Citation Nr: 21031882 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-35 827 DATE: May 24, 2021 REMANDED Entitlement to service connection for a left hip disorder, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1975 to October 1978. In March 2020, the Board most recently remanded the current claim for additional development. Entitlement to service connection for a left hip disorder, to include as secondary to a service-connected disability is remanded. In April 2020, the Regional Office (RO) procured a VA medical opinion to assess the etiology of the Veteran's left hip disorder. The examiner opined that it was less likely than not that the Veteran's left hip osteoarthritis was proximately due to or aggravated beyond its natural progression by his service-connected lumbar spine and/or bilateral knee disorder. The examiner cited the July 2015 VA examination report that documented the Veteran's right hip condition began shortly after he injured his back. The examiner also cited the February 2016 VA examination that indicated the Veteran only had low back radiation to the right hip. The examiner stated that the Veteran's mild bilateral hip degenerative changes were consistent with age and did not represent a significant pathology. Following this examination, the RO indicated that further clarification was required to explain the distinction that was the basis of an etiological relationship between the right hip and the back and the lack of an etiological relationship between the left hip and the back. See June 2020 Deferred Rating. As such, the RO procured an additional July 2020 VA addendum opinion from the same VA examiner who rendered the April 2020 VA medical opinion. In July 2020, the VA examiner opined that the evidence did not support that the Veteran's left hip osteoarthritis was at least as likely as not proximately due or aggravated beyond its natural progression by his service-connected lumbar spine and/or bilateral knee disorders. The examiner explained that the Veteran was service-connected for both right and left lower extremity radiculopathy and that radiculopathy of the right and left lower extremities could involve pain in the buttock, hip, and back of the thigh areas. He also explained that radiculopathy might contribute to the Veteran's left hip discomfort. The examiner concluded his rationale by citing a February 2019 office visit for the Veteran's left total knee replacement at which the Veteran complained of right hip pain, not left. In spite of the RO's attempts at trying to procure an adequate VA medical opinion, the Board finds that the current evidence of record is insufficient to adjudicate the Veteran's claim. In pertinent part, while it appears that the VA examiner attempted to explain the distinction between the back and left/right lower extremity radiculopathy and their etiological relationship between the left and right hips, this explanation provided conflicting information. Chiefly, the examiner opined that the Veteran's left hip disorder was not proximately due to or aggravated beyond its natural progression by his service-connected disabilities but also indicated that left lower extremity radiculopathy could cause left hip pain and discomfort. The examiner did not otherwise reconcile these contradictory findings. Accordingly, the Board finds the July 2020 VA examiner's opinion is insufficient for rating purposes and remand is warranted for a new VA medical opinion consistent with the directives herein. The matter is REMANDED for the following action: Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's left hip disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the opinion. If an examination of the Veteran is deemed warranted to provide the requested opinion, such should be arranged. The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's left hip disorder was caused or aggravated his service-connected disabilities, to include the bilateral knee disorders, lumbar spine disorder, and bilateral lower extremity radiculopathy. Aggravation in this context is defined as any increase in disability. In rendering the above opinions, the VA examiner must specifically consider and discuss the July 2020 VA addendum opinion that indicates radiculopathy may contribute to left hip pain and discomfort. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. The rationale must include a discussion of the underlying medical principles specific to the facts of this case and not simply reference generic medical literature. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.