Citation Nr: 21031821 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-55 996 DATE: May 24, 2021 REMANDED Entitlement to service connection for right hip disorder is remanded. Entitlement to service connection for left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 2006 to December 2012. These matters come to the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) Winston-Salem, North Carolina. Jurisdiction of this appeal is currently with the RO in Oakland, California. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge (VLJ) of the Board in October 2019. A transcript of the hearing has been associated with the claims file. This case was most recently before the Board in January 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. In addition, in a January 2021 rating decision, the AOJ granted service connection for bilateral lower extremity shin splints and assigned initial ratings. As this decision represents a full grant of the benefits sought with respect to these claims for service connection, such issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Service Connection Right Hip and Left Knee The Veteran seeks entitlement to service connection for right hip and left knee disorders. As noted above, the claims were most recently before the Board in January 2020, when the claims were remanded to the AOJ for further development. Specifically, the January 2020 Board remand directed the AOJ to obtain new VA opinions to determine the nature and etiology of her claimed right hip and left knee disorders, to include the Veteran's diagnosed patellofemoral syndrome and bone lesion. Specifically, the Board directed the VA examiner to furnish an opinion as to whether it was at least as likely as not that the Veteran's current right hip and left knee disorders began in or was otherwise related to service and to provide a complete rationale was requested for all opinions rendered. The requested VA examinations were afforded with respect to the Veteran's claims in February 2020 and January 2021. The examiners opined that the Veteran's right hip and left knee disorders were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In February 2020, with regard to her right hip, the examiner noted that during service, her condition was acute only. The examiner further reasoned that there was no evidence of chronicity of care, that there was no right hip diagnosis at that time, and no opinion was required and that a nexus had not been established. With regard to her left knee, the examiner noted that during service, her condition was acute only. The examiner further opined that there was no evidence of chronicity of care, that there was no diagnosis since a VA separation examination in 2012 and a nexus had not been established. In January 2021, with regard to her right hip, the examiner noted that there was no chronic diagnosis made for a right hip disorder or condition while on active duty. The examiner further reasoned that the Veteran's symptoms were subjective only, that the available medical records do not note medical evaluations, treatment, or a diagnosis for a chronic right hip condition while on active duty, that the available medical records also did not note medical evaluations, treatment, or a diagnosis for right hip bursitis while on active duty, that there was no objective medical evidence noted in the available medical records showing a link between the Veteran's current right hip disorder and her military service and that a nexus had not been established. With regard to her left knee, the examiner noted that during service her left knee disorder was acute only. The examiner further reasoned there was no evidence of chronicity of care and symptoms were subjective only, that the available medical records did not diagnose a left knee disorder and showed a pre-patellar bursitis of the left knee, that there were no further medical evaluations noted in the available medical records for a left knee disorder or condition while on active duty, that there was a lack of sufficient objective medical evidence confirming the chronicity of a left knee disorder or condition while on active duty, that there is no objective medical evidence noted in the available medical records showing a link between the Veteran's current left knee disorder and her military service and that a nexus had not been established. The Board finds the February 2020 and January 2021 VA medical opinions incomplete to decide the claims. The February 2020 and January 2021 VA opinions did not address the Veteran's diagnosed patellofemoral syndrome and bone lesion, as directed by the January 2020 Board remand directives and did not provide an adequate rationale. Therefore, the Board finds the February 2020 and January 2021 VA addendum opinions incomplete to decide the claims. Given these deficiencies, the Board is unable to find that substantial compliance with the prior remand has been achieved. See D'Aries, 22 Vet. App. at 105; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As such, remand is again to obtain VA opinions that comply with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. at 268, 271 (1998). The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, forward the claims file to the examiner who previously examined the Veteran to obtain an addendum opinion to determine the etiology of her claimed right hip and left knee disorders. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: Is at least as likely as not (50 percent or greater probability) that the Veteran's right hip and/or left knee disorders had its onset during any period of service, or is otherwise related to such period of service? The examiner must specifically address the diagnoses of record of patellofemoral syndrome and bone syndrome. In offering such opinions, the examiner should consider the Veteran's statements. The examiner must provide a complete rationale for all opinions and conclusions reached. (Continued on the next page) If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, Associate 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.