Citation Nr: 21024523 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 14-04 081 DATE: April 23, 2021 REMANDED Entitlement to service connection for a left hip condition, to include as secondary to service-connected left knee condition, is remanded. REASONS FOR REMAND The Veteran had active duty service from July 2005 to February 2006. A videoconference hearing was held before the undersigned Veterans Law Judge in April 2017. A hearing transcript is of record. In October 2017, June 2019, and October 2020, the Board of Veterans’ Appeals (Board) remanded this case for additional development. Previously the issue of entitlement to service connection for a left knee condition had also been on appeal before the Board. However, following the most recent remand in October 2020, the issue was granted in a November 2020 rating decision. Specifically, the Veteran was awarded service connection for a left knee strain with subsequent degenerative joint disease and osteofibroma and assigned a 10 percent disability rating, effective November 4, 2010, which constitutes a full grant of benefits for this issue. Therefore, this issue is no longer on appeal and will not be addressed further. Entitlement to service connection for a left hip condition, to include as secondary to service-connected left knee condition, is remanded. While the Board regrets the further delay in the adjudication of this claim, unfortunately, the record still lacks a complete medical opinion regarding the nature and etiology of the Veteran’s left hip condition. In particular, the Veteran contends she suffers from a left hip condition as a result of her military service, or in the alternative, as a result of her now service-connected left knee condition due to altered gait and posture. During the April 2017 Board hearing, the Veteran provided testimony that she had noticed left hip problems continuously since her separation from service. See Appellate Brief; see Hearing Transcript. The Veteran has also provided statements to explain why, despite the continuous left hip pain, she has not sought treatment in the intervening years. Specifically, she states she was unable to receive intensive treatment for her left hip condition while on active duty or post service due to her two pregnancies from 2006 to 2008, followed by a difficult divorce. See January 2012 Statement in Support of the Claim. A review of the Veteran’s service treatment records (STRs) shows the Veteran suffered from a left knee injury in September 2005, for which she is now service connected. Ongoing treatment records show continued complaints of knee pain, however, notably, an October 2005 STR does also show complaints of left hip pain in conjunction with the left knee pain. See STRs. As discussed in the October 2020 Board remand, the Veteran was provided a VA examination in March 2011 and again in November 2019 to obtain an adequate medical opinion regarding the nature and etiology of her left knee and left hip conditions. The Board’s October 2017 remand found the March 2011 VA medical opinion to be inadequate because it did not consider the Veteran’s lay statements of continued left knee and left hip pain following her injury in service. Unfortunately, the subsequent November 2019 medical opinion did not consider the Veteran’s lay statements of continued left hip pain either. See March 2011 VA examination and See November 2019 VA medical opinion. Following the most recent Board remand in October 2020, the Veteran was provided another VA examination in November 2020. While the examiner adequately addresses the Veteran’s secondary theory of causation, the medical opinion rendered regarding direct service connection is once again incomplete. The opinion relies on an inaccurate medical history and also does not consider the Veteran’s lay contentions regarding ongoing left hip symptomatology or her explanation for lack of medical care. In particular, the rationale for the negative direct opinion was that during service, there was no evidence of a left hip injury. The examiner stated the left knee incident in service was documented and there was also a single notation of left hip pain in January 2006, with a 7-month duration reported by the Veteran; however, there was no notation related to the left hip throughout the discussion of the left knee condition in 2005 (in service) and no documentation or complaints of hip problems until acute hip pain was reported in July 2014. The examiner stated these events occurred spontaneously, per the Veteran’s history, and there was no evidence of a chronic hip condition since service, despite the Veteran’s claims to the contrary. Therefore, the examiner concluded the event in July 2014, and discussed in records dated from October 2014, represented an acute and new condition. The Board notes, however, that contrary to the examiner’s review of the record, the Veteran’s STRs do show a complaint of left hip pain in 2005. Furthermore, it appears the finding that the Veteran does not have a chronic hip condition again appears to be based on a lack of medical records. However, this has been addressed by the Veteran and therefore the examiner should consider instead whether the reported symptoms represent a continuation of the in-service left hip pain, as documented in her STRs, to her present left hip condition. Accordingly, a remand is required in order to obtain an adequate medical opinion prior to adjudicating this claim. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left hip condition is at least as likely as not related to service, including lay assertions of continuity of symptomatology following an in-service injury in 2005? The examiner must review the claims file, including the reasons for this remand, prior to rendering his or her opinion, and include an adequate rationale to support the opinions provided. The examiner is asked to specifically address the Veteran’s lay contentions regarding her reports of ongoing left hip pain since service as well as the reasoning she has provided for the lack of medical documentation. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Churchwell, 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.