Citation Nr: 22019990 Decision Date: 04/04/22 Archive Date: 04/04/22 DOCKET NO. 17-05 077 DATE: April 4, 2022 REMANDED Entitlement to service connection for left hip pain is remanded. Entitlement to service connection for left knee pain is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1971 to February 1973. These matters are before the Board of Veterans' Appeals (Board) on appeal from February 2016 and March 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified, sitting in Des Moines, Iowa, before the undersigned via a videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed. The Board remand these matters in in January 2020 and again in July 2021, at which time it was remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998). These remands included the issue of service connection for a left foot disability and, after the Board's 2021 remand, a December 2021 rating decision granted service connection a left foot condition. As such, this issue is no longer on appeal before the Board. 1. Entitlement to service connection for left hip pain is remanded. 2. Entitlement to service connection for left knee pain is remanded. A July 2021 Board decision remanded the claims and directed the Agency of Original Jurisdiction (AOJ) to obtain addendum opinion to determine the nature and etiology of the Veteran's left hip pain and left knee pain. The March 2020 VA examinations noted diagnoses of left hip strain, left knee degenerative arthritis, and relatively large ossified bone fragment in the suprapatellar recess. However, the Board noted that the examiner did not provide an opinion as to whether the Veteran's left hip pain and left knee pain conditions are at least as likely than not proximately due to or aggravated by his left knee condition. 07/30/2021, BVA Decision; 03/17/2020, C&P Exam (hip); 03/17/2020, C&P Exam (knee). The December 2021 VA examinations indicated that the Veteran did not have current diagnoses regarding his left hip and left knee. 12/21/2021, C&P Exam (hip); 12/21/2021, C&P Exam (knee). Additionally, a January 2022 VA medical opinion from the same examiner merely reiterated that the Veteran is not currently diagnosed with left hip and left knee conditions. The examiner did not provide an opinion regarding whether the Veteran's left hip pain and left knee pain conditions, which were diagnosed during the period on appeal, are at least as likely than not proximately due to or aggravated by his left knee condition. 01/13/2022, C&P Exam. Subsequently, the Veteran asserted that the December 2021 VA examiner did not provide an adequate examination. The Veteran stated that he reported to the examiner that he experiences constant pain in both his left hip and left knee that is sometime tolerable. However, the Veteran further reported that the pain becomes intolerable when aggravated, such as when the Veteran is standing or walking more than three to five minutes. 02/10/2022, Correspondence. The Veteran's statement raises the specter of functional impairment in his left hip and knee. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018) (holding that "disability" refers to functional impairment of earning capacity). As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. Specifically, the December 2021 VA examinations and January 2022 VA medical opinion did not consider the Veteran's reports that he experiences constant pain in his left hip and left knee, and that the pain becomes severe upon aggravation. Additionally, the examiner did not provide adequate opinions as to whether the Veteran's left hip pain and left knee pain are proximately due to or aggravated by his service-connected left foot disability. Based on the foregoing, the Board finds the December 2021 VA examinations and January 2022 VA medical opinion to be incomplete and addendum opinions are needed before an adjudication on the merits. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After completing directive # 1, obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's left hip pain. The clinician is to review the virtual file, including a copy of this Remand, to become familiar with the Veteran's relevant medical history. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. Please complete the "Functional Impact" section of the report. See 2/10/2022 Correspondence. The clinician is to provide an opinion whether any current left hip condition, to include the diagnosis of left hip strain upon March 2020 VA examination, is at least as likely as not related to an in-service injury, event, or disease. Likewise, the clinician must opine as to whether any current left hip condition is at least as likely as not: (a.) proximately due to a service-connected disability, to include a left foot disability; OR (b.) aggravated beyond its natural progression by a service-connected disability, to include a left foot disability. The clinician must consider the prior diagnoses of a left hip condition during the appeals period. See 03/17/2020, C&P Exam (hip). The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. After completing directive # 1 obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's left knee pain. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. Please complete the "Functional Impact" section of the report. See 2/10/2022 Correspondence. The clinician is to provide an opinion whether any current left knee condition, to include left knee degenerative arthritis as diagnosed upon March 2020 VA examination, is at least as likely as not related to an in-service injury, event, or disease. Likewise, the clinician must opine as to whether any current left knee condition is at least as likely as not: (a.) proximately due to a service-connected disability, to include a left foot disability; OR (b.) aggravated beyond its natural progression by a service-connected disability, to include a left foot disability. The clinician must consider the prior diagnoses of a left knee condition during the appeals period. See 03/17/2020, C&P Exam (knee). A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Han 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.