Citation Nr: 21024700 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 16-58 638A DATE: April 23, 2021 REMANDED Entitlement to service connection for a left hip disorder is remanded. Entitlement to service connection for a right hip disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1975 to August 1978 and from December 1978 to February 1985. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In October 2020, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for a left hip disorder. 2. Entitlement to service connection for a right hip disorder. As noted in the October 2020 remand, the Veteran contends that his left and right hip disorders, diagnosed as bilateral total hip arthroplasty secondary to osteoarthritis, are related to his in-service duties and/or an injury that occurred when he fell approximately 12 to 14 feet down a ladder while he was aboard a ship. In this regard, while the Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to a bilateral hip disorder or injury, such reflect treatment for a back injury after falling down a ladder in January 1978. He further reports that, since such injury, he had achiness in his hips, which increased in severity from 2009 to 2012, and resulted in bilateral hip replacements in 2013 and 2014. Thus, the Veteran claims that service connection for left and right hip disorders is warranted. As noted in the October 2020 remand, while Dr. B.L. opined in January 2014 that the extreme physical demands of the Veteran’s in-service work accelerated the progression of osteoarthritis and Dr. E.P. opined in March 2014 that it was possible that his hip arthritis could result from his time in the Navy, the Board found such opinions inadequate to decide the instant claims as the physicians did not provide a rationale for their opinions and the latter is couched in speculative terms. The Board also observed that, while a June 2016 VA examiner opined that it was less likely than not that the Veteran’s bilateral hip disorders were related to his in-service duties, he did not address whether such hip disorders are related to his January 1978 fall from a ladder, or consider medical articles submitted by the Veteran that reflect a higher rate of risk or incidence of osteoarthritis among those who served in the military. Thus, the Board remanded the case in order to obtain an addendum opinion addressing whether the Veteran’s bilateral knee disorders had their onset in, or is otherwise related to, his military service, to include his duties and/or fall from a ladder in January 1978, which included consideration of the aforementioned private opinions and medical articles. Thereafter, in January 2021, after an interview with the Veteran, a review of the record, and a physical examination, a VA examiner opined that the Veteran’s bilateral hip disorders are less likely than not related to his active duty service. In this regard, she noted that, while there was evidence of a fall during service, such was an acute injury and resulted in a back contusion rather than a hip injury. The examiner further indicated that the Veteran’s separation examination was silent as to a residual back or hip condition associated with such fall, he denied relevant symptoms in 1985, X-rays in 2012 revealed osteoarthritis of the bilateral hips with the recommendation to lose weight, and a 2013 record reflects a history of worsening bilateral hip pain over the prior five years. Thus, the examiner found that the Veteran’s in-service duties, to include standing watch, or the fall down the ladder did not lead to his bilateral hip disorders. However, the Board finds a remand necessary in order to obtain an addendum opinion addressing the etiology of the Veteran’s bilateral hip disorders as the January 2021 VA examiner relied primarily on the lack of in-service treatment for the claimed disorders or post-service complaints for many years, despite the Veteran’s report that his that his hips have hurt since the 1978 injury. Furthermore, while she addressed the January 2014 and March 2014 private medical opinions in the context of a pre-existing disorder (which is not at issue in the instant case), she did not consider them in regard to direct service connection. Finally, the examiner did not consider the medical articles submitted by the Veteran in March 2014 that reflect a higher rate of risk or incidence of osteoarthritis among those who served in the military. Accordingly, the Board finds a remand necessary to obtain an addendum opinion addressing such concerns. The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to a VA examiner other than the January 2021 VA examiner, if possible, in order to obtain an addendum opinion addressing the etiology of the Veteran’s bilateral hip disorders. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s current left and right hip disorders, diagnosed as bilateral total hip arthroplasty secondary to osteoarthritis, had their onset in, or is otherwise related to, his military service, to include his duties and/or fall from a ladder in January 1978. In offering such opinion, the examiner should consider and discuss the Veteran’s reports that he performed rigorous physical duties while serving abord ships and, while his service treatment records do not document a bilateral hip injury at the time of his in-service January 1978 fall from a ladder, he landed on his tailbone and could not feel his legs. The examiner should further consider the Veteran’s lay statements indicating that he had achiness in his hips since the January 1978 in-service fall that increased over time, Drs. B.L.’s and E.P.’s opinions reflecting that the Veteran’s in-service duties accelerated the progression of osteoarthritis and possibly caused his arthritis, and the medical articles submitted by the Veteran that reflect a higher rate of risk or incidence of osteoarthritis among those who served in the military. The examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran’s service treatment records are silent as to a left and right hip disorder, or any complaints thereof. The examiner is also advised that a lack of medical records demonstrating a continuity of care after service cannot form the sole basis of a negative opinion. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Waite 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.