Citation Nr: 21028963 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 17-42 067 DATE: May 12, 2021 REMANDED Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to a temporary total evaluation for convalescence from surgery for a service-connected disability is remanded. REASONS FOR REMAND The Veteran had active duty in the United States Air Force from August 1979 to August 1983 and from April 1985 to September 2001. These matters come before the Board of Veterans' Appeals (Board) from a January 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge by videoconference in March 2021; a transcript has been associated with the claims file. 1. Entitlement to service connection for a right hip disability 2. Entitlement to service connection for a left hip disability The Veteran contends that his current right and left hip disabilities were incurred during his active duty or otherwise were caused by that service. In the alternative, the Veteran alleges that the hip disabilities were caused or aggravated by his service-connected back, right ankle, and/or left knee disabilities. The Veteran was afforded a VA examination in December 2015. The examiner diagnosed right and left degenerative hip arthritis. The examiner indicated that the right hip arthritis was from 2001 and the left hip arthritis was from 2000 which is during active duty. The Veteran also had a right total hip replacement in September 2015. The Veteran reported symptom onset about 4 years previously and that the condition began at that time. Following examination, the examiner concluded that it was less likely than not that the right and left hip arthritis was proximately due to or the result of the Veteran's service-connected disabilities. The rationale indicated that the Veteran had advanced degenerative arthritis in both hips based on medical records from August 2015. The examiner stated that the left and right hip disabilities were less likely than not the result of the service-connected back, right ankle, and left knee disabilities. The examiner concluded this despite noting, "Even though the above may have caused undue stress on the hip. The bilateral hip condition is due to Advanced Arthritis condition." The Board finds the report and opinion problematic for multiple reasons. Initially, the examiner stated that the Veteran's left and right hip arthritis began in 2000 and 2001, which would almost certainly have been before the Veteran separated from service in September 2001. It is unclear whether this notation was made in error. In any case, no opinion as to whether the right and/or left hip arthritis began during service or otherwise was caused by service. In addition, as to the secondary opinion, the opinion concluded that it was less likely than not that the hip arthritis was proximately due to or the result of the service-connected disabilities, but also clearly indicated that the service-connected disabilities "may have caused undue stress on the hip." Confusingly, the examiner concluded that the cause of the hip arthritis was the "Advanced Arthritis condition." Given these inconsistencies the Board concludes that a remand for a new examination is necessary. The Board also notes that a March 2017 private medical record noted the Veteran's complaints of right and left hip pain. The treatment provider wrote, "I do not believe his other injuries necessarily contributed to or, maybe [sic] his hip problem worse. However, I believe it is reasonable, even with a greater than 50% chance, that his hips were injured at the time of the manhole incident in 1998. These could've been due to his hip issues that led to a total hip replacement bilaterally." The foregoing suggests the possibility that the current hip arthritis was caused by service. Again, the September 2015 examination report failed to provide an opinion on this aspect of the claim. 3. Entitlement to a temporary total evaluation The claim for entitlement to a temporary total evaluation due to convalescence is inextricably intertwined with the remanded service connection claims and adjudication is deferred. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for the claimed right and left hip disabilities, including the right and left hip arthritis with subsequent total hip replacements. The examiner must review the claims file. The examiner is asked to provide a response to the following: Was either the right or left hip disability at least as likely as not incurred in service or otherwise caused by service, including the 1997-98 incident involving a manhole when the Veteran injured his now service-connected back. The Veteran now contends ongoing right and left hip symptoms from the time of that incident and that he has shortened leg(s) contributing to abnormal gait. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Provide a rationale to support the opinion(s). Is the right and/or left hip arthritis with subsequent total hip replacement (and any other diagnosed disability) at least as likely as not proximately due to the Veteran's service-connected back, right ankle, and left knee disabilities? Is the right and/or left hip arthritis with subsequent total hip replacement (and any other diagnosed disability) at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the Veteran's service-connected back, right ankle, and left knee disabilities? (continued next page) 2. After the above is complete, readjudicate the Veteran's claims. If a complete grant of benefits is not awarded, issue a supplemental statement of the case (SSOC) to the Veteran and his representative. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.