Citation Nr: 21021220 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 12-27 213 DATE: April 12, 2021 REMANDED 1. Entitlement to service connection for a right hip disability is remanded. 2. Entitlement to service connection for a left hip disability is remanded. REASONS FOR REMAND The appellant is a Veteran who had active service from December 1990 to November 1991. This case is before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 Department of Veterans Affairs (VA) rating decision. In September 2015 a hearing was held before the undersigned; a transcript is in the record. In November 2015, January 2019, and September 2020 these claims were remanded for further development. Because there has not been substantial compliance with the last previous remand, the claims must be remanded once again for further development. The Veteran’s service treatment records (STRs) show that she sustained a back injury (diagnosed as lumbosacral contusion) in a fall and continued to be seen for related complaints for several months thereafter. However, during treatment visits for her back pain, hip complaints were noted. For example, in July 1991, she had bilateral hip pain with range of motion. In August 1991, she reported a four-month history of left sacral pain. The diagnosis was possible sacroiliitis. A pelvis and sacrum x-ray showed mild hyper-trophic spurring at the symphysis pubis and possible very minimal sclerosis of the iliac margins of the sacroiliac joints. The Veteran’s DD Form 214 shows that she received a hardship discharge in November 1991. However, a separation physical was not conducted. After her separation from service, November 2012 bilateral hip x-rays on a VA examination showed very minimal degenerative changes. A later (March 2017) bilateral hip MRI showed stable degenerative changes. The September 2020 Board remand instructed that the examiner was to identify each right and left hip disability. The examiner was also asked to reconcile the objective medical evidence on November 2012 VA examination with the examiner’s conclusion that the Veteran did not have a hip disability. The December 2020 VA examiner did not address the findings of the November 2012 VA examiner or provide the opinion requested. Accordingly, the examination report/opinion is inadequate. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Considering the state of the record, another opinion (by a clinician in orthopedics) that thoroughly addresses both direct service connection and secondary service connection (and fully responds all questions posed) is necessary. The matters are REMANDED for the following: 1. With the Veteran’s assistance (identifying providers and submitting authorizations for VA to obtain any private treatment records), obtain for the record any outstanding medical records pertaining to evaluations and treatment she received for a hip disability. 2. Then, arrange for the Veteran’s record to be forwarded to an appreciate clinician in orthopedics for review and an addendum opinion regarding the etiology of any hip disability shown. [If further examination of the Veteran is deemed necessary for a fully responsive opinion, such should be arranged.] The consulting clinician should provide opinions that respond to the following: a. Identify each current right and left hip disability shown by diagnosis. b. Identify the likely etiology for each current right and/or left hip disability diagnosed. Specifically, is it at least as likely as not (a 50 percent or greater probability) that the disability was incurred in or aggravated by the Veteran’s service? The rationale for the opinion must acknowledge that the Veteran had hip complaints during her active service and a pelvis x-ray showed mild hyper-trophic spurring at the symphysis pubis and possible very minimal sclerosis of the iliac margins of the sacroiliac joints. This should be reconciled with the finding of the November 2012 VA examiner who noted that she had no current chronic hip disability despite x-rays and a later bilateral hip MRI showing both arthritis. c. If a diagnosed hip disability is determined to not be directly etiologically related to the Veteran’s active duty service and hip complaints noted therein, is it at least as likely as not that it was caused or aggravated (increased in severity) by a service-connected disability, to include the Veteran’s service-connected lumbar spine disability? d. If a diagnosed hip disability is determined to not be etiologically related to the Veteran’s service and her hip complaints noted therein, and to not have been caused or aggravated by her service connected lumbar spine disability, identify the etiology for the 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. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berryman, 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.