Citation Nr: 21021894 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-32 864 DATE: April 14, 2021 REMANDED Entitlement to service connection for a bilateral hip disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2007 to May 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision. The Veteran was afforded a hearing before the undersigned Veterans Law Judge in March 2019. In August 2019, the Board remanded the issues for further development. That development was completed, and the case has since been returned to the Board for appellate review. 1. Entitlement to service connection for a bilateral hip disability is remanded. The Veteran contends that his bilateral hip disability is due to service-connected left knee strain and service-connected back strain causing an altered gait. See March 2021 Appellate Brief. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for bilateral hip disability because no VA examiner has opined whether the Veteran’s bilateral hip disability was proximately due to or aggravated by his service-connected back pain. Additionally, the Veteran was afforded a VA examination in September 2020. The examiner opined the Veteran’s bilateral hip disability is less likely than not due to or the result of, or aggravated beyond its natural progression by the Veteran’s service-connected left knee strain. The examiner reasoned there is no clear evidence to suggest that an injury to one joint would have any significant impact or permanent aggravation on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or a shortening of the injured limb resulting in length discrepency of more than five centimeters so that the individual’s gait has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner also stated that use of contralateral body components as a result of avoiding use of a painful or limited component is a natural compensation. Whether the contralateral body part is capable of the increased load is a property of the contralateral part. It is not unusual for two joints to share properties in the same person, but one’s joint’s disease does not “spread” to another or cause damage to it. The condition of the bilateral hips is due to something intrinsic to the bilateral hips. The Veteran, through his representative, contends that the September 2020 VA examiner’s opinion is inadequate as it fails to consider the multiple types of altered gait in addition to the Trendelenburg gait when making the conclusion that there is no clear evidence of the left knee causing a significant impact to the bilateral hips unless there is an obvious Trendelenburg gait. Moreover, the Veteran cites an article entitled “Arthritis in Joints” which suggests that joints will compensate and undergo arthritic changes due to changes in gait. Remand is necessary for an addendum opinion for the examiner to consider the Veteran’s contentions. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to the September 2020 VA examination report from an appropriate clinician to determine the nature and etiology of a bilateral hip disability. The entire file must be made available to the examiner designated to examine the appellant. The examiner must opine whether: a) the Veteran’s bilateral hip disability is at least as likely as not proximately due to service-connected left knee disability or service-connected back disability, b) the Veteran’s bilateral hip disability is at least as likely as not aggravated beyond its natural progression by service-connected left knee disability or service-connected back disability. In so opining, the examiner is asked to consider and address the Veteran’s contentions, including the impact of an altered gait other than the Trendelenburg gait, and the research article “Arthritis in Other Joints” referenced in the March 2021 Appellate Brief. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alexia E. Palacios-Peters, 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.