. Whether it is at least as likely as not (50 percent or more) that the Veteran’s right hip replacement (and precedent right hip fracture) was incurred in, aggravated by, or otherwise attributable to, service? AND b. Whether it is at least as likely as not that the Veteran’s right hip replacement (and precedent right hip fracture) was proximately caused by or aggravated beyond its natural progression by service-connected left hip disability and left knee disability? The Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology and functional limitations, must be acknowledged and considered in formulating any opinion. Should the clinician reject the Veteran’s reports, she/he must provide an explanation for such rejection. Complete, clearly-stated rationales for the conclusions reached must be provided. Explanations are required that consider the record and pertinent medical principles and the clinician’s rationale should include citation to pertinent evidence and/or medical principles relied upon to form all opinions. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. J. Komins, 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.