Citation Nr: 21031042 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 19-03 380A DATE: May 20, 2021 REMANDED Entitlement to service connection for a bilateral hip condition, to include as secondary to service-connected lumbar spine degenerative disc disease (DDD) and stenosis, is remanded. Entitlement to service connection for a skin condition, to include as secondary to herbicide exposure, is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1967 to December 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held in October 2019. A transcript is of record. The Board issued a prior remand on these claims in March 2020. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral hip condition, to include as secondary to service-connected lumbar spine DDD and stenosis, is remanded. In response to the Board's prior remand, the Veteran was provided a VA examination for his bilateral hip condition in February 2021. However, the examiner provided an opinion that there was insufficient evidence in the file documenting a bilateral hip condition or back condition and thus a nexus opinion could not be rendered without resort to mere speculation. Therefore, in March 2021, the agency of original jurisdiction (AOJ) obtained an addendum opinion from another examiner. This examiner opined that there was "no specific injury diagnosed during [active duty]" and that, as a result, no direct nexus could be established. No additional explanation was provided other than to point out that the separation examination was negative. The opinions provided are inadequate in that they provide little explanation for the conclusions rendered. Moreover, to the extent that the reviewing clinician based her negative opinion on the lack of an injury during active duty, such ignores the lifting injury to the back that served as the basis for the grant of service connection for a back disability. Indeed, the Veteran claims that the same incident that led to his back condition was also the genesis of his bilateral hip condition. Additionally, the lack of specific documentation of a hip condition in service is not fatal to the claim. See, e.g., 38 C.F.R. § 3.303(d). Accordingly, a new medical opinion must be obtained on remand. 2. Entitlement to service connection for a skin condition, to include as secondary to herbicide exposure, is remanded. The Veteran was given a VA examination for his skin conditions in February 2021. The examiner diagnosed eczema and skin hyperpigmentation. The examiner noted that the Veteran's eczema was diagnosed in 2015 and provided a negative nexus opinion regarding the same. However, the examiner noted that the Veteran's skin hyperpigmentation began 20 years ago and has gradually gotten worse affecting 5 to less than 20 percent of the Veteran's body. The examiner did not provide a nexus opinion with regard to the Veteran's skin hyperpigmentation. Accordingly, another remand is warranted. The matters are REMANDED for the following action: 1. Obtain any outstanding relevant VA and/or private treatment records and associate the same with the claims file. 2. Thereafter, obtain an opinion from a qualified clinician regarding the nature and etiology of the Veteran's bilateral hip disability, other than from the clinicians that provided opinions in February and March 2021. If the reviewing clinician determines that a physical examination of the Veteran is required to provide the requested opinions, such should be accomplished. After review of the record and examination of the Veteran, if deemed necessary, the reviewing clinician should provide the following opinions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hip condition is etiologically related to his active service, to include his self-reported injury in 1967 from which his back condition was granted service connection? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hip condition was caused by the Veteran's service-connected lumbar spine DDD with stenosis? (c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hip condition was aggravated by his service-connected lumbar spine DDD with stenosis? In formulating an opinion, the reviewing clinician should consider: (1) the Veteran's lay statements regarding his 1967 injury; (2) the dates on which the Veteran's hip replacements actually occurred; and (3) the March 2017 opinion from the Veteran's private physician, Dr. T.T., opining that his back condition and bilateral hip condition is related to an injury that occurred while the Veteran was on active duty in 1967. A detailed rationale for the opinion must be provided. If the reviewing clinician is unable to offer the requested opinion, it is essential that the reviewing clinician offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. After the development in #1 above is complete, schedule the Veteran for a VA examination by an appropriately qualified clinician to determine the nature and etiology of his skin condition. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. A complete history should be elicited directly from the Veteran and the opinion should include a notation that this record review took place. After a thorough review of the record to include all in-service and post-service treatment records, the examiner should answer the following: Is it at least as likely as not (a 50 percent probability or more) that the Veteran's current skin condition, to specifically include hyperpigmentation, was incurred in or is otherwise related to his time in service, to include his conceded exposure to herbicide agents? The examiner should also note that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports of symptomatology, a reason for doing so should also be provided. The examiner should not mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A full and complete rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide a requested opinion without resorting to mere speculation, it must be stated, and the examiner must provide the reasons why an opinion would require speculation. As such, the examiner 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. 4. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran 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 K. Ruiz, Associate Attorney 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.