Citation Nr: 21026731 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 15-40 203 DATE: May 3, 2021 ORDER Entitlement to service connection for a left hip disability manifested by limitation of motion is granted. REMANDED Entitlement to service connection for bilateral knee degenerative changes as secondary to a service-connected left buttock disability is remanded. Entitlement to service connection for left ankle osteoarthritis as secondary to a service-connected left buttock disability is remanded. Entitlement to service connection for left foot degenerative changes as secondary to a service-connected left buttock disability is remanded. Entitlement to service connection for right foot drop, degenerative changes with hallux rigidus, right fifth metatarsal head and right fifth digit keratoma, and right fifth digit hammertoe (collectively "right foot disabilities") as secondary to a service-connected left buttock disability is remanded. FINDING OF FACT A left hip disability manifested by limitation of motion was incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left hip disability manifested by limitation of motion are met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from October 1995 to April 1996. These matters come before the Board of Veteran's Appeals (Board) on appeal from a January 2014 rating decision by the Regional Office (RO). Service Connection Entitlement to service connection for a left hip disability manifested by limitation of motion is granted. The Veteran claims entitlement to service connection for a left hip disability. He was medically discharged from service in 1996. His medical board records show he fell on a log during an obstacle course and developed a hematoma on his gluteus maximus, which developed into a "large myositis ossificans occupying a major portion of the gluteus maximus and part of medius on left side." The medical board records further show "examination reveals he has lost approximately 25 degrees of flexion of this hip, and it is possible he may lose more flexion in the future as this myositis matures. . . It is quite likely that the loss of hip flexion that we see today may increase with the passage of time." A few weeks prior to the medical board, a December 1995 treatment record shows the Veteran complained of left hip pain. Presently, a January 2014 VA examination report shows diagnosed degenerative changes of the left hip, and examination revealed loss of ranges of motion. In light of the medical evidence showing a current left hip disability manifested by limitation of motion, and the service treatment records showing complaints of left hip pain and loss of left hip motion that had its onset in service due to his service-connected left buttock injury, the Board finds that service connection for a left hip disability manifested by limitation of motion is warranted, and the claim is granted. REASONS FOR REMAND 1. Entitlement to service connection for bilateral knee degenerative changes as secondary to a service-connected left buttock disability is remanded. 2. Entitlement to service connection for left ankle osteoarthritis as secondary to a service-connected left buttock disability is remanded. 3. Entitlement to service connection for left foot degenerative changes as secondary to a service-connected left buttock disability is remanded. 4. Entitlement to service connection for right foot disabilities as secondary to a service-connected left buttock disability is remanded. The Veteran claims he has bilateral knee degenerative changes, left ankle osteoarthritis, left foot degenerative changes, and right foot disabilities, all as secondary to his service-connected left buttock disability. The Veteran asserts that all of the claimed disabilities were caused by an altered gait and limp as a result of his service-connected left buttock disability. As previously noted, the Veteran fell on a log during an obstacle course in service and developed a hematoma that later became a large myositis ossificans occupying a major portion of the gluteus maximus and part of medius on left side, he lost 25 degrees of left hip flexion at that time, and it was noted as likely to increase with the passage of time. He is presently service-connected for the left buttock disability and a left hip disability granted above. VA Medical treatment records in the file shows the Veteran is in his 40s, he has a "significant" gait abnormality, and he uses a walker for ambulation. A March 2018 VA podiatry record shows the podiatrist opined that the Veteran had a gait disturbance due to a service-connected disability, but the specific disability was not noted. Similarly, a December 1995 treatment record from the time of the Veteran's service notes an antalgic gait due to the Veteran's left buttock disability. A January 2014 VA examination report shows the examiner diagnosed all of the disabilities claimed herein - bilateral knee degenerative changes, left ankle osteoarthritis, bilateral foot degenerative changes, right foot drop and hallux rigidus, right fifth metatarsal head and right fifth digit keratoma, and right fifth digit hammertoe. The examiner briefly noted that the Veteran "walks with a limp." The examiner opined that the bilateral knee, bilateral foot, and left ankle disabilities were not caused or aggravated by his service-connected buttock disability. The examiner reasoned that myositis ossificans is calcification of a muscle and has no biomechanical relationship to the development of arthritis. The January 2014 VA examiner did not, however, address the Veteran's contention that his left buttock disability causes a limp or altered gait, which in turn caused or aggravated the claimed disabilities. A May 2016 VA medical opinion was obtained. The examiner opined the claimed disabilities are not caused or aggravated by the service-connected buttock disability. The examiner reasoned there is no pathoanatomical or physiologic relationship of a gait disturbance or limping causing arthritis found in a review of multiple online medical resources, and myositis ossificans of the left buttock has no biomechanical relationship to the claimed disabilities. The Veteran's representative requested at the Board hearing that the claim be remanded for an in-person VA examination because the May 2016 VA medical opinion was based on a mere records review and no in-person examination of the gait disturbance or limp was performed. In that regard, the Board acknowledges that the May 2016 VA medical opinion was based on records review only, and no in-person examination was performed at that time. Although the same VA examiner did examine the Veteran previously in January 2014, that report made only a very brief mention that the Veteran "walked with a limp," and the examiner did not address whether the left buttock disability caused an altered gait or limp that in turn caused or aggravated the claimed disabilities. The Board also acknowledges that this particular case involves a Veteran in his 40s who is documented in the medical records as having "significant" gait abnormalities and requiring the use of a roller for ambulation. Therefore, given the facts of this particular case, the Board will remand the claims so that the Veteran may be afforded an in-person VA examination with an appropriate examiner to clarify whether any of the claimed disabilities were caused or aggravated by a gait disturbance or limp due to the Veteran's service-connected left buttock or left hip disabilities. In addition, regarding the claimed right foot drop, medical records in the claims file raise the question as to whether the claimed right foot drop is caused by his service-connected spine disability. Therefore, the VA examiner should also address whether the Veteran has right foot drop that was caused or aggravated by his service-connected spine disability. Regarding the claimed knee disabilities, an October 2012 telehealth record notes the Veteran reported multiple areas of chronic pain, including "knee pain which may related to a longstanding history of left buttock pain." The examiner should review this record in forming an opinion. The matters are REMANDED for the following action: Afford the Veteran a new VA examination with an appropriate specialist to address the nature and etiology of the following claimed conditions: a) Bilateral knee degenerative changes; b) Left ankle osteoarthritis; c) Bilateral foot degenerative changes; d) Right foot drop; e) Right hallux rigidus; f) Right fifth metatarsal head and right fifth digit keratoma; and g) Right fifth digit hammertoe. The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed. The examiner should opine as to whether it is "at least as likely as not" that each disability identified on examination was caused or aggravated by his service-connected left buttock myositis ossificans. The examiner should opine as to whether it is "at least as likely as not" that each disability identified on examination was caused or aggravated by his service-connected left hip disability. Direct the VA examiner's attention to the Veteran's medical board narrative report from his active service, December 1995 and March 2018 treatment records regarding his gait, and a January 2014 VA examination report. Also, direct the examiner's attention to an October 2012 VA telehealth record noting multiple areas of chronic pain, including knees, that may be related to his left buttock. Also, please ask the VA examiner to address whether it is "at least as likely as not" that the Veteran has right foot drop that was caused or aggravated by his service-connected spine disability. Please direct the VA examiner's attention to March 2014, April 2014, and May 2015 private treatment records, and a February 2018 VA neurology and emergency treatment records, regarding the Veteran's service-connected spine disability, right foot problems, and possible DISH. Any opinion must be accompanied by a complete rationale. A. J. Spector Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Juliano, Janee L. 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.