Citation Nr: 21021639 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-43 856 DATE: April 13, 2021 REMANDED Entitlement to service connection for bilateral hip degenerative arthritis, also reported as trochanteric bursitis, to include as secondary to service-connected bilateral knee chondromalacia patella with osteoarthritis and/or lumbar spine osteoarthritis. REASONS FOR REMAND The Veteran served honorably in the United States Navy from August 1983 to November 1983, and again from January 6,1993 to January 29, 1993. She additionally served in the Navy Reserves. This matter comes before the Board of Veterans Appeals (Board) from a November 2013 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran participated in a hearing before the undersigned Veterans Law Judge (VLJ) in July 2018. The matter was previously remanded by the Board in August 2018 for further development. The matter of entitlement to TDIU was previously also before the Board. However, entitlement to TDIU was fully granted while this matter was on remand. See December 2020 rating decision. This claim has been granted in full and is no longer before the Board for appellate consideration. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to service connection for bilateral hip degenerative arthritis, also reported as trochanteric bursitis, to include as secondary to service-connected bilateral knee chondromalacia patella with osteoarthritis and/or lumbar spine osteoarthritis is remanded. The Veteran maintains she has a hip condition which began as a result of a motor vehicle accident (MVA) that occurred in January 1993 while she was in service. Alternatively, she claims her hip condition is secondary to her service-connected chondromalacia patella of the bilateral knees and/or her service-connected lumbar spine osteoarthritis. See July 2018 hearing transcript. In July 2018, the Board remanded the claim for an additional VA examination and opinion. It was explained that an earlier October 2012 VA medical opinion was inadequate for rating purposes, because it was based on an inaccurate factual premise. Notably, the examiner stated there was no mention of a hip injury from the 1993 MVA, but January 1993 private treatment records indicated complaints of pelvis pain. The Board remanded for a new examination and asked the examiner to address whether the Veteran’s bilateral hip disorder was related to the in-service MVA, specifically considering and discussing her complaints of pelvic pain. The examiner was further instructed to opine as to whether the bilateral hip disorder was secondary to Veteran’s service-connected back and knee disorders addressing whether it was caused by these service-connected disorder or aggravated by them. Although a VA medical examination was conducted in October 2020, pursuant to the Board’s remand, that report is inadequate for adjudication purposes. While the examiner did address both causation and aggravation for secondary service connection, the only rationale provided was that the “Veteran was never diagnosed with a chronic disability of the hip.” However, she was diagnosed with arthritis in a 2011 VA examination, a diagnosis which was later revised to bursitis. The Veteran also testified at the hearing that she had ongoing hip pain since the MVA in service which continued to worsen. The examiner was also asked to address the Veteran’s 1993 complaints of “pelvic pain” in evaluation direct service connection but failed to do so. The examiner erroneously stated the “Veteran had no complaints of pelvic pain” following the MVA. As noted above, the Veteran complained of pelvic pain when examined on January 6, 1993. Additionally, in addressing the secondary issues the examiner did not adequately address whether the 1993 MVA could have caused her bilateral hip condition or her assertions that pain has existed since that time. Rather, the examiner simply noted most hip pain was muscular and resolved over time. Regarding aggravation, the examiner did not adequately address the Veteran’s contentions that her knees, back and hip are all interconnected and that her back and knees aggravate her hips, including her reports of consistent hip pain since the accident. Rather, the examiner cursorily noted that aggravation usually occurs shortly after the initial injury and incorrectly noted that there were no complaints of hip pain until 2011, many years after the accident. Therefore, while the Board regrets further delay in resolving this issue, an additional remand is necessary to ensure compliance with the prior remand instructions and to gain all necessary information. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Obtain addendum opinions as to the etiology of the Veteran’s bilateral hip degenerative arthritis, also reported as trochanteric bursitis. The entire electronic claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. a) The VA examiner must opine as to whether it is at least as likely as not (i.e., there is at least a 50 percent probability) that the diagnosed hip condition had its onset in, or is otherwise related to, the Veteran’s military service, to include the January 1993 motor vehicle accident. b) The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s bilateral hip disorder is caused by her service-connected bilateral knee disabilities and/or low back disorder (either individually or in concert). c) The examiner should also opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s bilateral hip disorder is aggravated by her service-connected bilateral knee disabilities and/or low back disorder (either individually or in concert). The examiner is advised that aggravation is defined as an increase in any disability beyond its normal progression. In rendering the above requested opinions, the examiner must specifically address and discuss the Veteran’s complaints of pelvic pain and the reports of lower right extremity pain following the 1993 MVA as noted in private treatment records from January 1993. The examiner must also address the Veteran’s contentions of ongoing hip pain since the 1993 MVA. The examiner is advised that the Veteran is considered competent to report her symptoms, and that such reports must be acknowledged and considered in formulating any opinion. If her reports are discounted, the examiner should provide a reason for doing so. (Continued on the next page)   A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Stuedemann, Angela L. 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.