Citation Nr: 20009770 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 17-59 095 DATE: February 5, 2020 REMANDED Entitlement to service connection for hemorrhoids is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from December 1972 to December 2002. This matter comes before the Board of Veterans’ Appeals (Board) from a June 2014 rating decision by the Regional Office (RO). As an initial matter, the Board notes that the Veteran also appealed the issues of service connection for erectile dysfunction, service connection for keratosis pilaris, and service connection for depression (also claimed as insomnia). In September 2018, the Board remanded the issues of service connection for hypertension and service connection for an acquired psychiatric disability. In an April 2019 rating decision, the RO granted service connection for erectile dysfunction, keratosis pilaris, and depression. Because the Veteran was granted service connection for these disabilities and he has not disagreed with the disability ratings or effective dates assigned, the issues of service connection for erectile dysfunction, service connection for keratosis pilaris, and service connection for depression/acquired psychiatric disorder are no longer on appeal. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). As to hypertension, as the RO is currently undertaken development, that issue is not before the Board at this time. Entitlement to service connection for hemorrhoids is remanded. The Veteran contends that his hemorrhoids are directly related to service. In March 2019, the Veteran was afforded a VA examination for his hemorrhoids. The examination revealed a current diagnosis for internal/external hemorrhoids and reported the Veteran’s history of onset in 2011, including anal itching with occasional bleeding. The examiner opined that the condition was less likely than not related to service because there was no mention of complaints, diagnosis, or treatment for hemorrhoids in service. The examiner also noted that an August 2011 colonoscopy revealed abnormal findings of non-thrombosed external hemorrhoids, highlighting the significant lapse in time since service. The Board finds the March 2019 examination is inadequate as the examiner’s opinion relies solely on the absence of service treatment records to conclude the lack of a nexus between the Veteran’s disability and military service. Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007); see also Smith v. Derwinski, 2 Vet. App. 137, 140 (1992). Furthermore, a review of the service treatment records reveals numerous complaints for hemorrhoid related symptoms including a September 1981 notation for rectal hemorrhage, a November 1990 and June 1991 notation for gastric bleeding, and a September 1999 notation for hemorrhoids. Most notably, an October 1999 colonoscopy record revealed small polyps in the rectum and noted ongoing symptoms of intermittent bloody stools. Because the March 2019 examiner did not consider service treatment records evidencing numerous hemorrhoid related symptoms and treatment, the opinion is inadequate. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). As such, an addendum opinion must be obtained to determine the nature and etiology of the Veteran’s hemorrhoids.   The matters are REMANDED for the following actions: 1. With any necessary assistance from the Veteran, obtain all outstanding VA and private treatment records, if any. All efforts to obtain additional evidence must be documented in the claims file. 2. Obtain an addendum opinion from the examiner who conducted the March 2019 VA examination for hemorrhoids, or an appropriate clinician. The examiner providing the opinions must be provided access to the electronic claims file and indicate review of the file in the examination report. The claims folder and a copy of this remand in its entirety must be provided to the examiner in conjunction with the addendum opinion. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay statements; the examiner must indicate on the examination report that such review was undertaken. If examination of the Veteran is necessary, such should be arranged. After reviewing the claims file, including all objective medical evidence and lay statements provided by the Veteran, the examiner should address the following: Is it at least as likely as not (50 percent or greater) that the Veteran’s hemorrhoids had its onset or is otherwise related to active military service? The examiner must address the above referenced service treatment records of complaints and treatments for hemorrhoid related symptoms, including September 1981, November 1990, June 1991, September 1999, and October 1999. The examiner must provide a rationale in support of all opinions provided. If any opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. 3. Then, readjudicate the Veteran’s claim on appeal. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided a supplemental statement of the case. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Asfaw, 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.