Citation Nr: 21040276 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 16-63 884 DATE: July 3, 2021 REMANDED Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a lumbar spine disability is remanded. VETERAN'S CONTENTIONS The Veteran contends that his right hip and lumbar spine conditions developed as a result of or were aggravated by his bilateral knee conditions. See April 2007 Private Medical Record and May 2007 VA Medical Opinion. Alternatively, the Veteran asserts that his lumbar spine condition began in service. See November 2019 VA Examination. REASONS FOR REMAND The Veteran served on active duty from August 1975 to October 1978. This matter comes before the Board of Veteran's Appeal (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for the Veteran's right hip disability is remanded. This matter was previously remanded in February 2019 for further development to include a VA examination. The case has now returned to the Board for appellate review and, although it again regrets further delay, the Board finds that additional remand is required. After reviewing the medical evidence of record, the Veteran has been diagnosed with the following bilateral knee conditions: (1) left knee patellar femoral syndrome; (2) right knee traumatic gonarthrosis; (3) right knee traumatic synovitis; (4) rupture of medial meniscus of right knee; (5) rupture of medial collateral ligament of right knee; (6) rupture of anterior cruciate ligament; and (7) chondromalacia medial condyle of right knee. ¬¬¬¬ See VA Examinations dated December 1994, July 1997, and February 2002. Following the February 2019 Board remand, a November 2019 addendum opinion was provided. The November 2019 examiner opined that the Veteran's right hip condition was not secondary to his bilateral knee condition. See November 2019 VA Medical Opinion. In support of this conclusion, the November 2019 examiner explained that joint disease or arthritis in one joint does not result in joint disease of the other joint. Notably, the examiner did not explain the reasoning behind this conclusion. Although the Veteran has been diagnosed with degenerative arthritis of the right hip, the Veteran was also diagnosed with a right hip strain and a possible femoral acetabular impingement, which the November 2019 examiner did not address. See October 2018 VA Examination. Further, the February 2019 examiner did not address whether the Veteran's other bilateral knee conditions, as noted above, caused the Veteran's right hip conditions. Further, the examiner failed to acknowledge or address the March 2007 VA treating physician's notation that the Veteran's right hip strain was related to his right knee arthritis. See March 2007 VA Treatment Record. Therefore, the Board finds that the November 2019 VA medical opinion is inadequate for adjudicative purposes. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the Board finds that an addendum opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The VA addendum opinion should determine whether each of the Veteran's current bilateral knee conditions caused or aggravated the Veteran's right hip condition. The examiner should also address and reconcile his or her findings with the March 2007 VA treating physician's notation that the Veteran's right hip strain was related to his right knee arthritis. In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of his right hip disability. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). 2. Entitlement to service connection for the Veteran's lumbar spine disability is remanded. As noted above, although the Board again regrets further delay, the Board finds that additional remand is required. Here, the Veteran's lumbar spine condition has been diagnosed as lumbar spine strain, discitis, and bilateral sacroiliac joint diseases with sclerosis. See November 2011 Private Treatment Record and November 2019 VA Medical Opinion. As detailed in the previous section, the Veteran has multiple bilateral knee conditions. Following the February 2019 Board remand, the November 2019 opined that the Veteran's lumbar spine disability was not caused by or aggravated by his bilateral knee conditions. In support of this finding, the examiner stated that joint disease or arthritis in one joint does not result in joint disease of the other joint. See November 2019 VA Medical Opinion. As noted above, the examiner did not explain the reasoning behind this conclusion. Additionally, the November 2019 examiner did not address whether the Veteran's lumbar spine strain or discitis were caused by his bilateral knee conditions. Neither did the examiner address whether the Veteran's in-service complaints of lower back pain were early manifestations of the Veteran's lumbar spine strain or discitis. See November 2019 VA Medical Opinion. Further, the November 2019 examiner did not address the December 1991 treating physician's finding that the Veteran's inability to use his right leg would predispose the Veteran to a mechanical back injury. See December 1991 Private Orthopedic Examination. Therefore, the Board finds that the November 2019 VA medical opinion is inadequate for adjudicative purposes. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the Board finds that an addendum opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The VA addendum opinion should determine whether each of the Veteran's current bilateral knee conditions caused the Veteran's lumbar spine conditions. The examiner should also address and reconcile his or her findings with the December 1991 private treating physician's that the Veteran's inability to use his right leg would predispose the Veteran to a mechanical back injury. In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of his lumbar spine condition. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matters are REMANDED for the following action: 1. Obtain a new opinion from a new clinician addressing the etiology of the Veteran's right hip and lumbar spine conditions. The clinician should be given a copy of this Board remand. If the examiner request, an examination may be ordered to address the below: (a.) Please state whether it is at least as likely as not that the Veteran's right hip strain and possible femoral acetabular impingement were caused or aggravated by his service-connected bilateral knee conditions. Here, please specifically analyze and address whether each of the following bilateral knee conditions caused his right hip conditions: (1) left knee patellar femoral syndrome; (2) right knee traumatic gonarthrosis; (3) right knee traumatic synovitis; (4) rupture of medial meniscus of right knee; (5) rupture of medial collateral ligament of right knee; (6) rupture of anterior cruciate ligament; and (7) chondromalacia medial condyle of right knee. See VA Examinations dated December 1994, July 1997, and February 2002. (b.) If you do not find that the Veteran's right hip conditions were caused or aggravated by the Veteran's right knee conditions, please reconcile this finding with the March 2007 VA treating physician's notation that the Veteran's right hip strain was related to his right knee arthritis. See March 2007 VA Treatment Record. (c.) Please state whether it is at least as likely as not (50 percent probability or more) that the Veteran's lumbar spine strain, discitis, or bilateral sacroiliac joint diseases with sclerosis had their clinical onset in, was caused by, or is otherwise related to service. For the purpose of providing the opinion requested, please accept as valid the Veteran's statements that he has had lower back pain since service, and state whether a nexus between the Veteran's current lumbar spine disabilities and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). (d.) If you do not find that the Veteran's lumbar spine conditions had their clinical onset during service, please state whether it is at least as likely as not that the Veteran's lumbar spine conditions were caused or aggravated by his service-connected bilateral knee conditions. Here, please specifically analyze and address whether each of the following bilateral knee conditions caused or aggravated his lumbar spine conditions: (1) left knee patellar femoral syndrome; (2) right knee traumatic gonarthrosis; (3) right knee traumatic synovitis; (4) rupture of medial meniscus of right knee; (5) rupture of medial collateral ligament of right knee; (6) rupture of anterior cruciate ligament; and (7) chondromalacia medial condyle of right knee. See VA Examinations dated December 1994, July 1997, and February 2002. (e.) If you do not find that the Veteran's lumbar spine conditions were caused or aggravated by the Veteran's right knee conditions, please reconcile this finding with the December 1991 private treating physician's that the Veteran's inability to use his right leg would predispose the Veteran to a mechanical back injury. See December 1991 Private Orthopedic Examination. In offering any opinion, the examiner should consider medical and lay evidence. The examiner should provide a complete rationale for any opinion rendered. If the examiner's opinion is negative, he or she must clearly explain why, to include a discussion of why the evidence does not support a finding. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Foster, 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.