Citation Nr: 21042579 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-13 948 DATE: July 13, 2021 REMANDED Service connection for a left hip disability is remanded. REASONS FOR REMAND The Veteran had active service from November 2002 to October 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision issued by the Department of Veterans Affairs regional office (RO) in Lincoln, Nebraska. In July 2019, the Veteran testified before the undersigned at a videoconference hearing; a transcript of the hearing is of record. The instant matter was before the Board in November 2019 and returns for adjudication. Service connection for a left hip condition is remanded. The Board regrets having to remand this matter a second time; however, such is necessary before an informed decision can be made in this appeal. The Veteran contends that he has a left hip disability that is due to his service-connected knee disabilities. See March 2015 Claim; July 2019 Hearing Transcript, p. 3. The first evidence documenting a left hip issue is dated in February 2014, at which time the Veteran was diagnosed with Guillain Barre Syndrome (GBS) and told a VA nursing provider that he had pain in his left hip. In follow-up appointments to assess his GBS, the Veteran noted tingling in hip. At a June 2015 VA examination, the examining clinician noted a diagnosis of right trochanteric pain syndrome but stated that there was no diagnosis referable to the left hip. The Veteran told the examiner that he started to notice pain and stiffness in his left hip in 2008 and had received some chiropractic therapy. The examiner opined that there was insufficient clinical evidence to support a diagnosis associated with a left hip condition, given the normal X-ray findings and normal gait observed on physical examination. At his July 2019 Board hearing, the Veteran testified that he believed his left hip condition to be secondary to his service-connected knee conditions, insofar as he had developed an antalgic gait throughout the musculoskeletal system. The Veteran submitted a letter from private provider Dr. R.B. in July 2019. Dr. R.B. noted that the Veteran had been a patient for several years and had primary complaints in his left knee and left lumbopelvic, sacroiliac, and hip areas. It was his medical opinion that the injury and reconstruction surgeries in the Veteran's left knee contributed to the hip problems, likely due to the deleterious effects of his antalgic gait on the musculoskeletal system. The Board, in its November 2019 Remand, noted that Dr. R.B. did not reconcile his conclusions with the prior evidence of record showing that the Veteran's left hip problems appeared to stem from his GBS diagnosis. The Board remanded the claim so that the Veteran could undergo a hip examination. The agency of original jurisdiction (AOJ) attempted to contact the Veteran to schedule this examination, but the Veteran did not confirm he would attend. The AOJ proceeded to readjudicate the appeal without an examination or an opinion. While an examination may be informative as to the nature and etiology of the Veteran's claimed left hip disability, if an in-person examination is not possible, there may still be sufficient information in the record such that a medical professional can opine on the potential relationship between any left hip disability and his service-connected knee or back conditions. Accordingly, on remand, the Veteran should be afforded another opportunity to appear at an in-person examination. Should he not attend, an opinion addressing the etiology of the claimed left hip disability must still be obtained. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify, submit, or authorize VA to obtain any VA or private treatment records not already on file that he believes are pertinent to his appeal. 2. Schedule the Veteran for a hip examination. The claims file must be made available to the examiner for review, and all indicated tests should be performed. The examiner is requested to take a history from the Veteran as to the onset and progression of his left hip disability. The examiner should address the following: a) Identify all left hip disabilities found to be present since the date of the claim (i.e., March 2015). If the Veteran's left hip disability cannot be attributed to an underlying diagnosis, please still address whether any such condition manifests in functional impairment such as limitation of motion, weakness, instability, or the like. A condition manifested by pain and functional impairment is in fact a disability for VA purposes. b) For each identified left hip disability, state whether it is at least as likely as not (approximately 50 percent probability) that such has been caused or aggravated by the Veteran's service-connected bilateral knee and/or back disabilities. The examiner should consider treatment the Veteran has received for Guillain-Barre syndrome, as well as Dr. R.B.'s July 2019 opinion that the Veteran's left knee injury has contributed to his hip problems due to the effects of his antalgic gait on the musculoskeletal system. If the Veteran does not appear for an in-person examination, the file should still be sent to a medical provider for responses to the questions above, after a complete review of the record. If in the opinion of the reviewing clinician, responses to the questions above cannot be provided without an examination, this should be made clear with an explanation as to why. All opinions should be supported by a medical explanation or rationale. 3. Then readjudicate the issue on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.