Citation Nr: 21007396 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 10-00 347 DATE: February 9, 2021 REMANDED Service connection for residuals of an August 1999 appendectomy (necessitated by August 1999 appendicitis during service), to include an anterior trunk scar, is remanded. REASONS FOR REMAND This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. This claim was previously before the Board in March 2016, at which time the claim for entitlement to service connection for an abdominal hernia was reopened and remanded for further development. The claim was again remanded by the Board for further development in a July 2017 Board decision. In December of 2015, the Veteran was afforded a Board video conference hearing before a Veterans Law Judge (VLJ) who is no longer with the Board. A transcript of the Board hearing has been associated with the claims file. In February 2017, the Veteran was notified that he was entitled to another hearing in light of the fact that the VLJ who had conducted his video conference hearing was no longer with the Board. 38 U.S.C. § 7107(c) (West 2014). In September 2020, the Veteran elected a virtual tele-hearing due to the increased wait times for Travel Board hearings caused by COVID-19 closures. That hearing took place in November 2020 and a transcript of the hearing before the undersigned VLJ is of record. The Veteran was an emergency medical services (EMS) dispatch for the Air Force for over 21 years and is a dietetic technician. During the hearing he provided detailed testimony, including raising new theories of entitlement, for his claim of service connection for residuals of an appendectomy. These theories require a VA medical opinion from a clinician with expertise in gastroenterology to address. The matters are REMANDED for the following action: 1. Forward the Veteran’s claims file to a qualified clinician with an expertise in gastroenterology for a VA addendum medical opinion regarding the questions below. The relevant documents in the record should be made available to the examiner, who should indicate on the examination report that he/she has reviewed the documents. Specifically, the November 2020 hearing transcript may be especially instructive to the examiner as to the Veteran’s contentions. 2. Examination of the Veteran is not required unless the examiner determines that an examination is necessary to provide a reliable opinion. If an examination is required, a detailed history of relevant symptoms should be obtained from the Veteran. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should offer the following opinions: (a.) Whether it as least as likely as not (50 percent or greater probability) that the Veteran’s August 1999 appendectomy and residuals (to include an anterior trunk scar) is causally related to his service. This opinion MUST include a discussion of whether an initial perforation or leak in the Veteran’s appendix during service in 1985 (annotated as a perforation covered with white fibrotic material with evidence of healing) manifested in various ailments affecting his abdominal cavity, to include a 1988 episode of gastroenteritis, the episode of epigastric distress that caused him to seek emergency treatment in May 1999 and ultimately the August 1999 appendectomy. See November 2020 hearing transcript. (b). Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s 1999 appendectomy and residuals are proximately due to or caused by a service-connected 1991 umbilical hernia. This opinion MUST include a discussion of whether displacement of abdominal fatty tissue due to a hernia helped create the conditions of the appendicitis. (c) Whether it is at least as likely as not that the Veteran’s 1999 appendectomy and residuals were aggravated (worsened, even incrementally) beyond their natural progress by a service-connected 1991 umbilical hernia. This opinion MUST include a discussion of whether displacement of abdominal fatty tissue due to a hernia helped create or worsen the conditions of the appendicitis Please note that secondary service connection does not require permanent worsening to qualify for service connection based on aggravation by a service-connected disability but only incremental worsening. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner must provide complete rationales in support of opinions provided. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kyle McKone 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.