Citation Nr: A20008697 Decision Date: 05/15/20 Archive Date: 05/15/20 DOCKET NO. 190629-10677 DATE: May 15, 2020 REMANDED Entitlement to service connection for an inguinal hernia, is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Army from June 1987 to July 1987, from November 1990 to June 1991, and from October 2004 to January 2006. The Veteran filed a claim for entitlement to service connection for an inguinal hernia in March 2019, which was denied by the Agency of Original Jurisdiction (AOJ) in a May 2019 rating decision. The Veteran timely filed a Notice of Disagreement (NOD) using VA Form 10-182, to appeal the matter directly to the Board consistent with the provisions of the Appeals Modernization Act (AMA). The Veteran selected the Direct Review by a Veterans Law Judge (VLJ) option. Direct Review is the appeal option in which a Board decision is issued based on the evidence of record at the time of the prior AOJ decision. Entitlement to service connection for an inguinal hernia, is remanded. The Veteran contends that his inguinal hernia was caused or aggravated by his pancreatic tumor surgery in July 2017. In its May 2019 rating decision, the AOJ determined that the Veteran has a diagnosis of inguinal hernia. The Board is bound by this Favorable Finding. Thus, the remaining issue is whether the Veteran’s inguinal hernia resulted from or was aggravated by the Veteran’s service-connected abdominal scar, status post removal of neuroendocrine tumor, distal pancreatectomy, and splenectomy (pancreatic tumor surgery). The issue of entitlement to service connection for an inguinal hernia as secondary to pancreatic tumor surgery is remanded to correct a pre-decisional duty to assist error that occurred. The Veteran was afforded a VA examination in April 2019. The examiner opined that the inguinal hernia is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's pancreatic surgery. The Board is cognizant that the Veteran has contended that he did not have any type of hernia prior to his July 2017 surgery; however, a May 2017 CT scan revealed an umbilical hernia in the abdomen. The examiner did not address whether the Veteran's inguinal hernia was aggravated by the pancreatic tumor surgery in July 2017. Further, an August 2017 post-surgical CT scan revealed “fluid…tracking into a small fat-containing right inguinal hernia” and a treatment note from June 2018 indicates “inflammatory changes in the anterior mesentery, likely post-surgical.” Given that the examiner did not address aggravation or these potentially pertinent treatment records in the opinion or rationale, the Board finds that the April 2019 opinion was inadequate for rating purposes. When the Board identifies a pre-decisional duty to assist error in an AMA appeal, under Pub. L. No. 115-55, section 2(d)(2); 38 C.F.R. §§ 3.159(c), 20.802(a), the Board will remand the appeal back to the AOJ with instructions to correct the error. Following correction of the error, the AOJ must readjudicate the issue. Pub. L. No. 115-55, § 2(d)(2); 38 C.F.R. § 3.2502. Therefore, the appeal is remanded for an addendum opinion correcting the inadequacies described above. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician to determine the etiology of the Veteran's inguinal hernia. The report should include discussion of the Veteran's documented medical history and assertions. (a) The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's inguinal hernia is related to service. (b) The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability), that the Veteran's inguinal hernia was caused by his service-connected disabilities, including his pancreatic tumor surgery. (c) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's inguinal hernia was aggravated (permanently worsened beyond the natural progress of the disorder) by his service-connected disabilities. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. The examiner is advised that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should explain why. In providing the requested opinions, the examiner should refer to the pertinent evidence of record, including the Veteran's pre-surgery and post-surgery VA treatment records, as well the lay statements in support of his claims. The examiner must provide a complete rationale for any opinions expressed, based on the examiner's clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The examiner should also reconcile all prior reports, as necessary. If it is determined that another VA examination is required in order to provide the requested opinions, such examination should be arranged. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Sneeringer, 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.