Citation Nr: 25005709 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 16-26 937 DATE: April 25, 2025 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to a left knee disability and/or a right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1981 through November 1985 in the United States Air Force. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office. This matter has been before the Board several times. Most recently, a March 2023 Board decision denied entitlement to service connection for the Veteran's left hip disability. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2024 decision, the Court vacated the March 2023 Board decision. This issue has now been returned to the Board for adjudication. Entitlement to service connection for a left hip disability, to include as secondary to a left knee disability and/or a right knee disability, is remanded. The Board finds it necessary to remand this matter for an additional medical opinion to address the etiology of the Veteran's left hip disability. The Veteran has asserted that his left hip disability is secondary to his service-connected left knee and/or right knee disabilities. In a May 2022 Board decision, the matter was remanded to the VA Regional Office to obtain a medical opinion which addresses several questions. Notably, the Board requested the examiner to opine as to whether or not the Veteran's left and/or right knee disabilities caused the Veteran's left hip disability; as well as whether or not the Veteran's left and/or right knee disabilities aggravated the Veteran's left hip disability. The Board specifically requested that the examiner provide separate and distinct rationales for causation and aggravation. In August 2022, a medical opinion was provided regarding causation and aggravation. However, the examiner's rationale for aggravation was not separate and distinct from the rationale for causation. Thus, the Board finds that there has not been substantial compliance with the May 2022 Board remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, remand is necessary to obtain a separate opinion regarding whether the Veteran's left and/or right knee disabilities aggravated his left hip disability, in compliance with the Court's September 2024 decision. Accordingly, this matter is REMANDED for the following action: Request a medical opinion from a qualified clinician which addresses the etiology of the Veteran's left hip disability. In person examination is not required unless deemed necessary by the examiner. The entire claims file, to include this remand directive, should be provided to the examiner for review. After review of the claims file, the examiner is asked to provide an opinion to the following questions: (a.) Whether it is at least as likely as not that the Veteran's left hip disability was aggravated by his service-connected right knee disability. (b.) Whether it is at least as likely as not that the Veteran's left hip disability was aggravated by his service-connected left knee disability. The examiner is advised "aggravation" means any increase in the severity of the underlying disability. NOTE: Proximate cause is not required. It is sufficient if the Veteran's knee condition was a contributing factor to the aggravation of his left hip disability. A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. The VA Regional Office will review the medical opinion(s) to ensure substantial compliance with the Board's directives. The VA Regional Office will take any additional corrective action necessary to ensure substantial compliance.? J. Abrams Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Crain, N. 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.