Citation Nr: 21023202 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-18 478 DATE: April 20, 2021 REMANDED Entitlement to service connection for a right hip disorder, to include on a secondary basis, is remanded. Entitlement to service connection for a left hip disorder, to include on a secondary basis, is remanded. Entitlement to service connection for a right knee disorder, to include on a secondary basis, is remanded. Entitlement to service connection for a right foot disorder, to include on a secondary basis, is remanded. Entitlement to service connection for a left foot disorder, to include on a secondary basis, is remanded. REASONS FOR REMAND The Veteran had active service from October 1984 to October 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Veteran appeared for a hearing before the undersigned. A transcript of the hearing is of record. In a January 2020 decision, the Board granted entitlement to service connection for a spine disability, including the lumbar and cervical spine, and a left knee disability and remanded the issues of entitlement to service connection for a bilateral hip disability, right knee disability, and bilateral foot disability for further development. Specifically, the Board instructed that, in light of the Veteran’s hearing testimony that her bilateral hip disability, right knee disability, and bilateral foot disability were all secondary to her spine disability and the Board’s award of service connection for her spine disability and left knee disability, new VA examinations and opinions should be obtained addressing whether any of her claimed disabilities were caused or aggravated by a service connected disability, to include the Veteran’s spine disability and/or left knee disability. The Board also requested that any outstanding medical treatment records be obtained. Additional medical treatment records have been associated with the Veteran’s claims file. Additionally, VA examinations and opinions were provided in December 2020. The RO subsequently issued a supplemental statement of the case (SSOC) in January 2021, and the case was returned to the Board. Stegall v. West, 11 Vet. App. 268 (1998). However, as will be addressed below, the Board finds that an additional remand is necessary before these issues can be adjudicated by the Board. Entitlement to service connection for a bilateral hip disorder, right knee disorder, and bilateral foot disorder is remanded. The Veteran contends, in part, that her current bilateral hip disorder, right knee disorder, and bilateral foot disorder are secondary to her service-connected disabilities, to include her lumbar and/or cervical spine disabilities. In this regard, the Veteran testified at her November 2019 Board hearing that her spine disability caused gait abnormalities, which caused or aggravated her bilateral hip, right knee, and bilateral foot disabilities. Following the Board’s January 2020 remand, the Veteran submitted a medical article in May 2020 indicating that knee osteoarthritis caused gait abnormalities. The Veteran also submitted a private medical opinion in May 2020, which indicates that her right knee disability was related to her active service, noting agreement with a previous private medical opinion by a different provider. Based, in part, on this determination, the provider opined that the Veteran’s right knee and lumbar spine disorder resulted in gait abnormalities which caused her bilateral hip disorder. Notably, however, the referenced prior medical opinion indicates that the Veteran’s left knee disorder was related to her active service, and while she is indeed service connected for her left knee disorder, she is not service connected for her right knee disorder. Nevertheless, the Board acknowledges that this may have been a typographical error on the part of the provider. A December 2020 VA examiner opined that the Veteran’s bilateral hip, right knee, and bilateral feet disorders were not related to a service-connected disability, to include the lumbar or cervical spine. However, there is no indication in any of the secondary causation opinions that the examiner considered whether any of her currently claimed disorders could have been due to her gait abnormality as suggested by the private provider and the Veteran’s contentions at her Board hearing. Indeed, the only opinion addressing her altered gait was the aggravation opinion for her left hip disorder, which notes that it was more likely than not that her “gait alteration regarding the right knee pathology and its longevity would incur additional deterioration” of her lumbar spine disorder. While the examiner may have been suggesting that the lumbar spine disorder was not the cause of her gait abnormalities, the Board finds that this point is unclear particularly given that the only mention of her gait abnormality was within the aggravation opinion for the left hip; thus, the Board finds that clarification is needed. Therefore, in light of the foregoing, the Board finds that further development is necessary before a decision can be rendered on the issues of entitlement to service connection for a bilateral hip disorder, right knee disorder, and bilateral foot disorder. The matters are REMANDED for the following action: Obtain a medical opinion to address the etiology of the Veteran’s bilateral hip disorder, right knee disorder, and bilateral foot disorder. The electronic claims file must be made accessible to the examiner. If an addendum opinion is not feasible, schedule the Veteran for a VA examination to determine the etiology of her bilateral hip disorder, right knee disorder, and bilateral foot disorder. (a.) Identify all of the Veteran’s current bilateral hip, right knee, and bilateral foot disorders. If any previously diagnosed disability is not diagnosed, the examiner should provide a supporting explanation. (b.) The examiner should opine as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s bilateral hip disorder, right knee disorder, and bilateral foot disorder was caused by any of the Veteran’s service-connected disabilities, to include the Veteran’s spine disability and/or left knee disability. (c.) The examiner should opine as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s bilateral hip disorder, right knee disorder, and bilateral foot disorder was aggravated (made worse) by a service-connected disability, to include the Veteran’s spine disability and/or left knee disability. If aggravation is found, the examiner should identify a baseline level of severity of the Veteran’s bilateral hip disorder, right knee disorder, and bilateral foot disorder by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the bilateral hip disorder, right knee disorder, and bilateral foot disorder. If such cannot be done, it should be explained why. In rendering each of the requested opinions, the examiner must specifically consider and address: (1) the Veteran’s lay statements regarding the etiology of her right knee disorder, bilateral hip disorder, and bilateral foot disorder; and (2) the May 2020 private opinion indicating that the Veteran’s service-connected back disorder and/or left knee disorder was responsible for her gait abnormality and that her gait abnormality caused her bilateral hip disorder. An explanation of all opinions expressed must be provided, with consideration given to all evidence of record. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hite, 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.