Citation Nr: 20008326 Decision Date: 01/31/20 Archive Date: 01/31/20 DOCKET NO. 14-34 034 DATE: January 31, 2020 REMANDED Entitlement to service connection for a cecal tubulovillous adenoma, originally claimed as a right hemicolectomy, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps January 1979 to January 1983 and from August 1984 to August 2000. This matter before the Board of Veterans’ Appeals (Board) is on appeal from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky (Agency of Original Jurisdiction (AOJ)). The Veteran testified at a Board hearing before the undersigned in June 2017. A transcript of the proceeding is of record. This matter was previously before the Board in February 2019. At that time, the Board denied the claim. The Veteran subsequently appealed the Board’s decision to the Court of Appeals for Veterans’ Claims (the Court). The parties filed a joint motion for remand which the Court granted, vacating the Board’s decision and remanding the claim due to the Board’s reliance on an inadequate examination. Specifically, an October 2018 medical opinion provided that there was “no strong correlation” to support the Veteran’s claim and that it was “difficult to make a strong case for both the causal relationship and the temporal relationships of the tubulovillous adenoma.” The parties agreed that the surgeon seemingly required a strong correlation or a strong case, which is a higher standard of proof than that required under law. See 38 U.S.C. § 5107(b). In light of the Court granting the parties’ joint motion for remand, the Board shall remand this matter for an opinion that, cognizant of the required standard of proof, considers the etiology of the Veteran’s cecal tubulovillous adenoma and provides a thorough rationale. The matters are REMANDED for the following action: 1. The claims folder should be forwarded to a colorectal surgeon to determine whether the Veteran’s cecal tubulovillous adenoma is related to service. The claims file must be made available to and be reviewed by the examiner. The examiner should specifically indicate whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cecal tubulovillous adenoma, which led to right hemicolectomy, first manifested in service, or is causally related to an event in service, to include the presumed exposures at Camp Lejeune? In providing this opinion, the examiner is requested to consider the testimony of the Veteran of being informally told by his treating physician that the tubulovillous adenoma in the cecum, which led to the right hemicolectomy, had to have been present for 5 to 10 years based on the large size in light of the colonoscopy findings obtained in March 2003, June 2005 and July 2008. The examiner should express whether there is any medical reason to accept or reject the Veteran’s belief that his tubulovillous adenoma in the cecum had been present in service based upon the theory expressed above. The examiner must provide all findings, along with 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. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Victoria A. Narducci, 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.