Citation Nr: 21030247 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 16-42 899 DATE: May 18, 2021 REMANDED Entitlement to service connection for a right hip disability, to include as secondary to service-connected right ankle sprain, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1977 to April 1987, with additional active duty for training (ACDUTRA) and inactive duty training (INACDUTRA) in the United States Naval Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The matter was remanded in November 2018 for additional development. During the pendency of the remand, service connection was established for right ankle sprain. The Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board's November 2018 remand directed that the Veteran be afforded an examination to determine the nature and etiology of any currently present right hip disability. Specifically, the examiner was directed to provide opinions on whether any right hip disability had its onset during or was otherwise related to service, and whether any right hip disability was caused or chronically worsened by the Veteran's right ankle disability. The Veteran was afforded an examination in September 2019, and an opinion was obtained. Additional opinions were obtained August 2020 and September 2020. Notably, the September 2020 clinician observed that there was no objective medical record evidence to indicate that the Veteran currently had a chronic right ankle sprain, notwithstanding the September 2019 VA examination describing symptomatology of the Veteran's service-connected right ankle sprain including pain, limited range of motion, and instability. Moreover, the clinician opined that the Veteran's right hip disability was not "permanently aggravated" by his right ankle disability. The Court has held that the permanent worsening standard does not apply to cases involving aggravation for purposes of establishing service connection on a secondary basis. Ward v. Wilkie, 31 Vet. App. 233, 240 (2019). Any degree of worsening of a condition by a service-connected condition is sufficient to establish aggravation for purposes of granting service connection on a secondary basis. See 38 C.F.R. § 3.310 (b). Thus, the clinician applied the wrong standard in reaching the negative opinion. The Board observes that the Veteran reported being told by physicians of a possible link between his right ankle sprain and his right hip disability, and has asserted the existence of a relationship between the two conditions as well. See June 2015 Notice of Disagreement, August 2016 VA Form 9, and September 2019 statement. Based on these errors, remand is warranted for VA to obtain an adequate opinion addressing the etiology of the Veteran's right hip disability. This matter is REMANDED for the following actions: 1. Obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's right hip disability. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. It is up to the discretion of the reviewing clinician as to whether an examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: A. Is it at least as likely as not that the Veteran's right hip disability was incurred in, or is otherwise related, to his time on active service? B. Is it at least as likely as not that the Veteran's right hip disability was caused by his service-connected right ankle sprain? C. Is it at least as likely as not that the Veteran's right hip disability was aggravated by his service-connected right ankle sprain? For the purposes of this opinion, the VA reviewing clinician is to apply the proper aggravation standard, which is that any degree of worsening of a condition by a service-connected condition is sufficient to establish aggravation in this case. In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 2. After completing directive #1 above to the extent possible, readjudicate the claim. If the benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pelican, Luke H. 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.