Citation Nr: A19001663 Decision Date: 10/01/19 Archive Date: 10/01/19 DOCKET NO. 190806-18175 DATE: October 1, 2019 REMANDED Entitlement to service connection for a post-operative pilonidal cyst scar is remanded. REASONS FOR REMAND The Appellant served on active duty for training in the U.S. Army Reserve from January 1970 to May 1970. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from an October 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). VA received the Veteran’s notice of disagreement in February 2019 and issued a statement of the case in June 2019. The statement of the case provided information on the Appeals Modernization Act (AMA) of 2017. Later in August 2019, VA received a Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), that requested Direct Review by a Veterans Law Judge, without additional evidence or a Board hearing. As such, the Appellant opted into the AMA, electing the modernized review system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2 (d)); see 38 C.F.R. §§ 3.2400 (c)(2), 3.2500(a)(1)(ii) (eff. Feb. 19, 2019). The Appellant contends that he acquired a pilonidal cyst during basic training and in advance infantry training (AIT) and underwent surgery after active duty for training and later in 1973 and 1976. See September 2019 Appellate Brief. In a March 1970 physical examination, the Appellant reported that he had a pilonidal cyst. On April 24, 1970, the Appellant sought treatment, reporting that the pilonidal cyst was getting worse and was aggravated by bending during work details. He was prescribed “hot soak” and light work. See June 2018 STR-Medical. The record is silent as to any further treatment or surgery for the pilonidal cyst during or after active duty for training. In a June 1974 Reserve quadrennial physical examination, a military examiner noted that the Appellant had undergone an operation at age 18 and that the pilonidal sinus was draining. In a December 2018 statement, the Appellant noted that he underwent the surgery at some time after April 24, 1970 and the start of “summer camp” which the Board interprets as a short period of active duty for training followed by additional surgeries in 1973 and 1976. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d) (2 (2012), 38 C.F.R. § 3.159(c)(4)(i) (2018). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. Although there is no competent medical evidence of this disability, lay evidence from the Appellant and his spouse is competent to report current existence and discomfort or dysfunction from a scar as it is observable by a lay person. There is competent evidence of the onset of a cyst while on active duty for training and a suggestion that any current residuals were caused by the cyst. Therefore, the low threshold for a VA examination is met. Consequently, the Board finds that in order to make a fully informed decision, a VA examination is needed to completely assess whether the Appellant has a current disability of a scar, and if so, whether the current disability onset during active duty for training or was caused by that service. A remand is appropriate under the AMA as there is a shortcoming in VA’s duty to assist the Appellant in substantiating his claim. The matter is REMANDED for the following actions: 1. Take appropriate steps to contact the Appellant and obtain the names and addresses of all medical care providers who treated him for the pilonidal cysts. Of particular interest are surgery records from 1970, 1973 and 1976. After obtaining proper authorization, obtain any relevant records from these providers that are not already of record in order to ensure that complete records from these facilities are of record. If, after making reasonable efforts to obtain named records, the records are unavailable, notify the Appellant and (a) identify the specific records that VA is unable to obtain; (b) briefly explain the efforts that were made to obtain those records; and (c) describe any further action to be taken by VA with respect to the claim. The Appellant must then be given an opportunity to respond. 2. Request any outstanding VA treatment records pertaining to the claims remanded herein. All attempts to secure this evidence must be documented in the claims folder. 3. Thereafter, schedule the Appellant for an examination with an appropriate medical professional. The examiner is requested to perform an in-person examination and to review all pertinent records associated with the claims folder, including the Veteran’s service treatment records, post-service medical records, and lay statements. Based on the review of the Appellant’s claims file, and the in-person examination, the examiner is asked to opine on the etiology of the Appellant’s claimed post-operative pilonidal cyst scar and whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s disability, if present, is related to his military service. A complete rationale for any opinion offered must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2011). 4. Review the claims file to ensure that all of the foregoing requested development is completed and arrange for any additional development indicated. Then readjudicate the claims on appeal. If any of the benefits sought remain denied, issue an appropriate supplemental statement of the case and provide the Appellant and his representative with the requisite period of time to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. The Appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369. This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Abels, 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.