Citation Nr: 21071082 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-26 078 DATE: November 29, 2021 REMANDED Entitlement to a compensable rating for right inguinal hernia status post-repair is remanded. Entitlement to a compensable rating for a scar associated with right inguinal hernia repair is remanded. Entitlement to service connection for stomach ulcers, to include as secondary to service-connected conditions or the medications taken for them, is remanded. Entitlement to service connection for a lumbar spine condition, to include as secondary to the right inguinal hernia, is remanded. Entitlement to service connection for a right knee condition, to include as secondary to the right inguinal hernia, is remanded. Entitlement to service connection for a left knee condition, to include as secondary to the right inguinal hernia, is remanded. Entitlement to service connection for a condition of the hips (claimed as bone deterioration), to include as due to radiation, is remanded. Entitlement to a total disability rating due to individual unemployability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1976 to August 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2013 and January 2016 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in July 2021. After review of the record, the Board finds that remand is required for all the claims. Regarding the Veteran's claims for a compensable rating for right inguinal hernia and scar associated with hernia repair, in a September 2019 brief the Veteran's representative asserted that the examinations of record are outdated and do not reflect the current severity of the Veteran's conditions. With respect to the hernia, at the July 2021 Board hearing the Veteran testified that the condition has worsened to being constantly painful and swollen, and he has also been prescribed a support belt. Regarding the scar, he indicated that it is painful, and at an August 2018 hearing before a decision review officer, the Veteran offered an estimate of the size of the scar (approximately 3.5 inches long and 0.5 inches wide) that was substantially larger than the measurements provided at the most recent examination of record (4 centimeters long linearly). Given the evidence that the Veteran's conditions may have worsened to a degree that could warrant higher ratings, new examinations should be provided. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also 38 C.F.R. §§ 3.326(a), 3.327(a). Regarding service connection for stomach ulcers, in the September 2019 brief the Veteran's representative cited information that medications, to include NSAIDs prescribed for treating the Veteran's service-connected conditions, are a factor in stomach ulcers. Though a VA examination was provided in May 2017 and an opinion regarding a direct connection to service was provided, there has not been an opinion regarding any relation to the medication taken for the Veteran's service-connected conditions. Given the information indicating a potential connection, the Board will remand the claim for a new examination and opinion. McLendon v. Nicholson, 20 Vet. App. 79, 83, 86 (2006) (applying 38 U.S.C. § 5103A(d)); see also 38 C.F.R. § 3.159(c)(4). The Board takes this opportunity to note that the record reflects that in February 2019 the Veteran was scheduled for examinations to assess his hernia, scar, and stomach ulcers, and that the Veteran failed to appear for the examinations. The Board emphasizes to the Veteran the importance of attending the examinations that will be scheduled on remand following this decision. The examinations are intended to obtain information highly relevant to substantiating the Veteran's claims, and without such information the evidence may not be sufficient to grant the relief the Veteran seeks. Moreover, for claims for increased evaluations or original claims for service connection, regulation directs VA to outright deny the claim where a veteran fails to report for an examination without providing good cause. See 38 C.F.R. § 3.655(b); see generally Wood v. Derwinski, 1 Vet. App. 190, 193 (1990). Regarding the Veteran's claims for conditions of his lumbar spine and bilateral knees, VA examinations and etiology opinions were provided regarding a direct relation to the Veteran's service, to include an incident in 1977 in which, while rappelling down a rope from a helicopter in a training exercise, the Veteran's rope became tangled with another servicemember's, they both fell, and the Veteran was fallen on by the other servicemember. The Veteran has also contended, however, that he needs to wear a support belt for his inguinal hernia which causes him to need to walk "gap legged," and walking with this altered gait causes pain in his lower back and knees. Though a clinician was asked in May 2017 to opine on any secondary etiologies, the clinician unfortunately did not address this specific theory. Accordingly, the Board must remand for an examination that adequately addresses the Veteran's contention. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Regarding the Veteran's claim originally characterized as "bone deterioration due to radiation," the Veteran explained at the July 2021 Board hearing that this was specifically a condition in his hips. The Board has therefore restyled the Veteran's claim as seeking service connection for a condition of the hips, to include as due to radiation. With respect to the Veteran's contention of radiation exposure, he describes that while serving in Panama he and other servicemembers took a rest on a concrete slab that was near an installation surrounded by danger signs (resembling an electricity installation), and that when an officer realized that they were sitting on the slab, they were immediately ordered off it and to go be checked for radiation exposure. The Veteran also asserts that the condition could be due to the in-service incident in 1977. Treatment records establish that the Veteran has been diagnosed with bilateral avascular necrosis, and given the evidence of the Veteran's in-service injury in 1977, the Board will remand for an opinion that considers a potential relation to service. McLendon, 20 Vet. App. At 83, 86; 38 U.S.C. § 5103A(d)); see also 38 C.F.R. § 3.159(c)(4). Finally, throughout the appeal period the Veteran has asserted that he is unemployable due to his service-connected disabilities, to include the functional impairment from his service-connected hernia. Where the evidence raises the issue of unemployability due to service-connected disabilities in a claim for an increased rating, entitlement to a total disability rating due to individual unemployability (TDIU) must be adjudicated. Rice v. Shinseki, 22 Vet. App. 447, 448, 449 (2009). Here, since remand is needed to assess the current functional impairment caused by the Veteran's service-connected disabilities, and since the claims for service-connection for other disabilities could affect the Veteran's combined functional impairment due to service-connected disabilities, entitlement to a TDIU is intertwined with these claims and must be remanded with them. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for an examination regarding the current severity of his service-connected right inguinal hernia. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner should consider and discuss that the Veteran constantly wears a support belt, as well as a September 2016 CT scan that found the right inguinal hernia present. 2. Schedule the Veteran for an examination regarding the current severity of his service-connected scar associated with right inguinal hernia repair. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 3. Schedule the Veteran for an examination regarding the nature and etiology of any gastrointestinal condition, claimed as stomach ulcers, to include a diagnosis of GERD provided at a May 2017 VA examination. For any condition diagnosed, the examiner must opine whether the Veteran's condition at least as likely as not is (a) proximately caused by OR (b) aggravated (worsened beyond the natural course of the disease) by the Veteran's service-connected conditions to include PTSD or the medication taken for those conditions. 4. Obtain opinions regarding the etiology of the Veteran's lumbar spine and bilateral knee conditions. The clinician must opine whether the Veteran's conditions are at least as likely as not (a) proximately due to or (b) aggravated (worsened beyond the natural course of the disease) by the Veteran needing to walk "gap legged" while wearing a support belt for his right inguinal hernia. 5. Obtain opinions regarding the etiology of the Veteran's condition of the hips, to include diagnosed avascular necrosis. The clinician should opine whether the Veteran's condition at least as likely as not is due to the Veteran's service, including: (a) An injury in 1977 in which, while in a training exercise rappelling down from a helicopter, the Veteran's rope got tangled up with another servicemember's, causing the Veteran to land hard followed by the other servicemember landing on him (which, among other things, led to the Veteran's in-service hernia); and, (b) An incident in which the Veteran sat on a concrete slab near an installation that had danger signs nearby, after which he was checked for radiation exposure (and, per the Veteran's testimony at a July 2021 Board hearing, was told that he was exposed to radiation but "not enough 'to harm nothing'"). The clinician should consider and discuss an October 1, 2015 orthopedic note that found "it appears his alcohol abuse is the cause of his hip Av[ascular] N[ecrosis]." 6. After the above development and any other development deemed necessary is completed, readjudicate the Veteran's claims, to include entitlement to a TDIU. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.