Citation Nr: 22017432 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 18-18 732 DATE: March 25, 2022 REMANDED Entitlement to service connection for iliopsoas tendonitis, right hip (claimed as right hip condition), to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 2008 to October 2009 and from January 2011 to June 2011. This issue comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for iliopsoas tendonitis, right hip (claimed as right hip condition), to include as secondary to service-connected disabilities is remanded. The Veteran contends that his iliopsoas tendonitis of the right hip (claimed as right hip condition) was caused or aggravated by active duty service. Additionally, the Veteran contends that his iliopsoas tendonitis of the right hip was caused or aggravated by his service-connected back condition. See November 2021 Hearing Transcript. The Board notes that the Veteran was granted service connection for lumbosacral strain in April 2016. In addition, the Veteran submitted physical therapy notations that indicate that the Veteran's back pain corresponds with his right hip flexors. See Medical Treatment Records. A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110, 1131 (2012). Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be also established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. This claim was denied based on a lack of in-service complaints or treatment for the Veteran's right hip condition. Importantly, post-service records document continued complaints of and treatment for back pain from 2009 with complaints and treatment for right hip pain beginning in 2011. See Service Treatment Records. The Board notes that the Veteran underwent one VA hip and thigh condition examination for compensation and pension purposes; however, an etiology opinion regarding the hip disorder, to include if it was secondary to the recently service-connected back condition, has not been rendered. See December 2015 VA Examination. Notably, the December 2015 examiner rendered a positive nexus opinion for the Veteran; unfortunately, the nexus was based on injuries and treatment that did not occur during active-duty service. At this time, there is insufficient medical evidence for the Board to decide this claim. As such, it must remand this matter to secure a VA medical opinion on the etiology of the Veteran's claimed right hip disorder. McLendon v. Nicholson, 20 Vet. App. 79, 81(2006). The matters are REMANDED for the following action: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 2. Obtain a VA medical opinion regarding the etiology of the Veteran's right hip condition from a medical professional with appropriate expertise. The claims file must be forwarded and reviewed by the examiner. A notation should be made on the examination report that the claims file has been reviewed. Based on a review of the record, the examiner is to render the following opinions: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's right hip condition is the result of active-duty service? (b.) If the answer to (a.) is negative, then whether it is at least as likely as not that the right hip condition was caused by the Veteran's service-connected back condition? (c.) If the answer to (b.) is negative, then whether it is at least as likely as not that the right hip condition was aggravated beyond its natural progression by the Veteran's service-connected back condition? Please explain in detail any opinion provided and the supporting rationale. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. "Aggravation" means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease, and not due to the natural progress of the nonservice-connected disease. If aggravation is found, the examiner should attempt to quantify the extent of additional disability resulting from the aggravation. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. The examiner must specifically address, and reconcile to the extent possible, his or her medical opinion with the December 2015 VA medical opinion. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.