Citation Nr: 20021395 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 16-00 842 DATE: March 25, 2020 ORDER Entitlement to service connection for status post residuals associated with hernia surgery due to ulcers is granted. REMANDED Entitlement to service connection for anemia is remanded. FINDING OF FACT The Veteran’s status post residuals associated with hernia surgery due to ulcers are proximately due to surgery to repair his service-connected bleeding ulcer. CONCLUSION OF LAW The criteria for service connection for status post residuals associated with hernia surgery due to ulcers are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1972 to July 1981 and from January 1991 to April 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection - Status Post Residuals Associated with Hernia Surgery Due to Ulcers The Veteran contends that he has a hernia that is secondary to his service-connected gastric, peptic and duodenal ulcer, status post vagotomy with pyloroplasty. He reported that he initially underwent surgery in March 1994 in order to repair bleeding ulcers. In 1996, he noticed a lump at the incision site which was determined to be a ventral incisional hernia. See Statement in Support of Claim, dated April 2015. The Veteran indicated that he subsequently multiple abdominal surgeries to repair his ventral hernia at the incision site of the initial surgery in 1994, 1998, 2000, 2004, 2007, 2008, 2010, and February of 2014. After review of the record, the Board finds that the evidence supports the Veteran’s contentions, and that service connection is warranted for a ventral hernia, as a residual of surgery performed to repair his service-connected ulcer. An April 2014 private medical record shows that the Veteran underwent surgery to repair a recurring incisional ventral hernia, reflecting a current disability. Thus, the question becomes whether the current disability is related to his service-connected disability, as he has claimed. The Board notes that the Veteran underwent surgery to repair a bleeding ulcer in 1994. In September 1998, he was seen for a possible rupture of the prior surgery. An October 1998 medical record shows that the Veteran had a large upper abdominal midline ventral hernia secondary to his surgery in 1994. The hernia had been present for at least a year and was thought to be enlarging. Later that month, the Veteran underwent a surgery to repair the hernia using mesh. In March 2005, the Veteran underwent surgery for a recurrent ventral incisional hernia. The operative report reflected that the Veteran’s surgical history included a vagotomy and antrectomy via a midline incision, followed by a repair of a ventral hernia. He subsequently had a laparotomy for a small bowel obstruction and a repair of a recurrent hernia. The Veteran underwent another surgery in February 2014 to repair multiple recurrent incisional hernias with adhesion to mesh. The Board finds that the evidence of record attributes the Veteran’s current ventral hernia to the surgery originally performed in March 1994 to address his bleeding ulcers. The Veteran was provided with a VA examination in April 2014. The examiner was asked to opine as to whether the Veteran had a diagnosed disability that was related to “a specific exposure event experienced by the Veteran during service in Southwest Asia.” The examiner acknowledged that the Veteran had a history of ventral hernias but found that they were less likely as not related to any exposure during his service in Southwest Asia, based on the absence of any treatment for or diagnosis of a ventral hernia while the Veteran was in service. The Board finds that this opinion does not provide probative value in this case, for the following reasons. The examiner was only asked to opine as to the Veteran’s final period of service; however, there has been no opinion provided as to the Veteran’s contention that his current ventral hernia is a result of surgeries performed to address his bleeding ulcers, for which is he now service connected. As the opinion does address whether the Veteran’s current ventral hernia is related to his surgery to repair a bleeding ulcer, for which he is service connected, it is not probative. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current ventral hernia is due to surgery to repair his bleeding ulcer. Accordingly, the Board finds that service connection for status post residuals associated with hernia surgery due to ulcers is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Service connection - Anemia The Veteran has contended that he has anemia that should be service connected. An April 2014 VA examination shows the examiner’s assessment that the Veteran did not have anemia at the time of the examination, but it is unclear whether he has had anemia during the appeals period. McClain v. Nicholson, 21 Vet. App. 319 (2007). It appears that the Veteran has been in receipt of ongoing VA treatment; however, the most recent VA medical records in the claims file are dated in September 2014. Any VA treatment records are within VA’s constructive possession and are considered potentially relevant to the issues on appeal. A remand is required to allow VA to obtain them. In addition, an opinion should be obtained as to whether the Veteran has anemia that is related to service or to a service-connected disability, to include his ulcers. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records reflecting treatment since September 2014. (Continued on the next page)   2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any anemia. The examiner must opine whether it is at least as likely as not (1) related to an in-service injury, event, or disease, (2) proximately due to service-connected gastric, peptic and duodenal ulcer, status post vagotomy with pyloroplasty, or (3) aggravated beyond its natural progression by service-connected gastric, peptic and duodenal ulcer, status post vagotomy with pyloroplasty. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Harrigan Smith 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.