Citation Nr: 21032541 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 15-38 218 DATE: May 27, 2021 REMANDED Entitlement to service connection for a right hip condition is remanded. Entitlement to service connection for a left hip condition is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) prior to December 12, 2018 is remanded. REASONS FOR REMAND The Veteran served in active duty from September 1986 to August 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in November 2018 and January 2021, at which time it was remanded for a VA medical examination and opinion. Unfortunately, the opinions obtained did not address the specific questions issues requested addressed in the remands. 1. Entitlement to service connection for a bilateral hip condition is remanded. The Veteran was originally denied service connection for bilateral hip disabilities on the basis that a clinically diagnosed hip condition was not found and the pain he experienced was due to his lower extremity radiculopathy. The Board remanded the matter for an examination and opinion as to whether there was any hip disability separate from the already service-connected lower extremity radiculopathy and whether it may be secondary to his service-connected disability. An August 2019 addendum opinion for secondary service connection seemed to suggest that a hip disorder can be caused by partial or complete paralysis related to nerve damage or from an altered gait, however, the examiner did not address these issues. The matter was remanded again to specifically address whether the Veteran's altered gait, moderately incomplete paralysis in the lower extremities, and the falls associated with the back disability could have caused his hip disorder. In a March 2021 medical opinion, the examiner found the Veteran's hip disorder was less likely than not proximately due to or aggravated by his back disability. However, the Board finds the March 2021 medical opinion inadequate for several reasons. First, the examiner does not appear to have considered the Veteran to have significant nerve damage so as to be able to produce hip strain. However, because the Veteran has a moderately severe rating for the right lower extremity and a moderate impairment for the left (both effective from December 2018), clarification on this point should be sought. Secondly, the opinion provider indicated that falls could have many causes, and it was unlikely the Veteran's was due to his lumbar spine disability and radiculopathy. However, none of the other reasons for falls were identified, and no explanation was provided for concluding it was unlikely the Veteran's falls were due to service connected disability. (Notably, the record indicates that a fall in October 2016 was potentially considered a result of the Veteran's back pain, and other records indicated falls could be secondary to leg weakness and numbness.) While the opinion provider attributed the Veteran's hip strain to his body weight, since the other factors note above were not fully discussed, the conclusion concerning the role played by the Veteran's weight may not be considered adequately supported. Thus, the Board finds another addendum opinion is needed. 2. Entitlement to a total disability rating due to individual unemployability (TDIU) prior to December 12, 2018 is remanded. The Board finds a decision on the right and left hip issues could significantly impact a decision on the issue of whether a TDIU is warranted prior to December 12, 2018 (the effective date for TDIU), as the Veteran's bilateral hip claims have been pending since May 2017. Thus, these issues are inextricably intertwined. A remand of the TDIU claim is, therefore, also required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the nature and etiology of any right and left hip disability. The clinician should opine as to whether either hip disorder is at least as likely as not related to his service-connected lumbar spine disability, with radiculopathy, to include either proximately due to the lumbar spine disability with radiculopathy; or aggravated beyond its natural progression by the lumbar spine/radiculopathy disability. The clinician should recognize the Veteran as having incomplete paralysis of the sciatic nerve, and the specific severity of its rating for VA purposes, in offering the opinion. The severity of these disabilities and how that may or may not cause hip disability, or how they do or do not aggravate hip disability should be explained. The opinion should discuss whether service connected disability caused the Veteran to fall and whether this caused or aggravated any claimed hip disability. In addressing this, the reviewer should to the extent possible, identify what factors influence a person to fall, and which are present and absent in the Veteran's case. A rationale should be provided for each opinion expressed. The Board leaves it to the clinician providing the opinion to determine whether additional examination of the Veteran is necessary. 2. After completing the above actions, the Veteran's claims, to include whether a TDIU is warranted prior to December 12, 2018, should be readjudicated based on the entirety of the evidence. M. E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jaigirdar, 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.