Citation Nr: 21028518 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 09-47 084 DATE: May 11, 2021 REMANDED Service connection for right hip disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1965 to March 1966. These matters come before the Board of Veterans' Appeals (Board) from a May 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The matters were previously before the Board, most recently in May 2017, when remanded for further development. The Veteran died in March 2019. The Veteran's surviving spouse is the Veteran's appropriate substitute party. A February 2021 rating decision granted service connection for peptic ulcers, with an evaluation of 40 percent effective August 13, 2007 (for the purpose of entitlement to accrued benefits only). This grant constituted a full award of the benefits sought on appeal, namely: service connection. Therefore, the issue of entitlement to compensation under the provisions of 38 U.S.C. § 1151 for ulcers is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). Service connection for right hip disability is remanded. The Board cannot make a fully-informed decision on the issue of service connection for right hip disability because no VA examiner has provided any rationale for an opinion on whether the Veteran's right hip disorder was at least as likely as not proximately due to or worsened beyond its natural progression by service-connected degenerative arthritis of the spine or service-connected left hip injury. Once VA undertakes to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In January 2020, a VA examiner found that the Veteran's right hip disorder, diagnosed as osteoarthritis in 2008, was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness and provided rationale to support this opinion. The opinion, however, did not consider all raised theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F.3d 1039, 104344 (Fed. Cir. 1994). A medical opinion must contain not only clear conclusions with supporting data, but also a reasoned explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The January 2020 VA examiner opined that "it is less likely than not (less than 50% probability) that Veteran's R hip condition was directly related to active duty or to another SC condition now or during the period of the claim," but provided no rationale for this conclusion, largely repeating the same facts and data from the VA examiner's direct service connection opinion which included data that contradicts the conclusion. For example, the VA examiner included "other musculoskeletal conditions of the lower extremity and back" as "co-morbities that confound the etiology" of the right hip disorder. Degenerative arthritis of the spine is one of the Veteran's service-connected disabilities. The VA examiner did not resolve this inconsistency. The VA examiner did not offer a reasoned explanation for its conclusion that none of the Veteran's service-connected disabilities caused the Veteran's right hip disorder. Finally, the VA examiner did provide baseline data about the right hip condition at separation from service, but did not address whether the service-connected back or left hip disabilities, either alone or together, aggravated the Veteran's right hip disorder beyond its natural progression. An addendum VA medical opinion addressing these alternate theories of entitlement with sufficient rationale is warranted. The matter is REMANDED for the following actions: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's right hip disorder. The examiner must review the claims file, including a copy of this remand order. The examiner is asked to provide a response to the following: a. Is right hip disorder at least as likely as not proximately due to service-connected degenerative arthritis of the spine? b. Is right hip disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected degenerative arthritis of the spine? c. Is right hip disorder at least as likely as not proximately due to service-connected left hip injury? d. Is right hip disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected left hip injury? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. "Aggravation" means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease, and not due to the natural progress of the nonservice-connected disease. If aggravation is found, the examiner should attempt to quantify the extent of additional disability resulting from the aggravation. Provide a rationale to support the opinions. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.