Citation Nr: 21013169 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 17-12 828 DATE: March 8, 2021 REMANDED Entitlement to service connection for a disability of the pancreas, including as secondary to hypertension or to a stroke, is remanded. Entitlement to service connection for a gallbladder disability, including as secondary to a disability of the pancreas, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1965 to March 1968, including service in the Republic of Vietnam. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a June 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In December 2019, the Veteran testified at a hearing before the undersigned. In March 2020, the Board remanded the Veteran’s claims of entitlement to service connection for hypertension, a stroke, a pancreatic disability, and a gallbladder disability. In December 2020, a rating decision allowed service connection for hypertension and for a stroke. This represents a complete grant of the benefits sought as to those conditions. They are no longer in appellate status. 1. Entitlement to service connection for a disability of the pancreas, including as secondary to hypertension or to a stroke, is remanded. A February 2008 Discharge Summary from Massachusetts General Hospital indicates hypertension and cerebrovascular accident are “associated diagnoses” related to a pancreatic surgery. Thus, the issue of service-connection for a pancreatic disability, as secondary to service-connected hypertension and/or service-connected stroke, is indicated. A secondary service connection opinion is inadequate if it does not address both causation and aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013); Allen v. Brown, 7 Vet. App. 439, 448 (1995). Here, a November 2020 VA examiner provided an opinion as to secondary service connection for a disability of the pancreas. She did not address aggravation. The opinion is inadequate. An additional etiology opinion as to secondary service connection must be obtained. Id. 2. Entitlement to service connection for a gallbladder disability, including as secondary to a disability of the pancreas, is remanded. Service connection for a gallbladder disability is claimed as secondary to pancreatic surgery. A November 2020 VA examiner confirmed the Veteran’s gallbladder was removed during surgery to remove pancreatic growths. Accordingly, this claim is inextricably intertwined with the remanded claim for service connection for a pancreatic disability. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s pancreatic disability is at least as likely as not proximately due to or aggravated beyond its natural progression by service-connected hypertension and/or service-connected stroke disabilities. The examiner should address the February 2008 Discharge Summary from Massachusetts General Hospital which indicates hypertension and cerebrovascular accident were “associated diagnoses” related to an operation on his pancreas. The secondary service connection opinion must explicitly address both causation and aggravation to be deemed adequate. The examiner must be advised aggravation means an increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. 2. Following the above development, continue appropriate adjudication of the claim of entitlement to service connection for a gallbladder disability. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jeanne Celtnieks 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.