Citation Nr: 21032233 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 20-04 321 DATE: May 26, 2021 REMANDED Entitlement to service connection for a bilateral hip disability, to include as secondary to service-connected degenerative arthritis of the spine with stenosis and spondylolisthesis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 1961 to August 1962 and from May 1963 to November 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision letter issued by the Department of Veterans Affairs (VA) Regional Office (RO). For the reasons noted below, the Board finds that remand is warranted. In a March 2021 statement, the Veteran reiterated his position that his bilateral hip disability is due to his repeated jumps in service as a paratrooper or, alternatively, to his service-connected back disability. Turning to the medical evidence, an April 1976 service treatment record (STR) reflects a complaint of throat and leg problems with leg and muscle spasms noted. A May 1979 STR reflects a complaint of headache and pain down his complete back with no other symptoms. An undated STR reflects a chief complaint of a painful knot in right side at the waist. A September 2010 private treatment record reflects an x-ray of the bilateral hips and spine as the Veteran required a bone density assessment due to a condition associated with low bone mass/ bone loss (primary hyperparathyroidism). A November 2015 private treatment records reflects a note of hips show mild arthritis, but the real problem is his lower back, lots of degeneration of discs. A June 2019 private treatment record reflects an assessment of right lateral thigh pain from stenosis. A September 2019 VA medical center (VAMC) record reflects an active problem of bilateral hip pain present since back pain began years ago and is likely secondary to degenerative disease. Following VA hips examination in January 2021, the examiner diagnosed the Veteran with degenerative arthritis of the left hip. He opined that the claimed condition is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that, while the Veteran complained of hip pain during service, there is no documentation of record that there has been continued care and treatment of the condition. He stated that there is a greater than 35 year gap and was unable to confirm if the Veteran's current degenerative arthritis of the hip is related to the hip pain which occurred during service. He also stated that injuries following parachute jumps have been intensively studied (>200,000 jumps) and lower extremity injuries made up 65 percent of total injuries. He found that the data supports acute injury associated with parachute jumps; however, there is no evidence of late onset conditions associated with parachute jumps and cited the literature. Here, the record suggests that the Veteran was being treated for hip and back disabilities in approximately September 2010. This record is 26 years after the Veteran's separation from service in 1984 (and not 35 years as stated by the January 2021 examiner). As such, the 35 year reference point found in the January 2021 examiner's opinion is an inaccurate fact. Opinions based on inaccurate facts, particularly when the inaccurate facts are directly related to the basis of the opinion, have no probative value. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). Thus, the Board finds that the January 2021 VA examiner's opinion is inadequate for VA adjudication purposes. The January 2021 VA examiner next opined that the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of Veteran's service-connected condition. The rationale was that arthritis in one joint does not cause arthritis in another joint. The examiner found that a thorough review of medical literature failed to show such causal relationship. He stated that it is not unusual for two joints to share properties in the same person, but one joints disease does not spread to another or cause damage to it. He concluded that the bilateral hip disability is less likely than not related to the degenerative arthritis of the spine with stenosis and spondylolisthesis as a nexus has not been established. The examiner also opined that the Veteran's condition is less likely than not aggravated beyond its natural progression by the service-connected condition. The rationale was that there is no evidence of record or upon examination that there has been aggravation of the bilateral hip disability by the service connected degenerative arthritis of the spine with stenosis and spondylolisthesis or any other service connected disability. The examiner also reviewed the conflicting medical evidence and opined that, as far as the September 2018 private treatment report noting that the Veteran's left hip pain was almost certainly due to his lumbar stenosis, arthritis in one joint does not cause arthritis in another joint. He found that a thorough review of medical literature failed to show such causal relationship and remarked that it is not unusual for two joints to share properties in the same person but one joints disease does not spread to another or cause damage to it. The examiner concluded that the bilateral hip disability is less likely than not related to the degenerative arthritis of the spine with stenosis and spondylolisthesis. The Board notes that, although the January 2021 VA examiner addressed the September 2018 private treatment record, there are multiple records which suggest that the bilateral hip condition may be secondary to the back condition. As noted above, the November 2015 and June 2019 private treatment providers, as well as a September 2019 VAMC provider note, reflect assessments indicating that the bilateral hip condition is secondary to degenerative disease/stenosis. Here, the January 2021 examiner's rationale that arthritis in one joint does not cause arthritis in another joint is conclusory and not supported by a more reasoned medical explanation. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez, 22 Vet. App. at 301. It is a medical examiner's responsibility to provide a well-supported opinion so that the Board may carry out its duty to weigh the evidence of record. Id. at 304. A medical opinion is not entitled to any weight if it contains only data and conclusions. As such, the Board finds the January 2021 VA examiner's opinion concerning secondary service connection also is inadequate. There is no other opinion of record addressing the contended etiological relationship between a bilateral hip disability and active service. Thus, on remand, the RO should obtain another opinion which addresses these matters. The RO also should obtain the Veteran's updated treatment records. The matters are REMANDED for the following action: 1. Conduct any appropriate development to obtain the Veteran's updated treatment records. 2. Thereafter, forward the claims file and a copy of this REMAND to a clinician for an opinion concerning the nature and etiology of the Veteran's bilateral hip disability. If possible, this opinion should be obtained from a clinician other than the clinician who provided a January 2021 VA medical nexus opinion. The decision of whether the Veteran should report for examination is left to the discretion of the clinician asked to provide the requested opinion(s). Based on a review of the claims file and the results of the Veteran's physical examination (if held), the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a hip disability, if diagnosed, is related to active service or any incident of service, including as a result of in-service parachute jumps. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's service-connected degenerative arthritis of the spine with stenosis and spondylolisthesis caused or aggravated (permanently worsened) a hip disability, if diagnosed. A rationale must be provided for any opinion(s) expressed. A separate opinion and rationale should be provided for each of the Veteran's hips, if appropriate. If any requested opinion(s) cannot be provided without resorting to speculation, then the clinician must explain why this is so. The clinician is asked to address the clinical significance, if any, of September 2010 x-ray of the hips and spine, November 2015, September 2018, and June 2019 private treatment records, and November 2019 VAMC treatment records noting that the Veteran's hip pain is likely secondary to degenerative changes/stenosis. The clinician is advised that the lack of contemporaneous records documenting complaints of or treatment for a hip disability, alone, is insufficient rationale for a medical nexus opinion. The clinician also is advised not to review or rely upon a January 2021 VA medical nexus opinion in preparing his or her own opinion. 3. Readjudicate the appeal. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Alli, 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.