Citation Nr: 22016591 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 19-30 356 DATE: March 22, 2022 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to service-connected bilateral knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1986 to February 1987 and from March 1998 to August 1990. He also had additional service in the Army National Guard. The Veteran testified at a Board hearing in April 2021 before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. Additional VA clinical records were associated with the record that have not been considered by the agency of original jurisdiction (AOJ) in connection with this claim. Nevertheless, there is no prejudice to the Veteran as the AOJ will have the opportunity to consider these records on remand. Entitlement to service connection for a left hip disability, to include as secondary to service-connected bilateral knee disability, is remanded. The Veteran is seeking service connection for his left hip disability. He has asserted that his hip disability is secondary to his service-connected bilateral knee disability due to abnormal gait and weightbearing. In the alternative, he has contended that his hip disability is due to an in-service May 1990 motor vehicle accident. Service treatment records document that the Veteran was injured in a May 1990 motor vehicle accident. Although the records do not specifically mention the left hip, a subsequent clinical record indicates that the Veteran reported leg pain since the accident. The Veteran was afforded a VA examination in June 2018. After examining the Veteran, the examiner diagnosed avascular necrosis (AVN) and status post total left hip arthroplasty (THA). The examiner opined that the condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service-connected condition. The examiner explained that the Veteran had a left THA due to the AVN of the hip. The examiner observed a substance abuse history including nicotine of a half pack per day and previous heavy use of alcohol. The examiner rationalized that risk factors for AVN include excessive alcohol and cigarette smoking. The Veteran complained of chronic back pain, no known history of hip fracture, no history of sickle cell, SLE, etc. His service-connected osteoarthritis bilateral knees did not cause his AVN of the left hip. However, the examiner did not offer an opinion concerning the Veteran's left hip arthritis that was documented in January 2015 VA clinical records prior to his diagnosis of AVN. Moreover, the examiner did not address the Veteran's assertion concerning his hip disability being due to abnormal weightbearing and gait caused by his knees. The Veteran also asserted that a June 2014 fall where he injured his left hip was due to his knees, but this contention, again, was not addressed by the examiner. Further, the examiner did not offer an opinion as to whether the Veteran's bilateral knee disability aggravates his left hip disability. Importantly, the examiner did not provide an opinion as to whether the Veteran's left hip disability was caused by the May 1990 in-service motor vehicle accident. Thus, this examination with opinion is inadequate. As such, given the above, the Veteran should be afforded a new VA examination. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Because of the need to remand, additional VA clinical records dated from February 2020 to the present should be obtained. Further, VA clinical records indicate that the Veteran received private treatment for his hip in the Spring 2017. Thus, the AOJ should attempt to obtain any outstanding private treatment records. The matters are REMANDED for the following action: 1. Obtain VA clinical records dated from February 2020 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment records. Make two requests for the authorized records from any identified private providers, unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left hip disability. The examiner should review the claims file and clearly delineate all left hip disabilities, to include whether the Veteran has left hip arthritis. With respect to each diagnosed left hip disorder, the examiner must opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) related to an in-service injury, event, or disease, including the May 1990 motor vehicle accident. With respect to any left hip disability found not to be due to active service, the examiner must opine whether it is at least as likely as not (1) proximately due to service-connected bilateral knee disability, or (2) aggravated (any incremental increase) by service-connected bilateral knee disability. A detailed rationale for all opinions provided must be given. The examiner must consider the Veteran's service treatment records, post service treatment records and his lay statements. The examiner must specifically address the Veteran's assertions that abnormal weightbearing and gait due to his knees have caused his left hip disability. The examiner must also address the Veteran's contention that the June 2014 fall, which bruised his left hip, was caused by his knees. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.N. Moats 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.