Citation Nr: 22014387 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 14-08 644 DATE: March 12, 2022 REMANDED Entitlement to service connection for a right hip disability, to include as secondary to the service-connected back disability, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to the service-connected back disability, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from July 1965 to September1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2017, the Veteran testified at a hearing before the undersigned. This matter was most recently remanded by the Board in November 2021. The case has been returned to the Board for further appellate review. Unfortunately, another remand is necessary. 1. Entitlement to service connection for a right hip disability, to include as secondary to the service-connected back disability, is remanded. 2. Entitlement to service connection for a left hip disability, to include as secondary to the service-connected back disability, is remanded. The Board remanded this matter in November 2021 to obtain an opinion regarding the etiology of the Veteran's hip disability. In this regard, the VA examiner was directed to address whether it was at least as likely as not that the Veteran's service-connected back disability caused or aggravated the Veteran's hip disability. VA opinions were obtained in December 2021 and January 2022. The December 2021 VA opinion claims to address aggravation, however, the VA examiner primarily relies on a medical study addressing causation. Thus, the December 2021 VA opinion does not sufficiently address the issue of aggravation. The January 2022 VA opinions all rely on the same analysis to address both causation and aggravation. Specifically, the VA examiner opined that, because there is no objective evidence that the Veteran's service-connected back condition altered the alignment of the Veteran's hips, the Veteran's hip condition could not have been caused by or aggravated by his service-connected back condition. The Board finds that the January 2022 VA opinions do not contain a sufficient rationale for this finding. Specifically, the VA examiner appears to the conclude that the Veteran's hip condition was not caused by or aggravated by his service-connected back condition solely because his service-connected back condition did not alter the alignment of the Veteran's hips, without any further explanation. Because the December 2021 and January 2022 opinions are inadequate, remand for a new VA opinion is warranted. The matters are REMANDED for the following action: Obtain an opinion, preferably with a qualified clinician who has not previously examined the Veteran, to determine whether the Veteran's hip disability is related to the Veteran's military service. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled. After review of the claims file, and examination of the Veteran if deemed necessary, the examiner opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the Veteran's hip disability began in or is otherwise caused by the Veteran's active service. In addition, the examiner should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the Veteran's hip disability was (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran's service-connected back disability. Please note, causation and aggravation are separate concepts and must be addressed independently. In providing his or her opinion, the examiner must address (1) the Veteran's contention that his service-connected back disability affected the alignment of his hips, (2) the Veteran's contention that the pain caused by his service-connected back disability affected the Veteran's gait, thereby either causing or aggravating his hip disability, and (3) the 2009 VA examination report which reflects that the Veteran likely had abnormal hip biomechanics due to muscle tendinopathy, as well as the Veteran's history of hip injuries concurrent with his back injuries, most notably a February 2009 private treatment record reflecting a left hip injury and low back strain accompanied by a pulled muscle. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Elias, 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.