Citation Nr: 21042531 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 12-30 592 DATE: July 13, 2021 REMANDED Entitlement to service connection for a bilateral hip disability, to include as secondary service connection to service-connected bilateral knee disability is remanded. Entitlement to service connection for a lower back disability, to include as secondary service connection to service-connected bilateral knee disability and bilateral hip disability is remanded. REASONS FOR REMAND The Veteran served with the United States Navy from June 1959 to January 1962. Unfortunately, during the pendency of the present appeal, the Veteran passed away in April 2009. Accordingly, the Veteran's surviving spouse has been properly substituted as the Appellant. The Appellant testified before the Board at a hearing in November 2014. Since then, the Veterans Law Judge (VLJ) who held the hearing has retired. The Appellant was provided the opportunity to testify at a new hearing before a VLJ who would decide the claims by way of an April 2021 letter. As of the date of this remand, no response has been received, and therefore, the Board will proceed with readjudication. These matters were previously remanded by the Board of Veterans' Appeals (Board) in November 2019. The Board's November 2019 remand directives and the subsequent actions of the Agency of Original Jurisdiction (AOJ) will be discussed below. These claims have been returned to the Board for further appellate consideration. Although the Board regrets the delay, remand is necessary to ensure that there is a complete record on which to decide the Appellant's claims 1. Entitlement to service connection for a bilateral hip disability, to include secondary service connection to service-connected bilateral knee disability is remanded. Following the November 2019 Board remand, the AOJ was directed to obtain a nexus opinion for the bilateral hip disability claim. The medical professional concluded the Veteran's bilateral hip disability was not caused or aggravated by his bilateral knee disability. Regarding causation, the medical professional reasoned that simple gait accommodation does not cause degenerative joint disease in hips. The medical professional noted this is accepted medical knowledge that degenerative joint disease does not transfer from one joint to another. Regarding aggravation, the medical professional reasoned that the Veteran's hip condition was more likely age related and unrelated to any other condition. See September 2020 VA examination. The Board finds that the medical professional's opinion is inadequate as the examiner did not consider all of the evidence of record, including the Veteran's reports of chronic hip pain. The Veteran reported constant bilateral hip pain which causes him to use a cane with a limping gait. See September 2007 Medical Treatment Record p. 1, May 2008 VA examination, September 2020 Medical Treatment Record pp. 70, 71, 87, 89, 105. In sum the Board finds that new opinions are necessary in order to fully consider the evidence of record. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain an opinion, it must ensure that the examination or opinion is adequate). 2. Entitlement to service connection for a lower back disability, to include secondary service connection to service-connected bilateral knee disability and bilateral hip disability is remanded. Following the November 2019 Board remand, the AOJ was directed to obtain a nexus opinion for the lower back disability claim. The medical professional concluded the Veteran's lower back disability was not caused or aggravated by his service-connected bilateral knee disability. First, the medical professional noted that the Veteran did not have a lower back disability at any time during service. Regarding causation, the medical professional reasoned that degenerative joint disease is not caused by the conditions of another joint. Regarding aggravation, the medical professional found there was no evidence of aggravation beyond the natural course of the Veteran's degenerative spine disease due to any cause. See November 2020 VA examination. The Board finds that the medical professional's opinion is inadequate as it did not adequately consider all of the evidence of record, including prior diagnoses and the Veteran's lay statements. The November 2020 medical professional only provided a nexus opinion for the Veteran's degenerative spine disease and failed to consider the Veteran's diagnoses for lumbar disc disease and moderate spondylosis of L4-S1 with a spondylolisthesis of L4. See May 2008 VA examination; see also September 2020 Medical Treatment Record p. 498. Further, the Veteran testified that his hip disability resulted into his lumbosacral condition. See November 2014 Hearing Transcript. The medical professional only provided an opinion on whether the Veteran's lower back disability was related to his bilateral knee condition. In sum the Board finds that additional opinions are necessary in order to fully consider the evidence of record. See Barr, 21 Vet. App. at 312. (CONTINUED ON NEXT PAGE) The matters are REMANDED for the following action: Obtain a medical opinion regarding the nature and etiology of the Veteran's bilateral hip and lower back disability. Based on the review of the record the medical professional should answer the following: (a.) Is it at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's bilateral hip disability was either (1) caused by or (2) aggravated by his service-connected bilateral hip disability or bilateral knee disability? Separate opinions regarding causation and aggravation are required. The medical professional must address the Veteran's report of bilateral hip pain which causes him to use a cane with a limping gait. See September 2007 Medical Treatment Record p. 1, May 2008 VA examination, September 2020 Medical Treatment Record pp. 70, 71, 87, 89, 105. (b.) For each diagnosed lower back disability, is it at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's lower back condition was either (1) caused by or (2) aggravated by his service-connected bilateral hip disability? Separate opinions regarding causation and aggravation are required. (c.) For each diagnosed lower back disability, is it at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's lower back condition was either (1) caused by or (2) aggravated by his service-connected bilateral knee disability? Separate opinions regarding causation and aggravation are required. The medical professional should note the Veteran has a diagnosis for lumbar disc disease and moderate spondylosis of L4-S1 with a spondylolisthesis of L4. See May 2008 VA examination; see also September 2020 Medical Treatment Record p. 498. Further the examiner must address the Veteran's contention that his hip disability resulted into his lumbosacral condition. See November 2014 Hearing Transcript. A complete rationale for EACH opinion is required. If the medical professional is unable to provide any opinion without resorting to speculation, he or she must explain why this is so. J. O'CONNELL Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Emily A. Kotroco 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.