Citation Nr: 21026416 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-10 010 DATE: May 3, 2021 REMANDED Entitlement to service connection for a bilateral hip disability is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from December 1983 to January 1987. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing in February 2020. A transcript of this hearing has been associated with the claims file. The Board notes that this matter was previously before the Board in March 2020, at which time it was remanded to the Agency of Original Jurisdiction (AOJ) for further evidentiary development. While the Board regrets the additional delay, for the reasons explained below, the Board finds that another remand is warranted. 1. Entitlement to service connection for a bilateral hip disability is remanded. 2. Entitlement to service connection for a low back disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. The Veteran contends that his current bilateral hip disabilities, low back disability, and right knee disability are all either caused or aggravated by his service-connected feet disabilities, to include hallux rigidus of the right foot (right great toe and second metatarsal) and hammertoes of the left foot (fourth and fifth toes). Another remand is required for a medical opinion because the prior remand directives were not substantially completed and there is insufficient medical evidence to decide the claims. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The August 2020 VA examiner provided opinions addressing all of the Veteran's claimed disabilities. For each disability, the VA examiner stated that the claimed condition "is a separate entity from the Veteran's hallux rigidus of the great toe and they are not medically related." The VA examiner stated the same regarding the theory of aggravation. For the bilateral hip disabilities, the VA examiner stated that there was no diagnosis for either hip. These opinions did not substantially complete the prior remand directives because the rationale did not properly address the aggravation prong for secondary service connection. Additionally, the opinions did not address the Veteran's contention that he has altered his gait over time as a result of his service-connected feet disabilities, which resulted in the injuring of his right knee, hips, and low back. Further, the rationales for the causation prong of secondary service connection provided by the VA examiner are conclusory, and do not properly explain the reasoning behind the opinions. Moreover, the AOJ sought clarification from the VA examiner multiple times during development of the Veteran's claims, indicating that the opinions provided were not sufficient. However, the VA examiner did not provide proper clarification or further opinions. Additionally, there is conflicting evidence regarding the Veteran's bilateral hip disabilities; the record contains a diagnosis of bilateral hip bursitis, and VA examination reflects limited range of motion of both hips. However, the August 2020 VA examiner indicated that the Veteran had no disability of either the right or left hip. This inconsistency must be resolved upon remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate VA clinician regarding the etiology of the Veteran's low back and right knee disabilities. The VA examiner is asked to provide the following medical opinions: a) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's low back and right knee disabilities are proximately due to or caused by his service-connected right and left foot conditions? b) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's low back and right knee disabilities have been aggravated by his service-connected right and left foot conditions? Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. The Veteran's lay contentions, to include statements made regarding his gait, must be considered and weighed in making the determination as to whether a nexus exists. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. 2. Schedule the Veteran for a VA examination for his bilateral hip disabilities to clarify any current diagnoses and provide an opinion regarding the etiology of such. The VA examiner is asked to provide the following medical opinions: a) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's bilateral hip bursitis with limitation of motion is proximately due to or caused by his service-connected right and left foot conditions? b) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's bilateral hip bilateral hip bursitis with limitation of motion has been aggravated by his service-connected right and left foot conditions? The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The Veteran's lay statements regarding a gait disturbance should be addressed. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. M. Lowman, 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.