Citation Nr: 20002020 Decision Date: 01/09/20 Archive Date: 01/09/20 DOCKET NO. 06-21 166 DATE: January 9, 2020 REMANDED Entitlement to service connection for familial polyposis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1972 to November 1972, from April 1973 to April 1975 and then from September 1975 to September 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Board notes that jurisdiction of this matter has since transferred to the RO in Waco, Texas. The Board notes that this matter has been the subject of numerous remands by both the Board and the United States Court of Appeals for Veterans Claims (Court). Most recently, in a July 2019 Joint Motion for Remand, the Court vacated the Board’s October 2018 decision and remanded this matter for further development. Entitlement to service connection for familial polyposis is remanded. The Board last remanded this matter in December 2016 for a VA examination and such examination was obtained in November 2017. As the Court noted in the July 2019 Joint Motion for Remand (JMR), the November 2017 VA examiner failed to address numerous service treatment records indicating gastrointestinal symptoms. When VA undertakes to provide a Veteran with an examination, that examination must be adequate for VA purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). As such, the November 2017 VA examination opinion is inadequate, and a remand is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician who has not previously examined him to determine the nature and etiology of his familial polyposis. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including hemorrhoids. The examiner must opine as to whether it clearly and unmistakably (undebatable) preexisted the Veteran’s service. If the examiner finds it did clearly and unmistakably preexist service, the examiner must opine whether it was clearly and unmistakably not aggravated by service. If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including hemorrhoids. The examiner must thoroughly review the entire claims file. In discussing incurrence and aggravation, the examiner should address prior VA examination opinions. The examiner’s attention is invited to the following service treatment records showing gastrointestinal symptoms: May 14, 1973; October 1, 1973; February 18, 1975; May 19, 1976; January 4, 1977; and March 4, 1977. The examiner’s attention in invited to the September 7-10, 1975 VA treatment records concerning the removal of a perianal abscess. The examiner must address the Veteran’s contention that the VA doctors in 1975 told him that he needed to have his large intestines removed as they were the cause of his abscess and that if he didn't have this surgery performed by the age of 35 to 40, he would likely develop colon cancer. 2. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term “as likely as not” does not mean within the realm of possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. 3. After completing the requested actions, and any additional development deemed warranted, readjudicate the claims in light of all pertinent evidence and legal authority. If the benefits sought remain denied, furnish to the Veteran a Supplemental Statement of the Case and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brian P. Keeley 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.