Citation Nr: 21064015 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 17-02 390 DATE: October 18, 2021 REMANDED Entitlement to service connection for appendix condition and/or residuals of appendectomy removal as secondary to service-connected inguinal hernia is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to August 1968 and from May 1974 to November 1974. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in September 2019. 1. Appendix Condition and/or Residuals of Appendectomy Removal Unfortunately, another remand is warranted in this case. The Board sincerely regrets the additional delay, but further evidentiary development is necessary before the Veteran's claim can be adjudicated on the merits. The Board acknowledges receipt of an April 2020 opinion concluding that the Veteran did not have significant residuals of his appendectomy removal which were caused and/or aggravated by his now service-connected inguinal hernia. The examiner stated that the Veteran's appendectomy occurred in 2017. However, a review of the claims file notes that the Veteran underwent an appendectomy in December 2015 after reporting pain in the hernia area and undergoing a CT scan the previous month. See November 2015 VA Infectious Disease Note; November 2015 VA Telephone Encounter Note; December 2015 VA Surgery H&P Consult; December 2015 VA Operative Note and Nursing Note. Therefore, the Board finds that, in part, the April 2020 opinion is based on an inaccurate factual premise and therefore is inadequate to determine the etiology of any and all residuals of the Veteran's appendectomy. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). Additionally, the VA provider interpreting the Veteran's November 2015 CT scan indicated that "[n]eoplastic etiology cannot be excluded" from determining the cause of the Veteran's appendix enlargement. See November 2015 VA Telephone Encounter Note. The April 2020 clinician providing the medical opinion did not address this finding. Consequently, the Board finds that an addendum opinion should be obtained as to the nature and etiology of any and all residuals of the Veteran's December 2015 appendectomy throughout the period on appeal. The matters are REMANDED for the following action: Forward the claims file to an appropriate clinician who has not previously provided an opinion in this matter to determine the nature and etiology of the Veteran's appendix condition and any and all residuals of the Veteran's December 2015 appendectomy throughout the period on appeal. If the clinician determines that an examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. (a) The clinician should identify any and all residuals, including pain, of the Veteran's December 2015 appendectomy attributable to the Veteran throughout the period on appeal. (b) If the clinician identifies pain as a residual of the Veteran's December 2015 appendectomy, he or she should determine whether the Veteran's pain is such that would reach a level of functional impairment that would affect the Veteran's earning capacity. (c) For the Veteran's appendix condition diagnosed in November 2015 and each residual condition so identified and/or if the clinician determines that the Veteran's pain is such that would reach a level of functional impairment that affects earning capacity, the clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's appendix condition, residual condition, and/or pain was either (i) caused or (ii) aggravated by his service-connected inguinal hernia. NOTE: With respect to the question concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require "permanent worsening" of the nonservice-connected disability. If aggravation is found, the clinician should attempt to identify the baseline level of severity of disability prior to such aggravation. In formulating his or her opinion(s), the clinician should consider and address the competent medical and lay evidence of record, including but not limited to: (i) The Veteran's VA medical records, including but not limited to the November 2015 Telephone Encounter Note finding that a neoplastic etiology could not be excluded to determine the cause of the Veteran's enlarged appendix, the records surrounding the Veteran's December 2015 appendectomy, and the Veteran's medical records since that time indicating any residual conditions and/or pain; and (ii) The Veteran's competent lay statements regarding the onset and continuity of his symptomatology. If the clinician determines that the Veteran's appendix condition, residual condition(s), and/or pain is/are less likely than not caused and/or aggravated by his service-connected inguinal hernia, the clinician should discuss what other factor(s) caused the disorder(s) and/or pain. In other words, the clinician should ascertain the most likely etiology of the Veteran's appendix condition diagnosed in November 2015, residual condition(s), and/or pain from his December 2015 appendectomy. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoffman 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.