Citation Nr: 21073930 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 16-63 875 DATE: December 13, 2021 REMANDED Entitlement to service connection for colon adenoma, to include as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for nephrolithiasis (kidney stones), claimed as secondary to service-connected diabetes mellitus type II is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to March 1970, to include service in the Republic of Vietnam. This case comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in connection with his appeal, the Veteran requested and was scheduled for a videoconference hearing before a Veterans Law Judge, to be held in September 2021. Prior to the hearing, however, the Veteran cancelled his hearing request. 1. Colon Adenoma The Veteran contends that his colon adenoma is due to his presumed exposure to herbicide agents. In an alternative theory, he contends that such condition is secondary to service-connected diabetes mellitus type II. The Veteran underwent a VA examination in October 2015. The examiner opined that the Veteran's diabetes mellitus did not have any complication at that time. However, the examiner failed to provide an opinion with rationale addressing whether the Veteran's colon adenoma is related to service. The examiner also failed to provide an opinion with rationale addressing whether the Veteran's colon adenoma is caused or aggravated by service-connected diabetes mellitus type II. 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136 (2013). In light of the above, the Board finds the examiner's opinion is inadequate and another VA medical opinion is required. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate). 2. Nephrolithiasis The Veteran contends that his nephrolithiasis is secondary to service-connected to service-connected diabetes mellitus type II. The Veteran underwent a VA examination in October 2015. The examiner opined that the Veteran's nephrolithiasis is less likely than not proximately due to or the result of the Veteran's service connected condition. The examiner's rationale was that nephrolithiasis predated diabetes mellitus condition. The examiner noted that there is no medical literature that support a relationship between diabetes mellitus and nephrolithiasis. The examiner further noted that these conditions are different disease entities with different pathophysiological process unrelated to each other. The examiner, however, failed to provide an opinion with rationale addressing whether the Veteran's nephrolithiasis was aggravated by his service-connected diabetes mellitus type II. 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136 (2013). In light of the above, the Board finds the examiner's opinion is inadequate and another VA medical opinion is required. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician to determine the nature of the Veteran's colon adenoma disability. If an examination is deemed necessary, one should be conducted, to include via telehealth if warranted. The claims file should be reviewed by the clinician. The clinician should answer the following question: Is at least as likely as not (50 percent or greater probability) that a colon adenoma disability is related to active service or any incident therein, to include his presumed exposure to herbicide agents? If not, is at least as likely as not (50 percent or greater probability) that a colon adenoma disability or is either (a) caused or (b) aggravated by his service-connected diabetes mellitus type II? If aggravation is found, the examiner should identify the baseline level of severity prior to the onset of aggravation. The fact that the Veteran may not have a disease presumed service connection in veterans exposed to Agent Orange should not be used as a reason for finding that this Veteran's asthma disability is not related to exposure to an herbicide agent. A complete rationale for any opinion expressed should be provided. 2. Obtain an opinion from an appropriate clinician to determine whether the Veteran's nephrolithiasis is at least as likely as not (i.e., a fifty percent or greater probability) either (a) caused by or (b) aggravated by his service-connected diabetes mellitus type II. If an examination is deemed necessary, one should be conducted, to include via telehealth if warranted. The claims file should be reviewed by the clinician. If aggravation is found, the examiner should identify the baseline level of severity prior to the onset of aggravation. A complete rationale should accompany any opinion provided. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.