Citation Nr: 21075794 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 13-16 636 DATE: December 21, 2021 REMANDED Entitlement to service connection for residuals of vasectomy, to include scrotal pain, swelling, and lopsidedness is remanded. REASONS FOR REMAND The Veteran had active service with the Air Force from August 1984 to June 1997. This matter is before the Board of Veterans' Appeals (the Board) on appeal from March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In April 2017, the Veteran testified in a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the evidence of record. The Veteran's claim was remanded in July 2018, October 2020, and May 2021 for additional development. The Board regrets the delay but finds additional development is necessary prior to final adjudication of his claim. The Board remanded the Veteran's service connection claim for residuals of a vasectomy, to include scrotal pain, swelling, and lopsidedness in May 2021 for an addendum opinion from the February 2021 VA examiner. The February 2021 VA examiner was asked to consider the Veteran's competent April 2017 hearing testimony of scrotal pain, swelling, and lopsidedness since his in-service vasectomy in December 1995. In June 2021, the VA examiner provided an addendum opinion. The examiner opined it was less likely than not that the Veteran's claimed residuals of vasectomy to include scrotal pain, swelling, and lopsidedness were related to his in-service December 1995 vasectomy or otherwise had their onset in service. He underwent a vasectomy in 1995 and the medical records document that he recovered after some post-procedure swelling and discomfort, which is very common. The Veteran visited various medical providers over the years but did not report scrotal pain or swelling. The record also documented that he underwent other procedures including right inguinal hernia repair which could be associated with chronic scrotal pain. The eventual documentation of his reports of swelling and significant scrotal pain above and beyond the normal sensitivity of the testicle/epididymis (which does have pain sensation for all men) was years after the 1995 vasectomy. A scrotal ultrasound noted "swelling, not painful." The June 2021 examiner opined the degree of symptomatic scrotal pain that presented this late after the vasectomy suggested it was not likely caused by the vasectomy. The June 2021 addendum opinion failed to adequately consider the Veteran's April 2017 hearing testimony. In April 2017, the Veteran testified he underwent a vasectomy in December 1995. He had swelling and went back to the hospital. He was treated with Motrin for the pain. The doctor performing the procedure had difficulty accessing the right-side vas deferens of the scrotum and at one point indicated he might have to come back in six months to complete the procedure. However, the Veteran requested to proceed that day. The Veteran testified that he experienced swelling on the right side after his vasectomy. Scrotal swelling and pain were recurring problems for him since the 1990s. Additionally, he noticed the right side was lopsided. The June 2021 VA examiner did not address the Veteran's April 2017 hearing testimony. The examiner was advised the Veteran was competent to report his symptoms and history including those of continuity of symptomatology. These reports needed to be acknowledged and considered by the examiner in formulating an opinion. If the examiner rejected the Veteran's reports, the examiner must provide an explanation for such a rejection. Therefore, the Board finds that another medical opinion addressing the Veteran's testimony regarding the onset of his symptoms is necessary in order to make a fully informed decision. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the June 2021 examiner regarding service connection for residuals of vasectomy, to include scrotal pain, swelling, and lopsidedness. If the June 2021 examiner is not available, the opinion with rationale should be rendered by another qualified clinician. If, and only if, the examiner feels that a physical examination is needed, one should be scheduled. The reviewing clinician is asked to opine on the following: If it is at least as likely as not that the Veteran's residuals of vasectomy, to include scrotal pain, swelling, and lopsidedness had its onset in or was otherwise etiologically related to any event or circumstance of his service. The examiner is asked to consider the Veteran's April 2017 hearing testimony discussed in detail above. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. The complete record, to include a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. The examination report must include a notation that this record review took place. 2. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran and his representative should be furnished with a SSOC and be afforded the opportunity to response. Thereafter, the case should be returned to the Board for further consideration. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.L. Byers 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.