Citation Nr: 21027185 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 12-01 053 DATE: May 4, 2021 ORDER Entitlement to service connection for right hip degenerative arthritis as a residual of right femur fracture, is granted. REMANDED Entitlement to service connection for gastrointestinal disorder is remanded. FINDING OF FACT The Veteran's right hip degenerative arthritis is caused by his service-connected prostate cancer. CONCLUSION OF LAW The criteria for service connection for right hip degenerative arthritis as secondary to service-connected prostate cancer are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1972 to June 1974 in the United States Army. In December 2018, the Board remanded the claims for additional development. There has been substantial compliance with the remand in connection with claims decided here and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection 1. Entitlement to service connection for right femur fracture residuals is granted. The Veteran contends that residuals of his right femur fracture are secondary to his service-connected prostate cancer, specifically due to associated osteopenia. He suffered a right femur fracture after a fall from a bicycle in May 2008. He asserts that the fracture was due to osteopenia as a result of treatment for his service-connected prostate cancer. He submitted medical literature regarding prostate cancer causing osteopenia, and medical evidence from June 2008 showing that his left femoral neck had moderately low bone mineral density at that time, resulting in moderate fracture risk. The October 2019 VA examination clarifies that the Veteran has current residuals of a right femur fracture, to include right hip degenerative arthritis. By way of background the key question in this claim has been whether the Veteran's diagnosed osteopenia is the causal or aggravating link between the Veteran's right femur fracture residuals and his service-connected prostate cancer. In a March 2011 VA medical opinion, the examiner reviewed the record and "similar cases" in medical and urology textbooks and concluded that it is at least as likely as not that the osteopenia is secondary to the Veteran's service-connected prostate cancer. As rationale, the examiner noted that prostate cancer has "been linked statistically with osteopenia." Additional medical literature submitted by the Veteran further supports the secondary connection between osteopenia and prostate cancer. The Board finds that this evidence establishes a link between the Veteran's service-connected prostate cancer and osteopenia. The question before the Board is, therefore, whether osteopenia either caused or aggravated the right femur fracture which resulted in the current residual right hip degenerative arthritis. In a March 2021 VA medical opinion an examiner stated that it is less likely as not that a secondary relationship exists in this case between the fracture and prostate cancer. The examiner provided a lengthy rational in support of this opinion. However, at the conclusion of the rationale the examiner concedes that "certainly any fracture would be worsened by osteopenia." The Board finds that the examiner's statement at least establishes an aggravating relationship between osteopenia and the right femur fracture. As the Board states above the prior competent medical evidence of record (2011 VA medical opinion and medical literature) supports the theory of the Veteran's osteopenia developing secondary to his service-connected prostate cancer. Therefore, upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's right femur fracture was aggravated by his service-connected prostate cancer, resulting in the current residual right hip arthritis. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for right hip degenerative arthritis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102." REASONS FOR REMAND Entitlement service-connection for gastrointestinal condition is remanded. The claim must be remanded again because the medical opinions of record are inadequate as to whether the Veteran's diagnosed diverticulosis is etiologically related to active duty service. While the previous remand only sought an opinion on the Veteran's IBS, an October 2019 VA examination included a diagnosis of diverticulosis, dated 2008, for the first time. This additional gasterointestinal diagnosis was not addressed in the subsequent March 2021 VA medical opinion. As the Veteran's claims has been service connection for a "gasterointestinal condition," not limited to IBS, the Board finds that all current conditions must be adequately addressed. Further remand is necessary to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's diverticulosis is at least as likely as not related to active duty service. In answering this question, the examiner should consider and discuss as necessary the following: (i) the Veteran's lay statements concerning the onset and frequency of his symptoms; (ii) service treatment records documenting that the Veteran was admitted in November 1973 to the emergency room of Cutler Army Hospital at Ft. Devens with "crampy abdominal pain of approximately 24 hours duration." He was diagnosed with probable small bowel obstruction secondary to adhesions. A full rationale is to be provided for all stated medical opinions. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.