Citation Nr: 21032145 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 14-25 213A DATE: May 26, 2021 REMANDED Entitlement to service connection for a right hip condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1982 to May 1989, from May 1990 to October 1990, from February 2001 to June 2001, and from January 2003 to June 2010, with additional service in the Arkansas Army National Guard. The Veteran's active duty included service in Southwest Asia from March 2008 to December 2008. This case comes on appeal of a November 2011 rating decision. This case was previously before the Board in April 2020. At that time, the Board remanded this matter, as well as the issues of service connection for a right shoulder condition and service connection for a left knee condition. Subsequent to the Board's remand, in September 2020, the agency of original jurisdiction granted entitlement to service connection for the left knee and right shoulder conditions, effective the date of the Veteran's separation from service. Thus, those claims are considered granted in full and are no longer before the Board. As was addressed in the April 2020 remand, the Veteran testified at a video conference hearing in September 2019. Unfortunately, audio malfunctions resulted in an inability to produce a complete transcript of that hearing. The Veteran was notified of this in November 2019 and afforded the option of appearing at a new hearing. In December 2019, the Veteran responded to this notification and informed VA that he did not wish to have another hearing and instead wished to proceed with his claim based on the evidence of record. Entitlement to service connection for a right hip condition is remanded. Whenever VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). An adequate medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Here, the Board remanded the claim for a right hip condition to obtain an examination. The purpose of the examination was first to clarify the Veteran's current right hip disability or disabilities, and then to address whether any such disability was caused by or incurred in service. Notably, the Veteran's service treatment records demonstrate that in June 2007, the Veteran was seen for complaints of a one-month history of right hip pain. In July 2007, the Veteran had continued complaints of right hip pain. In February 2009, the Veteran was treated with complaints of right hip pain that had been ongoing for three years and worsened depending on activity level. Service treatment records continued to note right hip pain in June and November 2009. Subsequent to the Board's April 2020 remand, the Veteran underwent a VA examination in August 2020. At that time, the examiner diagnosed degenerative arthritis of the right hip. The examiner then opined that it was less likely than not that the current right hip disability was caused by or incurred in service. By way of rationale, the examiner stated that the right hip condition during service was acute only. The examiner referenced that a May 2002 profile gave the Veteran unrestricted movement of the hips and that a July 2010 right hip x-ray showed no abnormalities of the hip. The examiner then stated that there was no evidence of chronicity of care. First, the Board notes that the examiner did not address the three-year history of in-service right hip symptoms in the Veteran's service as noted above. Therefore, it is unclear whether the examiner considered the entirety of the Veteran's service treatment record. Furthermore, the examiner did not provide any medical rationale for the opinion. To the extent the evidence highlighted by the examiner was significant in forming a conclusion, there is no indication of why that is the case. Such rationale is necessary in providing an adequate medical opinion. Moreover, in addressing chronic disabilities, VA looks to continuity of symptomatology, not to continuity of treatment. Here, the examiner identified the lack of evidence of chronicity of care as supportive of a negative nexus opinion. In doing so, the examiner did not explain why this was medically significant. Therefore, on remand, the AOJ should obtain an adequate medical opinion, supported by medical rationale, addressing whether it is at least as likely as not that the Veteran's current right hip disability was caused by or incurred in service, to include the multiyear history of right hip pain documented in the Veteran's service treatment records. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate examiner regarding the Veteran's documented right hip disability. The examiner should review the entire claims file, to include a copy of this Remand, and the report of examination should include discussion of the Veteran's documented history and assertions. With respect to the Veteran's documented right hip degenerative arthritis, the examiner should render an opinion, as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that the disability had onset in, or is otherwise related to service. In doing so, the examiner should specifically address the Veteran's history of in-service complaints of right hip pain, beginning at least in June 2007 and continuing through at least November 2009. The examiner should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed report. Complete rationale should include an explanation of the evidence used in support of the conclusion, as well as an explanation as to why such evidence supports the conclusion. 2. Then readjudicate the issue on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Giaquinto, 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.